Star Ratings

2022 changes for Star Ratings & how this affects your telehealth strategy 

Every year, the Centers of Medicare & Medicaid Services (CMS) releases Star Ratings to determine how well Medicare plans perform. These ratings have big implications for plans including how members enroll. The system supports CMS’s efforts to empower people to make healthcare decisions that are best for them. 

As for providers and plans, the factors that influence Star Ratings, and how heavily they influence them, change annually. Just when you have it figured out, they change again. This blog post explains the 2022 changes for Star Ratings, how these changes affect your telehealth strategy, and how to move forward into 2023 and 2024.  

What are Star Ratings?

Plans are rated on a 1-to-5 scale, with one star representing poor performance and five stars representing excellent performance. When a plan is rated higher, more people enroll in it for a variety of reasons.  

Star Ratings are based on:   

  • Staying healthy: How well does the plan keep members healthy through checkup reminders and communication?  
  • Managing chronic conditions: How well does the plan help members get recommended tests and treatments for their condition? 
  • Member experience: How do members rate their experience with the plan? This includes the care they receive from doctors and getting prescription medications. 
  • Member complaints and performance: How often do members find problems with the plan? How has the plan’s performance improved each year? 
  • Customer service: Does the plan have foreign language interpreters and teletypewriter (TTY) services available? Does the plan process appeals and new enrollments in a timely manner? 

These categories are the main factors determining Star Ratings. However, there are other factors determining Star Ratings that change. 

Keep reading to learn how 2022 Star Ratings differed from the past, and what factors influenced these changes.  

2022: A record-breaking year for Star Ratings

2022 was a record-breaking year with the highest number of 4- and 5-Star Ratings. In 2022, there were more 5-Star plans than 3-Star plans.  

The first reason for the increase in Star Ratings is the “better of” methodology. This change allowed plans to report data from either the 2021 or 2022. Plans had the benefit of choosing whichever year had the better data. The “better of” methodology will no longer be allowed, which means we can expect a drop in Star Ratings in the coming years.  

Plans need to prepare for the future, because the CMS Star system will correct from COVID, leading to a significant loss in 4- and 5-Star Plans. Aside from the “better of” methodology, there were several other changes to 2022 Star Ratings. 

Most influential change to Star Ratings in 2022: CAPHS Weighting

In 2022, Star Ratings continue to place an emphasis on member experience by having an increased importance and weighting. Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores are shifting from two times to four times weighting 

CAPHS scores are often the lower performing category for health plans. Yet, in 2022, it becomes the highest weighted in the Star Ratings. Here is a breakdown of the CAPHS measures affecting Star Ratings: 

  • Getting needed care 
  • Getting appointments quickly 
  • Customer service 
  • Rating of healthcare quality 
  • Rating of health plan 
  • Care coordination 
  • Rating of drug plan 
  • Getting needed prescription drugs 

Member experience was by far the most important change in 2022 Star Ratings, and this trend will continue in the future.  

More changes to 2022 Star Ratings

In 2022, the plans that scored the highest were those that showed improvement in these measures 

  • Transition of Care (TRC): This measure assesses post-discharge transition from inpatient facilities. 
  • Medication adherence for chronic conditions: How well did the plan help patients get medications? Did the plan include refill reminders? 
  • Preventive services: Did the plan have the ability to reach members digitally and in a timely manner? 
  • Chronic conditions: Members with chronic conditions often have compromised immune systems, making them more fearful of contracting COVID-19. Did the Plan increase the use of test kits, in-home services, and mobile unites to accommodate those with chronic conditions? 
  • Blood pressure: Did plans engage members with uncontrolled blood pressure? 

In 2022, the Star Ratings removed the Health Outcome Survey (HOS) measures. Before, they had a 3x weighting.  

The removal of the HOS measures boosted most plans’ ratings, and this change will last for at least the next 3 years.  

Moving forward: Stars Ratings in 2023 and 2024

2022 Star Ratings were already solidified, meaning from now on, plans need to focus on Star Ratings for 2023 and 2024.  

Here are the changes we’ll see for 2023 Star Ratings: 

  • CAPHS: Member experience weights increase to 4x for 2023. 
  • Health outcomes survey (HOS): 3x-weighted HOS measures won’t be counted for the next 3 years. 
  • Controlling blood pressure (CBP): CBP continues to be included in 2023 Star Ratings after methodology updates with a 1x weight.  

In 2024, here are the Star Ratings changes to be aware of:  

  • Plan all-cause readmissions (PCR): This measure will return to the Star Ratings program with changes in 2024. PCR assesses the rate of adult acute inpatient observation stays that followed an unplanned acute readmission for any diagnosis within 30 days after discharge. 
  • Transitions of care (TRC): This measure assesses post-discharge transition from inpatient facilities with 3 new indicators. 
  • Follow-up after emergency department visit for people with multiple high-risk chronic conditions (FMC): This new measure tracks the percentage of adults with multiple high-risk conditions who had a follow-up service within 7 days of their visit. 

The 2023 and 2024 changes to Star Ratings reveal trends to keep an eye on for the upcoming years. Now that you understand 2022, 2023, and 2024 changes to Star Ratings, we’re going to unpack how these changes impact your telehealth strategy. 

How these changes impact your telehealth strategy?

By far the most important factor are CAPHS member experience measurements. How does telehealth impact member experience? Virtual visits have a higher patient satisfaction rate of 97%. In contrast, in-person visits have a 84% satisfaction rate. Just by offering telehealth services, a plan may be able to improve its Star Ratings. 

When offering virtual visits, here’s how to improve patient satisfaction rates:  

  • Move as many experiences to virtual as possible, including prescription refills, ordering future screenings, assessments, medical recommendations, pain screenings, and depression screenings.  
  • Offer a Digital Mock-CAPHS Survey to better understand and improve member experience. 
  • Focus on how to use telehealth to improve other Stars measurements. For example, offer telehealth monitoring of blood pressure to monitor patients. 

One key to improving member experience and providing higher touch care to more patients is to digitize medical services, when appropriate. 

Need help providing telehealth?

With Star Rating improvements relying so heavily on telehealth, plans need to make sure their digital strategy is in great shape. Just like any other tool, there are great telehealth tools, and there are some that will just further frustrate members. 

To help improve your telehealth services, rely on our Ōmcare Home Health Hub®. It ensures patients can get their medicine and speak with their providers, pharmacist, or caregivers in real-time. ​​Reach out to Ōmcare to learn more! 


Risk adjustment: what is it and how does it impact Healthcare for 2022

Risk adjustment is one tool that helps determine insurance eligibility and premiums, as well as reimbursements for providers. It allows insurance providers to compare members and determine which ones have higher risks of developing certain conditions or require more care than others. This information can then be used by regulators for setting appropriate reimbursement rates for different providers.

So, beyond that what exactly is risk adjustment? Why does it matter? And why will it continue impacting the way we approach health costs over the next several years?

What is the purpose of risk adjustment?

The official definition of risk adjustment, according to HealthCare.gov, is “a statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs.”

To understand risk adjustment, you first need to know how it is calculated. The calculation of an enrollee's risk score begins with their demographics and HCCs; a.k.a. the medical codes for their conditions.

To make sure that insurance providers are reimbursed fairly and accurately for services rendered, every member ends up with a unique risk score based on various demographic factors (such as age) combined together from predefined categories called Hierarchical Condition Categories or "HCC".

The demographic factors used to calculate risk scores include:

  • Age
  • Sex
  • Socioeconomic data
  • Disability status or eligibility
  • Medicaid eligibility
  • Institutional status (nursing homes, inpatient care, etc.)

The demographics are paired with an enrollee's list of diagnoses. These codes have all been assigned a specific value for risk adjustment. They're part of the standard ICD-10 coding system used in healthcare -- which assigns codes to every diagnosis based on many factors like severity, location, and condition.

HCCs with lower numbers are higher in severity on the scale and thus would raise someone's risk score. For example, diabetes that is well-managed with no complications would have an HCC of 19, while diabetes in full ketoacidosis would be an HCC 17, which is more severe than the 19. These numbers, paired with the demographic information, would determine how much risk adjustment is necessary for this enrollee.

HCCs and demographics are the two factors that might most affect someone's premium and eligibility in some medicare plans. In addition, people without chronic conditions might have more fluctuation in their risk scores due to diagnosis changing year over year. Still, those who require consistent treatment will likely remain in a high-risk adjustment program.

What are risk adjustment factor scores (RAF)?

Risk Adjustment Factors -- known as RAFs -- are the average risk scores for specific HCCs. They're used in combination with demographics to determine an individual's final risk score. The higher a person's RAF, the more likely it is that they'll end up in high-risk adjustment programs or see increased premiums due to their diagnosis and demographic information.

Health plans use special algorithms paired with patient RAF scores to predict costs. Patients with multiple chronic conditions would have a higher RAF score, thus likely having more healthcare needs with higher costs.

Why does this matter? Since risk adjustment is a calculation that takes into account both demographics and the severity of an enrollee's diagnosis, HCCs will have more of an impact on premiums than ever before.

There's no doubt that risk adjustment will continue to be a complex topic for healthcare professionals and insurance providers alike as we enter 2022. There are still many questions as to how this will play out in the future of healthcare, but there's one thing that seems clear: risk adjustment is going to have a very real impact on every aspect of care and coverage moving forward.

Patients with high RAF scores can always apply for a Medigap or Medicare Supplemental Insurance plan to offset added costs not covered by their Medicare plan. In 2021, there are ten different types of Medicare supplemental plans (Medigap) available in most states. Each is indicated with a different letter: A, B, C, D, F, G, K, L, M, or N. A Medigap policy would help people pay remaining healthcare costs like deductibles, coinsurance, or copayments—in other words, fill the gaps that aren't covered by Medicare plans.

What are the three risk adjustment models?

Depending on the situation, there are three different ways to adjust for risk. Each model has a different purpose and goal in mind.

CDPS — Chronic Illness and Disability Payment Systems

The first model is called CDPS and is used by state Medicaid programs for making capitated (fixed) payments to Medicaid HMOs for disabled enrollees. It may also be used for TANF (Temporary Assistance to Needy Families) for short-term assistance.

There are some precise characteristics of the CDPS model that make it stand out from the others. These are:

  • There are 20 hierarchical categories of diagnoses that group them by body system or diagnosis type.
  • A focus on those who need the most care.
  • Each category has subcategories that showcase their degree of expenditure, affected by the severity of the diagnosis.
  • Hierarchies are applied to every major category and count only the highest cost diagnosis. For example, if someone had two conditions under the cardiovascular category, the higher cost condition would be counted.
  • Patients can have multiple diagnoses across different categories.
  • This model has been adjusted multiple times to account for changes in medical coding.

understanding healthcare risk adjustmentsHCC — Hierarchical Condition Category

There are actually two forms of HCC: CMS and HHS. The CMS-HCC was developed after a mandate via the Balanced Budget Act of 1997 to adjust capitation payments based on its enrollees’ health status and demographics. Meanwhile, HHS-HCC came as a result of the Affordable Care Act. It intended to stabilize premiums for health plans offered on and off the Health and Humans Services health plan exchange. In addition, this model allowed for states who didn't want to operate their own risk adjustment program to use the HHS risk adjustment program.

CMS-HCC

  • Hierarchies are applied so that only the most severe or highest cost diagnosis is counted in each category—similar to the CDPS model.
  • All diagnosis codes are organized into 805 diagnostics groups, which are then organized into 189 conditional categories for a broad picture view.
  • The variables that most impact one's risk adjustment are: disability status, low-income status, Medicaid, the reason for entitlement, age, and sex.
  • They utilize prospective modeling, meaning they use previous year data to predict cost in the current year vs. concurrent modeling, which uses current year data.
  • They use an additive model where multiple categories can be added together to determine risk.
  • This model uses separate calculations for long-term care vs. new enrollees.
  • There is an entirely separate risk model for enrolled with ESRD (end-stage renal disease).

HHS-HCC

  • HHS-HCC is the newest model, implemented in 2014.
  • They work on a risk pool model, meaning its budget-neutral by transferring funds from low-risk plans to high-risk enrollee plans.
  • Again, only the most severe or highest-cost diagnoses are counted.
  • Age and sex are the demographics that most affect risk scores.
  • This model uses a concurrent model, using current year data to predict this year's costs, unlike the CMS-HCC that uses prospective modeling.
  • This model includes 127 out of the 189 conditional categories that best predict expenses, focusing more on chronic diseases.
  • Depending on the plan level (platinum, gold, silver, bronze, catastrophic), there may be separate calculations due to plans' varying actuarial value. Actuarial value is the total average of costs for covered benefits. For example, if a plan has an actuarial value of 80%, it means the enrollee is responsible for the remaining 20% of costs on all covered benefits.

ACG — Ambulatory Care Groups

Lastly, the ACG model was developed with a completely different approach than the other two. This model assigns diagnosis codes using 32 ambulatory diagnostics groups based on how the condition might affect an enrollee's health and resource needs. For example, the likelihood of disability, reduced life expectancy, or needs for specialists, therapy, or hospice care is all highly considered under this model. This model is often referred to as the Case Mix model because it is used for both risk adjustment and research.

case mix healthcare risk adjustmentRisk Adjustment and Healthcare

Risk adjustment allows for proper cost adjustments as well as setting a standard of premiums for high-risk enrollees. This is because people who are sick or have chronic conditions will be more expensive to treat than someone with few or no health issues. Overall this risk adjustment aims to provide the appropriate funding based on the severity of an enrollee's health condition.

It's a complex system that plans and providers need to have a plan for in order to create budgets properly, adjust plan coverage, and give enrollees the best possible care options. The Ōmcare Home Health Hub allows plans and providers to manage their risk by capturing RAFs (risk adjustment factors) over telehealth visits and ensures medication assistance, leading to healthier outcomes.

We are trying to make chronic care easier and more effective by allowing flexible, at-home care. If you have any questions regarding risk adjustment or bettering care for high-risk patients, reach out to us today!


medicare star ratings and choosing your plan

Medicare star ratings: how they work + how to compare plans

Medicare star system

If you become eligible for Medicare this year or are considering switching plans when open enrollment season starts, our guide will help you decide which plan is best for you. Before you do, it’s important to know that Medicare uses a 5-star rating system to measure the quality of health insurance plans.

Plans with higher Medicare star ratings have proven higher quality (which may mean more doctors in-network, better care, or more care options), while lower ratings have not. Knowing what these Medicare star ratings mean and how to utilize them in your search for the best health insurance can be a massive help in deciding which plan is best for you.

What are the Medicare star ratings?

Medicare uses a system that assigns each plan a star rating from one to five stars. Plans with higher ratings offer higher quality, meaning they offer better care at lower costs through well-known providers and hospitals in their network.

They also offer more favorable customer service hours and higher satisfaction ratings from beneficiaries who have used them in the past year. Although 5-star plans are ideal, this rating is extremely difficult to achieve.

The star rating breakdown:

 

5 star medicare star rating

Five stars

The highest possible rating given by Medicare and means that beneficiaries will have access to a wide range of doctors, hospitals, and other providers in their network without cost-sharing or restrictions. This includes specialists such as cardiologists and cancer surgeons—even if they're outside your plan's local area.

You'll also be able to see all pricing information before you sign up for coverage, so you'll know how much each doctor visit costs ahead of time. And when it comes time to go into the hospital or need nursing home care, there won't likely be any surprises about what bills might come due since everything should already be spelled out in your plan.

 

4 star medicare rating

Four stars

The next highest rating and means that beneficiaries will continue to have access to a broad range of doctors, hospitals, and providers in their network. This plan is considered above average and the highest number of Medicare plans fall into this rating.

 

Three stars

Three stars indicate that beneficiaries can choose from more than one provider within their plan's healthcare providers network. This includes specialists such as cardiologists and cancer surgeons—even if they're outside your plan's local area. You'll also be able to see pricing information before you sign up for coverage, so you'll know how much each doctor visit costs ahead of time.

 

Two stars

Two stars indicate that beneficiaries can choose from one provider within their plan's network without cost-sharing or restrictions.

 

One star

One star means the beneficiary will have access to only a single, non-network physician in their region who is contracted with Medicare.

 

What Medicare Advantage Plans have a 5-star rating?

Like we said, 5-star ratings are very hard to achieve for insurance companies and the Medicare advantage plan they offer. This is done intentionally to keep competition among plans. Sometimes it's something as medial as not offering transportation coverage that can drag down their 5-star to a 4.5. Plus, a lot of their fate lies in the hands of their members, who leave reviews each year indicating how well they met all levels of care.

Medicare Advantage plans have more stringent criteria to meet their star rating than other Medicare Plans, such as prescription drug coverage.  In general, you can change your plan or enroll in a new one only during a Special Enrollment Period. Their star rating is based on how well they do in each of the following categories:

  1. Staying healthy (member access to screenings, tests, vaccines, etc.)
  2. Chronic condition management
  3. Overall satisfaction with care and health plan responsiveness
  4. Member complaints and members leaving the health plan
  5. Customer service rating

Despite these regulations and categories, there are plenty of Medicare Advantage plans with near five-star ratings to their beneficiaries. Therefore, including Medicare Advantage plans in your search for the best health insurance can be a wise decision.

Get Help From The Pros

As you search for the right Medicare plan, and Medicaid services, you can compare plans based on your specific needs, plus filter by drug coverage, special coverages, and star rating at Medicare.gov. Our Ōmcare customer care team is available 24/7 to answer any questions and provide the expert support you and your loved ones need.


telemedicine equipment: automatic pill dispenser

Connected care and remote patient monitoring prove to be cost-effective methods to improve patient outcomes, medication adherence, and patient satisfaction

Exclusive technology from Ōmcare aims to eliminate common breakdown in chain of communication between patients, providers, and family caregivers.

By Lisa Lavin, founder and CEO, Ōmcare

The United States population is aging and, in the process, they will require more in the way of long-term care support and services. In fact, it’s estimated that between 2015 and 2050, the senior population will more than triple, with half of these individuals expected to need long-term care, which will come from either skilled nursing facilities or from adult children or family members. According to projections produced by the Congressional Budget Office, due to population growth, long-term care expenses could more than double from 1.3% of gross domestic product (GDP) in 2010 to 3% of GDP in 2050.[i]

In either scenario, the high cost of care creates financial hardships for individuals and families, taxes the personal time and relationships between family members, and can even impact the professional lives of caregivers. According to a 2016 report by AARP, family caregivers are spending roughly $7,000 per year ($6,954) in all out-of-pocket costs related to caregiving: household expenses, medical expenses, and more.[ii] The average family caregiver spends roughly $7,000 per year, or nearly 20 percent of their annual income, on out-of-pocket costs, according to AARP estimates.[i]

A common issue that often complicates caregiving, influences patient outcomes, and contributes to rising costs, is lack of medication adherence by patients. Nonadherence accounts for up to 50% of treatment failures, around 125,000 deaths, and up to 25% of hospitalizations each year in the United States.[iii] Studies show that 26% of readmissions are potentially preventable and medication-related, the most common of which was nonadherence due to patient choice (23.8%).[iv]

According to estimates by the IMS Institute, better medication management could produce $213 billion in savings annually, of which $105 billion would be from improved adherence.[v]

The ripple effect of caregiving needs

While the impact of increased caregiving needs for the aging population are many, two of the most significant areas of impact are related to cost and caregivers.

Financial impact. With healthcare costs set to hit more than $2.3 trillion, the need for more cost-efficient care has never been more important. Consider the fact that the annual median cost for nursing facilities ($97,455 for a private room) is more than double the median income of older households ($42,113). Likewise, according to the National Association of Home Care, the average cost of care from a skilled nursing facility is $544 dollars per day, while the average cost of home health care per visit is $132 dollars.[i]

On average, an American turning 65 today will incur $138,000 in future long-term care costs.[ii] Families will pay about half of the costs themselves out-of-pocket, with the rest covered by public programs and private insurance.[x] While most people with long-term care needs will spend relatively little on their care, about one in six (17%) will spend at least $100,000 out-of-pocket.[i]

Caregiver impact. Approximately 35 million Americans provided unpaid care to an adult age 50 or older in 2015. The vast majority (85%) were caregivers for a relative, primarily an aging parent.[vi] The term ‘sandwich generation' – the label used to describe adult children who are simultaneously caring for their children and their aging parents – is becoming so commonplace that it was added to the Merriam-Webster Dictionary in 2006. However, the dictionary fails to mention the heavy financial and emotional stress that being a part of this generation can cause on caregivers.[vi] Caregivers often experience the following:

  • Caregivers report high rates of depressive symptoms and mental health problems, compounded with the physical strain of caring for someone who cannot perform activities of daily living, such as bathing, grooming and other personal care activities.[vii]
  • 6 out of 10 (61%) caregivers experience at least one change in their employment due to caregiving such as cutting back work hours, taking a leave of absence, receiving a warning about performance/attendance, among others.[viii]
  • 49% arrive to their place of work late/leave early/take time off, 15% take a leave of absence, 14% reduce their hours/take a demotion, 7% receive a warning about performance/attendance, 5% turn down a promotion, 4% choose early retirement, 3% lose job benefits, and 6% give up working entirely.[viii]

Further exacerbating these factors is the poor or inconsistent communication that occurs between patients, caregivers, and healthcare providers. A study by the Accreditation Council for Graduate Medical Education (ACGME) found that 69% of health care providers do not have a standardized hand-off process – a real-time process of passing patient information from one caregiver to another – and only 20% have some standardization. This lack of process can create inaccuracies that lead to extended stays in clinical facilities or that complicate medication and therapy adherence outcomes.[ix]

Telehealth solutions impact all stages of care

Amidst rising costs and changing demographic needs, telemedicine has emerged as a viable solution for doctors, patients, employers, and insurance providers to cut costs and save money.[x]  It’s no surprise then that utilization of telemedicine is growing. According to Deloitte, physicians conducted about 100 million telemedicine appointments globally in 2014, which generated potential savings of more than $5 billion when compared to the cost of in-person doctor visits.[x] From 2014 to 2018, the use of non-hospital-based provider-to-patient telehealth grew 1,393%.[xi]

New telehealth and remote monitoring technologies are fundamentally changing the way people interact with health care.[xii]

Remote patient monitoring

Remote patient monitoring is a digital health solution that captures and records patient physiologic data outside of a traditional health care environment.[xii] As providers increasingly turn to remote patient monitoring technology to improve patient outcomes, limit costs, and cut down on using more expensive services, healthcare industry newcomers and legacy players alike are vying for a piece of this growing market.[xiii]

Remote patient monitoring is particularly helpful in managing chronic conditions and improving medication adherence because it provides visibility into patients’ lives outside of their scheduled appointments, which has historically been a barrier to timely and effective diagnosis and management.[xiii]

With data collected over time, care team members can manage and treat chronic conditions in a way that is effective, timely, and realistic to the patient and caregiver’s lifestyles. The data generated through this approach can help facilitate conversations between patients and physicians and facilitate opportunities to intervene quickly to avoid complications.[xiii]

In addition to providing care teams with better, more actionable information earlier, remote patient monitoring has been praised for engaging patients in their own care by providing them access to their own data so they can better understand the impact of their treatment and advocate for their medical needs.[xiv]

Connect caregivers with the right technology

From tracking vital signs with remote monitoring devices to communicating quickly with a nurse through a web portal to receiving on-the-spot care from a doctor via video chat, telehealth aims to make life easier.[xiv]

The right technology can give health care providers and caregivers a means of communication that is essential to improving patient outcomes. For example, patient monitoring programs that allow virtual check-ins enable patients to extend the duration between doctor's visits or unplanned hospital stays. Meanwhile, a KLAS Research report surveying 25 healthcare organizations found 38% of healthcare organizations using remote patient monitoring programs for chronic disease management reported reduced admissions, while 17% cited cost reductions.[xiii]

Older adults with long-term care needs should be able to live independently as they age while limiting stress on family caregivers. Telehealth strategies can support this process by improving access to care and ensuring its quality, while reducing the strain put on family members by increased time requirements, added mental and emotional stress, and financial burdens of providing long-term care to an aging loved one. The right technology can address these issues and allow for loved ones to age gracefully and in their best health.

About Ōmcare

Ōmcare is a health technology company aspiring to extend the reach of the caregiver, increase medication adherence, and to improve treatment outcomes by harnessing the power of remote care. We aim to achieve this through our proprietary interactive technologies - promising right pill, right time, right person. By partnering with pharmacies, payers, providers, and family caregivers, our vision is to help people live healthier, more vibrant, independent lives.

References

[i] "Long-Term Services And Supports For Older Americans: Risks And Financing Research Brief". ASPE, 2019, https://aspe.hhs.gov/basic-report/long-term-services-and-supports-older-americans-risks-and-financing-research-brief.

[ii] "Caregiving Innovation Frontiers". Aarp.Org, 2019, https://www.aarp.org/content/dam/aarp/home-and-family/personal-technology/2017/08/caregiving-innovation-frontiers-2017-aarp.pdf.

[iii] Kim, Jennifer. "Medication Adherence: The Elephant In The Room". Uspharmacist.Com, 2019, https://www.uspharmacist.com/article/medication-adherence-the-elephant-in-the-room.

[iv] "Up To 26% Of Hospital Readmissions Are Preventable And Medication-Based". Drug Topics, 2019, https://www.drugtopics.com/drug-topics/news/26-hospital-readmissions-are-preventable-and-medication-based.

[v] IMS Institute for Healthcare Informatics, “Avoidable Costs in U.S. Healthcare: The $200 Billion Opportunity from Using Medicines More Responsibly,” June 2013

[vi] "The Sandwich Generation | What Is The Sandwich Generation?". Seniorliving.Org, 2019, https://www.seniorliving.org/caregiving/sandwich-generation/.

[vii] "Caregiver Health | Family Caregiver Alliance". Caregiver.Org, 2019, https://www.caregiver.org/caregiver-health.

[viii] "Caregiving In The U.S.". Aarp.Org, 2019, https://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf.

[ix]  Wagner R, et al. CLER 2016 National Report of Findings, Issue Brief #5: Care Transitions. Chicago, Illinois: Accreditation Council for Graduate Medical Education, March 2017.

[x]  "Telemedicine Research Papers: Trends In Healthcare - Evisit". Evisit, 2019, https://evisit.com/resources/telemedicine-trends/.

[xi] fairhealth.org. (2019). A Multilayered Analysis of Telehealth. [online] Available at: https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/A%20Multilayered%20Analysis%20of%20Telehealth%20-%20A%20FAIR%20Health%20White%20Paper.pdf.

[xii] "Digital Health Implementation Playbook". Ama-Assn.Org, 2019, https://www.ama-assn.org/system/files/2018-12/digital-health-implementation-playbook-REV1.pdf

[xiii] "The Technology, Devices, And Benefits Of The Growing Remote Patient Monitoring Market". Business Insider, 2019, https://www.businessinsider.com/remote-patient-monitoring-industry-explained.

[xiv] "Telehealth And Seniors | Updated For 2019 | Aginginplace.Org". Aginginplace.Org, 2019, https://www.aginginplace.org/telehealth-and-seniors/.