Meeting patients where they are: A new approach to care for older Americans and the role of the specialty pharmacy

CONTRIBUTOR

Mark Vineis

Healthcare industry executive

Picture the following patient in your mind:

He’s 72 years old. He’s had a very long, physically-strenuous career and a history of drug use and smoking. What comes to mind when you think of this patient? Does he look weak and sick? Or, does he look like Mick Jagger?

Mick Jagger is the perfect example of how stereotypes about older patients can be misleading. Mick is 72 years old and has a history of using drugs, alcohol and tobacco. However, he has maintained a 28-inch waistline for most of his life, he exercises 5-6 days per week and eats a diet of whole grains and organic foods, and his father lived well into his nineties. He still stomps around on stage and delivers a high-energy performance night after night. His chronological age may be 72, but does that number provide a complete picture of Mick’s health? Does his age alone explain his healthcare needs?

The fact is, stereotypes about older people are ubiquitous in our society, but when those stereotypes become the basis for how healthcare providers treat patients, it can result in inappropriate or ineffectual care.

Understanding and meeting the healthcare needs of older patients has never been more important than it is today. An average of 10,000 people are turning 65 each day and as the population of older Americans grows, so too will the number of patients being treated for cancer, rheumatoid arthritis, diabetes and other complex diseases.

Specialty pharmacies are poised to play a critical role in engaging these older patients with programs designed to improve adherence, manage dosing and foster appropriate utilization – but only if they are able to fully understand the needs of this changing population and deliver services designed to meet them where they are.

Redefining the concept of age

When we discuss older patients, we typically classify them by their chronological age. However, this definition of age is merely mathematical and it doesn’t provide a complete picture of the patient. We need a more sophisticated metric for defining someone’s true age that also factors in their behaviors, physical health and lifestyle.

”Functional age” is a more comprehensive approach to assessing the needs of older patients. Functional age is determined by three components: (1) chronological age; (2) biological age, which reflects the patient’s physical health and genetic history; and (3) psychological age, which includes the patient’s mental state and attitudes. By evaluating all of these factors, functional age provides a more accurate measurement of a patient’s well-being and can help healthcare providers to better determine the services they need.

Additionally, the correlation between functional age and independence can help us determine the level of personal services needed. Functional age and independence are inversely related – the lower a patient’s functional age, the more independent they are. Patients with a low functional age are more likely to take advantage of self-service programs that offer immediate access to information and help on demand. As a patient’s functional age increases, providers may need to alter their services to provide a higher level of personalization with more one-on-one engagement and more frequent monitoring. In addition, providers may interact with caregivers more frequently as a patient’s functional age increases. Delivering a level of service that is consistent with the patient’s functional age can ultimately result in a better patient experience and improved outcomes.

A significant number of healthcare providers are already using functional age as a barometer for making decisions about care.  In a recent research study of more than 50 oncologists, Cardinal Health found that 55 percent assessed the functional age of their patients prior to selecting a therapy regimen.  While it’s encouraging to see that half of physicians are already thinking this way about their patients, many other providers, including many specialty pharmacists, are still using a “one size fits all” approach to delivering care and services to patients based on chronological age.

The Baby Boomer influence

Sign up for our monthly newsletter

Stay apprised of expert opinions on approaches to value-based care.

Adapting services and care based on individual behaviors and is particularly critical as a new generation of Americans ages – the Baby Boomers.

Born in the postwar years between 1946 and 1964, Baby Boomers are known for driving societal change in every aspect of their lives. Currently between the ages of 52-70, they can expect to live longer than their parents did, but they also have higher rates of hypertension, diabetes and obesity. Because the Boomer population is larger than any previous generation at 77 million, their sheer size will stretch the resources of the U.S. healthcare system as they age.  But more importantly, their attitudes and behaviors will force healthcare providers to rethink the way that care is delivered.

Baby Boomers have defined the modern notion of consumerism. Known for being savvy, discerning shoppers who are eager to spend money on everything from cars to luxury goods to travel, Boomers will drive healthcare providers to create a more consumer-like experience for treating patients as they age.  This will mean offering more care options and providing an enhanced level of service and support that is more akin to buying a latte at Starbucks or ordering a book on Amazon than it is to going to the doctor.

Baby Boomers will also be the most tech-savvy generation of older Americans ever. Having lived through such scientific advances as the birth of space travel and the sequencing of the human genome, Boomers are quick to embrace technology that will improve their quality of life. Consider these statistics:

  • Boomers spend more time consuming online content than both Millennials and Gen Xers.
  • 14 percent use mobile phones as their primary device for accessing online content.
  • The internet is one of the first places Boomers go to conduct health research.
  • They are interested in monitoring their health using new technologies, such as wearables and data collection tools.

These trends suggest that healthcare providers will need to evolve their services to incorporate new technology that will help Boomers manage better health as they age. Tools that support health management and independent living will become particularly relevant.  According to a USA Todaysurvey, 75 percent of Boomers say they intend to live in their current home for the rest of their lives. They don’t want to burden their children; they want to age in place and will use technology to retain control of their lives and maintain their health.

Implications for specialty pharmacies

Sitting at the intersection between the healthcare provider, the drug manufacturer, the payer and the patient, specialty pharmacies will play an increasingly important role in supporting Baby Boomers as they become senior citizens.  The need for patient education and adherence programs for patients with complex diseases will continue to grow, as will the demand for care coordination services for those who face reimbursement challenges or struggle to navigate Medicare.

Yet, specialty pharmacies also will be under pressure to evolve their offerings to meet the expectations of seniors as the market becomes increasingly competitive. In order to succeed, specialty pharmacies will need to adapt in the following ways:

1) Adopting assessment tools to measure functional age

Identifying the functional age of patients – and distinguishing the “Mick Jaggers” from seniors who are functionally older – starts with an accurate assessment at the time of the patient intake. While these assessment tools exist today, they are not widely used. Going forward, leading specialty pharmacies will not only use such tools regularly with new patients, they will routinely monitor existing patients, ensuring that changes in functional age are taken into consideration throughout the care continuum.

2) Establishing a spectrum of services to meet seniors where they are

Once functional age is established, specialty pharmacies will need to expand service offerings to better address the individual needs of seniors.  Patients who are functionally young will seek healthcare services with an Amazon-like experience – consumer-driven and interactive with immediate access to information through apps and portals.  As patients become functionally older, pharmacies will need to shift to services deliver more one-on-one engagement, such as counseling and care coordination via phone with a pharmacy technician or patient support representative.

3) Embracing new technology to support better care

Baby Boomers have grown accustomed to technological advances that improve their quality of life. In the coming years, new healthcare technologies such as robot companions, wearable/implantable medical devices, medicines with tracking sensors, and alternatives to nursing homes such as portable housing units and smart homes, will provide older patients with smarter, more intelligent care and will enable seniors to remain independent longer. Specialty pharmacies will need to be early adopters of these technologies because many of these tools will be used to support adherence and appropriate medication use. They will also play a key role in aggregating the data collected from these devices and delivering it back to providers and manufacturers.

Coming together for better care

Baby Boomers will redefine what it means to be a senior citizen, and as they do, the traditional “one-size-fits-all” approach to treating older patients will no longer be adequate.  Specialty pharmacists will continue to play a very relevant role in helping older patients to manage their complex diseases, but the way they support these patients and the experience they provide will need to evolve with the changing demands of a new generation. Providers can no longer afford to group older patients in one bucket. They must use functional age, assessment tools and new technologies to build an adaptable, personalized experience that meets patients where they are.