Telehealth, along with a number of other technology tools, can support health aging and enable older Americans to live independent, yet connected lives, according to a recent report published by the President’s Council of Advisors on Science and Technology (PCAST).
In the report, titled “Independence, Technology and Connection in Older Age,” PCAST examines three areas where older adults experience changes: social engagement and connectivity, cognitive function and physical ability. And, the organization investigated technology tools that promote individuals’ continued independence and productivity as these changes happen.
The U.S. population is getting older and Americans are living longer, on average, than previous generations and certain technology tools can maximize older adults’ independence, productivity and engagement, the report authors state.
The report includes four cross-cutting recommendations that span a wide range of technologies and eight targeted recommendations concerning specific applications to improve mobility, cognitive function, and social engagement. The PCAST report identified internet access, telehealth, monitoring technology, emergency preparedness systems, and intentional design are some of the technologies that will support healthy aging. The report also focuses on near-term Federal actions to advance these possibilities.
Telehealth is one technology that can help address changes in physical ability among aging adults, according to the report authors.
“By taking advantage of advances in communications and monitoring technologies, together with the capabilities of modern smartphones, telehealth can allow older adults to remain independent at home, prevent or delay institutionalization, effectively monitor chronic diseases and movement, and coordinate care between multiple providers that are not in the same location,” the report authors wrote.
Telehealth services can be particularly useful for older adults who live far away from medical centers or clinics, or have difficulty getting to a healthcare appointment because they don’t drive or there are few public transit options, or they have limited personal mobility.
The report highlights a number of federal government initiatives in telehealth, such as the Veterans Health Administration (VHA), which offers one of the largest integrated telehealth services across the U.S. The Department of Defense (DoD) Defense Health Agency uses telehealth for direct patient care as does the Indian Health Service for Native American, Alaska Native and Pacific-Islander populations.
“The Centers for Medicare & Medicaid Services (CMS) supports telehealth in the Medicare and Medicaid program. Many State Medicaid programs cover some telehealth services, without being exclusive to just rural areas. Traditional Medicare, however, is limited by law in reimbursing telehealth,” the report authors wrote.
However, there are a number of policy barriers that limit telehealth, such as professional licensure, and reimbursement.
The report authors wrote, “While there are legislative restrictions on how Medicare can cover telehealth, CMS can act by increasingly incorporating telehealth in Alternative Payment Models, demonstration projects, and Innovation Center models. The CMS Innovation Center has already included expanded access to telehealth in the Next Generation ACO model program and in the Bundled Payment for Care Improvement Initiative, and further action would be welcome.”
The authors continued, “In addition to Medicare, CMS can increase the number of state Medicaid waivers that allow for more use of telehealth in Medicaid programs. Actions by these two large payers would have ripple effects and remove significant barriers.”
PCAST calls on the federal government to improve regulation and payment of telehealth services.
Specifically, the report authors encourage the U.S. Department of Health and Human Services (HHS) convene the Federation of State Medical Boards and the National Governors Association to accelerate state licensure policies. “CMS should use the full capacity of the Innovation Center to advance payment policies that support innovation in telehealth,” the report authors state.
And, the PCAST report notes that the recent Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation required the Government Accountability Office to develop two reports examining telehealth, one of the Medicare telehealth program and another on remote patient monitoring technology and services. “These reports will identify opportunities to improve telehealth for federal programs,” the author state.
The report also highlights a variety of federal initiatives focused on research into improving telehealth, such as the DoD’s Telemedicine and Advanced Technology Research Center and the National Center for Telehealth and Technology. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides grants for tele-mental health, and the Agency for Healthcare Research and Quality (AHRQ) supports research on telehealth as well.
The PCAST report also urged HHS to support a standing private-public council, which private sector leaders from industry, academia and advocacy organizations, to advise on sector-wide ways to advance technology in the service of improving quality of life for older people.
With regard to technology that can aid older adults, more research is needed to spur further innovation, the report authors asserted.
“The National Institutes of Health (NIH), the AHRQ, the National Science Foundation (NSF), the Veterans Health Administration (VHA), the Department of Independence, Technology, and Connection in Older Age Defense (DOD), and the Defense Advanced Research Projects Agency (DARPA) should support interdisciplinary and translational research including robotics, advanced mobility technologies, communications technology with special emphasis on emergency situations, cognitive training, and home monitoring,” PCAST said.
As more information that older adults need, such as health records, have migrated online, there is a need to ensure older adults have connectivity and training to use new technologies.
PCAST also calls on the Assistant Secretary for Preparedness and Response, Office of the National Coordinator for Health IT, and CMS to promote more rapid access to relevant data and interoperability of electronic health records “to make possible the identification of vulnerable people and relevant medical information and resources in emergency situations.”
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