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:

• Call Center Agents: act as the first point of contact, triage patient symptoms and recommend appropriate levels of care on a person-by-person basis
• Administrative Assistants and Medical Office Specialists: help prepare patients for their telehealth appointments by calling ahead of the visit to assess and document their individual readiness for the care team, record preferred method of connection and language, and identify any family or caregivers that may assist during the visit, among other things
• Front Desk Staff and Volunteers: help patients navigate the patient portal, while volunteers offer additional technology support when available
• Medical Assistants: begin video visits at the scheduled appointment time, document home-based vital signs taken by the patient or an in-home caregiver and assist patients with technology and connectivity
• Physicians or Advanced Practice Providers: conduct visits and coordinate with social workers and geriatric psychologists when needed

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.