Where is the best place to care?
Covid-19 has been a dramatic crisis for the world’s health systems. It has caused tragedy for many, brought huge stress upon every aspect of healthcare, but at the same time has been a spur for innovation as regulators, payors and providers try and find ways — in particular through the rapid growth in telemedicine[1] — to do more with less.
There is another, perhaps even more profound crisis impacting health systems that needs equal innovation: coping with rising chronic disease in an ageing population. In some senses, this should be celebrated! It is partly caused by prolonging life expectancy. Nevertheless this rise creates challenges of capacity — by 2040 the number of Americans over the age of 85 will more than double, from seven million to 15 million[2] bringing with it significantly rising costs at a time when the US already spends 18% of its GDP on healthcare.
One key way to improve outcomes whilst reducing cost is pretty clear — keeping people out of hospital. The average hospital stay in California costs $3,700 per day[3]. Besides the cost, there is clear evidence that keeping people out of hospital is strongly associated with better outcomes for patients; the Nuffield Trust found that “a long length of stay is associated with particularly poor outcomes for older people”[4]. Of course this does not mean there is no role for hospitals, but a sustainable health system is one where as little as possible is done in hospital.
The best lever to achieve this, which has been a focus of ours for a number of years, is proactive and preventative care — particularly primary care. This was what inspired our investment in Elation last year. And there are many other great organisations that we admire working on the problems of prevention with a focus on chronic diseases — Omada, Cityblock and Wellframe to name a few.
Another key lever, in our opinion, is enabling those who do require care to be able to receive it in their own homes. Done right, this is lower cost, better outcome care. It is estimated that treating a patient at home can decrease healthcare costs by over 95% versus a hospital setting. This is why we are so excited about companies supporting the rapid development of the homecare and home health sectors — be that Cera or Honor as full stack providers or AlayaCare or Birdie which are building software tools for the industry.
The demand for homecare has never been greater. But there is also a real crisis facing the sector –carer supply. Too often the working conditions for carers have not reflected the value they provide. We are not going to be able to build a sustainable home health sector unless we focus on the experience, pay and conditions of carers. Some of this can only be solved with money, and the systems-level ROI from such investment is increasingly clear. Beyond money, improved carer experience can also be achieved with technology that improves worker experience: flexible and worker-centric scheduling with reduced travel times and more efficient tools that reduce paperwork. These topics deserve to be top of the agenda and this is why we are glad that AlayaCare, which we backed earlier this year, and which recently won the Impact 20 award from Fortune, are focused on enhancing the experience for frontline workers.
Looking forward, the role for care in the home will only accelerate. Advances in technology and clinical approaches are allowing for better use of home monitoring, for example as provided by TytoCare. Even further we are seeing the deployment of full “hospital at home” set-ups from the likes of Dispatch Health and Medically Home and those like Vesta who are going to combine home health with value-based care, like Vesta Healthcare. We are excited to back those companies which are enabling this kind of sustainable health system — one that uses technology to keep people well, to treat people out of hospital, to give patients dignified and high-quality healthcare and crucially to ensure that this is done whilst respecting and empowering the front-line healthcare workers who are crucial to making it all happen. If you are building such a company, please get in touch.
[1] https://www.healthcareitnews.com/news/study-365m-people-reveals-huge-jump-pandemic-telehealth-use
[2] https://acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2017OlderAmericansProfile.pdf
[3] https://www.debt.org/medical/hospital-surgery-costs/
[4] https://www.nuffieldtrust.org.uk/files/2017-01/improving-length-of-stay-hospitals-web-final.pdf
