The 4 Cs of Proactive Care

NIC comes to Dallas this week with its Spring Investment Forum and Aging2.0 will be running two sessions on Thursday (March 10) on the topic of innovation. My co-founder Katy Fike will be moderating a session about improving quality with technology and I’ll be moderating the panel: "Startups Powering the Shift to Proactive Care". This post outlines a bit more about what we mean by ‘proactive care’ and a peek at the startups we're highlighting.

A historic inflection point - from reactive to proactive care

Healthcare up until the rise of ‘modern medicine’ in the 19th century was as much an art as a science, and much of the interventions were about making the patient feel better, not necessarily making them better. The technological breakthroughs in the twentieth century shifted the focus from providing comfort to fixing things, using increasingly exotic procedures and interventions. However, as our populations age, more and more people (up to two thirds of people over 65) will have a chronic disease (or several), which by definition are not ‘fixable’. The focus needs to shift away from 'fixing' (which often results in expensive, uncomfortable unnecessary procedures) to keeping people healthy in the first place and spotting issues before they arise. As such, a new model of proactive care is emerging that is: customer-centric, connected, continuous and coordinated.


As Atul Gawande and most recently Paul Kalanithi have pointed out, the patient experience in today’s healthcare system can be inconvenient, expensive and frustrating. As in other areas of the economy, we’re seeing power - and dollars - shifting to the end user. In this case the patient is becoming the customer, and smart providers are delivering better experiences to customers on their own terms.

MedZed, an Atlanta based startup that has just raised $3.2m in funding, provides 'next generation house calls' creating a truly customer / patient-centric experience.  MedZed builds a bridge that connects the care team to the patient in the comfort of the patient’s home.  MedZed’s team of patient advocates and care providers go out into the community, targeting those most in need. Since around 5% of patient populations account for 40% of healthcare costs, and each individual can cost upwards of $50,000 a year, targeted in-home interventions can prevent escalation of conditions and reduce those expenditures.


Technology, digitization in particular, takes formerly disconnected products and allows them to be part of an information network. This creates data upon which analytics and machine learning can go to work. This information can be shared, analyzed and acted upon, leading to greater speed, efficiency and lower costs. It often also results in major changes to the business model and players - as Polaroid discovered the hard way.  

Sensassure is in the process of connecting the patient brief - or more accurately information about the status of that brief. It is ‘reimagining incontinence care for seniors'. The young Canadian founders are currently entering their ninth month straight living in a senior living facility - a fully ‘immersive’ experience that allows them to understand the needs of the people they’re looking to help. Managing incontinence emerged as a important area from their research, and is the source of significant costs as well as staff and patient stress. Their product detects moisture and can alert staff and family members on the status of the brief, and can help avoid pressure sores and other complications that arise via wet briefs.


Care is shifting from episodic to continuous, enabled by smart devices and ubiquitous connectivity. Most patients spend 99% of their time outside acute care facilities while lifestyle factors (diet, exercise, socialization) are estimated to account for up to 80% of clinical health outcomes. Social media, wearables and the Internet of Things have resulted in a near constant stream of data deliverered by connected devices. According to IDC, 111m wearables will be shipped in 2016, up 40% from the 80m in 2015. Cisco expects 11bn connected devices to be in use by 2020 - all generating data to be analyzed and acted upon. Consumer gadgets such as FitBit, Shine and Apple Watch are already tracking activity levels and sleep, and are increasingly being used for medical applications to spot trends and patterns.

CarePredict delivers wrist worn devices that allow long term care facilities and families to track real time location of residents and, uniquely, tracks activities performed by the dominant arm such as eating, drinking and brushing teeth among others.  This continuous observation by a machine replaces intermittent, fallible and inconsistent human observation of residents and creates a rich layer of information that can surface potential warning flags (such as frequent trips to the bathroom that could indicate a UTI) before they escalate. The key benefit for senior living operators is to keep residents in their current care setting - if an assisted living community loses a resident to a hospital or nursing home, in addition to the resident distress they face costs equating up to 1.5 times the base monthly rent to find a replacement.


Continuous data is useless if it's siloed and not seen or acted upon by the relevant people at the right time. The goal here is to coordinate the care experience across multiple settings, between families and care providers, and to ensure that any other conditions are integrated into the care plan. Two thirds of older adults have multiple chronic conditions, in fact, only 9% of older adults with diabetes don’t have any other conditions.  

Caremerge is a cloud-based care coordination network that is helping break the silos across healthcare settings. It simplifies communication and connects the dots between providers, payers, families and seniors. It provides a single view of the patient and "allows access to the right information at the right time to the right stakeholder so they can make the right decisions". In a hypothetical example in the near future, data could be pulled from Sensassure and CarePredict and help the care providers at MedZed focus on the exceptions and get reimbursed under the new CCM initiative.

These companies are just a few of those building a new model of proactive care, and the long term care industry is in pole position to support this important evolution. We hope to see some of you in person on Thursday, otherwise, happy to continue the conversation online, and at our forthcoming OPTIMIZE event in San Francisco on October 12-14, 2016.


Stephen Johnston
March 8, 2016


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