Earlier this month, a White House task force released a sprawling report encouraging aging services stakeholders to adopt technology designed to help older adults with activities of daily living, social connectedness and a handful of other key needs.
While the report stands as a call to action, home-based care providers and advocates are quick to point out the difficulties in finding, implementing and reaping real-world benefits from new tech.
One of the biggest challenges is simply sifting through the seemingly endless assortment of technology out there, ranging from electronic health record (EHR) and telehealth systems to medication management products and fall-detection hardware. To some extent, looking for a new tech tool or partner can often feel like drinking from a fire hydrant, industry leaders told Home Health Care News.
“Since I’ve gotten into home health, there is no shortage of technology solutions for every problem that we can find,” LHC Group Inc. (Nasdaq: LHCG) Chief Strategy and Innovation Officer Bruce Greenstein told HHCN. “But they’re often disorganized, not integrated and not adopted in a way that equates to organizational or behavioral change on behalf of the provider or the patient.”
Greenstein’s responsibilities include overseeing Lafayette, Louisiana-based LHC Group’s value-based contracting strategy and its accountable care organization (ACO) management company, in addition to its technology operations.
Prior to joining LHC Group in 2018, Greenstein served as chief technology officer for the U.S. Department of Health and Human Services (HHS) in Washington, D.C.
“The lift that we get is oftentimes very, very small,” Greenstein said. “IT doesn’t typically equate to great savings or better clinical outcomes — or improved patient, caregiver satisfaction.”
Home Instead Inc. President and CEO Jeff Huber echoed similar sentiments. Home Instead Inc. is the franchise company behind the Home Instead Senior Care network, comprised of nearly 1,200 independently owned and operated locations worldwide.
“There is a lot out there,” Huber told HHCN. “You name it, we’ve probably considered it.”
The global home health care technology market is forecast to hit at least $30 billion in revenue by 2023, according to recent market research. That’s driven mainly by demographics skewing older and demand for more personalized health care in the home setting.
The LeadingAge Center for Aging Services Technologies (CAST) — the aging services industry association’s technology arm tasked with expediting the development, evaluation and adoption of emerging technologies — breaks that market down into seven main categories.
Those categories are EHRs, medication management products and activity monitoring instruments, as well as telehealth and remote patient monitoring technology, care coordination tools, safety devices and tech focused on social connectedness.
When sorting through technology options, home health providers need to first reflect on their strategic plans, making sure a potential tool and their overarching goals as an organization align, Majd Alwan, senior vice president of technology at LeadingAge and CAST’s executive director, told HHCN.
“Is this tech tool going to be supportive of a strategic goal that I have, whether it’s being the preferred referrals source for an ACO dealing with high-acuity [congestive heart failure] patients with a high rate of re-hospitalization or something else?” Alwan said. “Does this tool help me grow my home care business and change the paradigm to deliver care more efficiently on an as-needed basis? These are the key, fundamental questions that could be asked.”
After considering whether technology aligns with organizational strategy, home health providers need to then figure out how they’re going to recoup costs, he said. That could mean, for example, securing an agreement with a hospital to care for a certain volume and type of patient.
Another important consideration is making sure new technology is compatible with existing systems.
“If I’m married to my EHR, married to my billing, I want to make sure that the new tool I’m selecting not only fulfills my must-have functionalities and features, but that it also interfaces and integrates — or interoperates — and can exchange data appropriately with other existing back-office systems,” Alwan said. “IT really is like getting into a marriage. It’s a longer-term partnership.”
In terms of return on investment to both providers and their respective payers, telehealth presents the greatest opportunity, according to Alwan. Telehealth examples include two-way video conferencing and remote patient monitoring.
Meanwhile, the category of technology currently with the most products in use is social connectedness and engagement, he said.
“Over the past few years, we’ve seen an explosion of social connectedness and engagement technology solutions coming on the market,” Alwan said. “We’re still seeing a significant uptick in their adoption.”
LHC Group’s tech strategy
When serving as CTO of HHS, not a single day passed where Greenstein wasn’t being called into or scheduling meetings to discuss artificial intelligence and blockchain, he said. But today at LHC Group, Greenstein’s focus is on workflows, processes and people.
Broadly, the home health, hospice and personal care company searches for technology that falls into three buckets: tech that goes into the back office, tech that goes into the home and tech tied to individuals, both patients and caregivers.
“We’re developing the technology platform that supports our move to own the home,” Greenstein said. “That’s the most elemental way to say it.”
Among LHC Group’s technology plans is a home-based skilled nursing facility (SNF) product that it will soon take to market, he noted. As part of that model, the company is leveraging a next-generation personal emergency response services (PERs) tool.
“[SNF at home] is something that goes beyond the complexity level that traditional home health patients would have,” Greenstein said. “The idea is to be able to take a larger share of patients that would otherwise end up in the SNF, thereby creating savings by the site of care on its own. But we have to provide better mechanisms for us to manage that patients — not just monitor.”
LHC Group’s SNF-at-home ambitions run counter to what others in the post-acute care segment have publicly stated. Genesis HealthCare (NYSE: GEN) CEO George Hager, for example, recently said the migration of SNF patients into the home setting is more or less over.
When it comes to hardware, LHC Group is largely agnostic, moving from one hardware platform to another in order to achieve better clinical outcomes, according to Greenstein.
“This is all very deliberate and the process very rigorous because none of this is free,” he said. “And some of the approaches the industry has taken and this company has taken haven’t provided the clinical outcomes that are superior enough to make the cost make sense.”
Home Instead tech push
In January, Omaha, Nebraska-based Home Instead announced it was joining forces with senior-friendly tablet startup GrandPad as a way to reduce client loneliness and improve their connectivity. The move marked the first major technology play for Home Instead, which made a minority investment in GrandPad.
Orange County, California-based GrandPad has raised more than $15.7 million since launching in 2014, according to online funding tracker Crunchbase.
“We believe there is a huge opportunity in the industry to transform the way we care for older adults,” Huber said. “That’s why we chose to partner with GrandPad — it goes beyond putting a device into the hands of seniors, but truly changes the way we care for them.”
Home Instead, which evaluates opportunities through its innovation team, has two main filters when looking at technology.
“Does it enhance the care experience for clients and their families?” Huber said. “And is it scalable for our large network and client base?”
Many technology solutions are meant to make life easier for the senior, but the user experience has many friction points – wifi access, passwords and confusing design among them.
To be successful, according to Huber, home care providers must have an interface that addresses these issues for a smooth operating experience while simultaneously solving a problem or serving a senior need.