The Center of Excellence for Telehealth and Aging recognizes SCAN Health Plan’s Insights Program and Technology, Education, and Coaching (TEC) Program’s use of technology-enabled care to provide
tele-behavioral health services and digital literacy coaching to older adults.
SAN DIEGO—FEB. 26, 2024— SCAN Health Plan’s Insights Program and Technology, Education, and Coaching (TEC) Program have earned the Age-Inclusive Telehealth Innovative Practice Award. This recognition is a testament to their outstanding initiatives, utilizing telehealth technology to enhance access to behavioral health services for older adults in Southern California. The award was presented by the Center of Excellence for Telehealth and Aging (CE4TA), a national organization established by the West Health Institute and its collaborative partners.
In 2016, SCAN Health Plan introduced the Insights Program to proactively tackle the prevalent mental health needs among its beneficiaries. This initiative was designed to adopt an integrated approach, specifically targeting areas such as depression, anxiety, loneliness, and overall quality of life. During the COVID-19 pandemic, the program shifted from in-person therapy sessions to audio-only. Therapists faced many challenges in maintaining engagement with their patients during one of the most isolating times in modern history.
Noticing an expanding digital divide among its clients, SCAN introduced the Technology, Education, and Coaching (TEC) Program in 2022. This program not only enhanced the efficiency of tele-behavioral services but also empowered individuals by fostering knowledge and comfort in utilizing technology for health management, social connection, and everyday necessities like grocery shopping.
“Clients in the Insights Program want to connect with family and friends,” says Pedro Carbajal-Madrid, LCSW, Clinical Director, “They want to engage in pleasurable activities and have access to other services. But often we find there is a lack of understanding of how to use technology for that purpose. And that’s where the TEC Program has helped.”
Between 2022 and 2023, these two programs have positively impacted more than 1,000 clients, demonstrating promising outcomes. The Insights Program participants reported up to a 55% improvement rate in their mental health, while those in the TEC Program reported a 68% increase in digital health literacy. Program graduates have also reported that the program has not only increased their confidence in using technology in their daily lives, but it has also positively impacted the lives of those they care for.
“Having completed the TEC Program, I am satisfied and happy to say it is an exceptional program,” one participant recalls. “Being the sole care provider for my sick husband and a full-time housemaker is such a challenging and isolating life. From what I have learned from this program, my quality of life has improved in a way that enables me to connect with my siblings more often using the apps on my iPad or iPhone to engage and socialize with my husband. [With my device] I have learned to research, read, and sometimes, watch free movies.”
Both programs serve older adults and caregivers living in underserved and underrepresented communities across the Los Angeles and Orange counties. These SCAN Health Plan endeavors are a shining example of how aging adults can maintain independence for as long as possible.
“When we designed the [TEC] program, we did it with the idea of ‘let’s just make sure that we maximize the possibility for these clients to keep their independence and their health,’” adds Carbajal-Madrid.
Having achieved measurable success with its clients and earning recognition from The Center of Excellence for Telehealth and Aging, the TEC team now plans to expand the program across the state of California.
About the Age-Inclusive Telehealth Innovative Practice Award
The Age-Inclusive Telehealth Innovative Practice Award highlights innovative telehealth programs that operate on three core principles of telehealth delivery: telehealth should be (1) equitable and accessible, (2) person-centered, and (3) integrated and coordinated. To learn more about these principles and this program, visit ce4ta.org. Organizations can show their commitment to, and endorsement of, the principles of age-inclusive telehealth by adding their name to the Pledge of Support page.
About SCAN Health Plan
SCAN is a not-for-profit organization dedicated to maintaining seniors’ health and independence. Since its establishment in 1977, this has been the organization’s primary mission. Today, this mission is realized through SCAN Health Plan, recognized as one of the largest not-for-profit Medicare Advantage plans nationwide. Independence at Home, a SCAN community service, plays a crucial role by providing essential services and support to seniors, disabled adults, and their caregivers. Moreover, SCAN extends its impact through education programs, community funding, volunteer opportunities, and various other community services across its California service area. For more information, visit scanhealthplan.com or find us on social media at facebook.com/scanhealthplan or follow us on Twitter @scanhealthplan.
About The Center of Excellence for Telehealth and Aging
West Health Institute (WHI), the University of Virginia (UVA) Department of Geriatrics and the Mid-Atlantic Telehealth Resource Center (MATRC) partnered to create the Center of Excellence for Telehealth and Aging (CE4TA). CE4TA was established to advance the adoption of age-inclusive telehealth. It is a unique platform to foster a national discussion and movement to advance age-inclusive telehealth for older adults. CE4TA’s mission is to provide an open learning community that supports providers and organizations in delivering high-quality and effective care to older adults that accounts for their unique needs and supports their ability to age in place and live with dignity.
DANVILLE, Pa. – August 2, 2023 – Geisinger has been named the first-ever recipient of the Age-Inclusive Telehealth Innovative Practice Award for its efforts to expand access to quality health care to underserved older adults in the rural central and northeastern regions of Pennsylvania through telehealth technology. The award is given by the Center of Excellence for Telehealth and Aging (CE4TA), a national organization launched by West Health Institute and its partners.
The Geisinger at Home program was exclusively using in-person visits with physicians traveling to patient homes. The Geisinger team quickly realized it could serve more patients, and serve them better, by also using telehealth technologies. Nurses and community health assistants now visit patients in their homes and coordinate social services and health care while physicians care for patients remotely. As a result, Geisinger achieved a four-fold increase in monthly in-home patient visits while simultaneously lowering the burden and cost of health care costs for older adults with difficult-to-manage health conditions.
“Digital technologies, and particularly our telehealth platform, provides an added level of accessibility for older adults and will be key to how we continue to care for our patient population,” said David A. Fletcher, associate vice president at the Center for Telehealth at Geisinger. “We hope other organizations around the country will not only adopt telehealth for older adult patients, but also ensure they’re adhering to the best practices set forth by CE4TA.”
With the inclusion of telemedicine in its services, Geisinger at Home has reduced emergency room and hospital admissions by 30% and seen an average annual reduction in costs of $8,000 per patient. A patient survey found near-universal approval of the program, with 97% of respondents saying they were “very satisfied” and 3% saying they were “satisfied.”
The Geisinger service area meets the criteria of a federally designated Medically Underserved Area, as defined by the U.S. Department of Health and Human Services’ Health Resources and Services Administration. In addition to being largely rural, 18% of the Geisinger service area is 65 years old or older, which is 4% higher than the U.S. average. The average household income is $60,378, 15.3% lower than the U.S. average, and 13.1% of the population has a household income of less than $15,000.
“By demonstrating the efficacy and practical application of CE4TA’s core telehealth principles in a medically underserved population, Geisinger has improved access to care and lowered costs, all while keeping health equity priorities front and center,” said Liane Wardlow, Ph.D., senior director of clinical research and telehealth at West Health. “West Health applauds Geisinger and its telehealth initiative, which stands out nationally as an example of how to leverage remote care successfully for older adults.”
The Age-Inclusive Telehealth Innovative Practice Award is presented by the Center of Excellence for Telehealth and Aging. The center is a partnership of West Health Institute, the University of Virginia Department of Geriatrics and the Mid-Atlantic Telehealth Resource Center. Together they promote three principles for delivering telehealth to older adults: equitable and accessible, person-centered, and integrated and coordinated.
“The Geisinger team is a worthy recipient of the inaugural Age-Inclusive Telehealth Innovative Practice Award,” said Laurie Archbald-Pannone, M.D., MPH, associate professor of geriatrics at the University of Virginia School of Medicine, which helped to launch the Center of Excellence for Telehealth and Aging. “As a geriatric physician myself, I see the access challenges that many of our older adult patients face, especially those living in rural areas. Through its program, Geisinger was able to document how it improved the health of its participants with an approach that could be replicated by other companies and organizations that care for older adults.”
Organizations can show their commitment to the principles of age-inclusive telehealth by adding their name to the Pledge of Support page at ce4ta.matrc.org.
About Geisinger
Geisinger is committed to making better health easier for the more than 1 million people it serves. Founded more than 100 years ago by Abigail Geisinger, the system now includes 10 hospital campuses, a health plan with more than half a million members, a research institute and the Geisinger College of Health Sciences, which includes schools of medicine, nursing and graduate education. With more than 25,000 employees and 1,700+ employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.
About The Center of Excellence for Telehealth and Aging
West Health Institute (WHI), the University of Virginia (UVA) Department of Geriatrics and the Mid-Atlantic Telehealth Resource Center (MATRC) partnered to create the Center of Excellence for Telehealth and Aging (CE4TA). CE4TA was established to advance the adoption of age-inclusive telehealth. It is a unique platform to foster a national discussion and movement to advance age-inclusive telehealth for older adults. CE4TA’s mission is to provide an open learning community that supports providers and organizations in delivering high-quality and effective care to older adults that accounts for their unique needs and supports their ability to age in place and live with dignity.
In the spring of 2020, the COVID-19 pandemic ravaged New York City. Continuing to provide primary care to nearly 6,000 patients, all of whom are age 75 and older, was a “blur” as Dr. Veronica Rivera, MD, geriatrician at the Mount Sinai’s Martha Stewart Center for Living described it. “We were all just trying to survive.”
The Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, which houses the Center for Living, quickly adapted, like many other similar programs, to utilizing telehealth services to continue providing access to care. While they originally envisioned telehealth as a temporary change during the public health emergency, its ever-apparent benefits ultimately led to it becoming permanently integrated into their standard of care. “Most providers, despite hiccups, have adopted [telehealth],” said Dr. Rivera. In 2023, telehealth visits continued to make up 7% of visits across their three clinics.
Mount Sinai contends that for telehealth to be successful, older-adult patients must feel empowered to ask for, and actively participate in, virtual visits. This involves tailoring virtual care to their specific needs, providing tools and education that are age-friendly, and preparing medical teams to support older adults before and throughout the telehealth encounter. The telehealth program at Mount Sinai’s geriatric care clinics serves as an example of implementing telehealth and aging best practices.
A Whole-Team Approach to Providing Accessible Patient-Centered Telehealth
In-line with the Principles and Guidelines for Telehealth and Aging, Mount Sinai’s telehealth programs prioritize a person-centered approach from the initial contact at the central call center to the follow-up steps after the telehealth visit. Staff members are trained in best practices to provide age-friendly care, assessing individual technology and health literacy, and how to provide technical assistance to patients to connect with their provider virtually. The team-based approach has enabled the clinics to provide effective and person-centered virtual care to their older adult population.
Team roles and responsibilities include:
Ensuring Integrated and Coordinated Telehealth
Mount Sinai has ensured that telehealth care is integrated and coordinated among all healthcare team members, which is a best practice for implementing age-inclusive telehealth as defined by the Principles and Guidelines. Zoom was determined to be the most user-friendly video platform. It provided features that were deemed important for the patient population, like quality audio and connectivity, and has closed captioning capabilities for hearing impaired patients. The platform was integrated into the Epic Electronic Medical Record (EMR), which allowed front desk staff to send links to access the video visit directly through the patient portal, or via text messaging, depending on patient preference. The video visit would then take place through the EMR, allowing for secure and confidential sessions.
Mount Sinai clinics are actively developing standardized workflows and determining a place in the EMR to consistently document key information from a telehealth visit. “Having a centralized place where we can document important information about patients…streamlines the process and allows [access] to information for team members who need it,” said Dr. Rivera, referring to relevant information regarding readiness and support for telehealth encounters. Standardized documentation also assists with better tracking of who is using telehealth and to better adapt and improve telehealth services.
Like many telehealth programs, digital literacy, access to devices, and a reliable Wi-Fi connection pose challenges for Mount Sinai in providing accessible and equitable telehealth. To address these factors, clinic providers and staff use different methods to connect with their older-adult patients, such as integrating supportive family and caregivers within the visit and connecting patients with community-based organizations that advocate for digital literacy among seniors. “These programs and community-based organizations for seniors exist and are powerful resources to help sustain equitable telehealth care for older-adults and to bridge the digital divide,” said Dr. Rivera. Mount Sinai also refers to affordable internet connectivity programs, like the SanoConnect program, to increase equitable access internet, and thus telehealth care.
Mount Sinai extends the reach of their telehealth care by coordinating with a paramedicine team, which offers in-home services like IV medications and nebulizer treatments. Vendor partners provide home lab and imaging services that integrate seamlessly into the EMR, enhancing the patient’s experience and ensuring coordinated and comprehensive care.
Creating Sustainable Telehealth for Older-Adult Primary Care
Mount Sinai has used telehealth to augment care through scheduled visits for patients who are homebound, a population that often requires extensive care but can be challenging to reach. “Getting primary care for homebound patients has been difficult and continues to be difficult,” Dr. Rivera says. Providers recognized telehealth as an important tool to pursue equitable care for their service area and are encouraged by the new access it provides.
Dr. Rivera recommends developing evidence-based industry standards and protocols focused on topics such as achieving a balanced approach between video visits and in-person care, performing comprehensive assessments, and partnering with community organizations for lab and imaging services. She emphasizes the importance of these steps to ensure the success, sustainability, and safety of telehealth for older adults.
Interdisciplinary collaboration is key as well for the success of telehealth. Quickly after implementing telehealth, Mount Sinai established a workgroup that included clinic leadership and passionate providers dedicated to improving the telehealth experience for older-adult patients, which has been meeting monthly since December of 2020. “We’re all struggling with similar things,” said Dr. Rivera, on the benefit of collaborating with other leaders. The workgroup is a space where clinic representatives can discuss challenges and help each other to develop practical solutions, workflow improvements, share ideas, and learn from each other.
To further the work of providing equitable virtual care, The Department of Geriatrics and Palliative Medicine joined the Collaborative for Telehealth and Aging (C4TA) in 2021. This collaborative, led by West Health Institute, University of Virginia Department of Geriatrics, and the Mid-Atlantic Telehealth Resource Center, created principles and guidelines to optimize the benefits of telehealth for older adults. The principles promote telehealth that is person-centered, equitable and accessible, and integrated and coordinated.
The Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai is an exemplary organization providing age-inclusive telehealth care to older-adults. To join them and other health systems, advocates and philanthropists that have signed the Pledge of Support for Age-Inclusive Telehealth, and learn more about the Principles and Guidelines for Telehealth and Aging, visit the Center for Excellence for Telehealth and Aging.
AMDA — The Society for Post-Acute and Long-Term Care Medicine has been a strong advocate for the use of telemedicine in post-acute and long-term care. AMDA is a member organization representing a community of over 50,000 medical providers within the Post-Acute and Long-Term Care (PALTC) field. Its mission is to enhance the development of medical practitioners and leaders in providing goal-concordant care across PALTC settings, such as nursing homes, rehabilitation centers, and assisted living facilities. This mission extends to new developments in telehealth delivery. AMDA is committed to encouraging the integration of age-inclusive telehealth best practices in PALTC settings and has demonstrated that commitment by signing the pledge of support for the Age-Inclusive Telehealth.
AMDA recommends that for a telehealth care model to be most effective at improving the health and well-being of older adults, it should be delivered based on three core principles. The organization believes telehealth should be 1) equitable and accessible, 2) person-centered, and 3) integrated and coordinated within the healthcare continuum. These principles were originally developed by the Collaborative for Telehealth and Aging (C4TA)—a national group of medical professionals and patient advocates with expertise in geriatrics, telehealth, and healthcare operations.
To further their work of optimizing telehealth for older adults, AMDA proactively formed a telehealth subcommittee to collaborate on strategies to ensure telehealth services benefits every type of patient regardless of age, ability, race, or socioeconomic status. The subcommittee was in operations before the pandemic, working to promote the utility of telehealth and telemedicine. The aim has shifted since the pandemic, “[now] the question is less about if we should do telemedicine, but more about how it should be done,” said Dallas Nelson, MD, CMD, Chairwoman of the AMDA telehealth subcommittee.
One of the subcommittee’s main points of advocacy focused on Medicare’s and private insurance coverage of telehealth visits. Prior to the COVID-19 pandemic, Medicare allowed billing for telemedicine only once every 30 days. Eliminating restrictions on how often telemedicine visits are covered by Medicare and private insurers permanently became an important topic for the group members. “AMDA has felt that telemedicine payment should be based on medical necessity. We would be happy to justify medically why telemedicine was the best choice for a person, but we don’t think that an arbitrary time frame and frequency of payment makes medical sense,” said Dr. Nelson.
AMDA has been outspoken about policy changes that should occur to better meet the needs of older adults in PALTC settings. Dr. Nelson believes eliminating payment restrictions would lead to greater equity in telemedicine, “if [telehealth] is not paid for in the fee schedule, then you’re going to get business-to-business arrangements. It’s well publicized that nursing homes do delineate on socioeconomic status. If you’re depending on business-to-business arrangements, only the highest socioeconomic nursing homes are going to get the added benefit of the increased access. I think that payment is critical to equity.” AMDA recently published an article outlining rational regulation changes to provide effective telemedicine. Read more about their recommendations in their JAMDA article “Innovation Through Regulation: COVID-19 and the Evolving Utility of Telemedicine.”
A Call to Action
AMDA was one of the first signees of the Pledge of Support for Age-Inclusive Telehealth Practices, which was initiated by the Center of Excellence for Telehealth and Aging (CE4TA). The pledge is a way for organizations to demonstrate their public commitment to providing and advocating for telehealth services that follow CE4TA’s Principles and Guidelines for Telehealth and Aging. CE4TA is led by West Health Institute, University of Virginia Department of Geriatrics and the Mid-Atlantic Telehealth Resource Center
AMDA is amplifying this message across its telemedicine subcommittee and among its fellow members. If your organization is also committed to providing high value telehealth care for older adults, visit The Center of Excellence for Telehealth and Aging for more information on the principles and guidelines or to sign the pledge of support.
Produced by West Health
October 26, 2023
Designing and curating the right suite of devices and technologies to deliver high-level acute care in the home can be a challenge for both older patients and providers. Older adults, who often present with complex medical conditions, are sometimes thought of as being the last to adopt new technological advances. In the case of telehealth and hospital level care at home, however, older adults were the early adopters and are advancing the movement for high-acuity care at home. Simple, effective, and integrated technology solutions are needed for patients who prefer to be treated at home.
Medically Home developed a healthcare delivery model that includes a technology platform to seamlessly provide hospital-level care to patients in their homes. Medically Home provides health systems with care model, technology, logistics, and tools to safely care for patients with serious, complex, or high-risk illness. They create a temporary hospital room in a patient’s home by installing a system for a hybrid of virtual and in-person care that easily connects to care teams 24 hours a day. Their aim—meet the needs of both patients and healthcare providers. “We wanted to create a platform that the patients would be able to use easily,” said Linda V. DeCherrie, MD, Vice President-Clinical Strategy and Implementation at Medically Home. “For the provider side, the platform needed to be something they could easily access to conduct their video visits, see the patient’s vital signs and gather all the necessary information.”
Medically Home is currently in operation with healthcare systems in 17 states and has served more than 24,000 patients since its inception in 2015. With the average patient age of 68 (men) and 69 (women) it was important that a system be designed to be approachable for all ages and abilities. “We really needed patients to not be intimidated and to feel like [the technology] was useful to them so they could communicate with their nurse or physician in a way that felt really comfortable,” said Pippa Shulman, DO, MPH, chief medical officer at Medically Home. “We also needed to make sure the clinical team knew that we were safely monitoring and caring for patients.”
Medically Home joined the Collaborative for Telehealth and Aging (lead by West Health Institute, University of Virginia Department of Geriatrics, and the Mid-Atlantic Telehealth Resource Center) in 2021 to help develop principles and guidelines to advance age-inclusive telehealth. These principles highlight the importance of ensuring telehealth is person-centered, equitable and accessible, and integrated and coordinated. They have continuously improved their care model and technology to ensure these principles are put into practice. In doing so, Medically Home has designed a technology solution that delivers home-based acute care that is high-quality, simple, and effective.
Building a System with Equity, Person-Centeredness, and Integration in Mind
Medically Home’s care model incorporates several strategies and capabilities to provide a virtual and in person system of care that is accessible, reliable, and safe. Both DeCherrie and Shulman said the components of the in-home technology suite were assembled to meet three criteria: patient safety, redundancy, and ease of use for the widest group of patients.
“Many [other] devices are created for use in a hospital or a very specific situation but that doesn’t work for a patient in their home. There was a need for a balance of what was clinically useful — what gives us the information we need to take clinical action for the patient without covering the patient with stickies and intermittent devices and making it really complicated,” Shulman said. The team went through many rounds of iteration during the early stages of Medically Home’s development.
To address connectivity and ensure equipment compatibility, Medically Home provides internet connectivity, and brings a group of devices to every home. The devices include: a dedicated tablet; a dedicated phone; an uninterruptible power supply; a Personal Emergency Response System (PERS) bracelet or pendant; a Bluetooth-enabled scale and biometric monitoring devices; and Cradlepoint, which provides backup internet connectivity and is equipped with chips for the two dominant cellular carriers in the area. To meet the needs of visually impaired patients, the tablet interface was designed with a large font and a color scheme tailored to visual impairments, as well as accessible buttons with large targets to quickly connect the patient to their care team. Patient education materials are included on the tablet.
The care model promotes integration and coordination in a few different ways. During the initial visit, the clinician works with the patient to ensure devices have seamless connectivity, are integrated with each other, that the physical locations of the devices are in highly frequented and accessible areas, and don’t pose a fall risk. Additionally, it facilitates bi-directional communication between the care team, patients, and in-home service providers and promotes data integration with electronic heath records. To do this, the company uses a software platform called Cesia that also supports logistics management for the home hospital visit.
Medically Home also prioritizes stakeholder feedback and observational data to develop and improve products and services. One example of continuous improvement was the phone provided to patients. The original version required the patient to dial their care team. However, patients didn’t like that feature — the buttons were small and not easily read. – Now, the dedicated phone in use provides a direct connection to the command center — no dialing necessary. Another example was simplifying the installation process for when a patient was admitted to the home hospital service. Many older patients found the process to be overwhelming with too many people involved. To overcome this challenge, a training program was developed to teach the clinician making the admissions visit — in most cases a paramedic — how to set up the technology as well as train patients on the devices. This created greater efficiency of the installation process and less disruption for the patient.
Their strategies facilitate access to health information, connect crucial stakeholders, account for technology literacy and readiness, and use telehealth to increase access to acute care. All of those components are pillar ideals highlighted in the Principles and Guidelines for Telehealth and Aging.
Looking Ahead
Medically Home wants to continue improving the efficiency of the care model to be able to provide this service to more people. “Our goal is to build a scalable program for a health system that is equivalent — or more — to a unit of their hospital. We want to be able to care not for just two or three patients, but 15, 20, 30, 40, 50 patients,” said Shulman.
They also want to ensure their model and technologies maintain high satisfaction among patients and providers, as well as continue to demonstrate improved patient outcomes. Of the patients admitted to Medically Home programs, 95% have said they would recommend it to others. The mortality rate for Medically Home program patients was reduced by 50% with all cause readmissions rate of 7.6% between January and November of 2021. Implementing a new virtual care model that is person-centered and integrated is challenging work for both Medically Home and the partnered healthcare system. But it’s necessary work to ensure telehealth can continue to be an effective healthcare option for all patients.
Pledge of Support for Age-Inclusive Telehealth Practices
Medically Home demonstrated their commitment to providing and advocating for age-inclusive telehealth services by signing the Pledge of Support for Age-Inclusive Telehealth Practices. If your organization is also committed to providing high value telehealth care for older adults, visit The Center of Excellence for Telehealth and Aging and sign the pledge. Also, visit the Center of Excellence to learn more about the Principles and Guidelines for Telehealth and Aging.