Old News: Innovating eldercare the new old-fashioned way

Silver Bullets for Graying Citizens

Here’s some Old News: Senior citizens are the fastest growing segment of the population in the US. One popular back-of-pocket statistic in the healthcare industry is that 10,000 people are turning 65 every day. And while Americans are living longer, those extra years come with added healthcare costs.

As Mr. Chunka Mui writes in Forbes: “Boomers’ medical needs will be magnified by the growing prevalence of obesity and chronic diseases.

  • More than one-third of adults over age 60 are obese and 25% are diabetic. Nearly two-thirds over 65 have high blood pressure.
  • Three out of four over 65 have multiple chronic conditions.
  • Total cost, including Medicare, out-of-pocket and long-term care costs, is estimated to rise more than 7% per year between now and 2025.
  • According to the Congressional Budget Office, Medicare spending alone is projected to increase from $591 billion in 2016 to $1.1 trillion in 2026.”

High Tech: IoOT (Internet of Older Things)

Connected health pioneer Dr. Joe Kvedar recently wrote a new book in which he calls out the need to address both “lifespan” and “healthspan” in delivering solutions to care for the elderly. His three major keys to healthier longevity involve maintaining three things: A Sense of Purpose, Social Connections, and Physical Activity. As the head of Partners Center for Connected Health, Dr. Kvedar is keen on the potential for connected technology from communication tools to fitness trackers to make an impact on the health needs of senior citizens.

source: HealthXL’s “New Models of Care Report”, 12/17

In their New Models of Care Report, HealthXL partnered with AARP and key thought leaders to pull together a comprehensive market scan of the booming Boomers market in digital health. Here are a couple of their key takeaways:

  1. A business case and a business model are two distinct things: We’ve seen time and time again that there is no “if you build it, they will come” in digital health. Successful business models will be nimble and responsive to new regulatory opportunities, e.g. bundled payments, as well as creative with regards to the particulars of this market, e.g. the consumer spending power of seniors and their families.
  2. See the industry as a forest, not just trees: Neither health systems, nor technology innovators are able to succeed in a vaccum; they will need to integrate with each other to develop “high tech, high touch” offerings that also offer a seamless, easy to use experience for seniors and caregivers. Cities, non-profits, and other community organizations also play enabling roles — though getting numerous stakeholders to play well together is an ongoing challenge.

AARP has been convening technology innovators for the better part of the last decade. The myth that older folk don’t like technology has been firmly disproven, and now it’s safe to say that this is a stable and growing market for digital health solutions that bring the right product and business strategy to the table.

Low-Tech: Independence by Interdependence

One of the more interesting “low-tech” approaches to eldercare is the “village” model, recently profiled in NPR. Villages were started in Boston in 2001 as a peer support group where a group of elderly citizens could help each other stay out of nursing homes or assisted living facilities. It’s funded by annual membership dues ranging from $250 up to $1k for couples, depending on the model.

With help from a non-profit, this model has grown to over 230 self-started communities across the country, with another 130 in development.

source: screenshot, Village to Village Network (12/17)

These dues include perks like transportation, social events, negotiated discounts on medical or wellness services, provider referrals, and access to volunteers to assist with everything from grocery shopping to computer support. These may seem trivial or quaint at first glance, but they carry plenty of economic rationale, as Stuart Butler at the Brookings Institute pointed out at a roundtable event:

“Falls, if you think about the elderly — The Centers for Disease Control estimates that we spend probably about $30 billion a year fixing people who have fallen, and in many cases this is an elderly person who is in an apartment maybe with rugs that are slippery or with a bathroom that is not really well designed and it’s more easy to fall and so forth.”

In this light, a model that affords help to change a bulb, take out trash, or handle other household chores starts making more sense. Moreover, the village model can easily check off all three of Dr. Kvedar’s “healthspan” criteria above: Sense of purpose, social connections, and physical activity. It even engages non-village seniors who work or volunteer as drivers, cooks, or other aides. In terms of a more direct financial impact, Villages provide the type of social safety net that the Center for Medicare and Medicaid Services (CMS) has started to incentivize for readmissions prevention — albeit indirectly, for now.

Though they represent a relatively low-cost, high-impact intervention, villages are not a panacea for all elderly citizens; they’ve tended to skew towards middle-class and wealthier demographics due to financial and language barriers, though that is beginning to change, as outlined in the NPR story. These models been successful across urban, suburban, and rural regions, raising the possibility of third party sponsorship by a major payor, or subsidization by some Medicare Advantage or Dual-eligible programs.

Connecting Tech and Touch: The new old fashioned way

Going into 2018, it’s a bit naive to discuss technology markets in healthcare without talking about the human considerations involved in purchasing, implementing, and adopting would-be solutions.

And by the same token, discussing human interventions without considering the role that data, smartphones, and the internet of things (IoT) are actively playing in augmenting the scalability and impact of those programs is a myopic way of designing solutions for a future that is graying, fast.

The good news is that the innovation conversation has largely begun to move past these artificial distinctions. Just as “connected health” evolved from wired devices to wireless devices, it’s seemingly come full circle to refer to human to human connections, facilitated with some data, a device, or even a good old fashioned phone call as needed.

This approach was validated years ago, with the acquisition of CareAtHand, a simple technology platform that armed the flies on the wall of at-risk patients — think busdrivers, nurses, support staff — with the tools to capture important health indicators and risk factors. It demonstrated that the social aspects of patients’ lives were a tremendously underused resource in our quest for prevention, early detection, and more holistic risk management.

So, what might a souped-up Village model look like? No need to imagine here — A company called AgeWell Global has already built it:

“AgeWell Global based in Washington, D.C., is pioneering a model of elder-to-elder peer care. It hires adults 55 years-plus to help look after other older adults, who are somewhat more frail. Agewells–as the part-time community health workers are known–visit their peer mates at home, offering friendship and support, and gathering basic health information, which they enter into a mobile app. The app has an algorithm that crunches the data and triggers automatic doctor referrals, if the condition warrants it.

AgeWell aims to be an early warning system of potential health problems before they become full-blown health problems. By keeping tabs of elders at home, it hopes to cut expensive hospital or emergency room visits. At the same time, it also provides employment for Agewells, who are retired, or semi-retired, and may themselves feel the need for more social interaction.”

Here is an example that weaves a technology platform together with the power of human connection to address the growing challenge of eldercare, addressing both acute “healthcare” use cases that save money, as well as the broader “health” opportunity of keeping people healthy by enabling them to engage and support each other in an authentic way.

What are other examples of eldercare innovations you’ve seen that are worth sharing? Leave comments or share them on twitter!

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