Telemedicine has the potential to more regularly and affordably connect older adults to their doctors, but several barriers still exist preventing its widespread adoption. Perhaps the biggest: seniors’ own embrace of technology.
Home care agencies can help turn that tide — and Senior Helpers is showing the industry how.
The Baltimore-based in-home care franchise powerhouse recently released results from a pilot study testing a new model of connecting frail, functionally limited patients with primary care physicians via telemedicine. As part of the pilot, Senior Helpers worked with telemedicine solutions provider Curavi Health, along with home-based primary care practice Capital Coordinated Medicine (CCM).
“If telemedicine is going to be a meaningful solution for high-need patient care, a friendly home care worker might be the best way to introduce it to the patients who need it most,” Michael Hughes, VP of strategic development for Senior Helpers, told Home Health Care News.
Broadly, traditional telemedicine programs lean heavily on a senior’s understanding and willingness to use technology independently — a reality that often leads to problems such as inconsistent utilization.
In Senior Helpers’ pilot, patients were seen virtually by a remote CCM physician, with Curavi Health’s telemedicine equipment facilitating the conversation. A specially trained, certified nursing assistant provided by Senior Helpers assisted throughout the process in a ‘telepresenter’ role.
The pilot — which explores a more clinical role for Senior Helpers — took place over the first half of 2019. About three dozen patients participated.
“Senior Helpers initiated this pilot to explore opportunities that we see emerging in the clinical space,” Hughes said. “We know that our owners and their employees have skills that clinicians need – and will need even more in the future. So, doing this pilot helps Senior Helpers to prepare for these opportunities.”
Overall, telepresenter-assisted primary care visits offered up to a 44% cost savings compared to the operational costs of an in-home visit, the Senior Helpers’ pilot found. Onsite visits by a telepresenter averaged 50 minutes.
Additionally, the telepresenter model was also shown to help keep more people in their homes and out of the emergency room — a major bonus in today’s value-based reimbursement landscape. Seven of the 33 participating patients would have otherwise been sent to the ER had it not been for a Senior Helpers telepresenter promptly connecting them with a CCM doctor.
“The telepresenter model provided the opportunity for these patients to get enough of the right care, at the right time in the right place — with a future possibility of a funding stream,” Dr. Amy Schiffman, founder of CCM, told HHCN. “Fundamentally it’s exactly what patients and providers need and want in a telemedicine program.”
Founded in 2002, Seniors Helpers has hundreds of franchise locations throughout the U.S., with services ranging from standard home care support to specialized visits for individuals with Alzheimer’s and other forms of dementia. The company launched a reminiscence therapy-adult day franchise model — Senior Helpers Town Square Franchising — to complement those services last year.
Pittsburgh-based Curavi Health launched with its first clients — a local skilled nursing facility (SNF) — in late 2016 to provide after-hours access to its network of physicians. Since then, the company has expanded into more than 100 SNFs, assisted living facilities (ALFs) and other settings, including the home.
“Senior Helpers has been our initial foray into at-home care companies,” Curavi CEO Alissa Meade told HHCN. “We are also working with a number of home health, payers and at-risk provider groups to drive models of care at home.”
In general, telemedicine works best when a home care provider can serve as the “eyes and ears” for what’s going on in the home, Meade said.
Meanwhile, CCM is a home-based primary care group based in Kensington, Maryland, serving roughly an equal mix of patients in the home and in ALFs throughout nine countries. CCM currently has about 1,500 patients on service, according to Schiffman.
“One of the great challenges with a [home-based primary care] practice is being able to provide urgent house calls in a practice that is designed … with pre-scheduled appointments,” she said. “While there is often room for urgent visits, [they] can be taxing to the system.”
The tech savviness of CCM’s patients has also been a challenge at times, Schiffman noted.
Despite public and private efforts to encourage the use telemedicine, just 3% of Medicare patients reported having any virtual connection with a medical professional within a prior six-month period, a 2017 Advisory Board study found.
Results from Senior Helpers’ pilot suggest there’s ample opportunity for home care providers to team up with telemedicine vendors and home-based primary care practices. Still, there are some sizeable financial- and reimbursement-related roadblocks.
Currently, there aren’t very clear pathways for reimbursement in terms of fee-for-service Medicare, according to Hughes.
That doesn’t mean it’s the end of the road, however.
“We believe that there is a compelling opportunity in value-based care,” he said. “It’s just one more reason why home care is an ideal partner for accountable care organizations (ACOs) and others involved in those contracts.”
Additionally, Medicare Advantage (MA) is steadily becoming more flexible when it comes to supplemental benefits for in-home services and supports. In April, the Centers for Medicare & Medicaid Services specifically finalized new policies to expand the use of in-home telehealth under MA.
For prospective telehealth partners, home care’s value should be clear, Hughes said.
“We stop countless hospitalizations each day when our caregivers alert us to changes in condition that might lead to something more serious,” he said. “When you add services like the one described in our study, clinicians can become more responsive to patient visit requests and have more opportunity to make informed decisions when it comes to escalations in care.”
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