In This Report
Our society is confronting a major dilemma around health care for older Americans. Fortunately, the healthcare landscape is seeing a range of innovative approaches to positively impact this situation. Four significant challenges are discernible as we consider the health and care of older Americans:
- The prevalence of chronic illness – a natural accompaniment to aging and something that expands as improved treatment of medical problems begets chronic conditions in need of on-going intervention.
- The availability of adequate numbers of care professionals – those who actually deliver care and support to individuals – for the growing “in need” population.
- The huge cost of our healthcare system itself – including the cost of support and medical interventions, the tools and technologies applied to those efforts, and the administrative infrastructure and its associated bureaucracy.
- The human desire to live longer at virtually any price(and frequently in the face of certain personal discomfort, emotional suffering and minimal or no chance for reversal or significant life extension), which underpins a broad-based, consumptive societal view about resource use – no matter how limited, unproven or expensive.
A wonderful outcome of our society’s focus on health – and the great advances in technical interventions led by American medical science and the industry it supports – is that we are living longer. Yet much of the illness that accompanies aging is treatable and tolerable rather than curable, and as a consequence we are aging with an increasing burden of chronic illness. Indeed, 80 percent of seniors (defined as those 65 years or older) live with at least one chronic illness, and as our age increases the number of such co-morbidities increases, with the average 75 year-old suffering from three chronic conditions.
Complexity of care, another outgrowth of multiple medical conditions afflicting an individual, adds to the problem. As the number of chronic conditions increase, so too do the number of specialists and care providers involved in the care plan (this is especially prevalent in a healthcare system with a bias towards specialist care as the foundation for the system). Additional consequences of an uncoordinated system such as unnecessary and/or redundant testing and duplicate or competing prescriptions are then added to the overall challenges of dealing with complex and chronic conditions.
The end result? Resource consumption, missed interventions, poorer health and spiraling costs – particularly for those individuals who are the most sick and vulnerable. But in the end, all share the huge and persistent burden – both in social as well as economic terms.
BARRIERS TO CHANGE AND INNOVATION
Despite the obvious challenges and the innovative responses to them (many of which are technology-based), the adoption of new approaches to care has been slow. The barriers to change are meaningful, led by factors such as:
- Slow adoption: Despite the potential value in technology solutions, seniors are traditionally slower than average adopters of technology. Less than half of all seniors over the age of 65 are online, and although about 90 percent of Americans ages 18 to 49 own cell phones, they are owned by only 57 percent of seniors 65 and older. One significant underlying reason for this is that most products are not designed with seniors in mind.
- Physician resistance: While studies show a positive link between patient health and technology adoption by physicians, doctors are far too often reluctant to change how they approach caring for their patients (distinct from the frequently quick use of newly introduced and marketed therapies, prescription drugs and medical equipment and devices). Further, a lack of Medicare and personal health insurance reimbursement for many new care delivery approaches for those without face-to-face interaction between doctor and patient among them – is a contributing factor. Economic incentives to engage all parties must be applied when striving for progressive change in our healthcare system.
- Out-of-pocket costs: A recent study from PriceWaterhouseCooper revealed that of the U.S. consumers willing to buy a remote monitoring device, 64 percent would only do so if it cost less than $50; and they would only use a mobile phone service to manage their health if it cost less than $5 per month! The costs of most devices far exceed this threshold, although representing a fraction of the costs for more traditional approaches to care.
- Reimbursement issues and lack of defined sales channels: Virtually all of the potentially relevant products have yet to meaningfully gain a presence in the senior market. This is at least partially a result of (1) the lack of third party reimbursement; and (2) relatively low levels of direct-to-consumer marketing in these areas to date.
- Regulation: The FDA has indicated that it intends to regulate the flow of health information, and there is significant confusion around what this means. This creates legitimate concerns with those developing health information products, and fosters ambivalence among those who might use them. Neither is good news for the prospects of adopting services that many view as positive change.
- Products instead of solutions: A key issue is that there are now dozens – if not hundreds – of technology products for the elderly and their caregivers, but they lack integration with each other in ways that will truly facilitate solutions to meaningful health and well-being challenges (rather than responding to single or occasional potential “events”).
It is obvious that the challenges that inhibit or delay change are significant, but the opportunity to improve how we care for and support our aging population is real and of immense importance. Despite the barriers and shortcomings in our approaches to date, this challenge is being addressed through a considerable number of innovative efforts to bring real solutions to the support of older Americans.
This report “Innovation & the Health Care Needs of Seniors” provides a foundation for considering the issues. It will be followed by a second installment addressing issues of equal importance, such as financial planning considerations and care for caregivers. We trust you will find these publications informative and useful.