The tech startups delivering on Atul Gawande’s vision for a better end of life


[caption id="attachment_7456" align="alignright" width="490"]AtulGawande-New_Headshot_ProfilePhoto Image credit: Aubrey Calo /[/caption]

At the event, bestselling author, New Yorker columnist and heart surgeon Atul Gawande presented his latest book, Being Mortal and shared its simple premise – that the US health system does a bad job in caring for people that it can’t cure. It over-medicalizes death, often giving people near the end of their life unnecessary, uncomfortable and expensive medical procedures, that only delay the inevitable, rather than figuring out what would actually make their final days better.

As one reviewer describes:

“We have come to medicalize aging, frailty, and death, treating them as if they were just one more clinical problem to overcome. However, it is not only medicine that is needed in one’s declining years but life – a life with meaning, a life as rich and full as possible under the circumstances.”

"Life is a sexually transmitted condition that is invariably fatal". With this levity UCSF Professor Alice Chen set the tone for an upbeat and at times inspiring presentation and Q&A held recently at the Commonwealth Club of California about the usually dark subject of death and dying.

Drawing on personal experience as a surgeon, interviews with experts and as a son dealing with a dying father, Dr Gawande makes a powerful case for innovation and reform, outlining many ways in which healthcare leaders could minimize trauma on patients and families as well as lower the staggering costs of care. Just one such data point – a study of the use of palliative care in patients with terminal cancer showed that they had one third fewer hospital days, one third lower costs, had lower levels of suffering and lived for 25% longer than the group who were treated traditionally.

I would highly recommend that you go out and read this important book (summary and press reviews here). What struck me when I was listening to Dr Gawande was how the person-centric approach he proposed resonates so well with what we’re doing at Aging2.0 - innovating to improve the quality of life for older people. Also, the two people he cited as having the biggest influence on his thinking, Laura Carstensen and Bill Thomas, have had a similarly large impact on us. The rest of this post is about how startups in general, and two companies in our new startup program in particular, can be effective tools for change in this important area.

From ideas to action – startups can deliver on the promise of innovation

The book comes amidst a growing chorus of dissatisfaction about the way we deal with death and dying, and will help raise awareness of the fact that only around 30% of people have made a will or have an advance directive. The recent well-publicized case of Brittany Maynard has raised awareness of the ‘death with dignity’ movement and the Institute of Medicine’s report highlighted the need for much improved end of life care.

The problem is often not in knowing what needs to be done, but in effecting change at large, lumbering organizations. This is where startups come in – small, nimble and laser-focused on solving a problem, technology startups are agents of change – providing proof points that change is possible, and the execution speed to make it happen.

We recently announced the 20 new members of the Aging2.0 Academy program – startups that are on the cutting edge of innovation in aging. We had an overwhelming number of applications for this year’s class, and it was striking to see the number of companies focused on the end of life. We picked two of these, Everplans and Vynca, who are developing technologies that can improve the quality of life for individuals and families as well as in healthcare settings.

Everplans – end of life and death planning made easy

Screenshot 2014-12-15 23.52.01Everplans (covered in TechCrunch here) is “the first comprehensive digital planning platform that allows families to create, store, and share essential end-of-life & emergency plans.” Started by Abby Schneiderman and Adam Seifer, two successful NY-based entrepreneurs, the site has been built into a rich content repository to guide people through a variety of life stages, and offers a new paid service to help securely manage and execute someone’s wishes. With the minority of Americans having a will or an advance directive, there is a need for an easy-to-use, attractive service such as this, that helps people prepare for their futures ahead of time. Everplans has now raised over $6m in funding and is growing fast.

Vynca - enabling best practices for advance care planning

Screenshot 2014-12-15 23.53.28Vynca is also focusing on improving care delivery at the end of life, but focuses on healthcare providers. Vynca offers a technology solution to share end of life care plans across the fragmented healthcare continuum. Vynca uses the Physician Orders for Life-Sustaining Treatment (POLST) paradigm that ensures a patients’ wishes are actually carried out. POLST is being rolled out in 43 states, but in almost 90% of cases the paper POLST forms are not available at the scene of an emergency – so Vynca provides a technology solution to digitize the forms and integrate them into healthcare providers’ workflow.

Both Everplans and Vynca also relate to one of Dr Gawande’s previous contributions to healthcare thinking – the Checklist Manifesto, which shows how checklists can reduce errors in hospitals. The use of checklists has been estimated to cut surgery-related deaths by 40%. If these startups reach scale and in so-doing improve quality of life and cut costs for millions of people, their potential impact could be similarly significant.

What is exciting is that these two are just the tip of the iceberg - there is a variety of other tech startups and innovators focused on making end of life planning and care better. Other startups include MyDirectives, AfterSteps, MyExitStrategy, Good to Go, After I Go and Vimty. In addition there are projects looking to change our culture and improve the process of dying and memorializing, such as: The Conversation Project, Death Over Dinner, DeathWise, Our Paths, SevenPonds, as well as new high-tech 'ethical wills’. Maybe innovation, like death and taxes, is inevitable after all?

Looking forward – with hope

The youthful, visionary entrepreneurs at Vynca and Everplans have the ambition and potential to bring about large scale change. The book says that 'the ultimate goal is not a good death but a good life – all the way to the very end", and in his quest to make that a reality for millions of people, Dr Gawande has a growing army of allies.