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Chronic disease management: Best virtual healthcare options 

Middle-age is when most adults are diagnosed with a chronic health disorder such as hardening of the arteries and diabetes (Type-2). Once a chronic disease has been diagnosed, it requires lifelong management so symptoms do not worsen. Healthcare check-ups to see whether medication prescribed to manage the disorder is actually working are common. For senior-aged people and other adults with disabling symptoms, virtual healthcare offers a way to have physician check-ups, request prescription re-fills, and obtain answers to questions without having to visit a doctor’s office.  

According to the Centers for Disease Control (CDC), 37% of adults used virtual healthcare in the form of telemedicine in 2021. Virtual healthcare options differ tremendously, and some are easier for senior-aged adults to use than others. A Forbes magazine article in 2021 described six of the best virtual healthcare options available at that time. Topping its list was Teladoc, which is an “on-demand” service that connects a caller to a healthcare clinician and is covered by various health insurance plans (including some Medicare Advantage plans). Meanwhile, advances in Artificial Intelligence (AI) are enabling the design of apps focused even more specifically on supporting adults living with chronic health diseases. 

Four types of telehealth available on apps for patient care

There are four different types of telehealth that are available either separately or in combination with each other (per the Center for Connected Health Policy). These are most often called:  

• Live video (which uses teleconferencing software, and enables “real-time” interaction between a patient and healthcare provider). 
• Store-and-forward (which involves electronic transmission of medical information such as documents, digital images, and pre-recorded videos). 
• Remote patient monitoring (which involves personal health and data collection that is transmitted to a healthcare provider for use in providing care and support to that patient). 
• Mobile health (which are basically healthcare and public health “best practices” and education supported by mobile technological devices such as Smart Phones). 

For people with chronic health disorders, the utilization of all four types may be advisable in order to prevent the necessity of frequent “in-person” healthcare visits. In particular, receiving daily reminders to take medication (or to remember an upcoming “in-person” or virtual appointment with a clinician) can be beneficial for elderly people with cognitive impairments. In this way, receiving virtual healthcare can potentially enable a person with mild dementia to remain in the home environment for more years, rather than be relocated to a nursing home. 

Encryption, virtual telehealth services, and videoconferencing

A medical research article in 2022 in Clinical Liver Disease noted that healthcare providers need to comply with the federal law called HIPAA that is focused on protecting patient privacy. For this reason, it specifies that platforms such as TikTok, Facebook Live, and Twitch are not acceptable for telehealth interactions. While Zoom (which is frequently used for social group events and business meetings) is among the most popular videoconferencing platforms, it lacks the encryption required for HIPAA compliance. In contrast, some platforms such as Doxy.me are HIPAA-compliant.  

Health insurance and virtual healthcare

Consequent to the Covid-19 pandemic, more health insurance companies than ever are covering the cost of virtual healthcare visits. Medicare coverage for telehealth was flexible during the declared federal Covid-19 public health emergency ending on May 11, 2023 (but with an extension of many Medicare telehealth coverage provisions through December 31, 2024). Moreover, an increasing number of Medicare Advantage plans are offering broader coverage for telehealth, including covering the cost of certain digital devices. Meanwhile, mental health therapists are typically paid 20-30% less for virtual therapy sessions as compared to “in-person” sessions, which is a likely reason that many health insurance companies are now covering the cost of virtual therapy sessions. 

Low-income senior-aged people are far more likely to be affected by chronic health disorders than their higher-income counterparts (per a medical research article in Healthcare). Yet, Medicaid plans (that are state-administered) do not cover virtual healthcare as extensively as Medicare or private health insurance plans. Therefore, low-income seniors may not be able to afford the “out-of-pocket” costs in the form of co-pays for virtual healthcare that is required of them. 

Mental health and substance abuse treatment: How virtual healthcare can save lives

Federal law (the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 [MHPAEA]) basically specifies that group health plans and health insurance issuers that provide mental health or substance use disorder benefits cannot limit these benefits to an extent greater than the limits on the medical/surgical benefits. It is well-recognized that adults with chronic health disorders are more likely to experience mental health disorders (such as clinical depression and anxiety) than adults without chronic health disorders.  

Early intervention for a mental health disorder can prevent development of dependency upon a substance (such as alcohol) for self-medication. Since a mental health disorder and/or substance abuse problem is linked to decreased self-management of chronic health disorders, access to virtual mental health therapy and substance abuse treatment for adults with chronic disorders may lessen the likelihood of worsened overall health status. Thus, this type of virtual care may be life-saving. 

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34% of consumers are digitally inclined: Implications for the healthcare industry  

An analysis of healthcare-focused survey data revealed that 34% of the entire US adult population is now digitally inclined, and interest among the senior-aged is surging. While preventing infection with Covid-19 prompted many Medicare-aged adults to schedule telehealth physician visits, there are other reasons that adults aged 65+ are more willing than before the pandemic to utilize technology-based healthcare services. From reminders to take medications to disease-specific health education – and individual wellness checks to answering patient questions – the use of wearable devices and digital healthcare platforms by the elderly is significantly growing.  

Due to the potential for improved overall health status, senior care facilities and Medicare providers (including Medicare Advantage providers) are focusing more attention and resources on this trend. As of 2021, at least one in five nationwide healthcare leaders reported that their organization/practice offers remote patient monitoring. Described below are some of the different digital approaches to improving senior health status that are being embraced by senior caregiving facilities and clinicians, as well as by more healthcare payers. Diverse ways that digital healthcare delivery approaches can reduce costs are also discussed. 

Digital health education as a chronic disease management tool

The American Diabetes Association notes that 29.2% of all adults aged 65+ in the US have diabetes. Even more have a condition termed pre-diabetes that – with lifestyle changes – may be controlled such that progression to full-blown diabetes (Type 2) does not occur. Since obesity is highly linked to developing diabetes, digital wearables can calculate both the total calories consumed in the food eaten and the reduction in weekly caloric intake needed to lose a targeted amount of weight (in pounds).   

While Fitbit and similar fitness trackers can aid in enabling a plan for weight management or loss, other types of digital wearables are more focused on aiding people diagnosed with prediabetes or diabetes to understand their daily glucose (blood sugar) intake from the foods eaten – so can promote both weight loss and lowered glucose intake. Moreover, they can include a “chat” feature to answer questions about caloric and glucose content in a specified amount of a desired food item, so that the individual can decide whether to consume it or not. 

Other chronic disorders such as heart disease and Chronic Obstructive Pulmonary Disease (COPD) can also require major lifestyle changes. By utilizing a wearable that offers digital health education, the afflicted person can learn how to better manage a newly-diagnosed condition or acquire informative reminders if a medical provider’s instructions are forgotten. 

Medication management: How digital platforms and digital wearables are useful

Many senior-aged people take more than one prescribed medication each day. Two of the most common are cholesterol-lowering medication and antihypertensives (that control blood pressure). More than four in every 10 elderly people take at least five prescription drugs per day – which is a three-fold increase as compared to 20 years ago. Although this has enabled many to live “better” and enjoy a far longer lifespan, it can also be confusing for these people to keep track of all of their daily medication. Therefore, more intensive medication management by the individual (or that person’s personal caregivers and medical providers) is needed to reduce medication intake mistakes.  

For adults aged 65+ residing in assisted living facilities as well as alone, recognizing negative effects from skipping a medication or accidentally taking more than the prescribed dose can be problematic. Meanwhile, elderly people with early dementia (such as early Alzheimer’s Disease) can tremendously benefit by a digital device that provides real-time reminders of which prescribed drug to take and when to take it.  

Furthermore, patients with a history of nonadherence to their medication can benefit from a digital call from a member of the healthcare team (or even a nurse care coordinator from that person’s insurance plan) to ensure that the needed medication are being utilized. (This is particularly useful for a senior-aged person with a past history of stroke prescribed a daily blood-thinning drug to prevent another stroke, but who forgets to take the drug due to forgetfulness resulting from the stroke.) 

Wellness and safety checks to relieve stress on caregivers

Around 28% of community-dwelling senior-aged adults live alone, and that number sharply increases after age 75. According to Harvard University’s Joint Center for Housing Studies, the number of people aged 80+ who are living alone is set to soar to an estimated 10.1 million by 2038. “Slip and fall” accidents are the most frequent causes of bone fractures and death in adults aged 65+, and over 800,000 are hospitalized annually due to a fall-caused injury. One of the most common reasons is waking in the middle of the night to use the bathroom, and then losing balance due to suddenly standing up from a lying-down position with resulting light-headedness. 

Utilizing a wearable digital device to dial for assistance in the event of an emergency is just one way that an elderly person who has fallen can obtain immediate aid. Another is a periodic call from someone (to ensure that the elderly person does not need immediate aid) in the form of a wellness and/or safety “check”. Through the capacity for periodic contact from a paid caregiver, family member, designated friend, or healthcare provider, prevention of a worsened healthcare outcome for the senior-aged person can be enabled. Likewise, it can also alleviate the anxiety and fear on the part of loved ones as to the health status and/or safety of that senior-aged person. 

The federal Agency for Healthcare Research and Quality (AHRQ) in 2020 reported that preventable hospitalizations among adults as of 2017 cost the US $33.7 Billion, and such hospitalizations occur most commonly among senior-aged adults. Therefore, insurance companies and healthcare organizations/facilities alike (as well as the patients themselves) are bearing preventable costs that digitally-initiated wellness and safety checks may curtail. 

Focus on Dementia: The importance of digital wearables to support patient functioning

An estimated 6.5 million adults aged 65+ in the US were living with Alzheimer’s Disease as of 2022. That number is expected to triple by 2050 (and one in three seniors is living with some form of dementia by the final year of life). Since dementia is highly associated with failure to take medication as prescribed, “slip and fall” accidents, and preventable hospitalizations, it is also linked to the overall increased cost-burden on the national healthcare system.  

When Alzheimer’s Disease is diagnosed at an early stage, interventions to promote cognitive functioning (such as engagement in online “brain health” games and programs) can be initiated to help prevent the afflicted individuals from experiencing a more rapid decline in cognitive functioning than otherwise. As noted in an article in Frontiers in Neurology in 2020, lifestyle modifications and enhanced social support may delay the need for nursing home care, while also reducing the patient’s overall healthcare costs resultant from living with dementia. In particular, involvement in visual art-making activities has been shown to improve cognition and relieve anxiety in people with Alzheimer’s Disease (and other forms of dementia), per a medical research article in Cochrane Database Systemic Reviews. 

Physical fitness and health status: Changed insurer attitudes toward fitness wearables

Reducing healthcare costs is a persistent issue for private health insurance companies targeting the senior-age demographic, as well as the US Centers for Medicare and Medicaid Services (CMS). Since physical fitness has been linked to both preventing numerous chronic diseases and decreasing the rate of age-related bone loss (osteoporosis), coverage of the cost of fitness trackers has been embraced by an increasing number of health insurers, as described by AARP.  

Meanwhile, a Fierce Healthcare article in 2022 reported that Humana is using wearable fitness tracking devices it distributed to enrollees to track data on their chronic conditions in order to encourage embracement of healthy behaviors. Likewise, United Healthcare in 2023 is rolling out a financial rewards program for its enrollees using provided wearable digital tracking devices who meet their daily exercise goals (or other healthful activity goals). 

By utilizing the data obtained from health-related digital wearables, insurers are better able to predict (and adjust for) upcoming year costs related to preventable chronic disorders. (While Medicare does not specify technological devices or wearables in its coverage language, it does cover “medically necessary” Durable Medical Devices [DMEs) – so it is likely that more digitally-driven DMEs will be covered in future years.) Meanwhile, a Health News article in 2023 suggests that current coverage of digital wearables as an added plan benefit (such as a fitness tracker or personal emergency alert system) are far more likely under Medicare Advantage plans. 

Digital wearables, telehealth, and teleconferencing

Talking to a clinician as needed is a way that patients can stick to action plans for recovery at home following different types of surgeries (and also action plans for addressing early symptoms of disorders that require medical attention). For example, patients that are recovering at home following hip or knee replacement surgery – and are participating in post-surgery Physical Therapy (PT) sessions – may benefit from initiating a video call with their physical therapist to boost the likelihood of daily performance of the prescribed exercise regimen.  

Since mental health can affect overall health and well-being, it is also a way that clinicians can remain abreast of their patients’ mental health status. Especially for patients with cognitive impairments, being able to talk to someone via a digital device can improve compliance with medical (and allied) provider recommendations for maintaining overall health. 

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