Show Notes

About Tom Koulopoulos

Transcript

Welcome back to Foresight Radio, where we dive deep into the technologies shaping our world and explore how they're redefining the way we work, live and lead. I'm Tom Ellis, and today we're going to take on one of the greatest challenges we face as a nation and as a globe health care. So let's begin with a really bold premise. What if we could make U.S. health care the envy of the world? I know that sounds absolutely absurd. It borders on insanity, given the current state of US healthcare. The fact is that everywhere you turn today, health care workers have reached their absolute breaking point. So let me throw some numbers out here. 48% of physicians reported burnout. 26% of nurses have left health care jobs, citing burnout as the reason that second only to retirement. The American Hospital Association tells us that there will be a projected shortage of up to 124,000 physicians by 2033. Covid certainly had an impact on this, but this is more of a systemic issue. The conclusion here is pretty darn simple. We're not caring for those who are tasked with caring for us. Add to this that by 2030, every baby boomer will be over the age of 65 and 1 in 5 Americans will be of retirement age or older by 2060. Will the clock forward a little bit further? The 65 plus population will nearly double from 49 million today to 95 million already. Americans who are aged 55 and older account for an incredible 56% of all health care spending. If we continue at this rate by 2060. We could be spending as much on health care for seniors alone as we currently do on all of health care for the entire population. Overall, costs are escalating so fast that the percentage of GDP represented by total health care costs is just about equal to the last two digits of the year. So in 2025, 25%, 2030 30%. This is accelerating by 2040 40%. Carry this to this absurd conclusion by 2100. Our entire economy is health care. The math just doesn't make sense. And this isn't just a US problem, it's global. Every health care system, regardless of country, will soon face the same foundational crisis a rapidly aging population, overworked health care professionals, and increasing complexity of care that will make current models of health care simply unsustainable. The United Nations has ran a projection that, by 2050, one, in six people worldwide will be 65 or older. That's up from 1 in 11 in 2019. This beautifully pyramid shaped demographic that once supported health care funding with a broad base of younger workers supporting an aging minority, is shifting into something far less stable in many countries, including the US. It'll soon resemble a tombstone. The math here is irrefutable the system as it stands today. Is not sustainable, not in the US and not anywhere in the globe beyond the next 20 to 30 years. You know, Covid 19 should have been a wake up call highlighting the weakness in our health care infrastructure and the urgent need that we have for fundamental shifts in health care. But the call pretty much went unanswered. While things like health care reform are complex. My take on this is, and it has been for some time that this is not impossible. So how do we shift to continuity of care over episodic care? The first and most important priority, I think, is that we have to let our health care workers to focus on what they do best, care for the patient. I've spoken with thousands of health care professionals over the past decade since writing Reimagining Health Care. Half of my time has been spent on health care. One thing is absolutely clear doctors, nurses, social workers are all deeply committed to their patients, and yet they're drowning in administrative tasks. The paperwork, the insurance negotiations, fragmented medical records consume so much time that could be spent on direct care. And if this trajectory continues, clinicians will spend more time managing bureaucracy than treating patients. Already today, a typical primary care doc spends at least 50% of his or her time on administrative tasks, rather on direct patient care. And yet, the presence of a primary care physician is known to lower health care costs by 30%. Problem here is that we can't train enough new doctors and nurses, and we can't do it fast enough to offset the growing demand that we're going to have because of this aging population. So the only viable solution is to ensure that existing health care providers are able to spend more time with patients and not on administration. The second step here is shifting to a sustainable system that will ensure access to integrated data and predictive technologies. The average senior has seen about 28 different physicians over his or her lifetime. And the issue isn't just the number of doctors, but the disconnected nature of medical records. No single provider, insurer or health care entity, including the patient, has complete access to their full medical history. This fragmentation that I'm talking about, it forces clinicians to make high stakes decisions without a complete picture, leading to redundant tests, medication conflicts and avoidable hospitalizations. Imagine that you walk into the emergency room and in some area of the country or the world where they don't know you, you haven't been seen. You can't advocate for yourself, and yet they still have to treat you with no context whatsoever of your medical history or your current conditions. In fact, today, half of all health care visits in the US occur in. Yeah, you probably guessed it, the e.R. This is a clear sign that our system is reactive rather than proactive. Instead of catching health care issues early and managing them effectively, we wait until they become a crisis. That's what I call episodic care. The result of this episodic care is that continuity of care is nearly absent. Instead. We have created this health care system that is constantly dealing with disjointed episodic episodes, which are driving up costs in undermining health care outcomes. But there's a solution. It's highly right in plain sight. It's not a solution that stems from a government owned health care record. While we focused a lot of our time and discussion on that, but rather a patient owned digital health care advocate, an AI powered system that ensures continuity of care by maintaining a patient's full medical history, tracking real time health data through wearables, monitor adherence to medications and therapies through ongoing human like dialogue between the patient and the digital advocate, and proactively flagging concerns for health care providers. In fact, we will see that your digital advocate can have conversations with your provider without you or the doc being at all present or available for those conversations actually working in the background for you 24 over seven. This notion of advocacy, by the way, it's not a new idea. It's long been recognized as It's critical to good health care patients with an advocate, most often a family member or a loved one see dramatically better outcomes. Patients with an advocate will experience up to 30% fewer hospital readmissions, 21% fewer medication errors, 17% fewer preventable hospitalizations, and 15% shorter hospital stays. For foster children and especially vulnerable population, advocacy improves mental and physical well-being, leading to a 40% greater access to mental health care and 25% fewer E.R. visits. And yet, advocacy is almost entirely dependent on having a dedicated loved one who can take on the role. The reality is that most people don't have an advocate available, or with the knowledge needed to track their care, to coordinate with doctors, or to take on the challenges that the system presents. The health care system presents when it's necessary in the moment, and a growing elderly population, overstretched social workers and fragmented medical records is only going to make that gap wider. Most of you listening to this right now have had to be that advocate for a loved one, a father, a mother, a sibling and aunt and uncle or grandparent. Without you in that position, you can well imagine how lost they would have been. So what does this look like? Imagine a system that functions like a personalized ChatGPT for healthcare. An AI that knows the patient's full medical history, monitors the biomarkers, identifies trends, interacts with the patient and with their doctors, understands the patient's genetic predispositions, and can even simulate treatment outcomes before the treatment begins. Based on the patient's unique genome and biology, a digital healthcare advocate could also notify a doctor when a patient's vital signs suggest something like early heart failure or alert a caregiver when a senior hasn't taken their prescribed medication. Schedule lab tests and in clinic or a telehealth visit. It could provide regular reports to authorized family. Members and partners about a patient's condition or anything needing attention. This kind of proactive approach shifts healthcare from a purely in clinic reactive crisis management approach to continuous preventative care. By the way, if all this sounds farfetched, it shouldn't because right now Salesforce is already doing this in non-healthcare applications with its multi-agent framework, having agents talk to agents and perform processes in the background that otherwise would occupy front office workers. Here's a couple of examples of where a digital healthcare advocate could help specifically. So the first is in nursing homes. Elder care is already in crisis. There are over 1.2 million older adults currently living in nursing homes in the US alone, and that number is projected to at least double by 2040. Yet 75% of nursing homes are already terribly understaffed. Anyone who's had a loved one in a nursing home understands the importance of having someone to ensure that medications are giving on time, that symptoms aren't are overlooked, that care plans are followed. But not every resident in a nursing home has someone who can dedicate that much time to their care. A digital health care advocate could bridge that gap. It could monitor biometrics, predict falls and sure medication adherence, and flagged potential health concerns before they escalate. And it could also speak on behalf of the individual. Many individuals in nursing homes and in elder care suffer from either memory decline from dementia, or from a fundamental inability to communicate. What if the digital advocate trained over time on that person's voice and on their mannerisms? Their behaviors could be the voice for that individual? Again, not far fetched. I've worked with a VC firm that is actually funding a company doing precisely that right now. The second area an example is foster care. Here, the power of digital advocacy cannot be underestimated. There's a crisis also in foster care. Every day, 400,000 children live in foster homes in the US. And yet social workers who are often responsible for these kids have twice or three times the recommended caseload to deal with. These kids are some of the most vulnerable in our society, and they experience the most incredible gaps in medical care, missed appointments and incomplete health records. A digital health care advocate can integrate medical, educational and therapeutic records to ensure that no child falls through these enormous cracks in the system today. If we continue on our current path, the health care crisis is unavoidable. We will be saddled with episodic reactive care. But with digital health care advocates for which we have the technology and the capability, today, we have an opportunity to redefine, truly reimagine what it means to care for people across their entire lifespan. The bottom line here is that continuity of care is impossible without advocacy and yet traditional advocacy. Models simply cannot scale to meet the needs of an aging population and an already overburdened health care workforce. Digital advocacy, in my mind, is the only viable solution leveraging AI to ensure that every patient has a voice, every record is complete, and every care plan is optimized. Look, we have the technology, we have the data. We have the ability to personalize and deliver precision medicine. What we need now is the commitment to shift from a fragmented reactive system to one that is continuous, is proactive, and is patient centered. This is the defining healthcare challenge of our time. Done correctly, it could well be the role model for the rest of the world to follow. We still have time to shape this future, but if we fail to act, we risk leaving behind a system that works only for the fortunate few, while the rest, especially those most vulnerable, are lost in bureaucracy, oversight, and neglect. It is time to stop treating healthcare like a series of disconnected crises. It is time to build a system that truly advocates for everyone. A system that cares for doctors, nurses, and clinicians so that they can do what they do best. Take care of us. Thanks for listening. If you're enjoying Foresight Radio, be sure to subscribe and share it with friends and colleagues. The best way to navigate the future. Keep asking questions, embrace change, and seek out new perspectives. Until next time, I'm Tom Phillips. As always, stay curious.