California faces a challenge as the number of seniors in the state and the costs to provide medical care for them continue to rise. With 6.4 million seniors -- including about 1.1 million who are eligible for both Medicaid and Medicare -- health officials are scrambling to provide care more effectively so existing money can be stretched to accommodate more heavy users of health care.
One way to deliver more efficient health care is wider use of better technology, according to Scott Peifer, executive director of AgeTech California, a new, tech-minded organization designed to do just that.
"We work as an educator, a policy advocate and we want to enable strategic change," Peifer said. "We're a broker of new opportunities. We help organize and connect people to new grant opportunities, sort of a consortium of providers and tech solutions."
The organization hopes to promote and develop tech connections within California to make futuristic health care delivery systems workable now, rather than many years from now. AgeTech is working on home telehealth systems, sensor telemonitoring and remote medication management.
The state's Coordinated Care Initiative aims to combine the funding sources of Medicare and Medi-Cal into a program that delivers better care, hopefully at a lower cost. Medi-Cal is California's Medicaid program.
"Under the CCI, health plans will be given new financial incentives to help consumers to stay in their home and communities," said Peter Harbage, a consultant working with the state on stakeholder outreach. "This will create new opportunities to develop innovative approaches to care, such as using telehealth."
Technological innovations such as home telehealth will go a long way toward helping the state realize its dual goals of better care and lower costs, Peifer said. Because the entire system of care for that population is being altered with the CCI duals demonstration project for dually eligible Medicare and Medi-Cal beneficiaries, now may be the perfect time to implement a wide array of technology solutions.
Most Technologies Home-Based
AgeTech California was started in January 2011 as a strategic partnership of Aging Services of California, which represents elder facilities, and the California Association for Health Services at Home, an organization of home providers. The goal was to create an entity that has expertise in the technology that could benefit both seniors and the state, and then has the influence to help implement those technologies.
Most of the tech systems AgeTech pursues are home-based. AgeTech doesn't work on the technology itself, Peifer said, but rather on promoting, organizing and advocating for it.
"We're not a technology company, we're not selling anything," Peifer said. "We're focused on doing continuous care, rather than episodic care. So we are advancing that, and advancing the expertise, as well."
There are a number of home health ideas that could be developed and implemented soon, either in the CCI duals demonstration project or included in health plans' coverage.
Home telehealth. The potential is high for providing better care for people remotely, especially those with multiple chronic conditions such as diabetes and heart disease. Conditions would be treated on a constant, regulatory basis, rather than acutely and episodically, Peifer said. Savings could be enormous. Peifer said California could potentially save $1 billion from implementing a system similar to the Department of Veterans Affairs' telehealth-based care coordination program. "Especially in rural areas, you have a lot more windshield time," Peifer said. "But even in an urban setting, you can spend a lot of time getting around to people's homes. The increase in efficiency enables physicians to proactively manage their pool of patients, and that helps everyone."
Sensor telemonitoring. When blood pressure or sugar levels can be monitored in real time, it takes relatively minor adjustments to keep people healthy, Peifer said. One of the big costs in medicine is emergency department use, and avoiding preventable crises can keep those human and financial costs down.
Remote medication management. When patients have multiple conditions and multiple medications -- often complicated by dementia or other mental health issues -- it can be more difficult to take the right medication at the right time. Managing medication delivery remotely could have a dramatic impact on people's daily lives, Peifer said.
Cognitive fitness. Mental acuity can be a debilitating issue as people age, and it can be difficult to handle in an office visit. A home health program could monitor and develop cognitive awareness.
Talk is Easy, Change is Hard
It's easy to talk about the wonders and possibilities of home health technology, but more difficult to implement them system-wide, Peifer said.
"It requires workflow change and innovation across the organization," he said. And change of that scope is rare, he added.
"When you go out and talk to care organizations, and you say, 'What's the last innovation you implemented?' There's always a big pause," Peifer said. "It can be a tough slog if you don't have it set up properly. Overcoming some of those hurdles can also be hard since there isn't a lot of reimbursement [for home health technologies], so how do you go about a rollout of them?"
That's why it's important to lay the groundwork now with health plans, providers, patients and health officials, he said.
"We have plans later this year to convene a provider roundtable, so we can openly dialogue about what providers need most in technologies in terms of functionality and usability and different cost points and other considerations, and we want to develop use guidelines and standards, as well," Peifer said.
Other states have implemented home telehealth services, Peifer said. For instance:
- New York has a home telehealth Medicaid waiver;
- Pennsylvania covers home telehealth, remote monitoring and medication dispensing;
- South Carolina instituted a home telemonitoring program with an eye toward reducing ED visits; and
- South Dakota has a home telehealth reimbursement policy and also covers medication management.
Those successes have convinced many in California of the efficacy of home telehealth, Peifer said. Now it's time to take the next step and codify it in California, he said.
"What makes AgeTech unique and hopefully more effective is the joint policy voice, both providers and technology groups together," Peifer said. "Right now it looks like health plans are seeing the value of home telehealth, and the private sector is more likely to provide it. But it's an important component of Medicare and Medi-Cal, as well."