Post CES reflection on role of technology and Alzheimer's.
Boston, mid-May, 2016
It’s a new era – patient engagement – but does that include seniors? According to a recent health journal article, welcome to the era of patient engagement. What’s that? “Empowering patients to actively process information, decide how that information fits into their lives, and act on those decisions is a key driver to improving care and reducing costs.” Like many of the heavily-invested Health IT improvements over the years, patient engagement strategies offer the industry a feel-good approach to preaching to and reaching the converted – those tech-enabled individuals with a fetish for looking stuff up and tracking it (see Google Health). Ah, but those with the least access to technology may need the most engagement -- they're not likely to peer at their patient portals. At last Pew count only 13% of the 65+ even looked online for information as a diagnostic tool. And fewer than half of those followed up with a medical professional based on what they found.
But there is a feeding frenzy for investment in the young and healthy. Continuing along the lines of preaching to the converted, the lemming mentality of investors sent $1 billion in just the first half of the year chasing prospective returns in health tech – with the number 2 sector (after practice management) being – you guessed it -- patient engagement. Wish them luck – patients are not, apparently, too engaged with their own health, never mind the health tech that represents today's fuzzy definition of patient engagement. Fuzzy or not, of course there is now a measurement index to evaluate hospitals in California on their progress in providing this engagement. Key to success? You guessed it -- "electronic access to patient health records, but also provide resources for ongoing disease management support, including mobile, tablet and desktop tools." Sigh, see Google Health-- and did I mention that only 18% of the 65+ have tablets or smart phones?
Medicare – another form of patient engagement -- comes too late. Health care costs for seniors dominate health care expenditures – 37% of health care spending in 2010 – despite being only 13% of the population. So to better control those costs, CMS added a penalty to hospitals for serving seniors too well – that is, readmitting them. Now hospitals are spending millions of dollars to keep seniors from being readmitted to the hospital – committing their own staff (versus lower cost home health care and companion care organizations) to making follow-up appointments, arranging transportation, and calling to see how they’re doing. And naturally, consultants have leapt in to offer guidance on how best to avoid re-admissions and their penalties projected at $300 million in 2013. So far by one measure, re-admissions are down 18% -- ah, but but outpatient observation status (not counted) is up. Want to bet that total cost has not shrunk?