The telehealth sector has gained significant momentum in the healthcare community over the last several years. There is growing evidence that the sector has been widely accepted across multiple settings, and its positive impact on quality, cost and access to care is well-documented. While telehealth progams have proven beneficial to the broad healthcare market, the sector is still fairly young when it comes to care for aging adults.
Until recently, telehealth was viewed as a promising experimental tool for older seniors in need of fairly basic services related to monitoring and/or long-term care; however, as the telehealth industry has diversified, its capabilities to serve the entire “smart aging” population (age 50+) have expanded.
Today, the industry offers a robust set of programs and services ranging from wearables and clinical sensors to disease-specific wellness platforms and video-enabled on-demand remote care offerings. Given these capabilities and the ability of telehealth to physically “meet patients where they are,” the telehealth sector is well positioned to address the unique challenges of the smart aging sector, particularly the physical, psychological, and social components of health in older consumers.
These three deeply interrelated components impact the health of aging adults but are often not addressed sufficiently and holistically by traditional “in-office” care.
While telehealth has the ability to positively impact and shape numerous aspects of care for aging adults, we believe the following telehealth-related trends will be of particular interest in 2019:
Growing need for after-hours provider coverage at skilled nursing facilities
Many Silled Nursing Facilities (SNFs) have limited after-hours provider coverage which can leave staffs ill-equipped to handle complex episodes at night or on weekends and holidays. As a result, SNF residents who need urgent care are often expensively and sometimes traumatically transferred to a hospital, treated, then readmitted to a SNF. This scenario is not only detrimental to seniors and SNF staff, but is costly to payers and can financially impact SNFs through damaged reputations, lost revenue, and readmission penalties.
Telehealth services help combat such dilemmas by offering “treat-in-place” tools that provide 24/7 virtual access to providers, utilizing two-way audio/video technology and digital diagnostic tools. These solutions provide opportunities to effectively treat a majority of seniors who need after-hours care without transferring them from their beds.
In fact, some after-hours SNF telehealth providers have successfully treated over 80% of SNF patients in place. Senior care organizations offering these telehealth services are successfully solving a critical need by providing access to highly-skilled care after-hours. Consequently, these organizations are able to improve clinical outcomes, differentiate their facility to key stakeholders, and grow their daily census by partnering with local hospitals.
This subsector of telehealth is beginning to consolidate, and new leaders are emerging. In 2019, telehealth providers in this market can add value by helping to combat the staffing challenges described above while also creating strong opportunities for client savings/return on investment.
Increased focus on behavioral health
Mental illness is a growing challenge to the smart aging community. As the number of available mental health providers declines, the demand for behavioral health providers increases. This challenge is particularly relevant to seniors with limited mobility or those living in rural areas where distance impedes access to quality mental healthcare. As such, there is a clear need to deliver solutions which provide accessible behavioral health services both in home and residential settings.
Because behavioral health providers often do not need a physical presence with patients, and because many individuals prefer to access behavioral health services discretely, using telehealth technologies to deliver mental health services is clearly one of the best and most impactful use cases within the sector.
Additionally, tele-behavioral healthcare requires effectively no specialized investments beyond a simple video connection or similar tool, making it an inexpensive and easy foray into the virtual care space for many stakeholders.
Numerous organizations currently offer virtual networks of psychiatrists, psychologists, and/or social workers to deliver real-time, remote care/therapy sessions to senior living communities via video or phone. It is anticipated that this subsector will continue its rapid growth as stigmas regarding mental health lessen and behavioral health continues to gain recognition as a key component of care regimens, especially for those managing chronic conditions.
Emergence of “smart home technology” and voice activated tools
Many retirement communities, assisted living facilities, and other senior housing environments are actively exploring, piloting, and integrating “smart home” programs and services in hopes of improving the safety, care, comfort, and convenience offered to residents. The spectrum of smart home technologies is wide and growing.
Products range from voice-activated speakers to motion/weight sensors and integrated systems that can remotely control lighting, room temperature, and security features. This technology also provides alarms for medication reminders, analytics that measure changes in activities of daily living, and can facilitate communications with staff, family, or caregivers.
Ideally, these technologies will allow residents to control numerous home functions from a single device, monitor their health remotely, and provide the real-time connectivity/telehealth services needed to reach loved ones or care team staff.
Organizations are on the frontline of these initiatives by helping senior care organizations establish the technological infrastructure, as well as the analytical and engagement tools, needed to support a smart home offering.
Telehealth and smart aging are becoming markets of interest for large retail and technology players
In 2018, large retail and technology organizations completed initiatives to enter the smart aging market, none more notable than Best Buy’s $800 million acquisition of GreatCall. GreatCall provides numerous connected health solutions that help aging individuals maintain safety and independence.
While Best Buy was previously selling GreatCall devices in its stores, this acquisition gives Best Buy an established product and enables direct access to GreatCall’s sizeable customer base of aging adults and senior care communities.
The transaction will also give GreatCall users access to BestBuy’s Geek Squad technology support team who will provide critical, timely assistance with device implementation and ongoing use.
Amazon, Google, and Apple have also recently explored how their solutions can benefit the smart aging market, and it’s likely that leading retail and technology players will continue to devote meaningful resources to this demographic.
In addition to the topics described above, we expect to see further telehealth growth in a number of other subsectors that serve the smart aging market including chronic care management, dermatology/wound care, and medication adherence.
Furthermore, while some providers view the uncertainty around third party telehealth reimbursement as a hurdle for implementation, it’s important to recognize that numerous recent legislative trends appear to favor expanding reimbursement, and that implementing telehealth can not only create value through potential reimbursement but through cost savings associated with preventing or quickly addressing adverse health events.
Of all population cohorts, telehealth may ultimately offer the most value to aging adults and their caregivers, and will be an integral tool in the smart aging sector both in the near- and long-term. The “holy grail” of telehealth solutions will utilize sophisticated artificial intelligence/data management tools that integrate and digest all aspects of a senior’s environmental social determinants, behavioral health attributes, and clinical needs to efficiently navigate care access to the right provider in the best care setting.
Grant Chamberlain joined Ziegler in 2015 as a Managing Director in the Corporate Finance Healthcare Practice (bio available here). Clayton Wilson joined Ziegler in 2018 as a Research Assistant. Ziegler’s Corporate Finance Healthcare team recently released a comprehensive white paper entitled “Deconstructing the Telehealth Industry: Part II.” This report provides a deep dive into the future of virtual care solutions and specifically discusses the growing role of virtual care within the smart aging continuum. Interested readers can visit the Ziegler website at www.ziegler.com to access the full report.
Grant Chamberlain is managing director in the corporate finance healthcare practice at B.C. Ziegler and Co. Clayton Wilson is a research assistant with Ziegler’s senior living finance practice program.
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