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The Next 90 in HealthCare
October 7th, 2014

The Ontario Hospital Association — based in Canada — is celebrating it’s 90th year. As part of that, it arranged for a number of experts to comment on the future of healthcare, and is running this in a site that “looks at the next 90 years.

Health care is the most complex issue that our society faces in our time. We really need some big and bold and very innovative thinking to deal with the scope of the challenges.

Health care is the most complex issue that our society faces in our time. We really need some big and bold and very innovative thinking to deal with the scope of the challenges.

They asked me to contribute a piece.

I’m still doing a *tremendous* number of talks in the health care sector; it is one of the most high velocity industries around. For more insight, check out the ‘health care trends‘ section of my web site.


The Next 90
by Jim Carroll

Everyone in a leadership position in the health care system worldwide knows that the challenges facing the system are substantial and immense. That’s why innovation has quickly come to be one of the top issues that senior healthcare executives and medical professionals are thinking about.

Everyone in a leadership position in the health care system worldwide knows that the challenges facing the system are substantial and immense. That’s why innovation has quickly come to be one of the top issues that senior healthcare executives and medical professionals are thinking about.

Yet many in the system are stuck in sort of a Groundhog Day-like existence — they get up every morning, and everyone around them keeps talking about the same old thing as the day before — in the US, healthcare reform. In Canada, the discussion is all about “hospital wait times.” In other countries, the issue of the future of healthcare often swirls around a single issue.

The result is that real healthcare innovation is stifled, smothered, and never given a chance to flourish. Yet there is so much other opportunity if we link ourselves to the major trends that are going to unfold in the future at a furious, blinding velocity!

We need big thinking, because the health care cliff in the Western world is massive. In many countries, we’ve got a ratio of workers to retirees of 4 to 1. By 2030, that will decline to 2 to 1. Most of those workers support the health care expenditures of those who place the greatest demands on the health care system. In Canada it’s suggested that as a result, by 2030, Old Age Security and health care is likely to suffer a $71.2 billion shortfall that will require a GST of 19% and a top tax rate of 71%. In the US, the numbers are even more mind-boggling.

The fact is, we need big, bold thinking, Grand ideas. Dramatic change. Champions with courage to challenge the status quo. The need is desperate.

There is a realization that there is an urgent need to challenge the very philosophies upon which the system is built. That’s why, when we look back from the future, everyone will know that it was the major scientific, technological, consumer and social trends that allowed for some very dramatic change in the concept of health care delivery. Preventative concepts are part of this big transition. I suspect by 2020 or 2025, we will have had successfully transitioned the health care system from one which “fixed people after they were sick” to one of preventative, diagnostic medicine. Treating them for the conditions we know they were likely to develop.

I’ve recently done a number of very high profile talks in the health care, pharmaceutical and related industries, including opening the recent World Pharma Innovation Congress in London, England.

Just last week, I was the opening speaker for a very early start at 730AM in New Orleans for over 4,500 people at the International Foundation 57th U.S. Annual Employee Benefits Conference – always a fascinating experience to have that many people out in N.O. for an early keynote!

The organizations selected me specifically because I could give them an overview of future health care trends, without taking at look at the political issue of health care reform. After all, the real trends that will provide the real solutions to some pretty massive challenges in the world of health care will come from the world of science, hi-tech and pure research — not from an ongoing, relentless, annoying and ultimately useless amount of hot-air from politicians, regardless of their political stripe.

For New Orleans, the keynote description emphasized this : which is perhaps why so many showed up!

“Jim Carroll, one of the world’s leading futurists, will share his thoughts on transformative trends that will define the road ahead in the critical area of health care. The fact is we will witness more change in health care in the next ten years than we have seen in the last 200. Hear Mr. Carroll forecast what paradigms will change as health care is transformed through the next decade, far beyond the impact of health care reform.

At events such as this one and the keynote in London, I take a look at the future of health care from the perspective of medical science, social and demographic trends, the impact of increasing velocity of knowledge and other major trends that have absolutely nothing to do with the political debate around health care reform. You can’t wish a problem into a solution — you need pure research and innovation to make things real.

And certainly one of the trends that is going to provide tremendous opportunities for innovation in the sector will come about as Silicon Valley sets its sights on health care. Years ago, a senior executive at Intel noted that “we have the potential to aim our innovation engine at the age wave challenge and change the way we do health care from a crisis- driven, assembly-line, hospital approach to a personal-driven approach, with people taking care of themselves with help from family, friends and technologies.” At the time they were speaking of health care being one of their top five sources of revenue in the years to come.

That’s why one of the biggest growth markets we are beginning to witness now is emerging as Silicon Valley and the hi-tech industry begins to get involved in the world of health care in a whole variety of different ways.

First and foremost, it’s happening in a very big way with consumer-oriented health care apps, particularly on the iPhone and Android. A recent survey indicated that:

  • 78% of consumers are interested in mobile health solutions
  • medical and health care apps are 3rd fast growing category for iPhone and Android phones
  • the Apple App store now has 17,000 health care related apps, 60% of which are aimed at the consumer

We will certainly see a huge amount of product innovation, such as the new iPhone based blood pressure monitor from Withings:

What is really significant is that with such personal medical monitoring and wellness technology, we are going to see very significant involvement by health care providers and professionals, insurers and others within the system to adapt to a new world in which a large number of patients become immersed in the world of interactive healthcare and wellness monitoring.

Then there is the world of bio-connectivity — a trend that will see the emergence of more sophisticated medical device technology that will let medical professional monitor their patients from afar. This is a topic that I’ve explored at length in a variety of posts on this site. Quite simply, in the years to come, the concept of a physical hospital is going to change as it goes virtual through the extension of bio-connectivity technologies and methodologies:

  • Imagine the hospital of 2020? I can 
  • The future of seniors care / assisted living: Big trends or crazy ideas? 

Silicon Valley will also play a huge role as it comes to develop real time health care predictive dashboards and other new forms of medical insight that will help the system to be better predictors of emerging health care risks and crisis situations. Big math, big computers, big analytics and health care – a match made in heaven!

  • Remember those kids who were really good at math? They own the future 

It doesn’t stop there. In the world of pharmaceuticals, the impact of Silicon Valley is going to have one of the most dramatic impacts on an industry that we have ever witnessed. For years, the sector has been busy exploring the opportunity for ‘pharmacogenetics’ — that is, how can we determine if a particular drug treatment is going to have its greatest impact on a group of people who share a common characteristic in their DNA.

This type of very specific genomic medicine has been around for years — but it is about to take off like a rocket as Moore’s law comes to have an impact. Quite simply, the cost to do what were once very expensive genetic tests are simply going to plummet.

  • Costs of DNA sequencing falling fast – look at these graphs 

I could go on ; there are dozens of examples where the impact of technology upon the health care system is going to be dramatic.

Suffice it to say, if you want to watch one of the trends that will have the most impact in the next decade, this is one of them.

 

I’m off to Europe to keynote two events; the first, a private talk on future health care trends for a major European organization.

The second is in St. Andrews Scotland, where I will be speaking to a a group of business executives.

Yes. I will golf.

The family is coming along, and so I’m otherwise busy.

If you do need to reach me, send me an email or call. I will be checking messages once in the morning, and once at the end of the day.

Enjoy your summer!

(This is a long post!)

Were my comments in the video below — recorded in front of 3,000 people at the annual National Recreation and Parks Association annual conference in Salt Lake City in 2009 — quite possibly the stupidest, dumbest  comments I’ve ever made on stage?

Could we really be headed to a world in which we are going to utilize a lot of technology and innovation to help us deal with a very real and significant challenge – that is, dealing with the tsunami of care-giving that will be required in the world of seniors care?

I’ve been debating this for quite some time, given the confluence of two issues: my wife and I  and sons (and her sister and family) have been quite immersed since December with a family member that has involved the rapid onset of Alzheimer’s and dementia. It is a very sad, intense and emotionally challenging situation; it has revealed to me the personal side of a very complex problem.

And while all this has been going, I had been working on and preparing for my keynote to the DSSI Annual Forum. DSSI is a major supplier within the US seniors care industry, and the conference features the participation of probably the bulk of the seniors care operators in the US.

My keynote was to be focused on innovation in the seniors care sector — where might there be opportunities, and what are the trends that will provide those opportunities.

How did I approach the topic? I truly believe that we live in a period of great transformation, and that people must challenge themselves to think boldly when it comes to innovation. Hence, the innovation opportunity comes from “thinking big.”

So let’s think about the scope of the problem. We all know that in Western nations and mature Asian countries, the seniors care challenge is massive. And with longer life expectancy, we are dealing with a reality in which the challenge of Alzheimer’s care for these seniors will go on for much longer periods of time.

In my keynote, I jumped right into the “scope” issue. Consider the reality:

  • in the US, the number of Alzheimer’s patients is set to triple to 16 million by 2050
  • the typical Alzheimer patient is disabled for 9 to 20 years – and this will increase to 40- to 50 years as medical advances continue and life expectancy continues to grow
  • we are spending $172 billion a year in treatment – and that is set to grow to $1.08 trillion by 2050 given the growth in the number of cases, and the impact of longevity
  • there is a lot of family care giving that is involved; as the St. Louis Dispatch noted, “Boomers may be spending more years caring for an aging parent than a child
  • and the challenge shows no end in sight: “40% of people over the age of 80 are suffering from dementia – there will be a million new cases a year by 2050

Put these facts into the context of the reality of what is occuring in the world of seniors care today:

  • an ongoing massive ramp-up in demand with shortfall in available and planned units
  • a funding crisis with plunging investment / housing values, and state, federal and municipal tax deficits
  • ongoing skills and staffing issues
  • increasing scrutiny in public eye
  • heightened expectations on quality of service from the boomer generation

That’s why one of the first points I emphasized is what I often do in my keynotes: “World class innovators aren’t afraid of thinking boldly!” Simply put, we have a huge problem, and society and government needs some pretty bold thinking when it comes to solutions. How is society going to care for, in a respectful way, an increasing number of seniors living with a very complex disease? How can we help the caregivers to give better care?

Which brings me to the Paro therapeutic robot.

“It’s Not a Stuffed Animal, It’s a $6,000 Medical Device; Paro the Robo-Seal Aims to Comfort Elderly, but Is It Ethical?” – Wall Street Journal

When I am preparing for a keynote, I often do research that involves reading through several hundred articles on a topic — I access these through an online research service. In this case, while doing my homework, I came across the Paro, as covered in an article in the Wall Street Journal:

It might be the cuddliest medical device ever to cause an ethical quandary. Five years ago, a Japanese robot manufacturer introduced Paro to the world. Built to resemble a baby harp seal—with a plush coat of antibacterial fur—Paro was hailed in Japan as a pioneer among socially interactive robots, one that would help lift the spirits of millions of elderly adults.

It never quite caught on. “It doesn’t do much other than utter weird sounds like ‘heeee’ or ‘huuuu,'” says Tomoko Iimura, whose adult day-care center in Tsukuba City keeps its Paro in a closet.

Now Paro has come to American shores, appearing in a handful of nursing homes and causing a stir in a way that fake seal pups rarely do.

My first reaction was, “that’s the dumbest thing I’ve ever heard.” I was thinking in the context of what my wife was going through; dealing with someone with Alzheimer’s involves a tremendous amount of love, care, time, and emotional commitment.

How, in my mind, could a fake pet ever provide a level of care that would equate to that offered by a loving family member?

And at that point, I had to check myself — after all, I always challenge people to avoid reacting to new ideas with such phrases. It’s a key part of what I often outline on stage — the “innovation killers” that provide such a degree of organizational sclerosis that it clogs up our ability to try to do something new.

So let’s think about the Paro therapeutic robot. It was approved by the FDA as a medical device; the Wall Street Journal had this to say:

“Powering it are two 32-bit processors, three microphones, 12 tactile sensors covering most of its fur, touch-sensitive whiskers and a system of motors that silently move its parts. They allow Paro to recognize voices, track motion and “remember” behaviours that elicit positive responses from patients”

– It’s not a stuffed animal, it’s a $6,000 medical device, WSJ, June 2010

The more I thought about it, I realized that I was probably guilty of the same anti-innovation attitudes that I often talk to my clients about. Who am I to say that such a device might not play a role in helping to provide for bold, transformative solutions to a challenge that is massive in scope?Maybe I’m guilty of the same type of innovation-blockers’s that I speak on stage about! I pondered that thought through the last month during my daily five mile walks….

Read further into the article, and you come across this:

One recent morning, staff at Marian Manor in Pittsburgh, one of Vincentian Collaborative’s homes, circulated three Paros among residents gathered for a sing-a-long. As 77-year-old Anita Biro sat down at a table, she berated two fellow residents and told them to leave, recalls Beth Kuenzi, activities manager for the home’s dementia unit.

But when Ms. Kuenzi put Paro in front of Ms. Biro, her mood changed. As Ms. Biro stroked the robot’s synthetic fur, the machine batted its eyelashes and tracked movement with its head and eyes.

“I love this baby,” Ms. Biro cooed.

Aides also take Paro to residents’ rooms to get them to socialize. At another Vincentian home, Lois Simmeth, 73, doesn’t always participate in group activities, but she ventures into the hall when she hears Paro’s sounds.

“I love animals,” explains Ms. Simmeth. She whispered to the robot in her lap: “I know you’re not real, but somehow, I don’t know, I love you.”

Five years out? 10? 15? Who knows what type of bold, innovative solutions we might see emerging that could help family members who are in a caregiving situation, or which might help to alleviate the huge burden of care within seniors facilities?

Further into my research, I came across the MedCottage. What a unique innovation this was — a small, wired, backyard “cottage” that a family could use to provide independent living for their parents.

It seems to tie into a key trend — at the DSSI event, former Kansas Governor Mark Parkinson (now President of the AHCA / NCAL, the main association representing the seniors care industry in Washington), noted that a survey indicated that 96% of American’s did not want to spend their later retirement years in a nursing home — they wanted to be in a home care environment.

And so could the MedCottage be a fascinating innovation to the trend towards home care?Absolutely — but it too will run into the “innovation blockers.” Such an idea could be doomed because of “NIMBYISM”  – “not in my neighbours backyard!” Yet things are moving fast on that front too:

The State of Virginia has passed a law allowing installation of MEDCottages in residential backyards, over the objections of homeowners who have expressed fears they don’t belong in neighbourhoods.” Checking up on mom from a distance, Toronto Star, September 2010

Telling this story on stage, I reminded my audience that to deal with the really big challenges that we are faced with, we need fundamental shifts in how we approach things, and a lot of bold thinking and big ideas. Certainly the economics for home-care are compelling. I put up these bullets for the audience of seniors care operators:

  • “In Ohio, home care is estimated at $1,400 per month vs $4,300 for nursing care
  • bold goals: plan shift from 42% to 50% within three years
  • the discussion is occurring – you need to be a part of it!

In other words, my challenge to the seniors care industry is this: clearly, there is a massive trend towards home care, which will also involve a lot of family caregiving. Which led to one of the key points in my keynote: “Innovative organizations make bold leaps, in order to keep up — and stay ahead —  of a faster future”, and this point : ““Our innovation mandate won’t involve tinkering around the edges.”

So where does all this lead in terms of the video clip from my NRPA keynote – was this the dumbest thing I ever said on stage? I don’t think so. Clearly, Silicon Valley has health care in its sights — and that will include seniors care, and home care. Noted one researcher at Intel:

We have the potential to aim our innovation engine at the age wave challenge and change the way we do health care from a crisis- driven, assembly-line, hospital approach to a personal-driven approach, with people taking care of themselves with help from family, friends and technologies

This ties into the research that I refer to in my keynote to the NRPA:

Researchers at the University of Missouri are using sensors, computers and communication systems …. to monitor the health of older adults who are living at home.”

“….motion sensor networks installed in seniors homes can detect changes in behavior and physical activity, including walking and sleeping patterns…early identification of changes can prompt health care intervention….

Study the MedCottage web site, and you’ll discover that it involves some monitoring and other technologies that do exactly that.

Clearly, we have some big challenges to solve in the seniors care industry. Clearly, there will be a trend to home care. And clearly, we are witnessing the emergence of new ideas and innovations that will provide for transformative change.

So no, I don’t think I was wrong in my video.

I don’t think that the experience that my family has been through negates the trends. I think as a futurist, sometimes you have to make bold leaps with your imagination, by carefully studying trends and innovations, and putting into perspective what they mean.

The future is coming — and while we might often wonder about the predictions that are made, we must never dare to question the boldness of what might emerge.

 

A semi-regular report of search phrases on JimCarroll.com

A few weeks ago, I began using the Reinvigorate.Net simple, real time web analytics & heatmaps” service on  my Website.

I thought it might be of interest to put in perspective, on a weekly basis, some of the things that people have been discovering on my site. With over 1,100 blog posts full of insight and content, there’s a lot of information in there!

So here’s the 2nd version of ‘search phrases’ that people were using this week — and the Web page on my site that the search engine directed them to.

Listed first is the search phrase; next is the page that they ended upon at my site.

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