The United States is aging quickly. By the end of 2019, there will be more Americans over the age of 65 than under the age of five. The U.S. Census predicts that by 2030, the proportion of U.S. elderly will be nearly double that of the year 2010 (20% vs. 13%). As the population ages, proportionally larger numbers of individuals living with chronic diseases will also increase. More than 8 out of 10 elderly people suffer from multiple chronic conditions, and the majority of these elders have four or more such conditions.
What do the elderly want?
Americans prefer to grow older in the most familiar environment, while receiving all their care needs. For many of the elderly with chronic conditions, even for complex conditions such as end-stage renal disease, the home is the preferred site of care. Simultaneously, the enormous costs generated by the elderly with chronic conditions has placed pressure on the Centers for Medicare and Medicaid Services (CMS) to identify high-quality, affordable solutions. Therefore, it is incumbent upon CMS and other responsible agencies to analyze the costs and benefits of home care for the elderly with chronic conditions.
Harnessing the power of new technologies
New technologies are enabling and supporting more in-home patient care options. Telemedicine, though not a new concept, is only now becoming reimbursable thanks to the introduction of billing codes that will allow practitioners to practice telemedicine. Remote monitoring for a variety of chronic diseases is now possible. For example, home monitoring of diabetes has been available for decades; however, only recently has remote communication of blood sugar results become widespread. This has allowed patients to avoid long, costly visits to physicians. Timely identification of imminent complications by remote monitoring also helps avoid expensive hospitalizations.
New clinical models for care at home
Changing demographics and technological advances are generating demand for new models of care that place the home at the center of care. The United Kingdom has been leading the way with respect to constructing these new care paradigms. The National Health Service (NHS) has funded a series of pilot projects testing various models of care to identify those that deliver the highest quality while controlling costs. As of 2018, as many as six such projects were active in the UK, all tasked with enhancing primary care, creating multidisciplinary teams, providing rehabilitation services, improving end-of-life and dementia care, and reducing the number of transfers to acute care hospitals. CMS should be encouraged to follow the lead of the NHS in developing “bottom-up” experiments designed to enhance the care of U.S. elders.
The impact of social determinants of health
Some important health parameters cannot be measured with remote monitoring devices. Policy experts are increasingly emphasizing the importance of social determinants of health (SDOH) for producing high-quality, low-cost healthcare. SDOH have been defined as the social environment, physical environment, health services, and structural and societal factors that affect an individual’s health. For the elderly in particular, the impact of social isolation is substantial. To that end, CMS has been expanding home services for the elderly in recognition that these services may provide the highest quality of care at reasonable costs.
Artificial intelligence and predictive analytics
Artificial intelligence (AI) has transformed from science fiction to science fact. Rather than representing threats of robotic world take-overs, modern AI is being harnessed to create platforms that help clinicians identify those elders with chronic conditions who are most in need of health services. Predictive analytics refers to the analysis of thousands of data points to generate probability maps that identify patients who are most likely to require services. The objective is to improve outcomes, and reduce hospital readmissions as well as unnecessary services. These technologies allow care providers and health plans to make the patient’s home the most effective and efficient setting for post-acute care and long-term management of chronic conditions.
What does the future of healthcare look like for seniors?
The convergence of an aging population with technological advances promises to deliver healthcare in a way that looks very different from the current system. Elders will increasingly be cared for at home, remotely, with the help of monitoring devices, and personally, with home health services. Predictive analytics will help direct scarce resources to the elders who need them most. It is incumbent on healthcare policymakers to get out in front and ensure that care models are in place to accommodate these changes.