Value of Integrated Medical and Behavioral Offerings in a Virtual Longitudinal Home Care Setting for Older Adults
Article by Pete Brock, MD,ABPN
With the increasing movement toward value-based care and consumer viewpoint on personalized health, health care delivery organizations are beginning to recognize the importance of a fully integrated and more wellness-based holistic approach in seniors. This “whole person” approach examines the biological, psychological and social determinants of health and well-being. It recognizes that all three domains play vital roles in quality of life and health status. The ability to perform an extensive intake assessment for each of these domains to generate a personalized, health-guided profile and an evidence-based clinical approach to maintaining health and vitality is critical to preventing complications associated with chronic medical and psychological conditions, as well as unmasking and addressing social determinants of health.
The challenge in the current system of care with just in-office visits is the limited resources and time spent at the brick-and-mortar primary care setting.
We propose that a longitudinal and virtual engagement under an integrated health team can accomplish this with efficiency and greater overall impact compared to traditional in-person care alone.
In the psychological domain, depression and anxiety are common conditions in the U.S. and they are often chronic or recurrent. These two conditions are some of the most commonly experienced by seniors and can complicate the treatment of coexisting medical conditions. Understanding that depression and anxiety in seniors may present differently than in younger adults requires senior-specific assessments and interventions. Similarly, substance use disorders are not uncommon in seniors and are often under assessed and treated in the traditional office setting of primary care. A home-based setting with more longitudinal care and follow-up allows for the ability to screen and monitor for substance use disorders that include alcohol, illicit drugs and prescription medications. Given that older adults, on average, are on more than 10 prescription drugs at any one time, their risk of drug-drug interactions and complications that office-based visits may not be able to detect are greatly increased.
The challenge in the current system of care with just in-office visits is the limited resources and time spent at the brick-and-mortar primary care setting.
Use of pharmacists skilled in medication therapy management and medication/substance interactions can reduce the risk that sometimes can occur with needing multiple medications in older adult populations. Under more virtual capabilities, these pharmacists' resources can be more efficiently deployed to serve a larger population in the home setting. As seniors age, the risk for cognitive impairment increases. The onset is often insidious and unrecognized until there is significant impairment to functional independence, whereby needing access to more acute care services can begin to emerge. This places enormous burdens on the family and caregivers. Caregiver stress directly impacts the well-being of the loved one, who is often unaware of their progressive cognitive deficits. The ability of virtual care and monitoring over time provides the ability to detect changes and deploy interventions to maximize functional capacity and minimize behavioral manifestations that often accompany cognitive impairments. This in coordination with the person’s health care team can prevent unnecessary emergency room visits, psychiatric hospitalizations, premature nursing home placements and caregiver burnout. In addition, it can provide significant peace of mind to caregivers and family members who often bear the stress and anxiety of looking after an older parent.
In the social domain, it is important to understand the patient’s life story, as behaviors and attitudes toward care and aging are often evolved through lifelong experiences. The ability to understand and empathize with their challenges and concerns allows for trust and engagement over time. Assessments for safety in the home (regarding stairs, rugs, access to transportation and the risk of violence or crime), and for financial and food security are critical to understanding and ameliorating their impact on well-being and functional independence. Functional capacity (i.e., ADL and IADL) should be continually assessed as these can be early indicators of worsening health and safety status. In addition, it is important to understand the level and utilization of support services needed, with the goal of matching the level of need to the available support services at the local, state and federal levels. We fundamentally believe that including the caregiver in the health care team decision-making process is an important component and can lead to better management of the patient and reduce the risk of burnout.
Finally, care fragmentation between members of the health care team leads to poor outcomes and lower quality of health. Guardiant Health’s mission is to link these three domains (the biological, the psychological and the social) under a single digital and virtual platform. Deploying a system of a personalized care plan that integrates and prioritizes clinically supervised interventions, in concert with the health care team, prevents or minimizes complications from chronic medical and psychological disorders and improves overall life quality, while keeping older adults safe and secure in their homes.
About the Author - Irvin “Pete” Brock, III, MD is a board-certified psychiatrist with extensive experience and background in geriatric psychiatry and integrated behavioral and medical offerings. Having led the clinical oversight for all behavioral health programs and products under United Health Group/Optum, Dr. Brock has now turned his knowledge as an expert clinical advisor toward Guardiant Health.
About Guardiant - Guardiant is a technology-enabled medical service company using monitoring and digital telehealth capabilities integrated under a single communications platform and clinical capability that provides an early warning and proactive intervention for better management of chronic medical conditions. The goal is not to replace traditional “brick-and-mortar” service delivery systems or family care providers, but rather to fill the gap between routine visits to the physician and home where many conditions first start to worsen. Early detection of these warning signs and immediate interventions can reduce unnecessary doctor visits, trips to urgent care clinics, emergency rooms and hospital admissions. Many of these early warning signs can be treated by the Guardiant clinical team from the comfort and security of a patient’s home. The utility of this technology is self-evident and has been dramatically demonstrated in the context of COVID and its health impact on seniors.
To hear more about virtual care for older adults and our model and approach, contact the Guardiant team at life@guardiantheath.com.
