LeadingAge Magazine · March/April 2012 • Volume 02 • Number 02

Technology for Mission’s Sake

March 13, 2012 | by Gene Mitchell

With technology as a tool, providers are improving business models to achieve their missions and survive in a shifting environment.

New business models—driven by changing demographics, changing public attitudes, recession, and most imminently by health care reform—are popping up all over in aging services. It stands to reason that ways to use new technologies to streamline operations and improve services are a must.

The LeadingAge Center for Aging Services Technologies (CAST), working to better understand new technology-enabled models and services, recently published a set of 18 case studies of LeadingAge-member organizations that have plunged into technology-driven change. The outcome is a report, Preparing for the Future: Developing Technology-Enabled Long-Term Services and Supports for a New Population of Older Adults.

This article is the first in a series inspired by those case studies; this one looks into the organizational consequences of these providers’ technology initiatives.

For much greater detail on the technological work these members are doing, download the CAST report.

The case study of Evangelical Homes of Michigan (EHM) describes three strategic decisions taken in recent years, which together have led to a redefinition of the organization. According to President and CEO Denise Rabidoux, fundamental change began with an in-depth market study.

“The most significant part was a journey … to discern the desires of older adults about their futures,” says Rabidoux. “We went through a strategic roadmap process, and a market study. It was the first time we’d done market research for the sake of doing it, without it being tied to bricks and mortar development. We asked what do we know about older adults who are not moving into our campus? What is happening to the older adult that isn’t using our services? How can we become their answer and resource as they stay in their home?”

In what Rabidoux describes as an “a-ha moment,” the board began to ask, “How could we right-size the organization, how can we pick up the rest of the market share? How can we expand in such a way as to offer a full array of services no matter where adults call home?”

The first strategic decision, to adopt an organization-wide health and wellness orientation and infuse it into the entire continuum of EHM services, tied naturally into the findings of the market study and led EHM to think about how that wellness approach could be offered outside its walls.

Rabidoux asks, “If we could deliver wellness in bricks and mortar, why not do it outside our walls?” To that end, EHM’s second strategic decision was to purchase both a Medicare-certified home care agency and a private duty agency.

The acquisition of these two separate agencies led EHM to brand itself as a provider of services, solutions and products rather than a senior retirement corporation.

“Individuals now realized one provider [could meet] their needs from skilled nursing to independent living, all the way to a wellness state, including personalized exercise training, nutritional counseling, massage therapy, as well as physical therapy or occupational therapy,” Rabidoux says. “Geriatric care management became part of it, along with affordable home care services for low-income seniors. We became a waiver provider for nursing-home eligibles and began reaching out to individuals in a vast way. We started to listen to the potential customer, really listening to their desires and just say ‘Yes we can!’”

EHM’s third major decision was a natural outgrowth of the first two. In 2010, it launched two subsidiaries: LifeChoices™ (a “CCRC without walls”) and LifeChoice Solutions™, an agency offering a broad array of services, from help with meals to help finding a plumber or other vendor, and offering home assistive technology.

The CCRC without walls, according to Stephen Hopkins, vice president and executive director of LifeChoice™ Solutions, “delivers capacity for people to stay in homes, it involves the wellness piece we’re talking about, and we are taking on people [who are] healthy when they come in. It offers the full continuum up to and including leaving their homes and moving into our skilled nursing community.”

Clients of LifeChoices™ pay an up-front fee of $35,000 to $50,000, and a monthly fee of $400. Now up to 30 enrollees, the plan gives them a package of services, as opposed to the “a la carte” nature of the services offered by LifeChoice Solutions™.

“What we’re really talking about is connecting to a brand that will deliver a person’s needs and desires from day one for the rest of their life,” says Hopkins. “A world where you have one single contact person or advocate who can activate everything from concierge services, to wellness, food, or transport, creatively based on what fits your profile. The icing on the cake is the already known capital cost, and there is no longer any question mark about the price of your care.”

Rabidoux says the CCRC without walls clients might be people who have had challenging experiences, usually financial, that makes aging a reality to them. Hopkins says, “This becomes an answer to people who need those services. There’s the navigation component: Where are my medical records? I’m going to different doctors, who’s got what information? It might be easier not to go [to the doctor] than worry about that. To have one lifestyle coach advocating for you, that comes back as the most valuable part of the program.”

EHM’s strategic changes are in the service of mission, not technology. Technologies are viewed as important tools but must be vetted through its road mapping process.

“We develop programmatic solutions and bring in technology as tools to deliver a desired outcome,” says Rabidoux. “We have a series of technology solutions that help us solve the outcome of that client in the home, whatever that may be, so in order to have an array of solutions at our beck and call, we need to be continually testing. Road mapping is when we work with a developer and test a technology, using our staff and some clients and really determining if it delivers the outcome we want.”

While EHM’s road mapping process tests a lot of technologies, Hopkins says the road map is a disciplined path to deployment; EHM does not introduce new technologies without careful testing. “We’ve learned through some pain, if you don’t follow that path you could be in trouble,” he says. “We love solutions, we road map competency solutions or technology solutions. That process continues, so by the time we get to the end, we never have to pull something out of the market. We can’t have failures if we’re trying to build confidence in our clients.

See the full Evangelical Homes of Michigan case study on p. 32 of Preparing for the Future.

Like Evangelical Homes of Michigan, ACTS Retirement-Life Services, based in West Point, PA, and operating 23 CCRCs in eight states, sees technology as a tool in service of mission, and has made health and wellness a key value in its service offerings.

The new “ACTS Signature Experience” orientation is, according to Peter Kress, vice president and chief information officer, a response to today’s environment and the need to eliminate silos and serve new generations of seniors.

“The emphasis is that with an aging-in-place model, increasingly there are different venues where residents want to receive care,” says Kress. “The venues [of care] will be more porous. Higher levels of need will still be addressed in lower care settings. It will be important that we stop running ourselves as if we’re three different businesses. Just as we talk more about universal workers, in an aging-in-place model, which set of services do I deliver in a standardized way no matter what setting?”

“Almost anything we do we can reference against the Signature Experience concepts, to give choices to empower residents’ lifestyles,” Kress adds. ACTS Signature Experience includes increased wellness programming and expansion of home health companion services.

The role of technology is an obvious way to offer those choices. ACTS’ commitment to technology has a long pedigree, as does Kress’ involvement with LeadingAge CAST, which he serves as a commissioner and as chair of the Standards Committee and the Electronic Health Record Task Group.

ACTS was an early adopter of point-of-care documentation systems, and has done a lot of work toward an electronic health record system. In addition to well-integrated “back-end” systems that a large organization needs, Kress says ACTS puts a lot of stock into equipping the “front end”—staff and residents/clients.

“Our workforce needs to be fully equipped to engage those [back end] systems, with tablets, handhelds, and automated sensors,” Kress says. “There has to be a flow of data coming through the whole system. The other part of the front end is setting things up so residents are interacting directly with you.”

In service of greater interaction for residents, ACTS has brought fiber-optic networks to eight campuses, and is working toward campus-wide wireless access. It is helping residents learn and become comfortable with personal computing technologies and social media, and is even considering the possibilities of iPads as “master remote controls” that might allow residents to control heating and cooling in their apartments, or request services.

“You’re making the front end far more diverse,” says Kress, “and the number of software applications goes down but the number of apps go way up. It’s a whole new game. As you move services directly to the front lines you remove layers of mediators that sit between residents need for services and the system that delivers the services.”

“We’re starting to demonstrate smart apartments that integrate a number of entertainment, safety, security, sound, communications, health and wellness capabilities,” Kress adds. “The products are typically off the shelf. We believe the consumer PC stage is dying fast. We think, among seniors whose adoption of PCs was always far slower, that we’ll see a significant shift toward tablet-style devices. By using it as a master remote control, all the smart apartment’s amenities or services are managed or manageable through the iPad.”

See the full ACTS Retirement-Life Services case study on p. 13 of Preparing for the Future.

Providence Life Services, Tinley Park, IL, is another technologically ambitious provider, but it has taken its level of expertise a step farther than most. Building on capabilities it first developed in the 1980s, the organization created its own IT company, ProviNET Solutions, a decade ago.

“We started doing data processing in the late 1980s,” says Carl Goodfriend, chief information officer for Providence Life Services and ProviNET Solutions. “In the early 1990s we were approached by other providers in the Chicago area, who asked for help. We started doing [IT] locally for a couple of providers, and gained momentum over the years.”

“Let’s say you’re a nursing home in Chicago and need an EMR [electronic medical record],” says Goodfriend. “You can call a company that will sell their software. But they don’t know that your building is old and needs a wireless system involved.” ProviNET can do infrastructure assessments, software installations and manage basic IT functions for clients, providing a “virtual system administrator” for each client.

An electronic medical record is now being developed, based on a core product by HealthMEDX. “We are about 50 percent through [the process] with our parent company,” says Goodfriend. “A smaller stand-alone community could do it in a year. For a bigger company like us, we are moving slow because we have so many manual processes and custom forms, plus each community has different relationships with hospitals, etc.

ProviNET has a staff of 60, including what Goodfriend calls “very high-end developers and programmers,” people Providence Life Services could never afford to hire otherwise. The in-house expertise has the bonus value of keeping Providence’s own IT costs down—they have not risen in six years. The company serves clients of all kinds—colleges, manufacturers, law firms and more. Because everyone in health care has to have an EMR in the next few years, says Goodfriend, business is good. ProviNET is even getting some of the work that other health-related software developers can’t cover.

See the full Providence Life Services case study on p. 69 of Preparing for the Future.