Optimizing Your Practice for Elderly Patients

Medicare Advantage open enrollment is a great time to reflect on how to serve the needs of the oldest members in our patient population: the “elderly.”
This demographic is subject to stereotypes: frail, chronically ill, costly, technologically illiterate, difficult to please. But the reality is that the 65-and-older crowd is an extraordinarily diverse and medically complex group.
It’s our job as primary care providers to familiarize ourselves with their wishes and needs by asking them, “What matters most to you?” while learning lessons they can teach us about the healthcare industry. Examining their needs, which range from youthful and active to long-term care and end-of-life preparations, can help to direct the “triple aim” of healthcare and unlock ways to lower costs, strengthen population health, and improve the patient experience.
To illustrate this point, let’s look at the numbers.

• Currently, there are 44 million Medicare beneficiaries, and by 2060, that number will have more than doubled.
• Total Medicare spending is projected to double between 2011 and 2022 and accounts for nearly 20 percent of the federal budget and 4.3 percent of national GDP.
• One percent of patients account for 20 percent of healthcare costs; 5 percent account for half.

The elderly population is large and has high utilization rates. This presents opportunities to develop and implement targeted interventions for those patients.
So what can we learn from this? And what are we going to do about it?

Encourage Annual Wellness Visits

A poll from the Kaiser Family Foundation shows that 88 percent of elderly patients have a primary care provider, making them nearly four times more likely to have one than millennials. This relationship is vital to patient health outcomes, especially when it comes to patients’ annual wellness visit (AWV). This checkup is an opportunity for nurses to paint a holistic portrait of patients’ functional, social, and behavioral needs while tracking changes over time. In addition, the AWV is a chance to attribute this patient to your practice if you use value-based contracts.
An AWV is the time for you to determine who is — or who has become — a high-needs patient, which is defined as one with “excessive total accrued costs, high-intensity utilization of services for a given period of time, and those with functional limitations.” Once you’ve identified these “high flyers,” you can undertake a care management plan, ideally one that embeds care managers within primary care practices to foster a truly patient-centered team experience.

Effectively Utilize Technology

Thankfully we live in an era of unprecedented technological resources, ones that my elderly patients never could’ve imagined in their youth. However, don’t assume that they’re digitally illiterate due to their age. Many of my older patients benefit from telephone-based coaching. This resource is especially beneficial to family members and caregivers in coordinating care.
In addition, many of my patients are quite adept at accessing online resources and utilizing the Privia Health™ Patient Portal, which allows them efficient, patient-centered access to their medical home. By using this resource, they are able to become more engaged in their overall treatment and play a more prominent role in shared decision-making regarding their treatment choices.

Offer Telehealth Services

The next step is telehealth, a resource many of my patients utilize. Elderly patients are already rather fluent in online resources. In fact, one survey found that 67 percent of patients aged 60 or older consider a practice’s digital presence when making their medical care decisions. Another study noted, “Satisfaction and quality assessment scores among older patients were similar to those for younger patients.”
One prominent use of telehealth is medication management as many elderly patients have specific, complex medication regimens. A telehealth visit is the perfect opportunity to review their adherence, correct any mistakes, and field questions about the symptoms to determine if any adjustments should be made.
Furthermore, the detailed displays and technology allow for a face-to-face experience that rivals that of an in-office visit but free from the logistical hassles such as transportation or issues with mobility that can deter these patients from visiting their doctor.  

Learn to Reduce No-Shows

These steps to meet the needs of the elderly begin with an annual wellness visit. Those important check-ups can’t happen if your rate of no-shows is high. No-shows are a challenge faced by practices across the country, but there are ways to reduce the number you experience.
Read this free white paper to discover actionable tips to increase this demographic’s appointment attendance.