A special CAST workshop, “Technology Deep Dive: Technology Shaping the New Health Care Ecosystem,” took place on Oct. 29, 2017, as part of the recent LeadingAge Annual Meeting & EXPO in New Orleans. Below are select learnings from each session.

Technology is Key to Thriving Aging Services & Integration into the New Health Care Ecosystem

Majd Alwan, PH.D., SVP of Technology, LeadingAge and Executive Director, Center for Aging Services Technologies (CAST) 
 
The long-term and post-acute care (LTPAC) sector talks about technology in a silo—and we won't make much progress until we bring stakeholders together and technology can create a new health care ecosystem.
 
CAST offers a broad range of tools to help providers understand and select technologies. 

Acute Care Perspective: Transforming Health Care through Data & Analytics

Onur Torusoglu, Chief Data & Analytics Officer, Ochsner Health System
 
Data is exploding, but not much of it is being analyzed. Each cancer patient produces 1TB of data each day, but only 0.5% of the world's data is being analyzed.
 
In spite of the recognized benefits and potential of big data in health care, industry action in this direction has lagged behind other verticals. Here are critical success factors for enabling big data and analytics in provider organizations:

  • Drive adoption of big data and analytics: Culture change and enablement across levels in the provider organization will change the game.
    Action: Maintain executive involvement, and communicate the vision at all levels.
  • Move from data to actionable insights: Data is necessary, but return on investment will be derived only if actionable insights are obtained—possible only through predictive, prescriptive, and cognitive analytics.
    Action: Invest in specialist human talent, the right tools and technology.
  • Recognize that every stakeholder in the ecosystem benefits. The true power of big data and analytics can be leveraged when we can give an end-user these abilities, backed by powerful tools.
    Action: Raise your organization’s data and analytics IQ. 

Big data and requests for technology to solve business issues will continue to grow. Yet many tech products and services solve for one piece of the puzzle. Have a game plan for system-wide problems rather than individual ones, and get all analytics teams together to solve for the same problem.

Payer Perspective: Innovative Payment Models and Must-Have Technologies, Data, and Tools

Jeetender (Jeetu) Kathpalia, Sr. Enterprise Architect, Blue Cross Blue Shield of North Carolina
 
A payment shift is coming in health care, which has been trying to evolve past the flaws in the Fee-for-Service (FFS) model for decades. We need contracts that incentivize the provider and enable the technology. For example, outline in contracts “$x increase in reimbursements for % quality/coding accuracy,” and use volume payments.
 
FHIR is a new technology that is gaining ground. It's more cost-effective and supports exchange across systems and mobile devices, so it is more interoperable. Also key is learning how to use mobile data to enable value-based reimbursements.
 
Value-based reimbursement is here to stay, and the markets are taking advantage of it. Here’s how you can, too:

  • Markets are evolving quickly. It’s best to adopt value-based models in smaller incremental adjustments.
  • Automate and align processes in provider and payer operations.
  • Data sharing— both clinical and claims data—is a key to success.
  • Align capabilities.
  • Technology advancements will continue to benefit adoption of new innovative payment models.

Technology Perspective: Technologies Shaping the Future of the Health Care Ecosystem

Susheel Ladwa, Industry Leader of Life Sciences, IBM
 
The current health care and human services systems are economically unsustainable. The United States spends 17.6% of its GDP on health care, or $2.8 trillion a year, growing at 2.5 times the economy, or 8% per year.
 
Too many treatment decisions are uninformed—as many as 44% of all initial cancer treatments are modified on the second course of treatment. Less than 50% of medicine is evidence-based. Aging populations can’t be served.
 
We have an opportunity to address this need. One way is through cognitive computing. This is a fundamentally new way for individuals and organizations to gain knowledge. Cognitive systems can navigate the complexities of natural language, and read and understand vast amounts of information, all while learning and getting exponentially smarter.
 
For example, in the past, we manually identified people who needed care management intervention. Now, with IBM’s Watson - Care Management, we have a holistic view of individual needs with improved accuracy to recommend and deliver the right services, at the right time.
 
Before Watson, cancer treatment decisions were made based on what doctors learned in residency and the 20-30 journal articles per year that they read. Now we have personalized, evidence-based decisions, insights from eminent experts in the field, and millions of peer-reviewed evidence resources.
 
Another technology of the future is blockchains. Businesses will have a separate ledger—or system of record for the business—for each business network in which the business participates.
 
A blockchain is a decentralized and distributed digital ledger that unites records from multiple participants, banks, insurers, regulators, and auditors. It is used to record transactions across many computers. The record cannot be altered retroactively without the alteration of all subsequent blocks and the collusion of the network. This shared, replicated, permissioned ledger has consensus, provenance, immutability, and finality.
 
Google and download “Blockchain for Dummies,” a free book, and review IBM Blockchain.

Policy Perspective: Health and Payment Reforms: Updates, Prospects, and Opportunities

Mark McClellan, MD, Director of the Robert J. Margolis Center for Health Policy, Duke University, and CAST International Chair
 
The National Academy of Medicine recently commissioned 150+ experts to provide expert guidance on 19 priority issues for United States health policy. “Vital Directions for Health and Health Care” named paying for value as an action priority.
 
Opportunities for higher-value health care include paying attention to approaches that can decrease costs yet often are not reimbursed:

  • Innovations to better target use of medical technologies to patients who will benefit.
  • Wireless/remote personal health tools and supports and telemedicine.
  • Lower-cost methods of treatment or sites of care.
  • Better care coordination.
  • Non-medical strategies for health improvement, such as targeted assistance to high-risk individuals, and support for accessing social and community services to prevent complications.

 
These competencies are needed for success in accountable care:

  • Board, leadership, and staff engagement in patient value goals, plus an organizational structure that reflects patient value focus.
  • Adequate capital and financial tracking and modeling.
  • Care models based on patient centeredness, care coordination and teams, and care pathways for quality and safety improvement.
  • An aligned health IT infrastructure, key data sharing including patients, and patient stratification for risk/impact assessment.

While most health care organizations are not yet succeeding in alternative payment models, new models that tie payments to the person, not specific services, are growing. Emerging models may be built on a fee-for-service architecture, and evolve to population-based payment. They give health care providers more flexibility and accountability. They can use approaches like telehealth and new ways to coordinate care, because payment isn't tied to traditional services.
 
For example, in a recent Center for Medicare & Medicaid Innovation (CMMI) comprehensive care pilot, 14 organizations took on accountability for attributed Medicare beneficiaries with end-stage renal disease in their regions—and would share in savings if total spending reductions were below the expected benchmark while achieving quality benchmark measures. Results were high performance on measures of quality of care, lower than expected mortality, and total spending per beneficiary 5% lower than benchmark, net Medicare savings 3.6%.
 
Models that offer more-efficient care supported by sustainable financing models, with strategies to get costs out of the system such as retooling how they work with specialists, have some of the most promise.
 
At CMMI, there is a shift to more voluntary programs and ones with fewer administrative burdens. They are looking at advanced alternative payment models with more patient involvement, such as those that share savings with patients, and quality and price transparency.
 
Expect more state flexibility and state direction in Medicaid waivers, and Medicare Advantage and Medicaid managed care plans working together. More programs are also integrating social services, such as transportation and other non-medical services with positive outcomes that keep medical costs down. 

Breakout 1: Value of Advanced Data Analytics in Senior Living

Russel Lusak, COO, Selfhelp Community Services
David Dring, Executive Director, Selfhelp Innovations, Selfhelp Community Services
Nadim Abi-Antoun, Chief Operating Officer, Presbyterian Homes
Mary Ann Anichini, VP of Continuous Quality Improvement, Presbyterian Homes
Moderator: Majd Alwan, Senior Vice President of Technology, LeadingAge and CAST Executive Director

Pain Management

Among other topics, this panel discussed how LeadingAge Service Provider Presbyterian Homes in Skokie, IL, when facing scattered data and scattered technology, undertook a new, goal-oriented strategic approach toward its data and analytics. A case study discussed the incidence of moderate or severe pain in post-acute residents. Nearly 40% of sub-acute residents report having moderate to severe pain when interviewed on Pain CAA. Nurses were assuming that Medicare residents understood the 0-10 pain scale and knew how to describe their pain, but patients were given choices in which scale they used. Pain assessments were rarely complete and often hidden in the record, where they were little utilized.
 
Different people prefer and can most accurately use a scale other than the 0-10 scale. The Verbal descriptor scale, the visual analog scale, and the PAIchoicesNAD scale were added as choices. Now nurses can refer to the assessment when analyzing the pain circumstance.
 
The previous process of pain documentation only reported pain positive assessments. It was impossible to determine if pain had been assessed and was zero or if the patient was in constant pain that was infrequently assessed. Now, a nurse must assess and document pain every four hours, which helps them determine if pain is inadequately controlled so that they can notify a doctor.
 
Pain assessments are now complete and actively used in the pain control program, which uses the CareWatch MDS analytics tool from CAST Silver Partner with CAST Focus ABILITY Network—and moderate to severe pain now is well below national and state norms.

Centralized Database to Manage Population Health

LeadingAge CAST Patron and CAST Business Associate Selfhelp Community Services, Inc. in New York City, which promotes independent living for at-risk populations, is working toward a centralized database that pulls data from multiple data sources across New York state. The goal is to capture assessments from community-based organizations, certified agencies, licensed agencies, and more. 

The project includes the states's eight Regional Health Information Organizations (RHIOs), which store each region's electronic health information, and the Statewide Health Information Network for New York (SHIN-NY), which enables RHIOs to exchange EHRs between each other. Two state grants are providing funding to support the project.

Once the data is available, looking at the clinical and financial analytics will help organizations to manage population health. 

Databases focused on social determinants of health will yield the big picture. Selfhelp programs support almost all of these social determinants of health: Education, social and community context, economic stability, neighborhood and environment, and health and health care.

Selfhelp measures success by relating its programs to outcomes that affect the health care system. For example, Selfhelp encourages healthy behaviors that prevent falls in the community, which prevents the injuries that often lead to death. By providing support for affordable housing, Selfhelp avoids homelessness. Selfhelp's assistance with supplemental income keeps older adults at home in the community.

Selfhelp's plans to align its infrastructure so that it can connect to RHIOs and SHIN-NY, push full data across the continuum, and demonstrate what it does against value-based payment. To do so, Selfhelp has this list of technology needs:

  • Increase WAN capabilities.
  • Develop a data warehouse and pull disparate databases into it.
  • Develop an interface connecting Selfhelp’s programs into a data warehouse.
  • Develop business analytics.
  • Develop evidence-based programs and run predictive modeling.
  • Demonstrate health care outcomes.
  • Create a centralized information and referral call center.
  • Connect to SHIN-NY/RHIOs.

Key Performance Indicators will show how programs, staff productivity, and the like provide positive outcomes and affect value. Early examples of success include the following:

  • Validating total clients served and average daily census.
  • Identified 300 clients eligible for a depression program that addresses client need and increases revenue through certified home health aides.
  • Created list of clients of their managed long-term care.
  • Creating standardization across the agency.
  • Improved reporting to satisfy complex funder requests.
  • Developing metrics/algorithms for social determinants of health. 

Breakout 2: Self-Driving Cars: Senior Living Applications and Implications

Michael Marcus, Principal, Consultants for Community Resources
Tommy Hayes, Policy Partnerships Manager, Lyft
Peter Kress, CIO, ACTS Retirement Living
Moderator: Robyn Stone, Senior Vice President for Research, LeadingAge
Cloud Application Services, Co-Chair - AHIP IT Advisory Group

The autonomous vehicle (AV) is coming. Within five to 10 years, expect a mix of human and autonomous vehicles, with fully autonomous vehicles within 10 years. AVs are said to be safe and to eliminate the 94% of fatal crashes (40,000 in 2016) involving human error.
 
In 2016, Google spun off Waymo after a high-profile road test. Today, nearly every car manufacturer has begun development on its AV technology, including General Motors, Ford, Mercedes-Benz, Audi, Volvo, Toyota, and Tesla Motors, and major shuttle vehicle developers Transdev and Navya.
 
Testing sites are scattered in cities and some communities throughout the nation. Babcock Village in Florida will be part of the first autonomous independent-living electric AV network in the country and fully powered by the community’s massive solar farm. Sacramento is testing AV systems to shuttle sports fans to games.
 
On Sept. 6, 2017, the United States House of Representatives passed the SELF DRIVE Act. The Senate followed one month later, introducing the AV START Act. The bills require developers to prove autonomous vehicles are at least as safe as other vehicles. In addition, 21 states have passed specific legislation relating to self-driving cars, and five governors have signed executive orders for AVs.
 
Older adults increasingly use ridesharing on their own. Nearly a million passengers of CAST Supporter Lyft are 55+, and 12% of Lyft passengers say they order rides for elderly friends or family. Lyft partners with leading providers of senior living and healthcare using its Concierge tool.
 
Recommendations for the aging field include the following:

  • Begin a wide-ranging discussion in the aging network regarding AVs.
  • Lobby government to discuss licensure and insurance liability, which will determine who can and cannot use an AV. Requiring a license for riders in Level 4 or 5 vehicles defeats the purpose; insurance should rest with the operating agency, not the passenger.
  • Encourage government and other entities to develop pilot programs focused on independence and enhanced mobility, and encourage private industry to design Level 4 vehicles with access in mind.
  • Manufacturers should work closely with a coalition of older adults, service providers, and representatives of the disability community.
  • We look forward to government and industry undertaking on-the-road testing of vehicles as soon as possible.