CEO of ClearCare Online, a home care scheduling system for private-duty home care, discusses aging, technology, and how to raise venture capital with other co-panelist at the 2016 Aging 2.0 conference in San Francisco.
Scott: For our first panel session of the conference and our final main segment for today, by the way, just so you know, and we have a short 5-minute closing after the panel. We have gathered together a really unique panel session here today to reflect on all the innovations that we've heard so far today and really to put their expertise at work here, and talking about how we can achieve greatest impact out of these innovations. We have compiled across section of viewpoints in innovation and aging. We have a global reinsurer. We a national health system. We have a national aging innovation center. We have a state health payer, private research policy institute, and a successful entrepreneur. It's truly a cross section of viewpoints. We're really excited to have them. Let me introduce our moderator, Mary Furlong.
Mary is President and CEO of Mary Furlong & Associates. She is a pioneer really in the Longevity Marketplace. She's been in the space for quite a long time. She founded her company in 2003 to help socially-minded and consumer-conscious companies understand the real needs of this growing market. Mary's clients and sponsors include AARP, caring.com, and LinkAge, PetPlan, UnitedHealthcare, First Republic Bank, et cetera, et cetera. She was named one of the 100 most influential women in Silicon Valley and was raised over $140 million in corporate sponsorships and venture financing for the boomer, senior, and caregiver markets. With no further introduction, I'm happy to introduce Mary Furlong. This is team panel.
Mary: First of all, congratulations to all of you. I've been coming every year and it's wonderful to see this crowd and the intellectual candlepower you've assembled in the room, so it's pretty exciting. We have a wonderful panel today. Farron Blanc, who's the Vice President of Innovation Studio, RGA. Dr. Bill Reichman, who's President and CEO of Baycrest in Canada, just back from China. When I talked to you, you were in Japan at 3 in the morning. You just came back from China. This is a global journey as we've seen today. Mark Waggoner, who's Senior Vice President of Blue Cross & Blue Shield of Rhode Island. I love this idea because I think if you want a test, testing a small state, so I think you should be swarmed after this. Diwen Chen, who is here from Dignity Health and quite a large healthcare system. Joe Smith from West Health Institute. Geoff Nudd from ClearCare, who had quite an exciting week because McKesson put money into your company, right?
Geoff: Right. We couldn't be more excited to be partnered with McKesson.
Mary: When I was just briefing for this, I asked Tom Rodgers at McKesson, "What company should I be watching at in coming to Aging 2.0?" He said, "ClearCare." I said, "He's on my panel." This is really great. One of the things we've seen today is that every dissidents of aging is a market opportunity. Every entrepreneur, whether they're 17 or 82 are hungry and want to get things done, want to build a company, want to build a team, want to get financing and most importantly, want to prove their concept and get a deal done. We're going to start with going across the panel and say how do we get a deal done. Let's start with you since you got this financing this week. How did you get that deal done with McKesson? What are the implications for your company?
Geoff: Absolutely. I'm Geoff. I'm with ClearCare. ClearCare provides a front-office and back-office platform for home care agencies and just so we all have context, home care agencies have local care managers that families hire to in turn staff caregivers to help seniors stay in their homes so they don't have to go to facilities. We provide the back-office and front-office platform that powers those home care agencies, doing everything from scheduling, billing, payroll, helping them match clients and caregivers, family portals, caregiver portals. Mary, to your question, we believe that home care has a huge role to play in solving the healthcare and aging crises of our time. Home care is the lowest cost institutional provider of care, serving the world's highest cost patient population. To realize its potential, it has to be enabled by technology. The value of our alignment with McKesson and the place where I think that we both recognized that we could work together is on that integration to the healthcare ecosystem.
ClearCare provides a homogenous network and data layer that we can plug various technologies and information from other parts of the healthcare ecosystem into. There's no stronger company than McKesson across the healthcare ecosystem to align with as a technology partner. There are quite a few places where I think that we can work together.
Mary: Usually, the good news is the company's finance. The bad news is the company has to make everything work. I'm going to come back to you and say 18 months from now, what is McKesson expecting from you and what are you going to have to do to deliver, okay? Why don't you go next?
Farron: Answering your question, Mary, as a global reinsurer, to get the deal done, I think there's a lot of sources of capital. RGA, we reinsure every life insurance company and every health insurance company in the world, basically. All the solutions that we saw today, they are great, but you just have to find that right investor. For us, we're looking at how can we build the next generation long-term care product so some of the solutions might not fit but that's fine, right? Just find that right investor, that right partner that could really accelerate your business.
Mary: I like that you said that you're very open to getting ideas from people. Recently, I was in Kentucky and a venture capitalist on the panel said, "I don't want anyone to send me email." I said, "How are they going to find you?" Let's talk next to Baycrest. How do we find you and what do we say if we want to partner with Baycrest?
Bill: Great. Thank you, Mary. Congratulations to all the entrepreneurs who shared some sensibilities that were very important to us at Baycrest and perhaps to the whole sector and that is ... While it's important to keep older adults healthy, it's just as important to give them a reason, once they're healthy, to get up the next day. Keeping us enriched no matter how old we are needs to be an imperative beyond just physical health status. With that said, Baycrest is headquartered in Toronto. Essentially, we're the world's leading academic health sciences center, focused on older people and brain health. We operate an academic, continuing care retirement community and our home to one of the world's leading cognitive neuroscience institutes, the Rotman Research Institute. As well, we're the largest training site in geriatrics in United States and Canada, training 2,000 students on the campus a year and many more across a global telehealth and education network.
With that said, the real reason I'm here is to announce that the Government of Canada as well as the 35 industry partners have committed $123 million to create the Canadian Center for Aging and Brain Health Innovation. While this is made in Canada, this is going to be a global asset to help us design, test, validate, adopt, and disseminate across our sector innovations to keep older people well and enriched.
Mary: I think that's [inaudible 00:08:54]. It's been quite a week because yesterday, they announced the Smart Ageing initiative in Ireland. Then I think Chuck Feeney put funding into UCSF, so these initiatives and the funding are going to be incredibly important to the tapestry of work of the entrepreneurs and the audience, I think. Let's go ahead to Diwen.
Diwen: Hi, everybody. I feel like I'm at aging con when they panels and folks are ... We're going to keep it lighthearted today. My name is Diwen Chen. I'm the Executive Director of Payment Innovation. My sector is working with the payers and providers as well as patients to really look at the intersect of innovation where a care meets delivery. At Dignity Health, we're headquartered here, actually. We've got sites all over California, Nevada, Arizona, and 17 other US states. We've got a national footprint. To answer the question about innovation is that I think we see this as a robust ROI. It's going to make sense for the providers and not to put words in your mouth, Mark, but for the payers and those who are investing in your product and everybody's product to pay for it, and in the way that makes value for us that seeks, provide the quality of the outcomes, but not breaking our backs trying to pay for something that is a bit beyond the investment.
I think ROI is big. Innovation is big, not only the people but also the process of how we integrate into the workflows of what we do in the daily lives, not only the patients but also the caregivers and their teams as well. Those are the comments there.
Mary: In our practice session, you talked a little bit about the doctors and what role they play because I wish I had a nickel for everyone who's given a business plan that says ... The first thing I'll do is to deal with AARP and the next thing I'll do is I'll have a meeting with the hospital discharge planner, and I think how much time does the hospital discharge planner have. How do you sell things into the doctors who are often influencers in the decision to adopt?
Diwen: One of our key insights and we have incubators and innovation within our own organization is how do we meet not just the customer segment that is our patient, which is very patient-centric. You probably have seen our campaigns of Hello humankindness. It's just really talking about what are the talents that are doing that, who were encompassing the care provider team and physicians as being such an incredible part of that. The key insight there is if it takes 45 minutes away from the clinical care, that's just not going to work. It's a bottom line because they have to be there to meet the patients from a clinical and medicinal perspective, and to take on the action of all the administrative burden as well. It's important, no doubt about it, but I think an ease in resolving for maximizing everybody to practice at the highest level of their degree is what we're after.
Mary: Mark, talk about how you 2 work together or could work together.
Mark: Sure, absolutely. Hello, everyone. My name is Mark Waggoner and I'm the Senior Vice President for Care Integration & Management at Blue Cross & Blue Shield of Rhode Island. We are a regional health plan, insuring Rhode Islanders. We insure about 70% of the commercial market and somewhere close to 70% of the Medicare Advantage lives as well in the state. Diwen and I had a very spirited conversation before coming into the room this afternoon. What's probably not surprising at all to a group like this is how very aligned the payer and provider community are becoming especially around the elderly population, the Medicare population and this need that we collectively have to solve some very, very big problems. Of course, ROI is a major focus of a health plan. We're looking for anything that allows us not simply to create margin but to have margin to then reinvest in provider partnerships like Dignity Health. We need to free up what is currently waste and non-value-added spending in the delivery system today and reallocate it to value-added activities.
Secondly, I would say, especially to a group of entrepreneurs like this, if you are also in addition to solving the cost problem, you're creating something from a health plan perspective, me as the purchaser of your services, something that allows the Blue Cross Medicare Advantage member to feel they're getting something differentiated as a result of being a Blue Cross member that I can offer exclusively potentially to them. That's a tremendous value add as well and having them select our product and also soliciting family and friends to select our product as well.
Mary: Talk a little bit about how you have to sell this up the food chain in the health system because it's not just you that makes the decision. How do you communicate it to the people above you?
Bill: I think you have to be explicitly clear on who's the customer for what you're developing. The value proposition has to essentially hit the 2 elements. One is how, for my perspective as a provider, how is this going to enable better care outcomes and how is it going to save me money to achieve those better care outcomes. Unless those 2 issues aren't addressed, it's not going to go anywhere.
Mary: I think sometimes the entrepreneur is so excited about their idea and their technology that what comes across is their passion and interest, and what they forget is to ... Almost have a designated listener when you're in the room who just takes copious notes about what the decision-making process is.
Diwen: I think to add to that too is help us know what information is valuable, right? We often get analysis paralysis, I'm sure everybody has heard that, but help us distinguish, not only in patient sector. Help us know what meaning we need to take away from data. Big data has been thrown around, these are key buzz words, but where we're sitting at and just going back to the physician example, we often hear from that segment of our customers saying, "What can I do? What is something that I can influence in my sphere to be able to move the needle whether it's quality, whether it's cost-savings or what have you, allows information and transparency to get to that resolution.
Mary: Joe, what do you think? You're nodding over here.
Joe: Yes. I'd say a couple things. We're at a point where the aging demographic has created both an economic and a logistical unsustainable scenario going forward. Many think that then anything that addresses that will find value, but the alignment at the moment of truth has to be that you don't create a burden for anyone in the use chain. As a doc, the notion that there's a solution that's going to provide me more information to look at is already a challenge. I think we heard in earlier presentation there are 500,000 annual publications in healthcare. There are 2,500 professional society guidelines. There's 21,000 medicines I have to keep track of. There's 50,000 medical devices. There's 141,000 codes I can now use, diagnostic and therapeutic. Please don't give me any more information. Don't give me data, don't give me information. Give me an unassailable queue for action or, in fact, make the action occur. It has to become much more automatic, coordinated, connected. If we've got a pyramid of caregivers, it's got to occur at the level where the skill matches the need. It can't go above that because already we have a logistically unmanageable problem.
Mary: Geoff, did you want to ...?
Geoff: I thought a number of good points made there. The notion of skill matching the need really resonates with me because to bend the cost curve, that is one of the greatest sources of leverage. As we look to the future, we look at the potential for care to move to the home. The lowest cost provider again is this caregiver that bills out a $20 an hour. If you can use technology to uplevel their capabilities and then escalate from that interaction to higher skilled clinical resources when appropriate then that's incredibly powerful. Just my way of example, we're doing a work right now. The first large skill work of its kind in home care with Harvard Medical School saying, "Let's take advantage of our position in the home." Our partners in the home 24 hours a week for a year with this, arguably, the most expensive patient population in the world, and so we're doing it with Harvard Medical School. We're saying, "Decisions about healthcare utilization are make here in the home where there are 25 hours a week." We're saying what precipitates healthcare utilization that's a change of condition.
What we're doing is we're having these caregivers at home simply track change and condition on things on the mentions that a layman can report on things like eating, drinking, ambulation, toileting, mental acuity, things that are observational for any of us. Then when there's a changing condition, escalating that to the local care manager that the agency provides to do triage. That catches things early. Then I think as we look to the future and add things like telemedicine to that picture, you can start really bending the cost curve and actually provide the care in the home.
Mary: You look like you want to jump in.
Farron: Yeah. I was going to say, Geoff, that project, that sounds awesome, but is it going to peer-reviewed and published so it's credible and clinically validated?
Geoff: Yes, absolutely. It's like over 5,000 seniors, 3 control groups, Dr. David Grabowski, it's grant-funded. It's pretty exciting. I think we'll have our first paper out in a peer-reviewed journal in just 4 or 5 months.
Farron: Yeah, it's cool because I think it's like one of the big challenges from the industry is the science has to be there because it's like you could talk about cost-savings of 10%, 15%, 30% but you can actually price it without an improvement in mortality or morbidity and it has to be peer-reviewed.
Mary: Although I've seen companies go wrong by having so much research and not enough design and sense of place. I started with my Mac computer, I had the first Loggable Mac and I love my iWatch that monitors my health all day. I'm 67 years old and I can't go anywhere without my iWatch. I really think that we've got to engage the customer and it's got to be, for women, attractive, if have even for men. It also has to be compelling, don't you think? The user interface has to be compelling or the adoption doesn't happen.
Joe: Can I offer an alternative view?
Joe: I think beyond compelling, it can become invisible. I think if we get to non-participatory monitoring, if we get to more ubiquitous, if it really becomes in the ether that we're talking about, continuous monitoring and smarts that you don't have to participate in, I think we can jump over the is it easy to use because asking people to use technology is not a limitation of the people. As we heard some seniors don't care for technology, I think that's a technology limitation, not a population limitation.
Mary: The training issues are always going to be there. Companies have discovered in the space that they've got to provide phone support and other things. Let's shift a little bit. I heard a great quote this week from Kara Swisher. She said, "San Francisco is assisted living for millennials." The millennials in San Francisco have meal delivery. Their garbage has taken out. We all travel in an Uber. Everything is done for the millennials so we could have the millennials at work as much as possible. Yet those of us that are 67 and above as aging boomer populations, we need these services, too. I think we've seen a lot today about innovation. I want to know what excites you. Also, how can we pivot so that some of these other companies begin to think about this market? When caring.com was bought by Bankrate, we saw the merging of the financial services sector and the caregiving sector, and we see FinTech Incubators in New York. When do you see the financial services organizations coming together and joining the revolution? What other companies do you see are going to come to the table?
Diwen: One point about community piece of it is I would encourage everybody to look at the market dynamics and what's there in existence. It's a part of the piece of our innovation that we're looking at is how can we bridge what we already do as in offer profit formerly religiously affiliated that has a strong faith and spiritual care as part of the communities and hospitals that we already served. We've got robust classes, community outreach, meals on wheels, transportation. That's just part and parcel of our historical mission vision values. One of the things that we're looking is how do we integrate from a people process system the communities that the hospitals are in and integrating that with the provider side as well as the payer side, and looking at what is the inventory of the market's art existence, and how do we elevate the rich resources that perhaps could be there.
Mary: Anything you saw today that just knocked you off your feet, I just thought it was really wonderful.
Mark: I'll take a round of that, Mary. Without noting any specific potential innovation, all of the work in the home space especially enabled by technology really energizing from my perspective. I'd give you, guys, just a quick example of how rich that space is in terms of financial opportunity and what goes along with that opportunity is the ability to impact people's lives when they need it most. At Blue Cross, we have about 50,000 Medicare Advantage members, all of which are living in their home for the vast majority are. About 3% to 4% of those individuals have medical cost annually that are 7 to 9 times the average Medicare Advantage members medical cost. They have 5 to 6 comorbid chronic conditions. They're on 7 to 10 medications. They're in and out of the ER, inpatient medical admits that are through the roof, 200% to 300% more than the standard population. They're not only sick but they're scared. The lack of any type of organized system is failing them. It's failing them not only in Rhode Island but it's failing them in every state of the nation.
I think the opportunity we have to think about bringing care and support, and weaving together these incredible social services that do exist in other support systems in every state, weaving that together and thinking about what people really need, where they live and where they fail. I think that is a formula for real success for entrepreneurs in this room today.
Bill: I would agree with all of that. The technologies that get me most excited are those that go beyond ensuring health and safety, and actually help us understand the difference between the desire to stay at home but the cost of bing alone. The technologies that key people in older age who were staying at home still socially connected and connected to their families, their friends, their communities, the things that enrich them. To me, that's the greatest challenge. We can monitor blood pressure and blood glucose, but it's a lot harder to ensure that we stay connected to each other as we get old and get isolated.
Joe: In that regard, I saw an interesting statistic. We often talk about how we overspend the OECD countries and healthcare at least by 50% oftentimes by a factor, too. When you look at what we spend in social services and I say this as a techno file but I have to say that for every dollar we spend in healthcare, we spend about 55 cents in social services. The OECD countries, every dollar they spend, they spend $2 in social services. If we overspend largely because we're solving social ills with medical skills. I think you can't do that at a bargain. This notion of wrap around social services so that people can age comfortably at home, I think is a potential gold mine if we're interested in trying to keep people home at a system that's economically and logistically manageable.
Mary: The only line that got a standing ovation at the White House Conference on Aging a couple decades ago, was that older people want a vision of the future not just a memory of the past. I think what we know about the boomers is they're going to redefine everything anyway. It's not only staying engaged in its home, it's so they could go out. They are the Uber drivers. They are the Airbnb host. I think that some of these things that are not only igniting their spirit is something important. Scott, do we have time for questions or ...? Okay, so you're going to help me show how this new technology ...
Scott: Sure. We can go ahead and pull up our Slidell voting and I'll let Mary engage just a little bit more here to get people a chance to begin using Slidell to ask your questions of the panel and this way then we can have those questions come up to the screen. They will be appearing over here on the right side, my right, your left. Just a couple more minutes here from Mary and start asking questions.
Mary: While we do that, I'm going to ask you what are 2 really important skills entrepreneurs need to develop in home. 2 critically important skills that they need to have. In fact, we have a list of the things that entrepreneurs must have before we will work with them. First, do you have your answer, Bill?
Bill: Pay more attention to the problem before you start spending a lot of your time and effort on the solution.
Mary: Okay, that was his answer.
Farron: Yeah, you stole it, actually. Yeah, I think definitely a clear view on who the problem is and who the customer segment that your solution, so it's not just tech searching for a problem but it's actually addressing a problem, a clear, clear problem.
Diwen: Listening, I think that's so key in listening to your stakeholders and understanding ... Again, going back to the problem and understanding truly what you're trying to solve for, but also listening to where the patients are in the time of their need is the other piece. You all have done such a great job of presenting and there's such a wealth of information that's out here and listening for the nuance of what is that threshold of meaningful information versus just information for the sake of collection.
Mary: I asked one entrepreneur I know who failed because some VC say they want to work with someone who succeeded and failed so they know the difference, and they know the warning signs. He said, "I listened to what I wanted to hear not to what the person was telling me. I really think listening to what the person is telling you is like a critical skill. How about you, Mark? What are the skill you'd like to see them have? Clearly tenacity.
Mark: Don't you know it? Clearly understanding and being clear about the problem that you're trying to solve and when you're trying to solve it for someone or a population, it gets to the listening but understanding that population and their perspective about the problem, and how they perceive and what would be a solution for them but sizing the solution, the problem, what's the size and the value that you're going to create, where does it sit in the larger ecosystem, is it worth your time and energy, will it get the uptake, will it get the attention of people who have the money to pay for it, or who have finite money, I should say, and have to prioritize what they are paying for.
Mary: Go ahead.
Geoff: I'll just reiterate what I've heard is listening and perseverance and the listening, that relentless focus on the customer and the customer's issues, and then adapting quickly and well against what you hear. I think people said focusing on real big problems and where you learn what those are is by listening, and then perseverance because the odds are you're going to have to make a lot of adaptations along the way.
Mary: You must have been pretty good at building a team.
Geoff: No doubt about it. I think our team is amazing and that's been absolutely critical, too.
Mary: Keeping the right team and coaching people off the team. Yes, go ahead.
Joe: It's tough to add at the end of a bunch of experts, but focus, I think, is terribly important. Where actually failure more often is when there's a desire to keep optionality on the table too long. I think there's focus commitment with the notion that you can't pivot but not keeping all your options open all the time.
Mary: Right. We have some questions from the audience and I love the first question. I hope I can see it. It says, "What countries can we learn from?" We have to look at the global aging perspective. I was in San Sebastian, Spain and they were redoing their economic development there. They were moving from a local economy to getting the banks and the grocery stores to all invest in what was the biggest opportunity in aging. When I saw the playbook they had, I thought, "This is incredible." Then I saw the Irish plan and I thought, "That is incredible." Today, we hear about the Canadian plan that has been funded. What countries do you look at who really have good blueprints and where would you go. LinkedIn was incredibly successful when they went to Brazil, but if had to roll out my global strategy, where would ... You just came back from Japan.
Farron: Yeah, Japan. I was going to say Japan. As a Canadian who spent a lot of times in Asia, definitely Japan. You have to go where the problem is, the country is already inverted. If you look at what Apple Japan post as one of our clients and IBM are doing, just Google that, that stuff is really, really innovative in terms of trying to keep seniors in home using robotics, trying to build a social community and the payment network.
Mary: Could you tell them to do that in America, too? I think we'd be really good if Apple and IBM, and the post office got together and gave seniors here.
Bill: I think at the end of your comment about Japan which is really important is as exciting as the robotics are what was to me a greater innovation in Japan was just introducing long-term care insurance that was affordable so that people could get the support they need. It's not perfect, but that's a low-tech solution. That's very meaningful.
Diwen: I think we're all clapping to the fact that we wish we had it here. My only point was that we can go insofar as looking at examples from other countries but unless are existing policies and the way that our policy landscape has been changing it and it continues to evolve to where it's going to be. I would say that there are some naturally-grown health systems within US that have given the current landscape and the regulations been able to be successful within our own homeland to do this. I look forward to a future with it. We can partner the 4-piece of the provider, payer, and homegrown model that is specific to the land that we live in and not wish for something that we didn't have from a policy standpoint.
Mary: I was talking to some of the executives in Washington. They were saying to me that the aging in place in Washington today is ... We were saying it was where the internet was in 1998. They said more like 1994. I think we're going to say phenomenal changes in Washington, phenomenal changes here in Silicon Valley and around the world. Do you have one last comment?
Geoff: Yeah. I think the time is now and the place is here actually to find these models. If you look at some of the things that happened just in the last few years, developments in remote monitoring, developments in telemedicine, developments in remote diagnostics, developments in medication adherence. We have the potential to move care to the patient, to move care to the home, to deliver better outcomes, lower cost, better quality of life and this is, arguably, the epicenter for that right here in Silicon Valley. All you have to do is look around the room at the, first of all, just the size of the crowd. This is a much different ecosystem than it was 4 or 5 years ago. The volume within the Silicon Valley community around these issues is at a whole different level. I'm excited about what I think we're going to be able to accomplish together here.
Mary: Anyone ... Go ahead.
Mark: I'd love to just make one last comment. There's a question that I'm reading here. "What do you think it will take to align incentives across the continuum of care?" Seeing that and listening to this conversation, they go hand in hand. One thing that I would encourage folks to do, something that we're doing in the small state of Rhode Island is spending an enormous amount of time with our senators in Washington, talking about federal payment and delivery system reform, spending a ton of time with our new governor, and with the secretary of Health and Human Services talking about payment and delivery system reform at the state level. Of course, doing that as well from a commercial seat in the provider community and trying to figure out how we can create alignment and synergy, and really start making sure that we have enough energy across the payer sources to start driving some of this real innovation that we're talking about and realigning those incentives to do it.
Mary: I think that's about to come. Thank you, all. What a great set of comments and ideas.
Scott: Many thanks.
Mary: Congratulations to you, Scott. This is just really great.
Scott: Thank you, it is. It's amazing to see this room. In fact, we're going to take a photo of everyone, but please join me in thanking the panel and Mary Furlong once again.