How Providers Can Improve Seniors’ Access to Telehealth
By July 2020, 80% of healthcare providers had conducted telehealth visits[1], yet the majority of patients seen were under the age of 65[2]. Much of this is likely because, unlike the 65+ population, younger individuals are typically more technologically adept and able to navigate the devices and applications needed for a telehealth visit. The elderly population, while they stand to benefit significantly from telehealth (they are more susceptible to COVID-19, and 85.6% have at least one chronic condition[3]), they need additional support from healthcare providers to effectively make use of telehealth technology. Trends suggest that older populations are becoming more familiar with technology; in 2019, 73% of people 65 and older versus only 14% in 2000[4]. Similarly, the start of the century saw limited numbers of smartphones used across all demographics, increasing to just over half of people over 65 nearly two decades later. Despite the growing ownership of devices amongst the senior population, only 26% report feeling very confident in the ability to use the device[5], with 73% reporting that they need assistance setting-up new devices. To overcome telehealth barriers, physicians must recognize the disparity and implement solutions that can prove to enhance the senior population’s access to telehealth. Numerous healthcare providers have already devised strategies to assist their senior patients in accessing telehealth[6]. Some healthcare organizations have begun supplying them to patients without the means to afford the necessary devices to enable telehealth. One provider has repurposed the vans used to pick up and drop off patients from appointments to delivery vehicles that bring tablets right to the homes of elderly patients. The drivers also serve as aids to help the patient log in and navigate their way to the telehealth visit. Other patients face physical limitations, such as vision and hearing loss that makes telehealth challenging. In cases such as these, providers are using family members and caregivers as an interpreter, relaying messages between the patient and the provider. When a family member or caregiver is unavailable, the provider can see the patient in person, often at their own home. For patients who have the necessary technology yet lack the skills to use it effectively, providers have started introducing “practice visits,” designed to provide the patient with the training needed to use their device correctly. Providers implementing this strategy found that both they and their patients have more successful telehealth visits. In addition, some providers choose to provide high-risk patient monitoring devices, like scales and blood pressure cuffs, teaching them and their caregivers how to use and report data accurately. For patients who would typically have frequent in-person visits, this data collection allows providers to detect irregularities in the patient’s vitals that could signal a worsening of their condition and require urgent care. Such strategies are proving effective at increasing senior access to telehealth. By providing support and resources to actively use telehealth, seniors can enjoy more time at home, increased independence, and enjoy better health outcomes. As technology continues to evolve and new demographics age, it will be interesting to see how long-term telehealth takes shape. [1] https://www.fiercehealthcare.com/practices/rush-to-embrace-telehealth-many-physicians-still-have-concerns-about-quality-care-survey [2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm [3] https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm [4] https://www.pewresearch.org/fact-tank/2019/06/18/americans-60-and-older-are-spending-more-time-in-front-of-their-screens-than-a-decade-ago/ [5] https://www.pewresearch.org/internet/2017/05/17/barriers-to-adoption-and-attitudes-towards-technology/ [6] https://www.pewresearch.org/internet/2017/05/17/technology-use-among-seniors/
Low-Income Seniors Are Disproportionately Affected by Lack of Telehealth
When the pandemic began, many healthcare providers made the switch from in-person care to telehealth to reduce disease exposure. This was not a problem for many patients, especially when they had the means to facilitate virtual visits. Other patient demographics, like seniors, may be underrepresented by telehealth visits, however. It is startling to consider that half of people older than 65 living alone do not have the financial ability to cover essentials, let alone new devices or internet access needed for a telehealth visit[1]. Plus, more than one in three households lead by senior citizens lacked access to a computer, and more than half do not have a smartphone[2]. Without the same access to technology as higher-income counterparts, low-income seniors are significantly less prepared to make the transition to telehealth. With doctor’s offices canceling in-person visits in favor of socially distanced alternatives, low-income seniors are at risk of missing out on crucial access to healthcare. While programs like social security have been effective at raising people out of poverty, 9.7% of people over 65 remain impoverished even with social security assistance[3]. A study found that nearly one in five people with the lowest incomes reported not knowing how to use devices that enable telehealth[4]. Not knowing how to use telehealth-enabling devices stems from the lack of accessibility to low-income populations. Access to care is further hindered as many rural communities lack the high-speed internet connectivity required to facilitate telehealth visits. In areas with low broadband access, patients made 34% fewer telehealth visits[6]. Similar initiatives are trying to expand internet access to rural residents as well. While improvements to internet infrastructure will not be immediate or address the concerns of patients unable to afford it in the first place, healthcare providers should look to implement outreach programs to lower-income patients. Even providing telehealth options without video can improve access to patients without a smartphone, tablet, or computer with a camera. While patients using audio-only options will not benefit from the face-to-face interaction with a provider, they can still speak with their provider to address any questions or concerns they may have. While telehealth has tremendous potential to serve previously underserved populations, providers must keep in mind the limitations that some of their patients may experience. Especially with vulnerable populations such as the elderly, challenges with internet access, low income, and device accessibility can limit the adoption of telehealth to meet their needs. Addressing these challenges will help patients benefit from a more equitable ability to access telehealth opportunities. [1] https://khn.org/news/technology-divide-between-senior-haves-and-have-nots-roils-pandemic-response/ [2] https://www.healthaffairs.org/do/10.1377/hblog20200505.591306/full/ [3] https://www.cbpp.org/research/social-security/social-security-lifts-more-americans-above-poverty-than-any-other-program [4] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772162 [5] https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2739054 [6] https://www.govtech.com/health/growth-of-telemedicine-slowed-by-internet-access-challenges.html
Demonstrating the Success of Remote Patient Monitoring (RPM)
Remote patient monitoring (RPM) is poised to change the way healthcare is delivered. Rather than physicians being provided with a limited snapshot into the health of their patients, RPM enables them to monitor health and symptoms continuously, even when the patient has left their office or been discharged after a hospital visit. While many healthcare specialties can benefit from the technology and insight into a patient’s condition that RPM provides, the public health crisis has enabled RPM to demonstrate its effectiveness in delivering wound care and improving health outcomes. Every year, Medicare estimates that between $28.1 billion and $96.8 million is spent directly on wound care, including non-healing wounds, postoperative wounds, and diabetic foot ulcers (DFS)1. Furthermore, it is predicted that up to 2.5 million seniors may require wound care throughout the pandemic. However, patients in need of wound care primarily overlap with those who are most susceptible to COVID-19 infection: those ages 65 and up, nursing home residents, individuals with heart conditions, severely obese individuals, and individuals with diabetes1. While seniors are increasingly choosing to age at home, the pandemic has caused issues such as isolation and a reluctance to attend in-person doctor appointments. Without applying technology to these situations, it would be difficult for patients to receive the care needed to properly care for their wounds. When it comes to wound care, telehealth and RPM is positioned to deliver more effective care to patients while they remain in the comfort of their home. In a recent study, a year-long prevention program for patients with healed diabetic foot ulcers was followed2. In the study group, patients were provided with a foot temperature monitoring mat allowing them to measure their foot temperatures daily while remaining at home. The results showed complete elimination of major amputations and a 52% reduction in all hospital admissions. The patients participating also reduced the recurrence of foot ulcers, emergency room visits, and outpatient visits. The success in this trial of RPM in improving patient outcomes with DFUs will lead to its expanded use in the treatment of diabetes, such as remote glucose monitors and reminders for the patients to take their insulin at prescribed times. RPM can also be used to care for wounds that are the result of operations or injuries. Before the pandemic, patients would receive help caring for wounds from specialists that would visit nursing homes or from home care agencies during home visits3. However, these patients are still in need of assistance when caring for wounds. Healthcare providers can monitor the condition of a patient’s wound virtually, examining it for signs of infection, changes in dressing, or ointments that may help the healing process. Plus, virtual tools can help providers teach the family members of patients to properly dress the wound when needed. This enables providers to receive the insight needed to monitor the condition of the wound while avoiding exposing patients to COVID and empowering patients to receive needed, quality care from home. Tools such as RPM will only become more useful as patients undergo elective surgical procedures that they put off during the pandemic. Healthcare providers will be able to more efficiently monitor wound healing progress, changes in symptoms, or any worsening condition that may require immediate care. RPM in wound care is only one application in which it is seeing success, and its value is being recognized by healthcare agencies and providers across the country. Even before the public health crisis, Medicare had expanded its coverage of RPM, allowing more providers to receive compensation for remotely monitoring patients4. Across its applications, RPM has decreased readmission rates up to 40% and emergency room visits by up to 92%4. As RPM continues to be successfully implemented throughout the healthcare agency, it will change the way care is delivered and how patients expect to be cared for. Sources: 1 https://www.mcknights.com/marketplace/marketplace-experts/an-answer-to-wound-care-in-the-senior-living-community/2 https://www.podiatrytoday.com/study-suggests-remote-patient-monitoring-decreases-dfu-recurrence-and-health-care-costs3 https://www.homecaremag.com/october-2020/technology-care-at-home4 https://www.medicaleconomics.com/view/your-doctor-will-remotely-see-you-now
How Providers Can Improve Seniors’ Access to Telehealth
By July 2020, 80% of healthcare providers had conducted telehealth visits[1], yet the majority of patients seen were under the age of 65[2]. Much of this is likely because, unlike the 65+ population, younger individuals are typically more technologically adept and able to navigate the devices and applications needed for a telehealth visit. The elderly population, while they stand to benefit significantly from telehealth (they are more susceptible to COVID-19, and 85.6% have at least one chronic condition[3]), they need additional support from healthcare providers to effectively make use of telehealth technology. Trends suggest that older populations are becoming more familiar with technology; in 2019, 73% of people 65 and older versus only 14% in 2000[4]. Similarly, the start of the century saw limited numbers of smartphones used across all demographics, increasing to just over half of people over 65 nearly two decades later. Despite the growing ownership of devices amongst the senior population, only 26% report feeling very confident in the ability to use the device[5], with 73% reporting that they need assistance setting-up new devices. To overcome telehealth barriers, physicians must recognize the disparity and implement solutions that can prove to enhance the senior population’s access to telehealth. Numerous healthcare providers have already devised strategies to assist their senior patients in accessing telehealth[6]. Some healthcare organizations have begun supplying them to patients without the means to afford the necessary devices to enable telehealth. One provider has repurposed the vans used to pick up and drop off patients from appointments to delivery vehicles that bring tablets right to the homes of elderly patients. The drivers also serve as aids to help the patient log in and navigate their way to the telehealth visit. Other patients face physical limitations, such as vision and hearing loss that makes telehealth challenging. In cases such as these, providers are using family members and caregivers as an interpreter, relaying messages between the patient and the provider. When a family member or caregiver is unavailable, the provider can see the patient in person, often at their own home. For patients who have the necessary technology yet lack the skills to use it effectively, providers have started introducing “practice visits,” designed to provide the patient with the training needed to use their device correctly. Providers implementing this strategy found that both they and their patients have more successful telehealth visits. In addition, some providers choose to provide high-risk patient monitoring devices, like scales and blood pressure cuffs, teaching them and their caregivers how to use and report data accurately. For patients who would typically have frequent in-person visits, this data collection allows providers to detect irregularities in the patient’s vitals that could signal a worsening of their condition and require urgent care. Such strategies are proving effective at increasing senior access to telehealth. By providing support and resources to actively use telehealth, seniors can enjoy more time at home, increased independence, and enjoy better health outcomes. As technology continues to evolve and new demographics age, it will be interesting to see how long-term telehealth takes shape. [1] https://www.fiercehealthcare.com/practices/rush-to-embrace-telehealth-many-physicians-still-have-concerns-about-quality-care-survey [2] https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm [3] https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm [4] https://www.pewresearch.org/fact-tank/2019/06/18/americans-60-and-older-are-spending-more-time-in-front-of-their-screens-than-a-decade-ago/ [5] https://www.pewresearch.org/internet/2017/05/17/barriers-to-adoption-and-attitudes-towards-technology/ [6] https://www.pewresearch.org/internet/2017/05/17/technology-use-among-seniors/
Telehealth Aids Rural Healthcare
Americans living in rural areas are disproportionately affected by the lack of quality healthcare service. With higher rates of preventable diseases and worse health outcomes than the 57 million Americans living in urban areas1. At the same time, rural physicians are challenged by workplace shortages and thin margins. To further compound this prevalent issue, in the past decade, 120 rural hospitals have closed. Of these, 39 were designated critical access hospitals, intended to keep essential services in rural areas3. These persistent issues can be solved through technology and the increase in home health. If COVID-19 has demonstrated anything, it was the healthcare community’s ability to rapidly implement telehealth alternatives. In the last week of March 2020, telehealth visits increased by 154%4. For Medicare beneficiaries, nearly half of all primary care visitors in April were a direct result of COVID5. The use of telehealth services was further supported by emergency presidential declarations lifting the Centers of Medicare and Medicaid Services’ geographic or site of service requirements. With this change, CMS was able to add 135 services to their telehealth services list. This increase in telehealth adoption shows the openness to telehealth options, previously not seen. In rural settings, telehealth is a particularly attractive solution to the challenges healthcare faces. As rural communities lose healthcare providers, telehealth is uniquely positioned to supplement limited resources6. Telehealth also opens the door to more efficient home healthcare and remote patient monitoring, which increases favorable patient outcomes. With remote patient monitoring (RPM), a patient’s condition can be monitored outside of the hospital through telehealth and digital devices to facilitate patient engagement and inform better treatment decisions. Physicians receive continuous data on patient conditions and can encourage patients to modify behaviors and take ownership of their healthcare journey7. Typically, patients can make positive behavioral changes while under hospital care but fail to maintain a health care plan when they return home. Using telehealth in combination with RPM can significantly improve a patient’s quality of life and reduce the risk for future hospitalizations. Before the public health crisis, home-based care delivery was in stages of experimentation but lacked consensus about what was reimbursable at home8. This changed as payers, providers, and patients became aligned in favor of home-based care. While not all changes have been permanent, it will give providers the ability to strategize how care is delivered in a post-COVID environment8. The widespread adoption and support of telehealth and RPM measures have shown that effective, efficient care can still be delivered in a home care setting. Not only does it make healthcare more effective, but it also makes it more accessible to the rural communities desperately in need of healthcare resources. Sources:
The Rise in Virtual Care Visits
COVID-19 imposed many challenges for the healthcare sector. Fears of contracting the virus led many patients to cancel in-person visits, generating large demand for telehealth and virtual care. While telehealth technologies are not new, they have long been discussed. However, the pandemic forced providers to quickly implement virtual care options to support the patient demand, advancing the use of this technology “seven years in the last seven months”1. This especially makes access to care easier for the older population that may prefer to receive care at home. In a study, 60% of patients report the desire to continue receiving healthcare through telehealth methods, citing the care felt more personal, convenient, and timely2. Rather than need to travel into the doctor’s office, patients were happy with the ability to revive quality care in an environment they feel most comfortable in. Plus, 90% report that the level of care they received was as good or even better than traditional in-person care. With the overwhelmingly positive response to telehealth, the technology will continue to be an asset and change the way people receive care far into the future. As telehealth adoption rapidly grew, remote patient monitoring (RPM) technologies were implemented to monitor patients at home. With RPM, continuous monitoring and frequent check-ins allow physicians to intervene early when necessary. This created a fundamental shift, patients are incentivized to stay healthy, and with real-time monitoring, patients are evaluated more than at 3, 6, 9, or 12-month intervals. Continuous data, like blood pressure, weight, or blood sugar levels, give physicians the data they need to understand the patient’s health. Beyond meeting the patients’ needs, the combination of telehealth and RPM will decrease inefficiencies experienced by home health providers. Rather than having set home health visits, patients can be seen only when necessary since these tools allow for constant and effective communication between patients and providers. Sick patients can be seen as soon as they begin to display signs of illness, while healthy patients can forgo seeing a physician. When a home visit is necessary, RPM enables providers to have all necessary documentation needed to justify the visit3. On top of the healthcare industry and patients realizing the value of telehealth and RPM, government agencies are getting on board as well. The USDA is investing $42.3 million to 86 programs, many of which include “connected health programs”4. These programs are designed to expand and support many healthcare programs, a major of which deliver telehealth to rural and underserved communities. At a critical time in the development of these programs, funding is imperative to continue to positive momentum and expand care to serve more patients. Despite the challenges of the pandemic, telehealth and RPM rose to meet the changing demands of patients around the country. Through more effective and efficient care, patient health is encouraged, and physicians can more easily collect the data needed for support. Rapid innovation and implementation of telehealth have already generated positive results, so it will be interesting to see where this technology leads in the future. Sources: