The Longevity

Breg Enters the Increasingly Crowded Virtual Rehab Field

With providers moving toward bundled payments and "value-based system" in healthcare, costly post-surgical services like physical therapy are finding themselves on the chopping block. One consequence is an accelerated move toward virtual rehabilitation. And companies like Breg who have developing products to enable this remote care are set to capitalize on their foresight.  

 “We are actively moving toward online physical therapy programs and our goal is to eliminate physical therapy for hips, only use in knees when we need it …,” said Richard Iorio, a hip and knee surgeon at NYU Langone Medical Center, at a panel discussion on orthopedic bundled payments last week at AAOS.

At the recently-concluded annual meeting of the American Academy of Orthpaedic Surgeons (AAOS), Breg executives were showing off a new sensor-device [called Flex] connected to a mobile app that can guide patients through their daily exercise routine following orthopedic surgery.

This is the first time the company has forayed into the digital health, Internet of Things space, confirmed Brad Lee, president and CEO, in a booth interview [with MedCity News] last week where demos of the Breg Flex system were being presented. 

Breg's Flex is certainly not the only virtual rehab provider in the space. Differentiators among them are what device they require (smartphone vs. console), whether they offer clinical decision support and therefore require FDA clearance and how well they integrate with electronic health records.

[Flex includes a] chargeable Bluetooth wireless sensor, worn by patients to track progress with prescribed PT exercises with a companion mobile app.

The sensor and app work in concert to record range-of-motion that is key to better clinical outcomes. The data is also shared in real time with providers such that clinicians can tweak exercise protocols. The interactive patient app has a virtual avatar that guides patients through exercises. The system can also collect patient-reported outcomes that are key to getting reimbursed for certain orthopedic procedures such as joint replacement under bundled care programs.

...Flex also works with the electronic medical record of a practice or a hospital [and] is FDA-exempt because it simply monitors and tracks and does not offer clinical decision support.

Competitors include Reflexion Health's Vera and RespondWell, recently acquired by Zimmer-Biomet, an Indiana-based company that currently holds the largest market share of hip and knee replacements.

Reflexion Health’s Vera virtual rehab program...uses the Microsoft Kinect gaming console and the Vera avatar to guide patients through their at-home exercise regimen. The system received FDA clearance in 2015.

....RespondWell virtual rehab FDA-cleared.

...Jintronics and Reflexion Health use the Kinect platform thereby tying joint replacement patients to a console or a TV to do their daily rehab. All Breg Flex needs is a cell phone, or tablet and a sensor-device. In other words, patients can be out and about, and still get their rehab done.

[T]he virtual rehab space is getting crowded with several companies vying to win. But Breg’s CEO shrugged it off. “There is a huge market and there will be a lot of good players in the space,” he said.

Photo: Breg Inc.

Senior Living Facility Launches Novel Pilot to Support Aging in Place

Mission Health is “in new territory,” Tina Thomas, senior vice president of operations, told Home Healthcare News. They are launching a pilot with digital health startup Reemo and business analytics firm Teradata to collect and analyze behavioral and health data not only on their own residents but also on potential residents who hope to age in their homes as long as possible.  

Founded in 2013, Reemo utilizes smartwatches and sensors to gather a variety of health data about seniors, and provides that in dashboards to caregivers, family members, and the older adults themselves...Teradata [is] a major business analytics firm that did $2.5 billion in revenue in 2015 and counts major health systems such as Harvard Pilgrim among its customers. Together, the companies believe they can deliver super-charged analytics and clinical insights about senior populations.

“We’d been chatting with Reemo and were very excited about the wearables, but it was the analytics piece that captured our attention,” Tina Thomas, senior vice president of operations at Mission Health, told Home Health Care News. “It’s a different platform than what we’ve seen.”

The Residence at North Ridge, a [Mission Health continuing care retirement community (CRCC)] in Minneapolis with 150 total units of assisted living and independent living, will be the site for the Reemo/Teradata pilot.

The pilot uses Samsung Gear S2 watches along with some in-unit sensors. Reemo co-founder and CEO Al Baker says that the watch’s “cool factor” is helping them recruit trial participants.

The devices capture information such as sleep patterns, number of steps, and heart rate. Taking these raw data points and being able to translate them into clinical insights is where Teradata—with its industrial-scale capabilities and previous work with massive amounts of health data—will be able to help Reemo and providers go the next level, according to Randy Lea, vice president of strategic initiatives at Teradata.

What makes this Mission Health pilot so novel is that it will also be offered to non-residents who hope to age in place as long as possible. In addition to building brand awareness in the community at large for Mission Health, the data can help caregivers and potential residents make informed decisions about when it’s time to move into assisted living, for example.

[Seniors] will be able to come into the CCRC on a regular basis for wellness exams...“This is new territory for us,” Thomas said. “Someone could come in once a month, and we’d look at her data, and say, you’ve got this many steps, your heart rate is x, we can do some other baseline assessments to help them make some decisions about their physical activity and what they can do to feel better, and to have better conversations with their doctors.”

Photo Credit: “Samsung” by Dennis Haslam, CC BY 2.0

AARP Announces $10k Innovation Prize

The Innovation Champion Award is aimed at spurring innovation in aging, "empowering people to choose how they live as they age." A primary criterion, however, will be universal design, that is, design that appeals and offers usability to all age groups.

Caregiving will be the theme of the competition this year, a field that will demand innovation over the next few years, according to AARP.

By 2020, 117 million Americans are expected to need assistance, but the overall number of caregivers will only reach 45 million. This is a huge opportunity for companies large and small to reach an emerging market – and improve the lives of caregivers and their recipients.

Entries in any of the six following caregiving categories will be accepted:

  1. Health & Safety Awareness
  2. Care Coordination
  3. Transition Support
  4. Social Well-Being
  5. Caregiver Quality of Life
  6. Daily Essential Activities

Companies interested in competing in the event need to apply by April 15th. In addition to the $10,000 prize, winners will receive a trip for 2 company representatives to Washington D.C. where they will be given a tour AARP’s Innovation Lab and meet with AARP Chief Innovation Officer, Terry Bradwell. They will also be given official recognition at AARP HQ event, an ad or Editorial coverage in i3 magazine, and AARP Innovation Champion consulting.

Wall Street Journal: Startup Could Improve Senior Care by ‘Predicting Death’

Aspire Health, a high-profile startup recently featured in the Wall Street Journal, has garnered significant capital and attention for its “death-predicting” algorithm to identify patients who could benefit from palliative care. The company already has provided care to about 1,600 residents in independent and assisted living and is exploring deeper partnerships in the space, CEO Brad Smith tells Senior Housing News.

Co-founded by Smith and former Republican Senate Majority Leader Bill Frist, Nashville-based Aspire in October secured $32 million in funding from GV, the firm formerly known as Google Ventures. So, it’s safe to say investors see a bright future in the Aspire model.

This model is based on that “death-predicting algorithm,” to use the WSJ’s language, which flags patients at risk of dying within a year. Aspire’s caregivers then can provide interventions for these patients in their homes—including senior living communities—to keep their quality of life high and their costs of care low, such as by preventing unneeded hospitalizations.


Baby Boomers Get To Change Diapers Again; This Time It’s Their Parents

The title of my article doesn't conjure up happy thoughts, does it? Unfortunately, this may be the new reality for many Baby Boomers, caring for parents at home. In a recent interview with the tech/healthcare startup, Hometeam, CEO Josh Bruno illustrated the dichotomy of adults providing direct care for their parents and grandparents. “Close to 92% of adults would prefer to live in their own home as opposed to a nursing home.  This, in conjunction with financial considerations, means that in the U.S. there are roughly 55 million adults taking care of their parents.”

How did this happen?  According to a 2016 report from the Population Reference Bureau, “The combined effects of delayed childbearing and longer life expectancy mean more adults in later-middle age may be ‘sandwiched’ between the competing demands of their children and those of their aging parents and parents-in-law. Women—who have traditionally served as care providers—are more likely to be employed than in previous generations, limiting their availability, and increasing their time constraints.”


Aging Boomers to Depend on a Little Help From Their Friends, Extended Kin

Family members already form an "invisible workforce" that cares for America's frail elders. But changes in policy and family structure — from later-life divorce to smaller families — suggest that friends and extended family will play even more important roles as caregivers in coming years.

Eighteen million Americans already care regularly for a fragile older relative, most often a spouse or a parent, and the number is expected to at least double by 2050.

Meanwhile, aging baby boomers have relatively fewer children than previous generations, creating what Richard Schulz, director of the University Center for Social and Urban Research and associate director of the Aging Institute at the University of Pittsburgh, calls a "looming gap between what's needed and its availability."

Those most in need of help are individuals with dementia or who have difficulties taking care of their own basic needs, from dressing and bathing to preparing their own food and managing their medications and finances, among other daily tasks.

That gap will likely widen further because fewer Americans are marrying, couples who don't marry are less apt to see themselves in caregiving roles for each other, and divorce among older couples has been on the rise. So caregiving networks increasingly include what some gerontology experts call "chosen kin" and "collateral kin," an umbrella that includes friends, neighbors and more distant relatives, like nieces and nephews or in-laws.

That shifting landscape of caregiving was a major topic during the 2016 annual meeting of the Gerontological Society of America, held in New Orleans in mid-November. Experts say not only are family and friends tapped to provide a large portion of the care frail old people need, but they're also tasked to provide more complicated care.


Online tool helps determine when loved one needs more senior care

There's a new online tool from the Council of Aging of Middle Tennessee to help guide people through the early steps of whether an aging loved one needs more, or different, care.

The council is partnering with Roobrik, a start-up in Durham, N.C., to put a 23-question assessment on COA's website that asks questions of family members, friends or even the individual to better understand the status and the options for care.

The online tool is great for the Council on Aging of Middle Tennessee's audience, who are often professionals who don't have the time to exhaustively research options, said Grace Smith, executive director. The Council on Aging puts together a directory of resources that people can peruse, but has been getting feedback that indicates the volume is overwhelming.

People looking for care often don't know what type of care is needed or what options are available.


How Home Health Providers Are Using Data in End-of-Life Conversations

For many home health patients who are chronically ill, there is a natural progression that takes place: home health is provided, eventually a palliative review is conducted after some period of decline, and the patient moves to hospice care where he or she spends on average, 7 to 12 days before passing away.

But what if patients could improve their quality of life, moving into hospice care sooner and spending a longer period of time with their friends and family at the end of their lives?

One technology provider is working with home health providers to this end. By running a complex analysis of OASIS patient data, the technology can gauge which patients are likely to experience decline leading to their end of life.

“Identifying patients earlier is a real value at the end of life when the patient overwhelmingly wants to be at home with family,” said Dan Hogan, president, CEO and founder of Medalogix, during a recent MedCity Engage Conference panel discussion in La Jolla, Calif.


Start-Ups for the End of Life

Death and dying can be costly, but they are rarely considered a business by consumers. Many would rather not ponder critical decisions about feeding tubes, funeral homes and other end-of-life issues until the need is thrust upon them.

But as our population ages and the industry gets more attention, new firms — many of them technology companies — are setting out to compete on price and convenience.

This $18 billion funeral industry has long been a technology holdout, said Dan Isard, president of the Foresight Companies, a financial management firm in Phoenix, which specializes in funeral and cemetery professions.

Mr. Isard said funeral directors “would rather sit across from someone and talk to them, listen to them, than have them go online and try and figure it out for themselves.” That is also one reason the death care industry, as it is called in the industry, has been able to maintain its lack of pricing transparency. But with nearly 2.6 million people dying annually in the United States, entrepreneurs see an opportunity to innovate.


AARP launches caregiver-focused website with help from UnitedHealthcare, Teladoc, others

AARP Services, a subsidiary of AARP, has launched a new, interactive website designed to address gaps in the caregiving market, from scheduling and telehealth to professional advice.

The CareConnection site, currently in beta, aims to be a central hub for caregivers, and is piloting services from a number of companies that provide resources for caregivers. The idea for the site is based on findings from a report conducted by the AARP and the National Alliance for Caregiving, which found the adoption of digital tools and technologies that make caregiving easier, more efficient and higher quality is still low.

“[AARP Services] is working as part of AARP’s organization-wide effort of innovation, advocacy and education to help millions of caregivers in the United States,” the company’s CEO Larry Flanagan said in a statement. “There couldn’t be a more appropriate societal challenge that calls upon technology and design to address.”