References to new healthcare delivery models today generally refer to systematic changes which reflect reimbursement strategy shifts. Some even go so far as to refer to them as innovations in healthcare design. I would take issue with labeling these new changes as innovative. These changes in care delivery are organizational. It must be said that patient-centric care differs from patient-centered care. Successful business models will be those designed around point of care patient interactions. A few years ago I described how business models of mobile health might be designed around the technology. It is just as important to have the technology designed around the business model which will reflect the care model, not vice versa as suggested in the first references above.
To be more specific, healthcare will be generally focused in the home. The National Institute on Aging’s website suggests ways in which the elderly can be helped at home. Unfortunately, it is designed for those who can afford total care, whether it be medical or non-medical aid. The site states that “…Some might be covered by Medicare…” It neglects to say that almost none if it is. Medicare resources need to be shifted from fee for service for high hospital reimbursements to reimbursement for total care which includes (and should be heavily weighted towards) home care. Most of all, it should be patient-specific (and should include older persons who are the ‘walking well’), not diagnosis-driven. Aging at home should include technologies aimed at preventive medicine efforts hopefully minimizing readmissions as well as non-medical support for both patients and caregivers. These issues were elegantly addressed by the European Union’s “Quality Care for Quality Aging” project.
Technologies which can aid the elderly and sick at home should be reimbursed, independent of an event such as a recent hospitalization. The technology should meet some minimal requirements. I was deeply moved by the movie Alive Inside which chronicles the effect of music on memory in patients with dementia. Music memories have been found to be the last ones to disappear in dementia patients. It activates more areas of the brain than any other sensory input. Private money is being raised to by $40 iPods for dementia patients (costing billions less than medications and providing better results). It is sad that red tape, lack of regulatory and budget flexibility, and reliance on traditional reimbursement models impede the rapid adoption of even proven technologies. The FDA has a process of ‘fast tracking’ drug approval. CMS must develop some way of fast tracking approval for reimbursement of digital technologies without necessarily incorporating them into large-scale overhauls of the healthcare system like the HITECH Act or the “Fostering Independence Through Technology Act”.
Technology is certainly available to develop mobile apps which allow caregivers to easily search for a piece of medical equipment from a list of Medicare-designated vendors, with direct price comparisons or which compare prices of different drugs of a given class based on the patient’s Medicare status (in or out of the ‘donut hole’) and supplemental insurance plan if they have one.
Most developed countries have much more extensive assistance available for people to be treated, recover, and live at home than the USA. It reflects cultural views on aging itself. New care models must be developed and the infrastructure which assists caregivers as well as technology to support them must be provided. The technologies already exist and are utilized on national scales. The Center for Technology and Aging’s 2014 report on The New Era of Connected Aging provides many examples of these available technologies. As Baby Boomers are now realizing the limitations of current healthcare models which encourage institutionalization of healthcare and aging, they will be the ones to champion new ones. Let us realize that change can and MUST happen, and let technology fit into the new paradigm of shifting healthcare from the institution to the home where most of us would desire it for ourselves.