1/1/2011: The Beginning of the End for Healthcare as We Know It

By Mark Shea, MCDM

A wave of change has arrived for the health care industry. Even the most powerful representatives of health care, government and business will be unable to stop this incoming tide. I can say this with relative certainty because I am a Baby Boomer. 79 million people, 26% of the US population, are about to get old. According to Pew Research, as of January 1, 2011, 10,000 Baby Boomers per day are having their 65^th birthday. This will continue for the next 19 years.

Wherever and whenever I have been in my life, I have experienced the strain that the sheer numbers of people in my generation place on an infrastructure. I experienced it in schools from Kindergarten through College. Classroom size was a problem but that was secondary to the need for physical classrooms. New schools needed to be built and lots of them. Another example, people of my generation didn’t like being conscripted to serve in the military and when we had a sufficient number of our generation eligible to vote, we imposed our democratic will. The draft was eliminated. So it has gone throughout my life. The list of situations, institutions, industries, and economic sectors that have been impacted and forever changed by having to respond to the sheer numbers of my generation is quite long. Now I am 56 years old. The Greatest Generation, my parents’ cohort, is straining our health care infrastructure to the point of breaking. Right behind them comes my generation. The health care industry is not prepared to handle us. The first baby boomer filed for early retirement and Social Security benefits in 2007.

Eric Dishman, an Intel Fellow and director of health innovation and policy for Intel’s Digital Health Group gave a lecture last year at Ted. He calls the “senior-ization” of the Baby Boomer generation, the “Y2K + 10” problem. Something significant happened near the stroke of midnight as the new millennium was ushered in and it wasn’t, as so many people predicted, the crash of our worldwide information systems. The United States changed from being a country that had a larger number of younger people to a country that had a larger number older people. Older people use the health care system far more than younger people. And, it is the “Y2k + 10” problem because it is ten years after the year 2000 that Baby Boomers begin to retire. That day is here.

Today, America’s elderly are living longer and the cost of health care is rising dramatically. Those two factors are going to make it incredibly expensive to take care of all of these retiring Baby Boomers.

Meanwhile, the sad truth is that the vast majority of Baby Boomers have not adequately saved for retirement. For many of them, their home equity was destroyed by the recent financial crisis. For others, their 401ks were devastated when the stock market tanked.

Company pension plans across America are woefully underfunded. Many state and local government pension programs are absolute disasters. The federal government has already begun to pay out more in Social Security benefits than they are taking in, and the years ahead look downright apocalyptic for the Social Security program.

We will have to leave it to historians to say where the health care industry falls on the technology adoption curve for personal, distributed, shared, and social computing. We are far from finishing these chapters of our story in human experience. What we do know right now is that the Health Care Industry is not the first economic sector to experience the disruptive effects of these technologies. To understand what kind of shift this will be for the health care industry, consider the changes seen in the music, video, recording, publishing, and journalism sectors over the past ten to twenty years.

By way of example, let’s turn to journalism. Print newspaper companies are folding at a rapid rate. Broadcast news, radio and television, are not faring much better as they try to compete with content on the World Wide Web. Now anyone who has a computer and broadband access can be a journalist or correspondent with the ability to publish their content to the world for free. People no longer need to have access to massive printing presses that cost millions of dollars to build and maintain. The technology to publish and market to a worldwide audience is now affordable, ubiquitous, and available to almost anyone who wants it.

So, if these media are waning, is there still going to be a need for journalists? Yes.

There are still journalists and there is still plenty of work for them to do, important work. Some people who consider themselves to be journalists simply don’t know where to report for work. This is quite literally true. There are an ever dwindling number of jobs that are linked to a printing press or traditional radio/television broadcast network. How, where, and why journalists ply their trade is rapidly changing. According to the U.S. Bureau of Labor Statistics, the job prospects for News Analysts, Reporters, and Correspondents will decline by about 6% between 2008 and 2018. That isn’t great news for them but it isn’t Armageddon either.

In the vocation of journalism new opportunities are opening for wordsmiths who are so inclined. Some of the new opportunities don’t even have names yet. I wonder what we will call a transmedia story-teller? Maybe simply “transmedia storyteller” but who knows what it will end up being? And people who never would have thought to refer themselves as journalists are now called bloggers and given press passes.

It is not only companies and their workers who experience the disruptive impact of these computing technologies. We all share in it. The very fabric of our culture is being re-woven. In the area of journalism we as a society are grappling with questions like: Is the Fourth Estate in jeopardy or will it re-make itself in a new form? And so it will be for health care. We will be questioning and challenging the basic tenets of the way health care is provided and consumed.

Whole industries that were considered inviolable just 20 years ago are now dying and being replaced by new ones that could not have been imagined just a few years ago. If you were able to travel back in time to 1999, how would you describe Netflix as it is today to the people there? Our language is being bent to this technology. Consider google: a word that found a beginning in the early days of the 20^th century as a children’s’ book, then as a cartoon character’s last name, that became the name of the number represented by 1 with a hundred zeroes after it, and then to name of an internet company. In the common vernacular, google is now a verb meaning to search the internet.

New consumer electronic devices are appearing on the market now. Some have been around for a while, for example, the Phillips Lifeline. Products like Lifeline are good for certain situations and for the right person. Unfortunately it requires someone to push a button to call for help and many seniors have trouble remembering to wear it. For the price of a television and a monthly cable bill, families can now install a passive monitoring system. Affordable passive monitoring systems, such as BeClose and Grandcare, are now arriving in the market. Now, the senior does not have to interact with the technical system at all. Activities of daily living like movement in the house, getting up, going to bed, going to the bathroom, and bathing can be monitored. The opening and closing of doors can be tracked. Medical devices like blood pressure cuffs and blood glucose testers can be connected to these systems. Medications can be dispensed at the correct time and in the correct dosage. The family caregiver, who can be anywhere in the world, can see this data on a Web dashboard. The customer pays for a monthly subscription that gives them access to this dashboard. They can add whoever they want to the dashboard.

The people who have access to the dashboard can monitor and analyze the data to identify and proactively act upon potential health and safety problems. For example, if the frequency of trips to the bathroom is increasing, this could be a sign of a possible urinary tract infection. This can become a serious problem for a senior if left untreated. The family will know that it is time to get Mom to the doctor or, in the future, have the doctor come to her.

The family caregiver can now monitor the situation on their own; team-up with neighbors, family, and friends; team-up with professional caregivers; and any other person that they want. The family now has an opportunity to interact with doctors, nurses, psychologists, social workers, clinics, hospitals, home care agencies and nursing homes. Long term care is moving to the home. This doesn’t mean that the other institutions that currently serve this need are out of business. It means that they are going to be placed in a position where the patient or their family has control over who has access to the care plan. The individual is now in control of who they want to have access to the care plan. They choose who is in the triangle of care which is comprised of the patient, the family, and professional caregivers. Families will now be able to not only use these systems for proactive health and safety monitoring but they will be able to use them in defensive ways. The BeClose system for example does not depend on a landline phone or broadband connectivity. The system accesses the internet via cell coverage. Now families can monitor their loved one in the nursing home. They will know when someone enters or leaves the room and how long someone stayed while they were there. By the way, it will be quite easy to add a camera and microphone to these systems for monitoring if that is what people want.

The health care system in the United States is floundering. The health care system continues under an industrial age business model. Eric Dishman calls this the mainframe mentality. The management of patients is done in an assembly line fashion. The assembly line only has capacity for so many widgets (patients). The assembly line has specific purposes and methodologies and has very little tolerance for alternative methods and purposes. The assembly line is a massive machine that is engineered and difficult to change. The assembly line does not understand unique and individual needs. The assembly line does not allow direct input by consumers to customize the output. The cost of creating an assembly line of their own is out of reach for most people. The cost of products produced by the assembly line is getting out of reach for many of its consumers.

This is the time when a disruptive technology has an opportunity to take root. There is a crisis that existing institutions are unable or unwilling to resolve. If people cannot get access to the goods and services that they want and need and the tools are available to do it for themselves, they will take matters into their own hands. These new systems coming to market now are just the first wave of many more to come. We can predict this with relative certainty because we have seen it happen already in other industries. The internet, broadband connectivity, cell phones, software and affordable consumer electronics placed in the hands of the individual will transform the healthcare system. Long term care will be the beachhead of this assault. There will be many attempts by large institutions that are heavily invested in maintaining the status quo to stop this power shift. Laws will be passed to try to stem this shift of power from the institution to the individual. We can anticipate that there will be much debate, name calling, and general grumpiness. It is highly likely that people who are using these devices to manage their own care will be branded as some kind of criminal. Our children who share music files with each other are called pirates, for example. The individual will not care because they will no longer need the institution as much as they did before. The individual will be empowered to interact and have conversations directly with resources, like doctors and nurses that they previously did not have access to. Individuals will be empowered to develop personal health care systems that serve their needs.

The winds of change are upon the health care system and the revolution will begin with long term care.

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