Editor’s note: On March 16th and 17th, 2017, Telehealth and Medicine Today convened a national conference of opinion leaders to discuss and debate “Technologies and Tactics Transforming Long-term Care.” What follows here is a podcast and timecode transcript of the keynote address by Michael Mann who is President of Geriatrics Life Care.
“We are truly at a time where there doesn’t have to be a care continuum.
It can be continuous care.”
It’s an honor to be here. Tory, thank you for making this happen. It’s fantastic that we can be here, in a community of collaboration, advancing the vision of telehealth.
Today, I’m going to talk to you from a care manager perspective. I started my journey as a social worker in the fire—Director of Social Services at a rehab center—and I learned about the discontinuation of care and all the challenges of getting mom home safely. As the years have progressed I have not seen that much change in what it should look like, and that’s why we’re here—making better care and achieving the vision for better care.
So, what should it look like? There are strategies and things we must never forget regarding telehealth when we envision the future of telehealth and how it fits together. I think of us as in a village, if you will, of making things happen. CareAngle,1 as one example, is no different from Steve Jobs or Henry Ford. It’s about making care the way it should be, bringing it back to the home, and bringing it back in real time to the patient, while alleviating the challenges that caregivers and families face.
There’s the potential for a huge impact: $25 billion for readmission avoidance,2 up to 25% of readmissions can be avoided.3 One statistic thing that drives the point for me is the AARP number around 41 million caregivers. [~43.5 million caregivers have provided unpaid care to an adult or child in the last 12 months.]4 That’s what I’m passionate about. How can we reach them? We’re not doing a good job. It’s very difficult to reach caregivers because they don’t self-identify. I believe there’s a huge opportunity to connect with them, and create better products and brighter solutions. It’s the person who’s checking mom into a memory care. It’s that person getting mom’s discharge together.
And I’m not alone in that. There are $279 billion dollars in caregiver innovation according to AARP.5 Another big number that is important to me is 11 million seniors at risk of social isolation.6 They’re at risk when living alone at age 65 years and older. This is a social issue. Social isolation greatly impacts health risks. It is probably the highest health risk that isn’t necessarily identified by the CDC.7
Telehealth has the power to connect people and lower health risks. There is reimbursement for telehealth, although it is still considered a barrier. But we are seeing Accountable Care Organizations (ACOs) value-based care risk sharing partnerships and alliances. ACOs are going to fuel opportunity and partnerships and entrepreneurial spirit to realized telehealth.
Barriers to Telehealth [3:23]
I want to go over some of the barriers to telehealth.
There is reimbursement, but lack of clarity is a big challenge to making this happen. Other issues include communication and the buy-in from C-Suite (a corporation’s most senior executives) to service line: poor design, no workflow consideration, really no strategy. Telehealth just for telehealth is not going to do it. You need a narrow niche and a good focus. But it can’t be too narrow, because when we’re talking about care management—activating a population via care navigators—they need data; and they need tools to help activate this community.
There are a host of challenges when you look at barriers of health (Table 1). One is full time equivalents (FTEs). You need dedicated staff. When dealing with the elderly population, an integrated, frictionless system is important. By frictionless, I mean, for example, what CareAngel did by just the using the phone.8 Using what they (patients) already have so you’re not trying to change behavior to activate care. And on the back end you’re using technology to automate. That’s what I mean by frictionless. How easy can we make it? We all know about failure with the electronic medical records (EMR), because of how many clicks it takes. So, the system must be as frictionless as possible.
I believe the platform is important for connecting with real time real data across the care continuum. The big thing is that older adults really aren’t connected with technology. So, you’ve got to make it flexible. There are some older adults (90 years old) that do Facebook better than I do, but that’s a rare occasion. Too often, we create these wonderful “clouds” in the sky, but how are we going to employ them to manage at the patient level of the user experience?
Opportunities for Telehealth [12:42]
There are big opportunities when you talk about discharge planning with medication (Table 2). Within less than 24 hours we need all of mom’s medications. How many times do people go from hospital to home, and there’s no idea what medications they have? You could simply do a tele call; and there it is, the medications, one by one. It might take a half-hour—probably should take a half-hour. So, that’s a huge for any navigator system—seeing medications.
In addition, we need coaching and medication adherence programs to ensure that the caregiver—the older adult in the home—is using those medications correctly.
We need health literacy in a way that’s digital, convenient, and makes sense. That is a whole business in itself. There’s so much opportunity, and there are companies with health literacy—making it in real time, meaningful, and connected with the patient.
We need to verify that at home, the care plan reflects the discharge plan—a discharge plan continuum. Care planning is the care you need where you are and when you are needing it. And the method used must empower care coaches and care navigators. We need to help on the back end with data to manage care so that care mangers aren’t being asked to do too much.
When you have the right data you’re able to empower them to do their job, and make these things happen. For example, give a caregiver a smart tablet, and on the back end I can alert them when needed.
Innovative Tools for Telehealth [8:56]
So, here’s just one story. Meet Sam my new friend (Figure 1). This is a technology company, and I believe they’ve named the robot Sam. It’s not really a robot; it’s really a smarter way to deliver care in a community. There’s endless capability with this, but if you see the robot, or Sam, it wheels around and you could cover a community (eg, 150 residents on a patient care unit). It has sensors connected to the older adult; and there are endless things you could do with that: check in with the resident each day, the resident can be connected with any family members and with any care team members.
Sam is just one solution that could lower the staffing, with endless programs. I came across for $99, a Hasbro robotic cat. This might reduce the use of anti-psychotics. It can create social connections. The possibilities are endless with voice connect Amazon Echo. So, we need to think about how can we help patients improve their quality of life through leveraged technology.
That’s really what I’m here for today, an innovative perspective at 60,000 feet. What are the possibilities. We’re all sharing real data. There’s no reason why we couldn’t have seniors connected through to seniors sharing a profile and almost like Facebook, that’s modified to aggregate all the different seniors to connect with each other.
There is something in England where they have a call center where someone can call if they’re lonely.9 I’m not sure if anything like that is in the U.S. I would imagine it has endless possibilities for telehealth as a low cost, effective way to help seniors be connected via automated calls that can be scheduled. It’s a mobility cognition issue; so now you have a way to connect them and get data to help manage the elderly in a home.
Final Thoughts [12:24]
The most important thing is empathy (Figure 2). We really need to design things that deliver better patient care and close that gap. We’re at the first point in time where there truly doesn’t have to be a care continuum. It can be continuous care powered by the real-time data analytics. I look forward to more people talking today and getting into the details. I thank you for your time.
Michael Mann, MHA, LALFA, CMC, is President, Geriatrics Life Care. Geriatrics Life Care is dedicated to empowering older adults in achieving their healthcare goals and bringing peace of mind to their family caregivers. We provide care management services for older adults and solutions to caregivers. We provide consultancy and guidance to healthcare organizations seeking to provide better and smarter care to their frailest population.
- URL: https://careangel.com.Accessed 4/1917.
- Preventing Hospital Readmissions: A $25 Billion Opportunity. 2011. URL: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0ahUKEwjdjdPI9LPTAhVB44MKHTz5Am8QFggtMAE&url=http%3A%2F%2Fwww.nehi.net%2Fbendthecurve%2Fsup%2Fdocuments%2FHospital_Readmissions_Brief.pdf&usg=AFQjCNH7bdzUolchidINhNfvl-pgz2Wc_w. Accessed 4/19/17.
- Kripalani S, Theobald CN, Anctil B, Vasilevskis EE. Reducing hospital readmission rates: current strategies and future directions. Annu Rev Med. 2014;65:471-85. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104507/. Accessed 4/19/17.
- Family Caregiver Alliance, Caregiver Statistics: Demographics. 2016. URL: https://www.caregiver.org/print/23216. Accessed 4/19/17.
- Caregiving Innovations Frontiers. 2016. URL: http://www.aarp.org/content/dam/aarp/home-and-family/personal-technology/2016-01/2016-Caregiving-Innovation-Frontiers-Infographics-AARP.pdf. Accessed 4/19/17.
- Stevenson S. 20 facts about Senior Isolation that will stun you. A Place for Mom. 2014. URL: http://www.aplaceformom.com/blog/10-17-14-facts-about-senior-isolation/. Accessed 4/19/17.
- Hall-Lande JA, Eisenberg ME, Christenson SL, Neumark-Sztainer D. Social isolation, psychological health, and protective factors in adolescence. Adolescence. 2007 Summer;42(166):265-86. URL: https://www.learnatnorth.org/lchaffee/PSY100/Journal%20Articles/Hall-Lande%20et%20al%202007.pdf. Accessed 4/19/17.
- About CareAngel. URL: https://careangel.com/about-care-angel/. Accessed 4/19/17.
- Weller C. This hotline gets 10,000 calls a week from lonely seniors starved for human contact. Business Insider. 2016. URL: http://www.businessinsider.com/lonely-seniors-call-silver-line-hotline-2016-9.