Dr. Allan “Chip” Teel, teacher, physician, innovator and entrepreneur, has plotted an independent path throughout his professional life. Now at age 66, when he might well be contemplating retirement, he is instead embarking upon a challenging new mission: to reconfigure the way health care is delivered to aging Mainers across the state.
Recently named medical director for clinical systems innovation at Brewer-based Eastern Maine Healthcare Systems, Teel, who is low key and soft-spoken, says the change in Maine reflects a national trend being driven by a combination of economic, cultural and medical factors.
The tax-funded Medicare program for Americans 65 and older already has started reimbursing medical providers for how well they manage their patients’ health and penalizing them for unnecessary diagnostics, treatments and inpatient admissions, he explained. That trend is growing, and by 2018, he said, Medicare aims to allocate up to 50 percent of its coverage for compliance with specific health care guidelines and positive patient outcomes instead of the more traditional fee-for-service payments for medical interventions. That means hospitals, doctors and other health care providers have a strong incentive to keep older Americans well, independent and out of institutional care when possible.
In addition, and perhaps more importantly, repeated surveys have shown that older Americans have a powerful preference for staying in their own homes and communities as they age and through the end of life, Teel said.
“Instead, we know that about 28 percent of Medicare spending occurs in the last few weeks of life,” he said, “driven by people dying in an expensive, medicalized setting instead of a warm, loving environment.”
Taken together, he said, these trends make it clear that the health care system needs to retool its approach to caring for the elderly, with a focus on building a powerful safety net of home-based and local community resources.
That doesn’t mean older people shouldn’t have access to needed and appropriate medical interventions, he emphasized.
“Fixing your knee at 85 is not a bad investment if it keeps you active, out of a wheelchair and living independently at home for another 11 years,” he said. “This is all about access and wise investment in appropriate health care.”
Developing a regional response
Teel, who lives with his wife, Carol, in the Lincoln County town of Nobleboro, knows something about these ideas. During his 30-year career as an independent primary care physician in Damariscotta, his patient population has consistently skewed older.
“I was always taking care of old people,” he said. “Maine has the oldest median age of all the states, and Lincoln County has the oldest population of any county in Maine.”
As a result of his patient interactions over time, Teel came to intimately understand the challenges facing aging individuals and their families. These included making appropriate decisions about health care interventions as well as issues related to safety, isolation and independence.
Over the past 20 years, Teel has pioneered a number of efforts to provide low-level support that can help seniors age safely in their homes and communities. He co-founded the Eldercare Network of Lincoln County in the mid-1990s and developed a “home-sharing” model in the region, helping older homeowners pair up with younger adult roommates who could help with daily activities and home maintenance in exchange for free or inexpensive rent. Alternatively, some older community members found safe, affordable housing with young families, occupying a spare room and taking part in family activities in exchange for a modest rent.
“We made some nice matches,” Teel said, but the informal home-sharing model ran into some real-world challenges, including the absence of a next step, when seniors’ needs escalated and occasional problems associated with privacy and trust.
In 1998, Teel opened the first of seven small assisted living homes in towns throughout Lincoln County. Known informally as “the Greens,” they are situated in renovated village houses close to amenities and activities. Pet-friendly, ADA-compliant and staffed by a small team of local caregivers, they each accommodate six to eight residents, except for Hodgdon Green in Damariscotta, which can house 16 residents.
“The idea was born of the rise of high-end ‘retirement homes’ along the coast,” Teel said. “They were in easy reach for people of means, but low-income people didn’t have much opportunity for that kind of living.” By contrast, the Greens are funded almost entirely by MaineCare, the state’s Medicaid program for low-income seniors.
More recently, Teel founded Full Circle America, a for-profit company based in Nobleboro that provides a range of technological services to help keep elders safe and well in their homes. From familiar telehealth technology — which allows doctors, nurses and other medical providers to make online home visits — to edgier in-home cameras, motion detectors and “smart” devices that can turn off appliances and lock doors from a remote location, the aim is to use technology to prolong independent living, promote safety and facilitate communication with caregivers and loved ones.
“My dad was my guinea pig,” Teel said. With his father’s permission, he placed cameras in the home so he could monitor activity and check on his dad’s well-being at any time.
“Because he had limited mobility and used a wheelchair, I could call him when I saw he was tooling past the phone and say, ‘It’s time to take your meds, and I’m going to watch you do it now.’ At suppertime I could say, ‘Go turn on the microwave for two minutes,’ and I could make sure he remembered to eat.”
Teel’s father died two years ago, but Full Circle America continues to operate and has served about 100 people to date, ranging in age from 80 to 105, for about 20 percent of the cost of institutional care.
Scaling up to a statewide system
In his new role at EMHS, Teel plans to bring the solutions he has pioneered to the next level, adapting them to rural and urban areas across the state. Importantly, he said, the organization already has a number of home-based programs in place, including telehealth capability, public health programming that promotes healthy lifestyles and partnerships with agencies that address issues of food and housing insecurity.
Colleen Hilton, president and CEO of the EMHS visiting nursing, home health and hospice arm, said Teal’s innovative thinking and technological expertise will be key to expanding the organization’s existing home-based services.
“We’ve been doing this for years, but now we’ll be seeing an intensification. The broader aim is to facilitate aging in place safely and at a high level of satisfaction for aging seniors,” she said. “The way health care is designed and delivered now is not sustainable. EMHS is investing in the future — not in the hospital but in the home.”
Hilton expects that within the next few months, the organization will have several people under care in the kind of “virtual assisted living” Teel has developed in Full Circle America. “Our healthcare system truly embraces innovation, and Chip is very forward-thinking about what we need to do in the future,” she said.
Teel acknowledges he has a learning curve to conquer as he seeks to scale up his home care model. His first task, he said, is to take an inventory of the programs already working to keep seniors safe at home within the EMHS system. That system stretches from northernmost Aroostook County south to Bangor, Waterville and, since the system’s acquisition of Portland’s Mercy Hospital in 2013, to Cumberland and York counties.
“The task the health care system has ahead of it is enormous,” he said. “It will require skill, teamwork and integrations that will create new opportunities and new demands.”
The payoff is also enormous. “If we can keep you at home where you want to be, if you’re happier, healthier and it costs less [than institutional care], what else do you need to know?”
And on a personal level, he added, “At this stage of my life, this is the most exciting thing I can imagine doing.”
