Innovation Challenges in the Aging Services

What Makes Innovation Challenging in the Aging Services Industry?

This week we are proud to highlight Nexus Fellow and industry expert, Jay Newton-Small.

In this Nexus video clip, she describes the unique challenges of the aging services industry and why it’s so difficult and complicated to innovate and make a meaningful impact.

“It’s such an inefficient industry and it’s so highly regulated. It’s a very intractable system that requires patience in innovating and ingenuity in innovating that other industries don’t require.”

Challenges for startups coming into the aging services space include selling into healthcare organizations that are under intense pressure due to rampant staffing shortages that have left them in a sustained state of crisis and placed a huge financial burden on them to maintain operations and meet basic regulations. The environment has been one of extreme stress, with little bandwidth or budget to invest in innovation or quality initiatives.

Information security protocols and other legal standards required to access patient data, while critical for protecting patient privacy, are also hard for small companies to meet on limited runways. And current fee-for-service payment models leave little room for innovation in holistic, person-centered care innovations.

“From the get-go, this is regulated in a really intense way, and there’s no way around that. So you have to think through, what is a way that we can innovate here that we can be able to have an impact, but also not harm people, which is a super important thing about health care. And also how can you find a way to make a profit and make your company viable. It’s one of the most challenging areas to innovate in.”

Newton-Small is the CEO of PlanAllies and the CEO and founder of MemoryWell, a tech-enabled patient engagement platform and SaaS that uses Natural Language Processing and “conversational interactions” proven to engage seniors and help Medicare Advantage plans lower churn. Unlike chatbots, MemoryWell uses journalists—or can train callers to interview like journalists using their proprietary software— to create real, effective dialogue with older Americans.

 

As a national journalist, Jay Newton-Small brings a unique perspective to the field of aging, insight into politics and policy, and a media platform. She also brings the heart of a personal-lived experience that led her to found her company, MemoryWell.

 

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Caroline Pearson Executive Director The Peterson Center on Healthcare

Caroline Pearson Named as Executive Director for Peterson Center on Healthcare

Exciting news for Nexus Fellow Caroline Pearson. She has been named as the new Executive Director for The Peterson Center on Healthcare.

“Caroline is a gifted leader who never hesitates to roll up her sleeves and do the hard work,” said Anne Tumlinson, CEO of ATI Advisory, and a Nexus Fellow. “It’s been a joy to work with her in various ways throughout her career, and especially as she’s tackled policy challenges in the senior care sector. I know she’ll continue to make significant contributions in this next chapter.”

“Caroline is the perfect choice to lead the Peterson Center,” said Nexus Fellow David Grabowski, a professor of health care policy at Harvard Medical School. “She has worked for over two decades to improve the US healthcare system by taking on challenging policy issues. She led our important research on the “forgotten middle” of older adults who are too wealthy for Medicaid but too poor to afford the current mix of senior housing options. I can’t wait to see what she does at the Peterson Center.”

Pearson, who started the new position in early January, is leading the Center’s portfolio of initiatives and grants, to help “transform U.S. healthcare into a high-performance system by finding innovative solutions that improve quality and lower costs,” according to an announcement from the Center. She brings deep policy expertise across a wide range of critical areas, including Medicare, Medicaid, private health insurance, prescription drugs, the Affordable Care Act, and aging issues.

“I am deeply honored to join the remarkable team at the Peterson Center on Healthcare to advance its mission to improve healthcare through lower costs and higher quality outcomes,” said Pearson.

Pearson previously was the Senior Vice President for Healthcare Strategy at NORC at the University of Chicago, a research organization that has broken new ground into the unmet needs of the “forgotten middle” when it comes to affording senior housing. Before NORC, she spent 14 years at Avalere Health as the Senior V.P. of Policy and Strategy, where she worked with Fortune 500 companies, patient groups and other healthcare stakeholders to solve complex business and policy challenges.

“I am so proud of the Health Care Strategy team we have built at NORC at the University of Chicago and the important research that they will continue on issues of policy, aging, and care delivery,” she said.
“We are very pleased to welcome Caroline, whose strategic vision and data-driven approach will bolster the Center’s work to lower costs and improve outcomes in U.S. healthcare,” said Michael A. Peterson, President and Chief Executive Officer of the Peter G. Peterson Foundation. “Caroline’s comprehensive understanding of the complex healthcare delivery ecosystem and her track record of identifying, validating and scaling innovative solutions make her a perfect match for the Center’s mission.”

Read the full announcement at Peterson Center on Healthcare

 

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Bringing together different perspectives with a common passon

Bringing Together Different Perspectives with a Common Passion

Nexus Insights is a think tank comprised of a diverse group of thought leaders and stakeholders in aging and health care (Nexus Fellows) with a shared vision to advance the well-being of older adults through innovative models of housing, community and health care. The goal of Nexus Insights is to affect change by sharing innovation across traditional silos, convening leaders from different perspectives in our Nexus Voices salons, and bringing positive, life-affirming ideas into the public domain.

What makes Nexus Insights truly unique is the diversity of our Fellows. We bring together different perspectives and different backgrounds, leaders with expertise in academic research, government policy, private sector startups, and successful businesses serving older adults. It’s the diversity of perspectives, together with the common passion, that drive the disruptive thinking within Nexus.

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 35 years of industry leadership, he has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly. Learn more about Bob Kramer at Nexus Insights.

 

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Investing in HCBS

U.S. Senate’s Special Committee on Aging Addresses the Need for Investing in Home and Community-Based Services (HCBS)

Nexus Fellow and ATI Advisory CEO, Anne Tumlinson, was invited to testify at the Senate’s Special Committee Hearing titled “An Economy That Cares: The Importance of Home-Based Services”. Tumlinson advised that in order to reduce reliance on skilled nursing care, more money needed to be invested in Home and Community-Based Services.

“HCBS makes it possible for many individuals with LTSS needs to remain where they want to be, which is in their home. But unfortunately our home care system and its infrastructure are vastly underdeveloped and under-resourced to meet the growing need for services…If we don’t invest in them, American families are going to face very serious economic challenges, possibly even more than they are today,” said Tumlinson.

Read more at McKnight’s Long-Term Care News.
Watch the full hearing on the U.S. Senate website.

 

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Housing For Middle-Income Seniors

Middle-Income Seniors – The Forgotten Middle

When it comes to senior housing, wealthy seniors can pay their own way and low-income seniors often qualify for Medicaid. The real problem is for those in the middle. They aren’t wealthy enough for private pay, yet they are too well-off for Medicaid. To make matters worse, the number of people stuck in the middle will nearly double over the next decade. Senior housing operators and policymakers have the opportunity to serve this new market, but how and to what extent?

Nexus founder and Fellow Bob Kramer discusses “The Forgotten Middle” with Nexus Fellow Caroline Pearson, senior vice president health care strategy, NORC at the University of Chicago in an episode of Foresight TV hosted by Steve Moran of Senior Living Foresight.

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Healthcare at Home Options for Seniors

More Healthcare at Home Options for Seniors with the Choose Home Care Act

Big news on the horizon for seniors and the aging services industry. A bill introduced last month in the United States Senate would allow for in-home care alternatives to skilled nursing facilities for rehab and post-acute services. The Choose Home Care Act, which was sponsored by Senator Debbie Stabenow (D-Mich.) and Senator Todd Young (R-Ind.), has bi-partisan support.

In a recent article in Senior Housing News, Anne Tumlinson, CEO of ATI Advisory, Founder of Daughterhood, and a Nexus Fellow, weighed in on the winners and losers, should this bill become law.

It would be a big win for seniors, allowing eligible Medicare patients to receive extended post-acute care services at home, rather than in a nursing home, “without placing undue burden on families to care for them.” According to Tumlinson, “The benefits are long overdue.”

Qualified home care agencies would also benefit, according to Tumlinson, with an additional avenue for billable services. “This legislation would essentially allow home health agencies to compete with skilled nursing facilities,” she said.

According to Tumlinson, the flexibility to consumers means more overlap in the post-acute services that skilled nursing facilities and home health care agencies could offer. Skilled nursing facilities may view the Choose Home Care Act as a threat. In fact, the American Health Care Association has expressed concerns that “it would supplant existing benefits and increase out-of-pocket costs.” If the bill passes, it may provide opportunities for private pay senior living providers, Tumlinson explained. “They can entertain partnerships with qualified home health agencies. For instance, they might team up with a Medicare-certified home health provider that will receive the expanded Medicare payments to care for residents that are recently discharged from the hospital, while the senior living provider would be able to collect the private-pay rent.”

In addition to bi-partisan political support, the legislation has broad support, including AARP, home care advocacy groups, and senior housing organizations such as LeadingAge. The bill was introduced in the Senate in late summer, and has been referred to the Senate Finance Committee.

Read the full story at Senior Housing News.

Follow status of the bill.

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Kelsey Mellard on the state of telehealth

The State of Telehealth & Telemedicine: A Snapshot with Sitka CEO Kelsey Mellard

The Covid pandemic and the shut-downs of 2020 had an enormous impact on telehealth. March of 2020 saw a 154% increase in telehealth visits over March of the previous year, according to the Centers for Disease Control and Infection (CDC). “For a period of time, telehealth went from a nice to have to a must have,” according to Kelsey Mellard, CEO of Sitka, and a Nexus Insights Fellow. Sitka is a value-based multi-specialty provider network, empowering primary care providers to remain at the helm of their patients’ care.

Telehealth expansion isn’t limited to the number of synchronous telemedicine visits. Providers and payors have been expanding their role with respect to telehealth, into providing the infrastructure and the tools and devices patients need to engage in telehealth. There has also been an expansion in reimbursement, and in the types of services provided by telehealth.

“For a period of time, telehealth went from a nice to have to a must have.”

Sitka, for example, has created a virtual network of specialty physicians. These physicians, who are not economically incentivized to do more tests or procedures, provide peer-to-peer consults via video and text, with primary care physicians who request their expertise.

In addition, there has been an increase in merger and acquisition activity and investment into the telemedicine and digital health space, including greater tech-enabled connectivity in home- and community-based care settings. Funding for Quarter 1 of  2021 funding closed with $6.7B in US digital health funding, the most-funded quarter to date, according to Rock Health. Average deal size ballooned to $45.M (up from $31.7M in 2020.). The pandemic prompted an acceleration in the adoption and mainstreaming of digital health. As buyer’s desire for connectivity, such as remote patient monitoring, has increased, the market has been responding. And CMS continues regularly to release new proposed payment codes.

Nevertheless, proponents of telehealth should not sit back on their laurels and celebrate just yet. Advocacy continues to be important. Telehealth is here to stay, and we can expect to see it continue to expand and to evolve. But, there is pressure from those invested in bricks and mortar service delivery to return to those models and State licensing regulations continue to impose limits.

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Relief ahead for health care worker burnout

Relief Ahead: HHS Funds 3-Year Program to Reduce Health Care Worker Burnout

Another cost of the COVID-19 pandemic? Caregiver burnout. Research firm Activated Insights conducted a two-year survey of 330 senior living and care workers. The results? “Worker burnout increased substantially during the pandemic at independent living, assisted living, memory care and skilled nursing facilities,” according to a report by McKnight’s Senior Living.

One of the surprising findings is that burnout declined by 12% for home care workers.

In a conversation with McKnight’s Home Care Daily. Activated Insights CEO and Nexus Fellow Jacquelyn Kung suggested an explanation for the decline. Home care agencies “have adapted very quickly and are supporting their employees a lot more than they have in the past.”

The good news? The U.S. Department of Health and Human Services (HHS) has announced $103 million in funding for a three-year program to Strengthen Resiliency and battle worker Burnout.

“Worker burnout increased substantially during the pandemic at independent living, assisted living, memory care and skilled nursing facilities.”

“It is essential that we provide behavioral health resources for our healthcare providers — from paraprofessional to public safety officers, so that they can continue to deliver quality care to our most vulnerable communities,” HHS Secretary Xavier Becerra said in the announcement.

The McKnight’s report went on to say, “In awarding the money, HHS said healthcare providers face many challenges and stresses due to high patient volumes, long hours and workplace demands during normal time. During the pandemic, those challenges were amplified and had a disproportionate impact on rural communities and communities of color.”

Read the full article.

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Patient and physician trust in U.S. Health Care

Trust in the U.S. Health Care System: New Findings

Caroline Pearson, Senior VP of Health Care Strategy at NORC at the University of Chicago and a Nexus Insights Fellow, announced the release of new research from NORC that examines physician and patient trust in the U.S. health care system. The research was conducted as part of the ABIM Foundation Building Trust initiative.

The study, which surveyed 2069 adults from the general public and 600 physicians, found that while 78% of patients report high levels of trust in their doctors, trust is lower among Black, Hispanic, lower-income, and younger patients.

Other key findings from the study:

  • Both physicians and patients trust clinicians more than they trust the healthcare system as a whole.
  • While most physicians trust community health services to support patients’ health and well-being, physicians report lower levels of trust in long-term care and home healthcare providers, who are essential during discharges and care transitions.
  • Physicians overestimate their patients’ ability to adhere to their treatment recommendations.
  • Although physicians understand the importance of building trust with patients, they do not always perform trust-building behaviors.
  • The majority of the public reported favorable or no change in how much they trust their doctor due to the pandemic, however roughly 30% of physicians experienced a decrease in their level of trust in the healthcare system and healthcare organization leadership during the pandemic. Rebuilding trust is needed.

The nonpartisan and objective research organization NORC at the University of Chicago was founded in 1941 as the National Opinion Research Center.  It’s purpose is to help governments, nonprofits, and businesses make better decisions through data and analysis.

See the findings.

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