As more health plans for low-income older adults include supplemental benefits for non-medical services such as transportation, food, housing and utilities, ConcertoCare sees an opportunity.
The New York-based company, which provides in-home healthcare services to older adults with complex medical conditions, believes this trend positions it to serve Medicare Advantage special needs plans for people dually eligible for Medicare and Medicaid. Social determinants of health, which the World Health Organization estimates account for 55% of health outcomes, are central to ConcertoCare's mission, according to Chair and CEO Dr. Julian Harris.
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Harris spoke with Modern Healthcare about how tackling social determinants of health, utilizing technology and treating seniors at home can improve outcomes and reduce costs. This interview has been edited for length and clarity.
What's driving the growth in home-based primary care for older adults?
Demographics definitely play a role. We know that most of the baby boomers are over 65 at this point. We also know that nine out of 10 seniors would prefer to receive care in their homes as they age, and that is a shift from past perspectives. Certainly, the work that we do at ConcertoCare leveraging technology, data and interdisciplinary teams to deliver complex care in the home, either as the primary care provider of record or a partnership with patients’ [primary care providers], is a reflection of the difficulty of patients with multiple complex chronic conditions and behavioral health needs face when they try to navigate the healthcare system.
Why is it so important to consider social determinants of health when treating older patients?
It is important to provide patient care holistically. We have patients who are navigating multiple chronic conditions such as diabetes, heart failure and [chronic obstructive pulmonary disease], and behavioral health conditions. Those patients are trying to optimize their medical and behavioral care while also trying to ensure that they have access to food, housing and transportation.
We often find that patients have needs that don’t fit neatly into one of those three boxes. We have patients who are really struggling to pay their bills and, in certain cases, face gaps that impact their care or their ability to receive care and services. We had a patient on oxygen who was unable to pay their electric bill and their electricity was turned off. We were able to help the patient access the resources that were available locally for low-income patients who had difficulty paying their bills. They were able to get their electricity turned back on, so we didn’t end up having a rehospitalization because this patient was facing challenges. Some patients face significant challenges affording some of their medication, so we try to identify drug discount programs that help them access medications critical to managing chronic conditions that could result in a hospitalization.
Can addressing social determinants of health reduce costs?
There’s quite a bit of data demonstrating that patients who are food-insecure post-hospitalization are at much greater risk of readmission if food insecurity isn’t addressed. We also know that patients that have complex chronic medical conditions and are experiencing isolation and loneliness are more likely to go to the emergency department for conditions that potentially could have been managed in their homes if their unmet social needs were addressed.
Payers seem to have a better understanding of the importance of social determinants of health. Do you agree?
This is why value-base care is so important. When providers have accountability for cost and quality, it incentivizes them to think holistically about patients in all of their drivers of healthcare utilization and all of the ways that a lack of access to integrated care across medical, behavioral and social needs impacts clinical outcomes. I do think value-based care models help to incentivize greater emphasis on social determinants of health, and that is one of the reasons why I’ve been so excited about that throughout my career.
How is ConcertoCare using technology in the home?
For us, it begins with having access to a range of resources that enable us to have a 360 [degree] view of the patient. We call our technology platform Patient 3D. It allows for us to leverage a range of data sources that really allows us to understand what is happening to that patient holistically.
How else do you see technology enhancing in-home senior care?
Opportunities exist to think about how we leverage remote patient monitoring. We really see a demonstrable opportunity to impact outcomes from a cost and quality perspective. I think people are also thinking creatively about ways to make visits with patients—both from home and a brick-and-mortar setting—more efficient and leveraging different tools to do that, including voice recognition technology and artificial intelligence, in order to make a provider visit with a patient more efficient.
There is a role for technology, and I think we’ll continue to see folks try and find ways to simplify the deployment of these tools. The patient population we have are hearing-impaired, vision-impaired and cognitively impaired. We have to ensure that as we develop and deploy new tools, we are doing that with the context that patients may have varying degrees of fluency with some digital tools.
