Framing the issue:
• The baby boom generation’s last chance to influence society is through the adoption of innovative health care tools and technology.
• Innovation can take different forms, from mHealth to better-designed, assisted living models.
• Without increased efficiencies, the health care system may collapse. Indications are that such things as technology-based remote care will gain acceptance relatively quickly.
• A handful of health systems are diving into the physician ratings game in an effort to beat third-party companies like Yelp to the punch. So far, it’s working.
Like movies, restaurant reviews, shoe shopping and practically everything else American consumers are interested in these days, health information and health care itself are becoming instantly available anywhere a mobile device can connect to Wi-Fi — and baby boomers are a major driver of that trend.
As they confront the medical issues that come with aging, boomers want to know more about their providers and have more direct input into decisions about their care. And the health care industry is quickly moving to meet those demands.
Health data can be transmitted to caregivers via mobile devices or in-home monitors. Internet video allows for consultations with clinicians in more convenient locations than the medical office or hospital. Technology allows patients to learn more about their personal health and the quality of their providers, and it will enable them to receive more and more care in the venue they most prefer: their homes.
The vast boomer generation can be split into older and younger cohorts with differing views of technological innovation, according to research conducted by PricewaterhouseCoopers. The older segment, those 56–68, takes a more measured approach. “They’re very cost-conscious,” says Paul D’Alessandro, principal and customer leader for health industries at PwC. They’re the most interested in alternative care services, such as retail clinics, telehealth and other new forms of care delivery. “They still want a human involved in the process and, ideally, they want a doc or a nurse involved,” he says.
On the other hand, younger boomers are more interested in such new technology as remote monitoring and wearables, and new forms of data collection and analysis. “They’re kind of data junkies around their health,” D’Alessandro says. They not only recognize that the data have value, but they view data as a form of currency.
No matter where they land on the generational spectrum, all boomers expect more out of old age than their parents did. “They want to be well physically, emotionally and spiritually until they die,” says Kevin Svagdis, president of Morrison Senior Living. And they expect health care providers and other services to help them do so.
Read on for a sampling of the ways that hospitals and other providers are testing and using innovative clinical approaches to serve a patient population that, led by the boomers, is demanding more.
They Did What?
istorically, patients have left health care decision-making to doctors and nurses. But now, boomers are arming themselves with information and sharing it with the rest of the world. That makes some providers nervous.
When physicians affiliated with University of Utah Health Care, Salt Lake City, asked whether something could be done about online ratings websites that posted negative reviews of them, health system officials came up with an unexpected solution: They posted reviews on their own site.
Doing so fit with the system’s effort to be transparent and consumer-friendly. “We have these data already; why not share them?” says Brian Gresh, senior director of interactive marketing and the Web.
Initially, physicians were not thrilled, even though the data already had been disseminated internally. But, posting the unfiltered Press Ganey ratings helped to reassure them that patients would not rely on Yelp-like sites alone when choosing a doctor.
University of Utah Health Care only posts star ratings for doctors with at least 30 qualifying surveys. That provides more balance and credibility than other ratings sites, which often rely on just a handful of reviews for a given doctor.
“It’s allowed us to tell our physicians, ‘We have your back, you look really good,’ ” Gresh says.
The physician ratings also have boosted the organization’s online presence. “It draws a huge amount of traffic to our site,” Gresh says, noting that in Google search results, the system’s ratings now rank higher than those of the ratings sites the physicians were so worried about.
Other health systems are following in the University of Utah’s footsteps. Matt Gove, chief marketing officer at Piedmont Healthcare in Atlanta, says his organization also posts physician comments, editing them only to remove vulgarity or to keep protected information safe.
“If someone has a bad experience, we post it,” Gove says, adding that, after some initial skepticism, physicians are now “surprisingly positive” about the concept.
From the Ground Up
Health care innovation doesn’t have to come out of an academic medical center, a well-funded foundation or a technology-focused startup. Las Vegas is home to a forward-thinking retirement development that is integrating a spectrum of health care facilities, incuding an acute care hospital, into the $1.2 billion project.
The Union Village senior residence development, based in nearby Henderson, Nev., aims to accommodate 1,500 residents as they traverse the various levels of care, whether it’s moving from acute care to rehabilitation, or from a skilled nursing facility to assisted living or their own home, says co-founder Craig Johnson. “What you have here is all of these step-down, subacute care options integrated on one campus,” Johnson says. Anchoring the site will be 142-bed Henderson Hospital, part of Las Vegas-based Valley Health System, which is owned by Universal Health Services.
Having the ability to transfer patients between settings within a single campus benefits everyone, Johnson says. The traditional model involves transferring patients to different sites, sometimes miles away. That can be hard on patients both physically and emotionally, difficult to coordinate among providers, and all too often results in lost records or miscommunication. At Union Village facilities, patients will be transferred by wheeling them down the hall.
Planners identified 17 types of health care partners that will work together in an integrated way. All are enthusiastic about the village concept, Johnson says. “What started out as an idea has been embraced by every single health care group with whom we’ve talked. The validation has been incredible.”
Despite the large presence of health care facilities, Johnson says, developers are trying to focus first and foremost on overall wellness. “When a senior comes to the wellness village, we’re going to be all about working with him or her to stay out of the hospital as long as possible,” he says. Telehealth and related home-monitoring technology will aid in that effort.
In addition to residential and health care space, Johnson says, the developers plan to add retail companies and a hotel on the site.
Make It Easy
With the boomer generation aging quickly, the health care system will rely on innovation to improve care and lower costs.
“It’s the intersection of care design and technology that is going to provide some increased capacity in the system,” says Jonathan Niloff, M.D., vice president and executive medical director for McKesson.
The Mayo Clinic Center for Innovation is one source of much-needed creativity. It has assembled a 5,000-square-foot Healthy Aging and Independent Living Lab attached to a continuing care community, with the goal of helping seniors to live longer and more independently.
The lab allows Mayo researchers to test ideas in a real-world environment, says Barbara Spurrier, administrative director of the Center for Innovation.
A lot of its current work involves delivering care without the patient’s having to leave home. “We’re trying to do it in such a way that people can live their best lives and the technology doesn’t get in the way, so it’s simple and easy,” says Spurrier, co-author of the recently published innovation guide, Think Big, Start Small, Move Fast.
For instance, testing initially relied on user-friendly Skype for patient communication. “We knew people were already connecting with their kids and their grandkids through Skype, and we didn’t want them to go out and buy an expensive technology,” Spurrier says. “We’re trying to make it real simple and easy. Patients need to be able to connect with things like home computers without having to add a lot of bells and whistles.”
The program is now working to build a well-living lab with an expanded scope of study. In addition to testing technology in the home, it will look at lesser-studied subjects, such as air quality and lighting. The research could be scaled up to encompass community settings, such as offices and schools.
“We’re pretty excited about that,” Spurrier says.
There’s More Action
ew models of care targeting the period after a patient has been treated in an emergency department or discharged from a hospital are among the most-watched areas of innovation. Reworking post-acute care to include wellness and prevention are among the most effective strategies.
Tandem365 and New Hanover Regional Medical Center, Wilmington, N.C., offer examples of how post-acute care can be improved. Tandem365, Grand Rapids, Mich., is a joint effort of four continuing care facilities and an ambulance service. It provides high-cost patients with targeted care.
Central to the concept is a personal emergency response system that is the first place an enrollee in the program should go for health-related issues. With one touch of a button, a patient can get anything from a telephone consultation to an ambulance ride to the ED.
The goal is to keep patients where they’re most comfortable. “The majority of people want to stay in the home in which they’ve lived for 30-some years,” says Brandee VanVuuren, business process specialist.
New Hanover Regional Medical Center also targets high-use patients, adopting the relatively new concept of community paramedicine to bring wellness and primary care into the home. While approaches to community paramedicine vary, the basic concept is that paramedics receive additional training to provide in-home patients with preventive and consultative care.
The incentive to focus on select patients emerged from the revelation that close to 30 percent of 9-1-1 calls were for nonemergencies and that in one year, the 10 biggest users of 9-1-1 accounted for 702 responses, says David Glendenning, education coordinator for EMS. “So the same 10 people traveled back and forth to the hospital 702 times,” Glendenning says.
After a pilot project, the system received grants aimed at patients with congestive heart failure, a second and third year.
Readmission rates for CHF patients fell to 9 percent, compared with a national average of about 20 percent, Glendenning says.
he baby boom generation can easily become bored, so getting them engaged in their care may be an uphill battle. Scripps Health, San Diego, one of the more active health systems in testing, developing and using advanced technology, is helping to develop a software-based program for managing cardiac rehab patients. The program, called Care4Today, is designed to make it easier for caregivers and patients to do the somewhat tedious work of coming back from a heart attack or other heart problem.
The program combines high-tech monitoring with low-tech brochures and hands-on education.
“It provides more efficient tracking of patients, it provides more efficient recruitment of patients and, ultimately, more efficient feedback to providers on how their patients are doing,” says Christopher Suhar, M.D., director of Scripps Center for Integrative Medicine, the division testing the program.
The program monitors and tracks patients’ blood pressure, pulse, blood sugars and telemetry, and includes an educational component for patients. “The ultimate goal is a state-of-the-art software program that will digitize cardiac rehab, and it’s pretty exciting,” Suhar says.
In addition to giving the caregivers a systematic approach to managing rehab, the model creates incentives for patients to stick with it as well. “It almost becomes second nature to you,” says Michael Roche, a patient who had been enrolled in the program at Scripps. “It is like your social life.”
For more on the Scripps effort, watch an online video interview with Suhar, Roche and another patient who enrolled in the program, at the Boomer Challenge, found in the Special Reports section of hhnmag.com.
Patient-centric mobile health technology will play a fundamental role in the success or failure of the health care system in caring for the aging baby boom generation. Knowing what happened with a patient’s care in just the hospital or physician’s office is no longer enough.
“The technologies that we’re seeing more as time goes on are the technologies that can follow a patient through the whole continuum,” says Karlene Kerfoot, R.N., chief clinical integration officer with API Healthcare.
Providers will have to spend more time with a growing population of aging patients and, since they’re already fairly busy, technology will have to make care more efficient. “They don’t have any more hours in the day,” says Martha Thorne, senior vice president and general manager for Allscripts.
The types of mHealth applications that might ease the stress of treating boomers fall into three overlapping categories — telehealth, remote care monitoring and sensing technology — according to analysts at Healthcare Information and Management Systems Society.
Telehealth is getting a lot of attention from payers, says David Collins, senior director of HIMSS. They view it as an option for making population health management more efficient by providing better care in a cost-effective manner.
Remote monitoring also is drawing interest from hospitals, which are subject to stiff readmission penalties by Medicare. Remote monitoring makes it easier to check in frequently with patients. Some health systems are using a new discharge toolkit that includes computer tablets and other tools. The toolkit costs $1,000, far cheaper than a penalty for readmission, Collins says.
The technology to use sensing devices to monitor patients 24/7 exists, but the large amounts of data that are produced create problems. “I think there’s value there; it’s just balancing it and figuring out how much data to capture,” Collins says. “It’s going to work as a supplemental tool, but it’s going to take some work for it to become a standard.
This is the sixth and final installment in Hospitals & Health Networks’ yearlong series that examines the many ways the nation’s roughly 75 million baby boomers will affect the U.S. health care system as they grow into old age. This month, the topic is health care innovation, and how it might ease the pressure created by the boomers’ entrance into the health care system as seniors. The series includes articles in the magazine, blogs in our e-newsletter, H&HN Daily, and online videos.
The boomer challenge
The financial impact
New care models
Staffing and management
Innovation in facilities and care design