Aging 2.0 Conference Highlights: Digital Health Innovation in Elder Care Must Address Specific, Actionable Needs

Undeniably, the world is aging at an astonishing pace. In the United States, nearly 100 million people are over the age of 50, and those aged 65 and older constitute the largest and most costly cohort of healthcare consumers. Today’s seniors differ markedly from previous generations, implying that the healthcare industry should tailor medical technologies and services to their needs. This approach embodies the “people-first, technology-second” philosophy central to the transition toward value-based care, designing solutions around specific patient requirements.

Recently, at the "Aging 2.0" conference held in San Francisco, which focused on new technologies for elderly care, multiple industry experts discussed the relationship between elderly care and digital health innovation. VCBeat (WeChat: vcbeat) has compiled and translated the main points of the discussion for you.

Digital healthcare has permeated various consumer segments, with demand for home healthcare services rising year by year. According to a recent report by Zion Market Research, the global market value of this sector (including private care, telemedicine, medical devices, and therapeutic services) was nearly $229 billion in 2015 and is projected to reach $391 billion by 2021.

From October 12 to 14, 2016, the “Aging 2.0” conference was held in San Francisco. At the conference, digital health innovation undoubtedly took center stage in discussions on the elderly population, covering a wide range of topics—from enhancing the independence of seniors aging in place, to providing support tools for caregivers, to remote monitoring solutions that enable more efficient physician outpatient visits and reduce hospitalization rates.

Economist and McKinsey Global Institute partner Jaana Remes noted at the conference that healthcare consumption is undergoing a significant shift, driven primarily by a long-overlooked demographic: older consumers. For years, pervasive stereotypes about this group have obscured its true potential. In reality, today’s older population is more equitable and diverse; they are more likely to remain in the workforce later in life and to live single. As the most educated generation of seniors to date, the majority are highly proficient with advanced technologies.

Remes pointed out that this means applications, remote monitoring systems, and interconnected platforms designed for elderly care teams must also take into account the elderly’s own use of technology.

A series of laws enacted last year have set the industry on a path to transition from fee-for-service to value-based care, underscoring the need to focus on the largest group of healthcare consumers: the elderly. For individuals aged 75 and older, as there are fewer younger family members available to provide care, products should be tailored to their specific needs. Meanwhile, for seniors aging in place and their caregivers, tools that enhance quality of life and improve the efficiency of medical care services are essential.

Bruce Chernof, CEO of The SCAN Foundation, a charity focused on aging and long-term care, noted that life expectancy in the United States has undergone significant changes. While people are indeed living longer, they are not necessarily living healthier lives, with chronic diseases severely impacting the quality of life for older adults. Technological innovation is needed to address this issue.

Although half of adults aged 65 and older will qualify for nursing home coverage under the Medicare program, the vast majority will choose to remain in their existing communities. This means that their places of residence will need to provide seniors withComprehensive in-home care support. Therefore, relevant practitioners need to reimagine how to provide care services for elderly individuals living at home, as well as the types of tools and technologies required to succeed in this new environment.

As household sizes have shrunk and the proportion of older adults living alone has risen significantly compared with previous generations, those providing caregiving support are under mounting pressure: approximately two-thirds of older adults receive unpaid care from relatives, friends, and other informal sources.

Chernof stated that as the demand for skilled nursing personnel and care support rises, healthcare innovation must first clearly define the specific problems it aims to address.

Healthcare providers have consistently been reluctant to integrate social services, largely because they are uncertain how these services add value. For instance, physicians often treat behavioral health separately from other medical issues or refer patients to agencies that may not even accept them. In contrast, technologies designed to integrate various aspects of healthcare can save time and money while delivering better treatment outcomes.

Chernof argues that 1.0 technological solutions are ineffective in a 2.0 problem environment. Launching an app akin to “food delivery services” is clearly not a 2.0 solution. Instead, developers should first identify the various reasons why users experience “hunger,” and then design corresponding technical tools accordingly. For instance, enabling users to access transportation services, facilitating their connection with the community, and determining the support they need at home—these constitute the 2.0 solutions required today.

In a panel discussion featuring leaders from the aging and elderly care sectors, experts explored how the industry should respond to this demographic trend and the evolving demands for healthcare services. Their consensus was to welcome innovations in digital health tools that improve care outcomes, provided that all such innovations align with the industry’s needs.

Lily Sarafan is the CEO of Home Care Assistance, a home care company headquartered in Palo Alto. During a panel discussion, she noted that from a purely technological perspective, innovation can reside in extremely simple solutions—such as a dashboard report accessible to all family members. This tool clearly indicates which sensors users can interact with at home, enabling them to track the daily living patterns of their care recipients. It also facilitates family conversations, rather than requiring the periodic involvement of professionals every few weeks or months to identify underlying issues.

The field of elderly care faces numerous challenges, such as proprietary information silos and subsidy policies. Panelists believe that interoperability of new technologies is highly valuable in this ecosystem.

Dan Hirschfeld, President of Genesis Rehab Services, stated that interoperability provides innovators with a pathway to consider how to achieve data integration. He noted that the senior care industry is relatively siloed. For instance, in acute and post-acute medical care services, there are approximately ten descriptive settings, of which only six are recognized and reimbursed by Medicare programs.Hirschfeld also expressed his expectation for the lawful sharing of technology and data.

Building on this, Bill Mills, founder of Chronic Care Management, a company dedicated to serving patients during the intermediate care phase, noted that electronic health records (EHRs) are becoming more open to connecting with innovative solutions. For instance, Epic and athenahealth have released open APIs, enabling innovators to integrate their technologies through various approaches.

In addition, older adults themselves need to update their understanding of care. Hirschfeld noted that nursing homes in the United States often have so-called “acquired dependency” elderly residents who require assistance with eating, dressing, bathing, and medication administration. However, this runs counter to the goals the industry aims to achieve. The industry hopes that older adults can learn to be independent, thereby enhancing “patient engagement.” Therefore, care providers and recipients need to work together to ensure that older adults benefit from such care.

Home care is the next hot sector for companies to enter and raise capital. However, Sarafan cautions that a prudent approach is warranted. While the favorable momentum in home care will indeed continue to attract more funding and innovation, all companies attempting to enter the aging and elderly care market should bear in mind that they must shed their startup status as soon as possible and evolve into truly mature enterprises.

Panel experts stated that if innovators wish to enter the elderly care sector, they must first identify the appropriate channels to engage with senior living and eldercare companies.

Sarafan pointed out that Home Care Assistance frequently receives pilot requests from various companies, but many of these are for products the company has already developed or for which it already has corresponding solutions. Additionally, some companies offer hardware with impressive features but lack design thinking focused on usability for older adults at different stages of aging. Elderly care companies need to see more than just an idea; the ability to execute and implement that idea is often more important.

Furthermore, technology integration must not become a burden for care providers. Hirschfeld noted that, in general, clinicians are resistant to change; therefore, technology companies should begin by engaging those who are willing to embrace technological innovations. Nursing service companies possess data, clinical libraries, and established care pathways, among other resources. Consequently, collaborating with them to deploy technologies for use by clinicians and staff yields the best outcomes.

Trish Barbato, Senior Vice President of Revera, a retirement and long-term care company, stated that the adoption of new technologies will unleash a massive data deluge upon the industry. In the future, it is highly likely that sensors will be embedded in all furniture and equipment, resulting in a backlog of data awaiting processing and a constant barrage of alerts. Consequently, data management will become a monumental undertaking. Therefore, the immediate priority is to streamline this process. Developers must devise appropriate information-processing methods to assist staff in delivering timely care and to clearly guide caregivers on their current tasks, thereby preventing confusion.

Barbato stated that although some tools are currently being developed to address this issue, their effectiveness remains far from sufficient. To achieve this, developers need to acquire sufficient information and determine its relevance. Unfortunately, no one has yet been able to access all the data and figure out how to proceed.

Moreover, not all industry insiders have embraced new technologies and innovations with enthusiasm. Sarafan points out that some caregivers and clinicians may not necessarily wish to elevate accountability to a new level. Past experience makes it understandable why some practitioners are reluctant to embrace data transparency: once data becomes transparent, all relevant parties become subject to accountability. However, Sarafan argues that the results of certain pilot projects have already demonstrated that the value and benefits of information integration far outweigh the potential risks and liabilities associated with it.

Barbato added that both practitioners and patients may initially feel apprehensive about new technologies. She cited examples such as nurses using mobile devices to manage schedules and patients using iPads to access health education: once people become accustomed to these technologies, they often find it difficult to imagine returning to a time without them. Just as it was hard to envision the current prevalence of mobile internet when Wi-Fi was not yet ubiquitous in buildings five years ago, developers should anticipate the future needs of practitioners and residents.

Group members stated that once a technology capable of improving elderly care is identified, piloting and evaluation are critical components of its ultimate adoption. However, the most challenging aspect currently lies in the technology identification phase during initiation—specifically, determining which type of technology to select or which areas it should serve to maximize its impact.

Mills pointed out that physicians will soon need to decide how to comply with the Medicare Access and CHIP Reauthorization Act (MACRA), and there are many ways to choose value-based care pathways. In his view, the home care sector is where much innovation is taking place. Among the most valuable innovations are applications that allow patients and caregivers to integrate chronic care management into daily life, as well as sensors that provide data and give physicians insight into patients’ conditions during interim periods—often referred to as the “gap” in patient care.

Previously, medical care plans prescribed by physicians were often discontinued once patients were discharged and returned home. The advent of chronic care management applications has significantly improved this situation. Consequently, risk-bearing healthcare providers have shown strong interest in this technology and have begun leveraging it to enhance the continuity of patient data between outpatient visits.

Sarafan stated that building backend technology is crucial to enhancing the value of care. It enables the creation of analytics and systems to track patients’ health status, schedule staff, match patients with appropriate caregivers or clinicians, and gain deeper insights into relevant populations to develop more personalized care approaches. She introduced that Home Care Assistance is committed to collecting more and better data to share with its 10,000 referral partners across the United States, enabling them to understand patients’ conditions during “gap periods,” as well as the status of emergency department patients or those undergoing check-ups who are discharged home after two or three follow-up visits per year. To date, Home Care Assistance has maintained round-the-clock engagement with patients for months or even years. Only through such efforts can the company continuously share optimal patient data with various stakeholders in the ecosystem and reduce patients’ preventable hospitalization rates.