As patients age, their medical costs soar – more than 25 percent of all Medicare spending is in the last year of life - and the United States is quickly growing older on average. Health reformers hoping to 'bend the cost-curve' will have to confront that inconvenient trend.
In 2000, 600 million people worldwide were older than age 60. By 2025, this number is expected to double. And in the United States, projections indicate that in two decades seniors will make up nearly one-quarter of the nation’s population. For many, this "age wave" is fraught with economic uncertainty. Eric Dishman sees the demographic shift as a market opportunity.
As the director for health innovation and policy at Intel, the Santa Clara, Calif.-based microprocessor pioneer, Dishman dreams up products and strategies to improve care for this rapidly growing segment of the population. He helped develop the FDA-approved Intel Health Guide, a product that allows doctors to electronically monitor and manage care, allowing patients to stay their homes. This concept and others in the pipeline are meant to redefine the role of institutions like hospitals and nursing homes, keeping costs down while improving care.
KHN's Christopher Weaver spoke to Dishman in late July just after the Intel exec finished a lobbying trip to Washington. Here are edited excerpts.
Q: What were you doing on the Capitol Hill last month?
A: I was evangelizing [about] moving health care to the home as a fundamental part of our health reform strategy. We went to almost all the major players’ offices trying to say 'look, I understand you are focused on coverage. But the coverage-of-the-uninsured message has sucked the oxygen out of the room. You’re not going to pay for the uninsured if you don't fundamentally change delivery. You can't separate payment, coverage and delivery. They've all three got to be re-imagined.'
Everyone talks about the 80 percent of costs from 20 percent of the people, but a high percentage of those people can be cared for appropriately, safely, effectively and remotely -- via secure e-mail with their doctor, via remote patient monitoring where you're capturing their vital signs at home, via video conference check-in by their nurse.
Q: How broad are these opportunities?
A: The President needs to put out a going-to-the-moon call for innovation that says, by 2015, a third of all care in the United States is done at home, and not in the institution. From a market opportunity stand point, you're talking about 2 billion people on the planet age 60 and above halfway through this century. Somebody [in] Europe, or the U.S., or Japan -- is going to develop virtual care technologies, systems, services and know-how. They're going to use it for their own country, and then they're going to sell [it] to other nations. I sure would like the U.S. to reap the benefit of that.
Q: How's the rest of the world doing at this?
A: If you look at Europe, they're way ahead of us on the age-wave curve. In their discussion of health reform, they've made it clear that home-based care has to be a fundamental part of their international strategy. They're setting themselves up to not only solve the cost problem in Europe. They're setting themselves up to be at the forefront of this new care-services industry and to deliver those services to other parts of the world like India and China where the really large market opportunities are.
Q: How did you get into health care?
A: I was a family care giver for a grandmother with Alzheimer's when I was sixteen. My focus on independent living and disease management started way back then. I've been thinking for a long time something's got to give, because it was a pretty miserable experience.
I'm trained in anthropology, ethnography, a lot of the qualitative methodologies in sociology and psychology. Almost twenty years ago, [I was] invited to be the first intern for [Microsoft co-founder] Paul Allen's think tank, Interval Research. It was great. One of my projects was on technologies for places that don't have any, like nursing homes.
Q: Wasn't it a leap to go from anthropology to health technology?
A: When I came to Intel my very first work was not on health care. It was on digital entertainment. We were doing studies of what we now know as iPods, and [Personal Video Recorders] and TiVo. Those things didn't exist then but we knew they were coming, so we were trying to understand people's relationships to media. We went to live in and observe [people's] homes. [We'd see] people struggling to deal with chronic disease or to take their eight medications a day. The families would start talking to us about, “Gosh, if you guys really want to help us, design some technologies that would help take care of my Mom.”