Technology Enabled Care Coordination
According to the U.S. Census Bureau, by 2030, 25 percent of the U.S. population will be 60 and older, and 19 percent of the population will be 65 years of age and older. At least 90 percent of those 65 and older now have one or more chronic conditions. On a broader scale, 30 percent of U.S. adults who are caregivers for parents or spouses sacrifice wages and benefits. On a societal level, U.S. employers lose up to $33.6 billion per year because of absenteeism due to caring for an older relative. AARP surveys consistently reflect that seniors prefer to age in place at home. Increasing evidence suggests that addressing health-related needs through enhanced clinical-community linkages can improve health outcomes and reduce costs. Unmet health-related needs may increase the risk of developing chronic conditions, reduce an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.
Many integrated health systems where incentives are aligned, such as the Veterans Health Administration, Kaiser and the Defense Health Agency, have taken the lead in addressing these challenges through the use of telecare services. Telecare can be defined as the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, connection to community based services, and public health services. Believing that being connected to patients in their home environment can lead to improved management of chronic conditions, earlier detection and resolution of acute conditions and more meaningful communication with a patient’s social support network, telecare services have been rapidly deployed and widely scaled in these systems with demonstrable improvements in care coordination and team based care.
Despite these trends, reimbursement by Medicare continues to lag. Although increasing evidence suggests improvements in care coordination and cost reduction, reimbursement policy for technology enabled aging in place has been piecemeal. Medicare imposes tight restrictions on which services qualify for reimbursement. In addition, even when these services technically qualify for coverage, Medicare currently only pays for such services when beneficiaries live in a rural area or in an area with a shortage of health care professionals. Medicare also does not pay for other patients who might benefit from telecare, such as homebound people who are too frail for a long trip to their clinician’s office or who do not have easy access to transportation.
Currently, there is no cohesive federal government strategy for deployment and evaluation of these services. Several avenues exist, however, to promote the use of telecare as part of a comprehensive care coordination scheme as well as to evaluate and build evidence for the integration of community based services that enable Medicare beneficiaries to access care earlier, more conveniently and through a broader network of community based providers and national experts to promote aging in place. This project will build evidence for greater telecare adoption through the following paths:
- Evaluate Medicare Advantage results as an analog for Medicare to assess utilization and outcome metrics
- Work with federal government stakeholders to identify overlapping workstreams, funding and evaluation opportunities that can support an evidence based roadmap for incremental telecare adoption and reimbursement
- Understand existing pilot opportunities within CMMI to test telecare to identify services and regions where telecare expansion would enable enhanced care coordination
- Pilot testing of telecare services in assisted living facilities to evaluate utilization and outcome metrics
A project supported by the: HHS Innovator-in-Residence Program
Stakeholders from CMMI, HRSA, ONC, ASPE, AHRQ and West Policy Institute
September 2016: Innovator-in-Residence Project begins
October 2016: Stakeholder Scan and Input
December 2016: Design pilot program for assisted living facility
January 2017: Stakeholder convening
May 2017: Identify pilot opportunity with CMMI
May 2017: Evidence based roadmap for greater telehealth adoption