January 13, 2014 1 Comment
I spent last week in Washington DC leading about 20 MBA and 5 MPP students during a “Week In DC” associated with the Duke Fuqua Health Sector Management’s class HLTH716 “Health Systems and Policy” (the course-work was in the Fall semester). I did my first ever twitter interview via Direct Message on the way home (I wasn’t driving) about the course, that is captured by Duke’s Office of Federal Relations.
The week in DC was interesting, great fun and I learned a lot. I have one overriding impression from the week: one of the hottest potential business opportunities in the next few years may be to identify ways to keep vulnerable groups (elderly, living alone with low income) out of the hospital, most typically by triaging problems with housing and/or substandard community based long term care arrangements, and/or connecting such vulnerable persons with the correct resources. Several points on this:
- Most such interventions of this type will likely be low cost, and based on sending relatively low wage/low skilled persons to people’s homes. There is a potentially high gain from avoiding hospital readmissions. The key is figuring out who will pay for this value added?
- Often the problems identified will not be “medical” in nature. Readmissions because of infections from bad insulin….call for a refrigerator that works, and so on. Not health care. But, cheaper than a readmit. Integrated delivery systems who are on the way to taking on more risk for more lives (in Medicare and Medicaid) would be where I would go to try and sell this type of service first.
- From my own families experience of seeing my mother in law go from 3 hospitalizations in 44 days, to none in the last 366 days after a huge long term care change, I recall that the primary intervention was the same social worker seeing my mother in law and my family on all 3 admits. During the first 2, she asked my wife “can you care for your mother at your home safely?” The last time, she changed it ever so slightly, but forecefully to “it is clear that you cannot care for your mother in a safe way in your home.” A very low tech intervention.
- In my mother in law’s case, Medicare has saved from the pace of readmits that we ended 2012 with, but the costs of increased (explicit) long term care costs were simply shifted to the family and private insurance company. The key for a business is adding value like this to the health system, but finding a way for LTC to work in a fragmented system in which most don’t have the mix of insurance and resources that my mother in law has. In her case it really included assisted living or a nursing home, but there will be some lower hanging fruit.
- You could try 9 or 10 low investment companies using different angles on reducing readmissions in the time that you could try and bring a single drug or a device to the point where someone might be ready to pay something for it (a more traditional MBA Health Sector Management route). Only one of these has to take off……and you could be a part of truly transforming the health care system.