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2/2/2018
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Louisiana Hospital Assn. “Getting Beyond Healthcare Reform to the Opportunities Ahead: Policy to Purpose”
Bruce Clark, DPH [email protected]
925.285.4083
Note: All slides in this presentation are the copyrighted property of DBC. This information is provided as a courtesy and is intended for the sole use of the individual to whom it has been provided and may not be used for public presentation or duplicated without written permission.
Thank you!
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Issues We’ll Explore
• From “Faith in” to “Fear of” HC• The Multi-Generational Workforce• Chronic Disease Pandemic and the Community
Care Solution• Lifestages of HC and Work• Caregiving: A Women's Issue• Digital Health & Homehealth Revolution• “Will we be Good Ancestors?”
Issues We’ll Explore
By looking at the future of healthcare, tech, caregiving and policy through the lens of the new consumer discoversome of the opportunities ahead?
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The New Consumer
“The patient is the most underutilized resource in
healthcare”
Fear vs. Faith in Healthcare
Clearly, “faith in” healthcare is being replaced by “fear of” healthcare. Healthcare today consistently ranks at the top of lists of what consumers fear most. It is understandable that patients and providers are confused…and politicians don’t help.
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The Face of Fear Driven Healthcare
“the hope, the hype the ha
Turn Down the Dial?
“Canadian plan has been likened to genocide, or even worse, to Europe, where the prevailing belief is patients languish on filthy cots waiting for aspirin to be invented"
-- David Sedaris
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Healthcare Reform in the News
“the crisis of the uninsured”
“soaring costs”
“over-utilization of services”
“find something to replace
fee – for – service system”
Harper’s Magazine
October, 1960
“the crisis of the uninsured”
“soaring costs”
“over-utilization of services”
“find something to replace
fee – for – service system”
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HC Reform???* Politicization of HC is troubling
Average person has limited ability to discuss -- like asking to vote on “fusion vs. fission”…
Insurance is simple… create two classes of customers – good risks and bad risks – (avoid the later as much as possible)
Problem with healthcare is that it is “hard” – complex, path dependent, interlocking, huge, with substantial ethical and moral considerations
Reform: Least interesting of major trends transforming HC…unending clash of special interests
The consumer is desperate for clarity
“Purpose”vs.
“Policy”
Healthcare Reform?
Goal: sick care to health care…
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Fear vs. Faith in HealthcareAs consumers enter their high utilization years and entitlements erode, “faith in” healthcare is being replaced by “fear of” healthcare. Healthcare today consistently ranks at the top of lists of what consumers fear most. There is no quick fix here, but it is critical to understand the mindset of today’s “new” mature consumer.
Research/Guidance Ideas:Helping Docs/Groups/Plans Guide Older
Patients Through Uncertain Future:-- Defining Characteristics of NMC’s-- Demand for Alternative Medicine-- Redefinition of Quality and Service -- Evolution of Prov/Pat relationship-- The Need for Community Health
Generational Diversity
Everybody embraces diversity…race, gender, disability, sexual orientation, religion…
Impact of generational diversity overlooked
Breach between youth and age creates need for understanding
Age viewed as “disability”
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Six Living Generations
…each with a unique set of values
• Millennial (Gen Y): 1981 to 1995• Generation X: 1965 to 1980• Baby Boomers: 1946 to 1964• Silent Generation: 1932 to 1945• World War II 1917 to 1931• Great Depression: 1901 to 1916
“Gen Z” starting to come of age…iGen, Centennials, Plurals, Homelands
Our Challenge:
Overcoming “Generational Myopia”
One Generations Perceptions & Judgments of Another Generation as Seen Through the Lens of Their Values
When did you get on board with this one …
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Chronic Disease Pandemic& Community Care
Research/Guidance and the NMC
The Boomers are getting sick
And now…
54-72
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Pandemic of Chronic Disease
We are heading toward a future in which chronic disease will be pervasive. As our population of 65+ grows from 41 million today to 72 million by 2030, our emphasis on community-based services will need to grow dramatically. These patients will be both “sick and well”.
Spotlight on Chronic Care70% of Care Related to 5 Chronic Conditions:
Diabetes
Asthma
Congestive Heart Failure
Coronary Artery Disease
Depression
Cancer -- 5%
Maternity -- 4%
Halverson/Kaiser Family Foundation
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With the New Mature Consumer in Mind, What
Does the Healthcare System of the Future Look Like?
We’ve Got the Wrong HC System for What Lies Ahead
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AssistedLiving
Financial Orgs.
Hospitals &Employers
AdultDaycare
RSVP
HospiceHome CareTelemonitoring
SocialWorkers
Meals on Wheels
Doctor’s OfficeMedical Group
Religious Orgs.
PBM
Pharmacists
LTC
Transportation
SeniorCenters
Pallative Care
Respite Care
On-lineSupport
The Community Care Network
CaregiverSupport
“New” mature consus will:
“Getting older is inevitable…Aging is optional”
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AdultLifestages
Work & Career
Remarriage
Grandparent
Caregiving
Empty Nesting
Retirement
Widowhood
Singlehood and Remarriage(“new family formation”)
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0
20
40
60
80
100
55-64 65-74 75-84 85+
Ratio: Older Men to Older
Women
Women
Men
Number of Men per 100 Women
Source: U.S. Census, CPS, 2002
Second Singlehood and Remarriage
• Women biologically superior to men• Outlive mate 6-8 years on average• 50% marriages end in divorce• 40% marriages involve remarriage• 1 in 7 marriages a third marriage
…critical need to understand“new family formation”
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Retirement ?
A Personal Opinion…
everybody gets
tired of their job…
…nobody gets
tired of work
Widowhood
• Average woman today who experiences50th birthday will experience 92nd birthday
• 85% of women will experience “widowhood”• Dramatic loss of previous social structure• Feelings of separation and exclusion• For 65+
--50% of women are widowed--only 14% of men
• From “we” to “me”
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Aging of America…a women’s issue
Everyone with patient contact needs to better understand the importance of “new family formation”
2009 IPG Research / Packed Facts
• Widowhood• Remarriage• Singlehood• Long Life• Caregiving• etc….
Healthcare Implications ofthe Adult Lifestages
Research/Guidance Ideas: • Segmentation of NMC by Lifestage • Key HC Needs that Correspond to Lifestage• Healthcare Decision Making: Male vs. Female• Impact of New Family Formation on HC• Uneven Impact on Women
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Caregiving: A Women’sIssue
Research/Guidance and the NMC
Caregiving
65.7 Million Caregivers*
* (20/hrs week caring for loved one)
• 1 in 5 US households
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Caregiving…A Women’s Issue
• 85% female driven• Profile: 53 yr old daughter
caring for 77 yr old Mom• 30% of caregivers are 65+• Many live far apart • Many woman will spend
more years caregiving Mom than children
• Help is hard to find…
Other NMC concerns …
• Alternative & Complementary Therapies• Healthcare in Retail Settings• Collaborative Providers• Consumer-centric Technology
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Health Information Technology…(HIT)
“we’ve been holding healthcare to a different standard… a lesser one”
Peter Neupert, Microsoft
HIT…Connectivity 1.0good start for consumer…
• EHR• On-line Support• Provider/Patient Comm• Social Media • Smartphones• Health Information
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HIT 2.0
• Biotech• Cloud/Data• CAD/AI • Precision Medicine• Gene Therapies• Bioethics 2.0?
New Technology in HC: Game-changers for Consumers?
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Meet your New Healthcare Partners/Competitors?
Watch? Big Deal…
Like Breaking the 4 Minute Mile…Roger Bannister
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Big Deal
“In the same way that Luther challenged the Catholic Church, smartphones are poised to
upend the medical profession”
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Tele-Health/Monitoring…missing link in homecare
Revolutionize Home Care Personal Emergency Response Systems
Echo/Alexa, Siri…home assistants
Telemedicine/Telediagnosis
Medication Adherence (“Follow Me Home”)
Home Monitoring Systems/Sensors *
*single lead ECG, heart rate, heart rate variability, respiratory rate, skin temperature, posture, fall detection and severity, steps, movement, sleep, meds, etc.
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Long-Range Mass Market Home Health Monitoring
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Medical Adherence (“follow me home”)
Staying in Touch…
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Why Home Monitoring?
Falls a leading cause of death due to injury among the 65+
Falls account for:-- 25% of hospital admissions -- 40% of nursing home admissions -- nearly half of those admitted do not return to independent living -- 25% die within a year.
Centers for Disease Control, December 2016
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HIT is Revolutionizing Caregiving/On-line Support
Caregiver Support 2.0
And now…
patientslikeme.com WebMD Health Exchange
medhelp.org curetogether.com
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Cancer Forum…30,258CLL…603
Helping Patients Find Each Other
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Social Networks a Lifeline for the Chronically Ill
The dementia rate for 65+ is one in eight; for the 85+ population it is a staggering 47%. Alzheimer’s is on a steady growth rate to overwhelm our healthcare system. Social networks can help.
Mass Dementia…
• Depression• Alzheimer’s• Parkinson’s• Alcoholism related
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Alzheimer’s Disease…on pace to overwhelm care resources
• 5.5+ million today in US • growing faster than projected• 1 of 3 seniors die with Alz/dementia• 6th leading cause of death• 2/3 live at home• require 15 million caregivers• $259 billion annually
And now…Facebook Health?
Haven’t Scratched the Surface…
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Caregiving Crisis & Opportunity
Research/Guidance Ideas:• Caregiver Segmentation• Role of Social Media in HC• Home Care Technology Survey• MD/Caregiver Communications• Connecting to Community Care
Let’s Not Kid Ourselves…
We’ll still be seeing doctors but the
relationship will be increasingly altered
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The Future of Health & Longevity:Shangri-La or “Geriassic Park”
Research/Guidance and the NMC
As genomic and biotech breakthroughs radically alter late-life disease and even human aging as we now know it, battles will erupt over who will decide how these technologies will be controlled and who will have access to them.
“Geriassic Park”
Who lives, who dies, who decides….? T Koppel
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What will it be like….
to know from the moment of your child’s birth their likelihood of developing some form of chronic condition, cancer, or disease. Knowledge that would shape, and perhaps determine their future.
The End of Insurance?• Public/Private Payers Struggle with Complexity
• Significant Decline in Testing Cost(Duchenne muscular dystrophy, epilepsy, hereditary, CA & heart, etc., $350-900 test)
• TX costs…Serepta/Anthem ($300k)• CAR-T therapies (90% remission/$300-500k)• Novartis/Gilead…Solvaldi …$84k vs 28k
• What happens when longevity becomes purchasable???
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Will we be good ancestors?
Hospital/Drs Office on Bioethical Frontlines?…“Trusted Guide”
As genomic and biotech breakthroughs radically alter late-life disease and
even human aging as we now know it, battles will erupt over who will
decide how these technologies will be controlled and who will have access
to them.
The Future of Aging
Research Ideas:• The Bioethics of End of Life Care• The Impact of Predictive Knowledge…
“Patients in Waiting”• Is Traditional Health Insurance about to Become Obsolete?
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Summing Up:
The New Consumer
“The patient and the home are the most underutilized resources in
healthcare”
…and eldercare will dominate the future of HC
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Healthcare will always require the human touch
Cannot over estimate the importance of your work…
Healthcare and caregiving at their best uniquely connect us in a deeply spiritual way….
I wish that our religious institutions did half as well
Opportunities
Fear vs. Faith in HC Continues
Caregiving & Chronic Care
Future of HC More Patient/HIT Centric
Uneven Impact on Women
Community-Wide Care Network
Digital Health & Reinvention of Homecare
Hospital/Dr’s Office on Front Lines
Listen, Listen, Listen…Consumer Driven
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Navigating End of Life
• America: It’s Time for a Grown Up Discussion about “End of Life Care”
• You can Help Lead this Dialogue
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We are entering into a stage of life that
throughout most of human history has
not existed. You willhelp define it.
The Third Age
Our Challenge…
And who better than hospitals to create the delivery system and professionals to meet the needs of the new consumer…
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Louisiana Hospital Assn. “Getting Beyond Healthcare Reform to the Opportunities Ahead: Policy to Purpose”
Bruce Clark, DPH [email protected]
925.285.4083
