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“Changes in care patterns over the past year indicate the COVID-19 pandemic has fundamentally changed seniors’ view of telehealth. We have seen important innovations from our heritage companies, our provider network, and CMS regarding telehealth. We encourage our members to reach out to their doctor to see if telehealth is the right channel for their health needs.”
— Patty Blake, president, Medicare, Tufts Health Plan and Harvard Pilgrim Health Care
Throughout the pandemic, technology adoption has become widespread across all age groups, and most surprisingly among seniors. According to a survey conducted in July of 2020, 61% of Medicare-eligible seniors ages 64 and up reported embracing technology more during the pandemic for entertainment, communicating with loved ones, and staying informed. The study also reported increased use of technology for health care and a 300% increase in senior use of telehealth services specifically.
To better understand the unique benefits and challenges of telehealth for seniors, we spoke with internal experts at Tufts Health Plan and Harvard Pilgrim Health Care, as well as geriatric health professionals across New England and our partners at Doctor on Demand. Here’s what we learned:
Telehealth can improve care for the whole person
Once seniors have been onboarded with virtual care, the benefits of telehealth can be expansive. Dr. Tong, chief medical officer at Doctor On Demand, notes that for Doctor On Demand specifically, they were able to expand their medical services in May of 2020 to include Medicare Part B coverage, which mostly addresses the 65 and older population. Beneficiaries can now access consistent medical care virtually for 90% of the most common conditions treated by both primary care and urgent care facilities, “including diagnosis and testing of COVID-19; typical ailments like infections and rashes; ongoing care of chronic disease like asthma and COPD, diabetes, high cholesterol and thyroid issues; and for prescription refills, helping to keep seniors out of care facilities and reduce unnecessary COVID-19 exposure.”
According to our health experts, here are a few ways telehealth has been successful at evolving and enhancing senior care, especially when it comes to preventative care, remote monitoring, post-surgery follow-up, and mental health care:
Making care more convenient
For some seniors, getting to and from doctors’ appointments proposes a series of challenges, from mobility barriers — especially for those who are homebound — to stress of time constraints for family caregivers who would take time off to assist with visits. Using telehealth, patients can effectively access care from the safety and comfort of home, which is especially beneficial if they have a condition that makes them vulnerable to COVID-19.
Dr. Susan Wehry, the chief of geriatrics at the University of New England College of Osteopathic Medicine and the director of AgingME, notes that seniors have embraced overall efficiencies when it comes to how they receive care with telehealth. These include the elimination of waiting room time, as well as feeling that their providers can spend more time with them and they can carry conversations at their own pace without hurrying for the next patient. Additionally, telehealth can help providers identify who requires in-person care versus who can be seen virtually, making it a useful screening tool.
Improving remote monitoring for routine to post-discharge care
Telehealth has allowed for more frequent contact between patients and providers, enabling providers to more regularly monitor changes in their patient’s health, as well as evaluate a patient’s medication use in order to appropriately prescribe or deprescribe. Dr. Andrea Schwartz, MD, MPH of the VA Boston Healthcare System, explains that, because providers can see inside of their patients’ homes with video capabilities, they can also help assess and improve how patients manage their day-to-day to help keep them safe at home as well as help patients age in place.
“In the past year, when the COVID-19 pandemic affected senior’s health usage, 38% of visits with primary care providers and 86% of behavioral health visits for Tufts Health Plan Medicare Advantage members were conducted via telehealth.”
Beyond telehealth coverage of primary care, specialist, and mental health visits, Tufts Health Plan provides in-home care. This benefit provides members with specific health conditions — such as heart failure, chronic obstructive pulmonary disease (COPD), cellulitis, or pneumonia — the option to receive health services and support from home as they recover. Care is overseen by a physician and is delivered through a combination of telehealth visits, in-home clinical visits, and remote biometric monitoring. Necessary equipment for telehealth visits and biometric monitoring are also provided for the duration of the episode.
Enabling collaborative care for families and specialists
With multi-person video capabilities, telehealth makes it possible for a patient’s partner, family members, or caregivers to be more involved in their care plans. It also allows health professionals from different fields and practices to meet with a mutual patient to discuss their care needs, improving continuity of care. This type of partnership can be especially helpful in the event of an emergency such as a stroke where there is a short window of time to take the appropriate action, as well as for patients who live in remote geographies but still require access to their providers and specialists.
Establishing digital literacy is essential
For younger generations who have grown up in the digital age, the shift to telehealth was a seamless transition. As we think about older individuals, however, a digital-focused way of living isn’t always instinctual.
To help seniors bridge the gap in technology, digital education and tech support have been critical for adoption. Sometimes that digital education comes from care staff at senior living and nursing home facilities, and in other instances, it’s family members who become educators. Some special health care services and programs even have technicians who will call and assist seniors with setting up their devices for telehealth. Schwartz explains that for the VA, this dedicated tech support and education has been imperative to making seniors feel comfortable about virtual health care.
In addition to helping seniors understand how the technology works, overcoming digital literacy requires quelling other emotional deterrents, such as anxiety over the learning process. A major issue interfering with adoption for older adults, Wehry explains, is their perceived impatience of the person who is trying to teach them how to use the technology. In research currently underway, it’s been found that seniors report feeling that the person calling to assist with technology setup didn’t understand the individual’s anxiety over getting it right or their need to learn slowly. To effectively increase telehealth adoption with seniors, exhibiting empathy and patience in technology education is just as important as technology education itself.
“Digital literacy can be a challenge for seniors, but we’ve actually seen growth from older populations that you might assume would be slower to adopt telehealth. In March 2020, we saw almost 150% growth in patient registrations for the 65 and over age group.”
—Dr. Ian Tong, chief medical officer, Doctor On Demand
There’s a need for more widespread access and connectivity
One of the largest barriers to telehealth adoption for seniors has been a lack of access to the internet and appropriate devices with both audio and video capabilities. Early in the pandemic, organizations like Iora Health, ChenMed, Landmark, and Oak Street, which primarily serve elderly populations averaging a low to moderate income, found that many of their patients did not own a smartphone or a tablet, nor did they have WiFi, data plans, or other internet services to support these technologies.
“Throughout the pandemic, some patients were doing mostly phone visits. When we’re able to send them tablets through the Digital Divide Program and have one of our team members call and walk them through the setup – the excitement of being able to connect and see one another’s smiles, that’s been really powerful.”
— Andrea Wershof Schwartz, MD, MPH, Division of geriatrics & palliative care, VA Boston Healthcare System, New England GRECC (Geriatrics Research Education and Clinical Center)
At a national level, the Federal Communications Commission (FCC) is working to bridge the telehealth gap for all Americans with programs like the Emergency Broadband Benefit Program, arising from the need to improve broadband accessibility and affordability during the pandemic. This program enables eligible households to receive a discount on broadband service to certain connected devices.
When it comes to telehealth and seniors, the advantages can be wide-ranging and can endure long after the pandemic comes to a close. Moreover, Tong notes that while health disparities do exist in our health care systems, digital health helps to deliver more equitable care to vulnerable populations, like seniors. Recognizing the benefits and need for flexibility, currently, both Harvard Pilgrim Health Care and Tufts Health Plan cover certain telehealth services at the same co-pay as in-person visits for members. However, bear in mind each person’s health and circumstances are unique, so if you’re considering telehealth for yourself or a loved one, be sure to check with your provider first to find out if telehealth is right for you.
Updated November 2022:
Point32Health health plans Harvard Pilgrim Health Care and Tufts Health Plan are the first in New England and among the first nationally to achieve full NCQA Health Equity Accreditation. Learn more about our commitment to reducing disparities and improving care so all we serve can reach their full health potential: read the press release.