What was dispiriting to this Editor was that in her now 11 years in related health tech (telehealth and telecare), the status of many issues were the same as in 2006. The inadequacy of ‘aging in place’ supports and “assisted living”; a culture that brutally devalues people as they get older starting after 50; a belief that whiz-bang technology will fix it, but it doesn’t; the non-recognition of ‘aging-consumer-driven healthcare’; the lack of attention from investors because aging is not glamorous–are still there. What was hopeful? The candid recognition of these factors and the open discussion around them. There was a blunt admission expressed somewhat differently by two speakers, June Fisher MD of UC Berkeley and Charlotte Yeh of AARP, that without co-designing solutions with older people, we will get nowhere, and that imposing ‘fixes’ from the outside hasn’t and isn’t going to work. We also have a new middle age of 55-75, but the work market and employers have not adapted to that lengthening of productiveness, with the ‘pasture’ of retirement still pegged theoretically at 65.
Highlights of each panel:
The Longevity Economy, or the Silver Economy, was estimated by Merrill Lynch‘s Surya Kolluri at $7 trillion, with a surprising 90 percent of package goods spending done by 65+, and not just that but also areas such as home improvement. But healthcare spending is about 200 percent over the population average, and caregiving factors into that as well. There are profit opportunities for companies in this market, including developing/future areas such as robotics.
- Linda Fried, Dean of Columbia’s Mailman School of Public Health, pointed out the need for designing for meaning and purpose the extra 30 years of life–‘the third demographic dividend’– and the cumulative advantage of health in older age, which leads to its own have-and-have-not divide, with those without far sicker.
- Melissa Mitchell of the Global Coalition on Aging discussed ‘the caring economy’ linked to the Silver Economy that affects families financially, in their careers in the late 40s into 60s, and socially. 34 million in the US are providing care for an aging family member, often at a distance.
- Demographics and better health have created a ‘new middle age’ of 55-75, but also a new old age of 85+, which is the fastest growing demographic group and eventually forecast to be 14 percent of the population. William Scanlon, a long-time researcher in health policy, maintained that the current system cannot scale up as is, but we need an adequate safety net for those with disabilities who at present aren’t getting good care or services. Impediments are siloed data (clinical vs. administrative) and the lack of grasp on real cost of care.
- Consider this simple insight from Mr Scanlon, especially if you are a patient advocate: Healthcare hasn’t transformed based on customer demands as other areas have–it’s driven by economics, not by patients. (This goes a long way to explaining why healthcare doesn’t respond like other ‘consumer’ areas despite billions in spend. Add in the layer cake of regulations and requirements affecting cost, delivery, and inflexibility. “The Patient Will See You Now” is nowhere near. )
- Black Rock Institute‘s Bruce Wolfe noted how people underestimate how long they are going to live and overestimate their assets.
- This led into a discussion on what constituted meaningful work for older adults since ‘retirement’ is a phase, not a withdrawal. A disappointment to this Editor was that most of the answers seemed to be about unpaid (volunteer) or low paid work which is not satisfactory for those with asset concerns or satisfying for those with greater skills. In a partial rebuttal, Dr Fried maintained that older adults can create new jobs by harnessing their assets (presumably their expertise and funds) and that there is a whole new area for job expansion in care needs and services. This is in spite of the estimated loss in 15 to 20 years of 47 percent of the world’s jobs due to automation.
The Future of the Built Environment addressed design issues for living spaces closely allied to social determinants of health.
- Making homes over for older and disabled people is not only a design but also a community and policy issue. The design is there but the demand is not. Policy must stimulate demand and solutions for poor housing. The design has to be aesthetically pleasing and ‘normalized.’ (Louis Tenenbaum of HomesRenewed, both a contractor and advocacy group for adaptive design)
- Older people desire as much autonomy as possible and are fighting aloneness. It is hard to accept limitations, and financially getting older is terrifying. In housing, ‘mundane’ solutions can go a long way to making a home more livable–‘my heroes are handymen and Meals on Wheels’–but older adults and caregivers spend too much time searching for existing design products to make life a little easier. Doctors don’t have time or the understanding of these problems. (June Fisher MD of UC Berkeley).
- She was joined in this by Susan Szanton of Johns Hopkins, whose experience with geriatric nursing in Baltimore led to her developing the CAPABLE model of handyman services with nursing and occupational therapy, and Dr Joseph Kvedar of Partners HealthCare on social connectivity to relieve aloneness.
- About new designs and products, they are being designed and prototyped (Stanford Longevity Program) but investors don’t understand or want to fund them (Fisher).
Leveraging Disruptive Innovation to Create Better Outcomes was about promising innovations and a systems approach to implementing them.
- Unity Stoakes of the StartUp Health accelerator/funder posited that health tech is at 1994 in comparison to the Internet’s development timeline, and it’s ready for 2.0. He cited CarePredict which, to this Editor, is a 2.0 version of QuietCare. (Are we that far behind? – Ed.)
- Bastiaan ‘Bas’ Bloem, MD, of the Parkinson Center Nijmegen (NL), has created a three-part ecosystem model to treat and support the 50,000 Parkinson’s patients in the Netherlands. This coordinates about 3,000 professionals in regions, facilitates their sharing knowledge and also includes an educational website (Parkinson TV) for patients to use at home. Results to date have been a savings of €30 million. This system is being copied in Luxembourg and other EU countries, as well as a pilot in the US. They are also piloting the Verily (Google) smartwatch.
- “Apps looking for a condition” aren’t integrated (Bloem) and our system can’t pay for ‘this thing’ (Mark Miller of MedPAC). In Miller’s view, the payment system has redesigned for more flexibility so that adding a system or technique doesn’t have to go through multiple approvals.
- StartUp Health is backing a ‘Cost to Zero’ “moonshot” to drive cost on large-ticket healthcare to zero. Example: free MRIs (the cost paid for by deidentified data sale).
Aging Priorities for the New Administration concerned the explosion of over 65s after 2030 and the inability of the current system, very much in flux, to care for them in the mixed Federal (Medicare) and state (Medicaid for low income) system.
Investing in the Future of Healthcare looked at what areas (not what companies) will be hot up to 2030.
- Robotics in healthcare to help solve workforce shortages. Terry Fulmer, PhD of the John A. Hartford Foundation gave as an example automated functions ‘manned’ by robots in a Taipei hospital.
- Passive remote monitoring of activity, automated diagnostics that enhance the skills of providers and P2P community care. Sara Eshelman’s investment company, Omidyar Network, has invested in Koko, a cognitive therapy app that provides P2P emotional support.
- Tech that gets rid of tech (e.g. Alexa) or that addresses a specific need, such as dementia caregiving products (Unforgettable in UK) and hip/fall airbags (not named, but certainly ActiveProtective) (Stephen Johnston of Aging 2.0).
- Elegant and simple design that is affordable. Tech that gives providers ‘superpowers’. AI not there yet, and full robotics in healthcare make patients uncomfortable. Wearables generate more data. Structure data to proactively guide patients. (Gaspard deDreuzy of Pager).
And in conclusion, the wrapup from the Summit’s co-chair Avi Seidmann, PhD:
- Senior concerns all begin with A: autonomy, activism, adaptation, affordability, authenticity, agitation, acknowledgement, aloneness, and aesthetics
- Senior needs that threaten quality of life: lack of money, isolation/loneliness, insufficient exercise, functional limitations, sub-optimal health care, cognitive impairment/dementia
- Other needs: life care, high touch, finding something that matters to do, housing to remain in, community support (physical public facilities, social construct, clinical)
- Clinical care gaps: incentives to providers are short-sighted, populist solutions are just that, value of outcomes is not measured, missing a robust care continuum, need for ROI limits flexibility, wrong priorities, reimbursement
- Successful initiatives from the session:
- Use tech as a tool, not as a goal (system, not an app)
- Empower multidisciplinary teams (doctors, physical therapists, handymen)
- Health transformers (moonshots)
- Empower patients (Parkinson TV)
- Digital behavioral therapies (diabetic control)
- Business model innovations
With appreciation to the event organizing team from Brand and Butter, including Monica Piraino, and University of Rochester’s Anna Stevenson.