Do health innovators think about the oldest adults?

Everyone wants to see more innovation in health care delivery.  Not to miss the remote healthcare visitation party -- a relatively recent employee benefit -- Verizon just announced its new Virtual Visits platform, expanding medical access for patients who may wait " an average of 27 days for to schedule an appointment." That’s a 2010 statistic, in case you were wondering. By 2013 the average wait time was more like 18 days. But perhaps the wait time is beside the point – what if you don’t live or happen to be near a doctor?  Would you use a remote visitation service? If you’re elderly, do you NEED a remote visitation service? Yes, perhaps. For some – it can enable access to a doctor’s advice without the hassle of traveling to the office. But does it matter if the oldest adults would not benefit - what if only 34% of those aged 75-79 and 20% of the 80+ seniors have access to broadband? No remote visitation for them.

The doctor may see you, but can your doctor SEE you? Considering that healthcare spending may be declining (even driving down GDP!) – what problem are we solving with remote visitation?  And for whom? Let's consider an example. With a sophisticated new business model, One Medical is very proud of its remote visit capability, smartphone app, and low annual membership fee. It has found numerous ways to provide high quality customer service, fast access to providers (though not necessarily a specific doctor) and low cost, high availability, Uber-like service. Are they marketing to older adults?  Apparently not. According to a company employee, it seems that the average age of One Medical customers in current urban hipster markets (SF, LA, NY, DC, etc.) is in the low 30’s.  Are they, as Venture Beat asserts, really reshaping the future of healthcare for all Americans? Or just the youngest adults, those least in need of medical care.

Remote visitation is the video variant for the quantified self – designed for the young, by the hip. But what if all of the most basic cost assumptions about health care are wrong? See how these linked biggest drivers of health care cost include end of life care of the oldest, and likely describe the 80% of the aged 80+ who don’t have broadband. Read those drivers of costs -- then wonder about solutions that sound like remote visitation, reinventing the doctor’s office, better customer service, spiffy smartphone apps, quantified self-absorption, and other trendy innovations.  Not that reinventing all of these things is bad for our health. These are good ideas, but they are nibbling around the edges of reshaping health care, charming, cool, but not sufficient. And surely not relevant to the disconnected and offline.    

What is the Real Problem Here?

We elders may not be up to speed on all the latest techie happenings, but that does not mean we are stupid, an inference I often sense from the youngish caregiving entrepreneurs. With easy to use equipment we can actually gather many of our own vitals measurements. We can than even write them down on a chart that would let us know if we are in or out of our recommended ranges. Then, we (who are not stupid) can determine if we are out of range for one or more of our readings and then actually dial, yes even a rotary phone, to call a medical professional, who had access to our medical record. Then such a person, or even a voice activated computer, would actually take our telephone call so that we could give them the same information all this high tech gear was supposed to collect and send to some place or person yet to me named. All this new technology is trying to solve the problem of data collection and transmission. But the collection and transmission of data is not the problem. The problem is, and has been since days sixty plus years ago, that when we called our doctor on the phone, told him (yes they were almost all “Him”s 60 years ago) what was going on. He then told us what action to take, telling us to come into the office, go directly to the hospital or that he would stop by the house and see us later. How and where he delivered his services was not a condition that determined if, how, or how much he would get paid as it is today. Having a knowledgeable receiver for the data to help make appropriate changes to the care plan is the critical point of the dilemma, not the means by which the data is transmitted. Nor should the “how” or the “where” of the service delivery determine if or how much the provider would be paid.

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