Abstract
Finding and financing long-term care services is a rising concern for older adults, persons with disabilities, and their families. It is also a major challenge faced by state and federal governments.
In the marketplace of today, a tool that allows for collaboration across the care continuum to support patient care is inexistent.
AtCura is a Southern California company with disruptive healthcare technology intended to be a solution to the inefficiencies of the discharge process. This paper is a study of AtCura from the business information management point of view.
We will discuss the background information, the current problem, AtCura’s goal to solve the problem, a brief SWOT analysis for the company, the business parts, and the proposed solution.
Keywords: long-term care, healthcare, disruptive technology, senior living, elderly
Background: AtCura
AtCura, Inc. is a Southern California company founded in 2012. It is a B2B and B2C technology company focusing on post-acute care coordination and the long-term care needs of the elderly and people with special needs.
Individuals may receive long-term care services in a variety of settings: in the home from a home health agency or from family and friends, in the community from an adult day services center, in residential settings from assisted living communities, or in institutions from nursing homes, for example. Long-term care services provided by paid, regulated providers are a significant component of personal health care spending in the United States.
Finding a way to pay for long-term care services is a growing concern for older adults, persons with disabilities, and their families, and is a major challenge faced by state and federal governments.
The number of individuals in the U.S. over age 85 will increase by 18.7% by 2020, and the number of individuals between the ages of 65 and 84 will increase by 38.8%. In 2010 there were nearly 40 million seniors over the age of 65. This number is expected to reach over 54 million by 2020. (Grayson & and Velkoff, 2010).
There are an estimated 30,000 assisted living facilities (ALF) in the U.S.; estimated 1,000,000 residents pay $3,000 to $4,500 per month for senior care (Ortiz, n.d.). Over 8,000,000 people in the U.S. used long-term care services in 2012 (Harris-Kojetin, Sengupta, Park-Lee, & Valverde, 2013). Tell (2013) reports that up to 70% of people over 65 will eventually need long term care for an average of 3 years.
Nearly one in five Medicare patients discharged from a hospital -approximately 2.6 million seniors- are re-admitted within 30 days, at a cost of over $26 billion every year. The Center for Medicare and Medicaid Services (CMS) spends close to 25% of Medicare beneficiary expenses on post-acute care. (Center for Medicare & Medicaid Services, n.d.). Medicaid finances a major portion of paid, long-term care services, followed by Medicare and out-of-pocket payments by individuals and families.
However, the distribution of financing sources varies by provider sector and by population. Most residents pay out-of-pocket for assisted living, with a small percentage using Medicaid to help pay for services. In contrast, the largest single payer for long-term nursing home care is Medicaid, whereas Medicare finances hospice costs and a major portion of the costs for short-stay, post-acute care in skilled nursing facilities for Medicare beneficiaries (Tell, 2013).
Standard placement of a resident in a board and care facility (B&C), residential care facility for the elderly (RCFE) or adult residential facility (ARF) generates up to 125% in commissions to the placement agent, which translates to $2500 – $6000 each.
This archaic model is comparable to the travel industry of the 1980s with agents holding all the knowledge and information while consumers are left with no transparency in the process. The facilities are forced to use these agents because they have no other viable, sustainable method for lead generation. The existing online lead generators have the same high commission model with little or no customer service provided to the facilities.
Recent governmental advents of Accountable Care Organizations, Bundled Payment plans and Duals pilot projects are designed to promote innovative ways to curb costs by more efficient care; but, no tool exists in the marketplace today that allows for collaboration across the care continuum to support patient care.
Statement of the Problem: AtCura
The pitfalls that exist along the long-term care path today contradict quality care and erode cost efficiency.
Project Goal: AtCura
AtCura is positioned to be a solution to the inefficiencies of the discharge process with its disruptive healthcare technology. The company’s proprietary analytical platform utilizes cloud-based technology to support the transition process of patients across multiple care levels throughout the care continuum by tracking beds, coordinating real-time care and analyzing patient data, to reduce overall health care costs associated with long term care.
SWOT Analysis of AtCura
| Strengths
Technology Economy of scales Access to the Market Size of the Market Relationships Patent Pricing model First in the market
|
Weakness
Financial resources and access to funding Training Geographical location of IT team Speed-to-market Size of the Market Market awareness User adoption Complexity of Healthcare system |
| Opportunities
Revenue streams Innovation First in the market Proprietary software New products and solutions Expanded Markets Market stabilization and consolidation Education |
Threats
Piracy Established competitors taking Market share Data inaccuracy and timeliness Data mining and security vulnerability Inconsistent data entry by end users HIPAA violations Litigation Market disruption Stagnation
|
Business Parts
AtCura Payroll includes Software Developers, IT, HR, Sales, Marketing, Call Center, Administrative, case managers, social service, transition specialists.
The AtCura platform is based on a technology stack which includes enterprise architecture with MySQL database with HIPPA enabled security, PHP, Ajax, Java and other technology for the front end and User interface. All these technologies are hosted in the cloud using Amazon Web Services with failover, redundancies and load balancing. The AtCura platform provides connectivity to other applications via web service calls.
Business information management at AtCura requires a holistic security testing approach to cover the whole software development lifecycle across all products and security threats. According to Bachmann and Brucker (2014), most security vulnerabilities are caused by bad programming patterns, misconfiguration of security infrastructures, functional bugs in security infrastructures, or logical flaws. AtCura’s IT department is using several security testing techniques to help detect vulnerabilities.
To achieve excellent supply chain management, AtCura capitalizes on the requirement for internal and external collaboration (Wallace, 2013). For the supply chain management, facilities are categorized into one of three groups:
- Subscription Member: Subscriber who enrolls their facility or facilities and pays the annual subscription fee to take advantage of the benefits as a member of the AtCura network. Subscribers maintain and update their profile and availability regularly in accordance with the AtCura Terms & Conditions. Subscription service of $5/bed/month paid annually by RCFEs.
- Affiliate Member: someone who enrolls and publishes his or her facilities in our system but elects not to pay the annual subscription fee. Affiliates maintain and update their profile and availability regularly in accordance with the AtCura Terms & Conditions. Affiliate members pay an additional Transaction Fee based on room rate.
- Unaffiliate Member: facilities that are listed on our site that have either declined enrollment or have not yet been contacted for enrollment by the AtCura Enrollment Team. The facility is published on AtCura with a limited “listing only” profile that is managed and controlled by AtCura. Unaffiliate members pay an additional Transaction Fee per based on room rate.
Solution
AtCura has established an online platform with an inventory of long-term care residential facilities. This is searchable by consumers and health professionals with specific criteria including preferred cultural, social or medical needs. AtCura directly collects proprietary details from these facilities, including two very unique features: listing of room prices and updated current bed availability. It tracks the available beds for hospitals, skilled nursing facilities (SNF), RCFEs, ARFs, and B&Cs.
The company connects networks of clinical and non-clinical providers allowing for improved communication, ease of access, and appropriate use of care services. AtCura’s advanced proprietary technology system follows patients in and out of acute, sub-acute skilled nursing, long term care and residential care settings.
The technology developed by AtCura captures detailed data of patients and facilities for high level matching to appropriate care facilities, beds and other vital resources.
AtCura intends to work with health plans, medical groups and other entities involved in population health to reduce health care costs associated with the frail and elderly residing in long term care residential facilities. The AtCura platform also has features that will provide member data to health plans.
As part of the feasibility study, AtCura established a pilot program that covers 5 counties in Southern California and statewide in Arizona, including RCFEs and SNFs totaling 116,848 potential beds. During the first year, a one percent penetration of the market would yield annual revenue of $558,585. After five years, 10% penetration yields annual revenue of $5,585,835. The revenues were calculated by multiplying the number of beds available per month by a per bed cost, by 12 months to get total annual revenue potential, then multiplying by the estimated penetration.
Conclusion
AtCura is a comprehensive resource that provides knowledge and services to families who are trying to make informed decisions about senior living and long-term care. It is a cost-effective solution to the financial burden caused by the existing disconnection in the care continuum. The company connects networks of clinical and non-clinical providers allowing for improved communication, ease of access, and appropriate use of care services.
We believe that there is an immense opportunity to have one online platform that can be used by consumers for residential searches while also having a database that includes all care facilities for the needs of care managers, social workers and discharge planners who can use both databases. A platform that is accessible by various stakeholders would be a unique and disruptive solution to the current inefficient and burdensome system.
This platform can be used as a model for other problems and applications, such as care and services for the veterans, for homeless, and even for pets.
References
Bachmann, R. & Brucker, A. (2014). Developing secure software. Datenschutz und Datensicherheit, Volume 38, Number 4, 257-261. doi: 10.1007/s11623-014-0102-0.
Center for Medicare & Medicaid Services (n.d.). Community-based care transitions program fact sheet.
Grayson, V. K. & Velkoff, V. A. (2010). The next four decades, the older population in the United States: 2010 to 2050 (Current Population Reports, P25-1138). Washington, DC: U.S. Census Bureau.
Harris-Kojetin, L., Sengupta, M., Park-Lee, E., & Valverde, R. (2013). Long-term care services in the United States: 2013 overview. National Center for Health Statistics. (DHHS Publication No. 2014–1040, Series 3, No. 37). Washington, DC: U.S. Government Printing Office.
Ortiz, J. (n.d.). Assisted living facilities. SBDC Net.
Siricharoen, W. V. (2011). Exploiting user centered design approach and interactivity in web based software developing. Journal of Software Engineering and Applications, Volume 4, Number 8, 465-475.
Tell, E. (2013). Shaping affordable pathways for aging with dignity. Overview of Current Long-Term Care Financing Options.
Wallace, P. (2013). Information Systems in Organizations: People, Technology, and Processes. Upper Saddle River, NJ: Prentice Hall.
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