Leveraging telehealth adoption to tackle the burgeoning rates of MCI, dementia, and ADRD in older adults
Telehealth visits accounted for 8% of total outpatient visits between March and August 2021, up from less than 0.5% of total outpatient visits before March 2020. The expansion of telehealth – and growing receptivity among healthcare stakeholders – generated new opportunities to prevent, diagnose, treat, and facilitate recovery from a range of routine, emergency, and chronic conditions. Importantly, this growth has opened the door to enhanced diagnosis and treatment of cognitive health issues facing older adults, including mild cognitive impairment (MCI), dementia, and Alzheimer's disease and related disorders (ADRD).
A wide range of clinicians and provider types, including care and disease managers, already leverage online interactions to manage the care of their more mature patients. Meanwhile, caregivers, who remain front and center in the care of older adults struggling with cognitive decline, have also started to utilize and embrace telehealth at greater rates.
While the pandemic accelerated and expanded telehealth care across a broad range of use cases, it fell short in offering those with cognitive decline viable solutions. Worse, socioeconomic factors still prevent many seniors from getting routine care let alone access to treatment options for dementia and related cognitive diseases. A recent study published in JAMA found that the risk of death among all seniors with Alzheimer's/dementia rose by 26% in 2020, but “it was pegged at 36% among Asian Alzheimer's patients; 37% among Black patients; and more than 40% among Hispanic patients.”
Lo Fu Tan, Senior Medical Director of Digital Health at Optum, expressed concern with disparities, saying "there are gender and racial distinctions in access to treatment for cognitive decline. Two-thirds of patients are women and Blacks are roughly 1.5 to 2 times as likely as whites to develop Alzheimer’s and related dementias. The socioeconomically disadvantaged don’t get equal access to resources for care.”
Riding the wave of telehealth adoption
Specialists are among those who now deliver a full spectrum of disease-specific care using telehealth. This suggests that providers who care for older adults with MCI, dementia, memory loss, and ADRD could emerge as an invaluable catalyst to promote better care through and by leveraging technology. Doing so would level the playing field in terms of access and, importantly, could contribute to better overall health outcomes, independence, reduced isolation, and quality of life for older adults as well as their caregivers.
Medicare Advantage plans already use telehealth to deliver care and related services into the homes of older adults. Plans have invested heavily in disease management for conditions such as diabetes, focusing on early detection, diagnosis, treatment, and monitoring. But they’ve done little to intervene in cognitive decline beyond offering pharmacological solutions. Plans that expand digital services to older adults could benefit in multiple ways – from market competitiveness and member satisfaction to family/caregiver engagement and closing gaps in care. Programs addressing depression, isolation, and other behavioral health services can be complemented by extending and enrolling members in programs that actually address cognitive issues. Plans could also generate savings by controlling the costs of avoidable complications like emergency department visits due to falls.
Providers and payers together can leverage increased adoption, and the telehealth “pipes” that already exist, to easily enroll those suffering from any stage of cognitive decline. They can then deliver the tools, education, and support resources needed to better monitor and evaluate effectiveness and progress.
There are solutions
The most meaningful programs will build on the legacy and lessons learned from telehealth “1.0” and importantly, create new opportunities for older adults (and their caregivers) to interact, enhance functions, and improve their overall quality of life.
Payers and providers have several new opportunities to manage cognitive decline:
- Extend and build upon existing telehealth initiatives in primary care and behavioral health with programs that address cognitive decline;
- “Prescribe” and enroll patients in innovative new programs that can profoundly make a difference in their independence and quality of life; and
- Use technology to solve for social determinants of health and the racial, ethnic, rural, and income barriers that block access to cognitive health interventions.
Together Senior Health offers a non-pharmacological solution that combines movement, mindfulness, and social connection on an online cognitive health platform. Initial studies reveal improvements in older adults' cognitive and physical function two to three times greater than best-in-class drugs. Anchored in research from the University of California, San Francisco (UCSF), and the U.S. Department of Veteran Affairs, Together Senior Health blends the best of face-to-face group programs with digital innovations that allow older adults and their caregivers to participate from home or a convenient care location.
“Together Senior Health looks like a very promising solution. Evidence-based findings of early trials indicate improved quality of life, decreased social isolation, increased function, and possibly reduced cost of care,” says Dr. Tan. “The program could be connected seamlessly to existing telehealth offerings and offered as a benefit to at-risk patients.”
Telehealth is with us and here to stay. It can precipitate remarkable changes in the lives of older adults and their caregivers. Health plans in particular have the opportunity to leverage and extend what they’ve already invested in and in so doing, add incremental value to the digital healthcare services they provide. All of this can result in reduced costs and higher member satisfaction and engagement and can help older adults stay healthy and independent at home.
