Evolving Long-Term Care: From Traditional Models to Tech-Enabled Solutions

The US long-term care (LTC) and, more specifically, the long-term care insurance (LTCI) sectors are going through a massive shift. Consumers, care providers and insurers are all under financial pressure from rising care costs. Care delivery labor shortage and related costs is a complex issue exacerbated by economic dynamics. Despite the sector’s struggles, overall demand is rising. US census data shows that the 65+ population will exceed 70 million by 2030. Research shows many of them will need long-term support services fueling some optimism for the industry’s growth. As an early sign of resurgence, several states are actively collaborating with private insurers to redesign and launch new types of LTCI products and services.

Amidst the crisis, one trend is undeniable: technology innovation in consumer healthcare and its data ecosystems has the potential to revolutionize the entire LTC value chain. Many long-term care technology leaders are hard at work upgrading legacy systems that underpin middle- and back-office operations, care management and service delivery. However, it is crucial for the next generation CIOs to go beyond modernization and tap into new forms of care-related data generated from consumer health technologies (CHTs). Utilizing data from care-related technologies, alongside analytics and digital platforms, LTC technology leaders can transform long-term care into a more personalized, efficient and affordable experience for all stakeholders.

Modernizing LTCI with Data

For LTC insurance, underwriting and claims have the greatest potential to be modernized. The rise in wearable devices, remote health monitoring and mobile apps will open up access to granular and contextual health and wellness data. LTCI underwriting and claims processes will tap into this granular data to better evaluate policyholders’ abilities to perform activities of daily living (ADLs) and assess cognitive risks and lifestyle factors such as community support. As new data infusion improves margins, the next-generation LTCI technology leaders will see value in becoming orchestrators of care service technologies. They will also build sophisticated data integration architectures to embrace a collaborative ecosystem of partners in the care delivery value chain.

Improving Tech-enabled Preventive Care Through UX

The healthcare and insurance sectors are moving toward tech-enabled preventive care to improve health outcomes and reduce costs. To gain broader acceptance and adoption, technologies deployed for preventive care must have intuitive UX design and seamless, empathic experiences at the critical moments in care delivery. Care recipients face a range of physical, cognitive and social changes that can affect their abilities and preferences for human and technology interactions. A coherent set of well-designed technologies will surely ease the adoption of tech-enabled care services in a recipient’s living environment.

As an example, home-based diabetes self-care is a disjointed experience today. Effective UX design can create seamless experiences between diabetes home testing kits, health-monitoring apps and the care recipient’s specific abilities. A user-centric design experience that integrates blood test strips, data capture and screen navigation empowers individuals to actively manage their health using tech-enabled preventive care solutions.

Tackling Perpetual Risk of Fraud

Finally, implementing technology for fraud detection in LTC insurance is crucial. The personalized nature of LTC services increases the propensity for fraud through false representation in coverage eligibility, fake claims or policy misuse. Fortunately, advanced analytic tools can spot fraud using data from CHT devices and electronic visit verification (EVV). Predictive models can highlight early warning signs, enabling quick alerts and investigative workflows to catch fraud early. Inevitably, LTC insurers will tap into all the data in the ecosystem and deploy AI/ML tools to continuously combat fraud.

Transforming the LTC technology landscape requires a tough balance between modernizing the old systems and building for the new digital world of care services. Armed with the vision as orchestrators of data and tech-enabled experiences, LTC technology leaders guide the change with an innovative ecosystem of solutions, better engaging long-term care recipients.