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Eldertech Enabling Complex Care, Haven Lessons Learned, Startupland Predictions-The HSB Blog 1/12/21

Eldertech Shifts Paradigm to More Complex Care for Seniors

Our Take: COVID is busting the myth that seniors can’t or don’t want to use technology. Where there’s a digital divide between older and younger generations, older adults are gaining new tech skills during this time. Although eldertech (tech for the elderly) is in its infancy, it is growing fast in both application and market influence. With over $273M raised across 47 deals in the sector during the first three quarters of 2020 alone, investment funding is now the highest level since 2016. Moreover, given the risks and disproportionate impact of COVID on seniors in care facilities on top of the already existing desire by individuals to remain in their own home, demand for eldertech is growing dramatically. Seniors not only benefit from technologies that monitor their physical movements, activities, and physiological outcomes but also from technology that allows them to communicate with others. Where loneliness is linked to serious physical health effects, including increased risk of dementia, heart disease, stroke, and hearing loss, interactive apps help elderly people engage with others and remain mentally active.

Description: As 90% of people want to age in the comfort of their own homes, there is a rising demand for technology to allow care providers to monitor and engage with the elderly remotely. For example, social isolation can be a major cause of mental illness and even death. Pre-pandemic, some 43% of adults aged 60 and older reported feeling lonely, according to a national study. This can not only lead to depression, but other health complications like dementia and hearing loss. Eldertech can play a role in bridging some gaps for seniors. Where it won’t replace the relationships that seniors have with other people or replace some of the things that are working well for them, it will enhance and augment what already exists. In addition, certain technologies can help compensate for certain effects of aging such as hearing loss. Advances in semiconductor and processing power have made these technologies much smaller and cheaper, so those who suffer from hearing loss would have the option to control the volume of their conversations and even eliminate background noise (through the use of advanced noise canceling technologies). While wireless monitoring technologies will not replace in-person caregiving, they can make a significant difference in the lives of older adults and help them live independently longer. Technologies used in institutional care settings can monitor weight (e.g. bath mat, mattress, bed), image (sensors embedded in cameras), location (location sensors and technologies including GPS, RFID, and Wi-Fi), and other health data through wearables (heart rate, oxygen levels). In addition, new technologies such as SmartSole, a monitoring technology, provides a smart insole to fit into shoes with a built in GPS that can be used to keep track of a loved one with dementia who may wander off and get lost. The device pinpoints the person’s whereabouts on a map, supplying addresses and outdoor locations to within 15 feet every five minutes. Remote monitoring technology allows the perfect balance of giving seniors independence they desire while giving healthcare providers and loved ones added convenience and ability to monitor their conditions and care. Giving seniors the freedom to stay in their home will allow them to age more organically and happily, and could hence help them live longer.

Implications: Remote and virtual care technology is more cost effective, has better health results and is more convenient for patients and caregivers than institutionalized in-person clinica. For example research on hospital at home programs shows patients recover faster, have fewer complications and are more satisfied, while cutting costs by approximately one third. In addition, studies show that remote monitoring is more cost effective than standard care for certain high-cost conditions such as hypertension and congestive heart failure. A recent article in the journal Hypertension noted that self-management of hypertension with telemonitoring and self-titration was more cost-effective than usual care. Moreover, in a study by the Journal of Cardiovascular Electrophysiology demonstrated that while total outpatient and physician claims costs for implantable cardioverter-defibrillators (ICDs) were higher with remote monitoring, the average per patient-year costs were lower as was the cost-effectiveness ratio. While the use of remote monitoring and virtual care technologies have grown during the pandemic, providers and payers must remain conscious of the digital divide that exists in underresourced communities and work to combat this. A recent issue in JAMA indicated that as much as 41% of Medicare recipients don’t have an internet-capable computer or smartphone at home ,[please see our 9/8/20 blog article Access to Telemedicine Is Hardest for Those Who Need It Most]. Clearly, without broadband internet connection, patients are limited in using remote monitoring technology and the ability to digitally communicate to healthcare providers and this must be taken into consideration. In addition to being cost effective, remote monitoring enhances quality of life and care by allowing patients to enjoy the comfort, convenience and now safety of remaining in their own homes with studies noting that 90% of people want to age in their own home. In addition, with remote technology, health care providers can devote more time to in-person critical care. The combination of convenience, lower cost, and positive health outcomes will create a new market for remote monitoring technology even once the pandemic is over.

Inside the Collapse of a Disrupter: How Haven’s High Hopes of Redefining Health Care Came to a Crashing Halt

Event: On January 4th Haven, the highly touted partnership between Amazon, Berkshire Hathaway and J.P. Morgan designed to “reimagine employer-sponsored care”, announced that they would cease operations at the end of February. Since its founding in January of 2018 and despite the corporate pedigree and deep pockets of its backers, Haven had not been able to show much progress towards its stated mission and by all measures never measured up to its potential. According to those interviewed by STAT (and a number of other corroborated sources) Haven suffered from three major shortcomings: 1) a failure of a clearly defined mission, 2) a series of strategic blunders (poor CEO choice, competition between Amazon and Haven), and, 3) an inability to retain top talent.

Description: As noted above, perhaps Haven’s biggest failing was that it “lacked a clear vision” and never truly elaborated “an actual reason for coming together and what they wanted to achieve”. While the company had a broad goal of providing” simplified, high-quality and transparent healthcare at a reasonable cost” to it’s combined employees, it never outlined the specific steps it would take to achieve these goals or how and by what metrics success would be measured. In addition, while Atul Gawande was a high profile, intellectually powerful voice as CEO he had never had an operating role at a business nor did he commit to taking leave from his other responsibilities to make what was effectively a startup his sole priority (where commitment and focus are key). Moreover, it appears the partners never clearly outlined what their contributions to the partnership would be nor what their commercial expectations were. For example, while all three companies had agreed to contribute funding and provide healthcare coverage for some segment of its population through Haven, Amazon appeared to be the partner most interested in creating a commercial opportunity in healthcare, noting at an AWS event in 2019 that healthcare could be one of its next major revenue drivers. Haven’s structure as a not-for-profit also made it difficult to incent employees to offer competitive compensation packages and non-cash compensation. Lastly, its highly secretive nature (perhaps a reflection of the Amazon influence) and poorly defined mission contributed to culture issues which made it difficult to rally employees behind its nascent mission and show them tangible progress.

Implications: While it was believed such renowned names joining hands would make an impact to methodically fix the healthcare delivery system, the partners may have jumped in too quickly without acknowledging the unique nature of the healthcare industry. As noted, despite the significant financial and technical support, Haven’s vision wasn’t specific nor well defined. Moreover even with a clearly defined vision many would argue that approaching healthcare problems is best done incrementally, with a distinct goal. In the words of one observer, “a boulder-sized problem as big as healthcare cannot be solved with an equally sized sledgehammer solution. It is best done in moderation with a chisel, and over time”. As noted by Professor Erik Gordon of the University of Michigan’s Ross School of Business “the company might have benefitted from publicly targeting a well-defined chunk of the healthcare business such as pharmacy benefits or even access to primary care”. In addition, despite the presence of many large organizations in healthcare, “healthcare is always a local delivery and local financed industry...the challenge is always in aligning interests and goals''. Even then and even within organizations in the same geographies, healthcare challenges can vary widely among organizations. As highlighted by Kim Buckey, VP of client services at Direct Path, there is no one-size fits all approach. “Putting ideas into practice is truly individual to each organization-there is no one ‘right’ solution for every employer just as there is no ‘right’ plan for every employee. Given how heavily regulated, hierarchical and lethargic healthcare is one major lesson from the failure of Haven can best be summed up by Kate Brown of Mercer who said “in complex systems like U.S. healthcare, there is no single solution or entity that will deliver higher quality care at lower cost”.

Here Are 9 Predictions of What’s to Come in Startupland for 2021

Event: Noting that “venture capitalists make a living by trying to predict which startups and technologies may be the next big thing” Silicon Valley Business Journal recently ran an article highlighting many of the predictions they received from prominent venture capitalists for 2021. The predictions came from founders and directors of firms and tech experts sent into SVBJ.

Description: While the predictions were varied and broad ranging (from construction to woman’s sports) the following had specific applications to emerging digital health companies.

  • The push for diversity will grow, “ in 2018 Amazon adopted [a rule to interview at least one minority candidate] when filling board spots, and now additional companies are evaluating similar mandates as we continue to address social inequalities. Look for the private sector to take a giant step forward in 2021 with meaningful increases to executive and board-level representation.”-Michael Proman, Scrum Ventures

  • The purported demise of the S.F. Bay Area exodus that has attracted so much attention during the pandemic will peter out next year. "Silicon Valley will continue to be the global center for technology innovation, but the rise of remote will pollinate many other parts of the U.S.-James Currier, Pete Flint, Gigi Levy-Weiss and Morgan Beller, NFX

  • People ``who aren't currently working or who are working from home with plenty of time for thought and side hustles will create a tidal wave of new businesses…[while] in a post-Covid world—after a lot of time spent doing less, people will be eager to do more. Businesses will ramp up events to make up for what they couldn’t do in Covid. Las Vegas, convention sites, party and vacation space and more will see tremendous traffic.”-Ben Narasin, New Enterprise Associates

  • “In 2021 we will see significant adoption of live and recorded video in enterprise learning, training, HR, sales, marketing and customer support. We predict that enterprise workers will interact with live or recorded Video more often than written communication soon."-Upal Basu, NGP Capital

  • “Everyone will talk about [the election] but it won’t change their decisions. The factors that are driving societal change and technology adoption are more about the pandemic fallout and overall technology advancement and remote work trends.’-Issac Roth, Shasta Ventures

  • "We see special purpose acquisition companies (SPACs) becoming the preferred choice for venture-backed entrepreneurs and venture boards given benefits in time, complexity and, now, ability to raise as much capital as a traditional IPO.”-Brian Walsh, WIND Ventures

  • “The digitization of healthcare that we have seen this year will continue to grow after the pandemic: "Covid has driven up healthcare awareness across the nation. Consumers want to be able to see their health records, receive test results and access prescriptions digitally.”-Scott Francis, Fujitsu Computer Products of America Inc.

Implications: While difficult to generalize, it is clear that a number of the impacts of COVID (as well as some of the social unrest during that time) will remain with us for a while including: heightened attention and efforts at improving diversity; the continued expectations and impacts of remote work (in whole or in-part) on employee quality of life and employer expectations; heightened use and access to video communication and collaboration tools to reduce distance and improve service; continued innovation in capital formation allowing private capital to further cannibalize public markets; and, the unstoppable impact of regulatory easing during COVID to propel the adoption and use of digital tools in healthcare. While it is always difficult to predict the future, 2021 will be additionally more difficult due to the uncertain timing of “the end” of the COVID pandemic and a return to what will become the “new normal”.

UCLA Health Develops Triage Process to Identify When Telehealth is Appropriate for Care Delivery

Event: On December 30th, NEJM Catalyst reported UCLA Health’s development of telehealth-centered triage protocols to ensure that patients with specific care needs are assessed in-person and others facing less urgent threats are given the telehealth option. The careful consideration of patients needs will ensure that patents are receiving adequate and quality care, producing the best overall patient outcomes.

Description: At the beginning of the COVID-19 pandemic, the U.S. Centers for Medicare and Medicaid Services (CMS) expanded coverage for telehealth resources. During a period of fear and uncertainty, this served as a major tool to ensure that patients still had access to the care they needed, despite the stay-at-home order. When researchers spoke with primary care physicians (PCPs) at UCLA Health on how transitioning to telehealth impacted delivery of care, PCPs agreed that the decision to deliver care through telehealth as opposed to an in-person visit should be based on careful assessment of the risks and benefits associated with each approach. According to the article, about 7% of all telehealth visits from March to September 2020 could have been considered inappropriate outside of a global pandemic. Concerns were also expressed regarding training, technology support, patient access to technology, data privacy and security, and clinical appropriateness.

Implications: As the pandemic continues to surge, health systems need to reevaluate the best way to provide care to patients. As a result, the proposed use of a telehealth specific triage protocol to offer clear guidance on when to deliver care via telehealth versus in person care is certainly necessary. This concept was broken down into three steps- 1) Forming a multidisciplinary team that includes clinical, operational and financial stakeholders to take the necessary steps to increase the likelihood of high quality virtual care, 2) Taking into consideration the risks associated with both virtual and in-person, and consulting with providers, operators, and patients to identify key factors that indicate when virtual care is appropriate, and 3) Establishing performance metrics and collecting regular feedback from physicians, staff, and patients to improve triage protocols. With the implementation of this protocol system, this can help ensure that patients are receiving quality, appropriate, and reliable care throughout this pandemic and for years to come.

As Employee Mental Health Buckles, Nvidia Among Companies that Bolster Services

Event: On January 6th, an article in the Silicon Valley Business Journal reported that Nvidia Corporation (Nasdaq: NVDA) employees had tripled the usage of the company’s confidential counseling services from 2% to 6% since the pandemic. The article notes the increased need placed on benefit teams to provide services that fit the needs of those seeking support for stress reduction and mental health support.

Description: Since the COVID-19 pandemic, stress has been on the rise for many employees working remotely. A poll from the anonymous workplace app Blind found that 80% of employees at Paypal, Nvidia, Facebook, and Yahoo felt that remote work hurt their mental health more than their counterparts at ServiceNow, LinkedIn, and Oracle (74%). A report from Boston employee wellness company Wellable, Inc. found that 88% of employers are increasing investment in mental health programs, and 94% expect to expand virtual wellness services this year. New programs and strategies have been deployed at Nvidia that target the unique needs of employees who face stress and need mental health support. The company aims to provide easy access to employees to find counselors through their medical plan or Crossover Health, providing employee medical clinics and services to large companies. Additionally, telehealth services and virtual seminars are offered to employees to provide easy access to support services. Another strategy to reduce the stigma around mental health topics is having company leaders and managers talk to employees and share on topics such as time management and stress management.

Implications: Given the increased stress incurred during the pandemic, employers have been placing even greater emphasis on prioritizing employee mental health and mental health services given recognizing that proper coping strategies can affect how we handle stress and respond to challenges. The article noted the need to destigmatize seeking mental health support to achieve better health outcomes. Many employees have adjusted to working remotely, but working remotely can have negative implications for their mental health due to social isolation and lack of interaction. This is especially true when employees are too timid to seek support services. Nvidia has also made accessing services easier by providing employees access to telehealth services and counseling offered via phone. These services offer several new options to access care given the range of employee needs and familiarity with counseling service. As noted in the article, with the right education, support, and access, employers can help employees reduce stress and lead healthier, more productive lives.


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