Within the last decade, Information Technology (IT) has fundamentally changed the delivery of healthcare in the U.S., driven by patient demand, the growing number of health IT vendors, and programs created by the Center for Medicare and Medicaid Services (CMS). One of the segments of the U.S. population that stands to benefit the most from these advances is senior citizens – a group facing ever-increasing healthcare costs.
Senior citizens make up the fastest growing percentage of the population, tend to have complex healthcare needs, and use the healthcare system frequently. According to the U.S. Census Bureau, in 2016 seniors made up 15% of the U.S. population, and that proportion is expected to rapidly increase given the fact that over ¼ of the population is between the ages of 45 and 64.
In addition to being the fastest growing segment of the population, senior citizens account for more healthcare dollars spent each year than any other age demographic. The graph below demonstrates the huge discrepancy in healthcare expenditures between seniors and other age groups.
CMS Incentive Programs Target Healthcare IT
In response to the new reality, CMS has launched several programs that impact physicians serving Medicare patients. The programs are designed to improve health outcomes by promoting the adoption of healthcare IT solutions. Meaningful Use, and now MACRA, are serving as the driving force behind the adoption of electronic medical records, e-prescribing, patient portals, and electronic sharing of medical records. The large-scale objective of these programs is to lower healthcare costs for Medicare-eligible patients (primarily senior citizens) by using healthcare IT to optimize patient engagement and provide quality based care.
Barriers to Seniors Using Technology
Given the impact that IT has already made on the U.S. healthcare system and the growing population of senior citizens, it is clear that developing technology policies that target the needs of seniors is instrumental to optimizing patient care. Senior citizens face specific challenges to adopting new technology:
- Often have disabilities that make technology more difficult to use
- May be inexperienced with using technology
- More likely to lack resources (ie. smartphone or PC) to go online
Technology Use Among Seniors is Increasing
Despite these barriers, a recent study by the Pew Research Group demonstrated that technology use among seniors is widespread and growing. In 2014, the percentage of seniors who used the internet was 59%, up six percentage points from 2013. Meanwhile, 77% of seniors had a cell phone, up from 69% in 2012.
Many of today’s seniors are baby boomers, a term used to refer to individuals who were born in the two decades after World War II. Although we often think of seniors as lacking the basic skills needed to use technology, this assumption is simply false. The oldest members of this cohort were in their 30s in the 1980s, when personal computers were becoming widespread. Therefore, many of the baby boomers entering the ranks of “senior citizens” have used technology for more than three decades.
Technology Use Varies by Income and Education
Although overall technology use among seniors is high, it is important to note that this segment of the population is not monolithic in its comfort with technology. More educated and affluent seniors are more apt to view technology positively and use it in their daily lives. In fact, according to the 2014 Pew Research report, affluent seniors often use technology at least as frequently as their younger counterparts.
However, a large percentage of senior citizens in the U.S. lives on limited incomes. According to a 2015 study by the Kaiser Family Foundation, in 2013 half of all individuals on Medicare had incomes of less than $23,500 annually. As demonstrated in the graph below, seniors with annual household incomes greater than $75,000 were significantly more likely to go online than lower-income seniors with annual incomes of less than $30,000 (90% versus 30%).
The study highlighted education as another factor that plays a significant role in technology adoption. Of the seniors surveyed, 87% of seniors with a college degree went online versus 40% of seniors without a college degree.
Developing strategies to target the needs of seniors is fundamental to providing patient-centered, value based care. The number of seniors who use technology has grown significantly and will continue to increase as the population ages. Furthermore, many of the obstacles that some seniors face are mirrored in other high risk patient pools that lack familiarity with technology or the financial resources to go online, like low income individuals, immigrants with limited English skills, and the homeless.
Policies that address the obstacles seniors face in accessing technology also serve the larger purpose of meeting the needs of other high risk patients. New fee-for-value based reimbursement programs (like the MACRA Advanced Alternative Payment Models) financially incentivize providers who care for seniors and high risk patients to offer better coordinated, higher quality care instead of paying for each procedure. This shift motivates providers to focus more on prevention and to reduce treatment spending. To control spending, it’s imperative that healthcare organizations continue to implement technology solutions to improve team coordination and patient care, develop policies to access CMS incentive payments, and share health data with patients. Engaging patients through tools like mobile apps and patient portals is an essential piece of the puzzle for healthcare organizations seeking to utilize technology to improve the quality of patient care while reducing operational costs.
Engaging Seniors through Healthcare IT
Implementing technology initiatives that engage seniors is instrumental in providing patient-centered care, and will become more important as the U.S. healthcare market transitions from a fee-for-service payment model to a reimbursement model that focuses on quality. To take advantage of the new quality based reimbursement models, providers need to engage patients through policies that emphasize self-care and chronic disease management.
Patient portals, whether those be mobile app-based or web browser-based, are a prime example of how technology can be used to empower patients to achieve these goals. Through patient portals, patients can review their medical records, request prescription refills, and communicate with their providers. Engaging seniors may require a slightly different approach to training them on the new technology. However, it is worth the extra effort.
Teaching Methods that Target Seniors Include:
Be respectful of patients’ knowledge and wishes
Avoid mandating that patients adopt a new technology. Patients want to maintain their autonomy and control their healthcare decisions. Technology has the potential to facilitate both of these goals. To convince seniors who are skeptical of the benefits of a new technology, it is necessary to recognize and be respectful of their decisions. No adult wants to be treated like a child who is being taught a new skill. Provide seniors with the information about the technology and offer them additional training, if desired.
Develop targeted training materials
Effectively teaching new skills to a complex population like senior citizens involves utilization of multiple teaching methods. For example, create a video that explains how a patient portal works and preparing written material about patient portals targets both seniors who are familiar with technology and those who are not. When preparing written materials, it is important to choose a font style and size that is easy to read.
It is also necessary to consider how learning a new technology is different from learning other skills. Almost all technology-based platforms require the user to remember a password. Developing mnemonics or other strategies that help seniors remember their passwords will facilitate adoption of the technology.
Provide additional time and resources
Technology initiatives that target seniors should be marketed towards them and have staff dedicated to the program. Having dedicated staff who know the patients and are available to help teach the new technology is an important component of a successful implementation strategy. It may be best to offer group classes in order to provide in person training to as many people as possible. Also, having a nurse or clinic staff check in with each patient after the training is an added personal touch that may go a long way in engaging patients and helping them adopt the new technology.