As the blog has matured, it seems that I have talked more and more about entrepreneurship. Those of you who are interested in putting your non-clinical skills to use to earn you extra income alongside your medical careers have expressed interest and so I’ll try to write about entrepreneurship when I come across interesting topics.
In this post let’s focus on where future dollars will likely be spent in medicine. It’s not hard to predict. We know that the population is getting older and more unhealthy, so for sure lifestyle diseases such as:
- obesity
- cancer
- neuropathy
- diabetes
- arthritis
- hypertension
- atherosclerosis
- hyperlipidemia
- dementia
- infectious diseases
The above diseases already have hefty market saturation. Instead, let’s focus on another niche topic, our aging population. I know it sounds boring and we’ve heard about the ‘baby boomer’ thing forever but let’s delve into the details – actionable steps, even.
The Elderly Population
I don’t know about your patients but the majority of mine are obese, sedentary and on multiple medications.
Old age doesn’t mix well with noxious lifestyles. When a parent or grandparent becomes incapacitated due to old age & poor health it affects family members. Next, it spills over onto the community and finally it becomes the responsibility of the government.
Identifying Entities Which Will Be AFFECTED
Family members, as I mentioned, will need to spend more of their time and money in order to take care of their frail, elderly family members.
Insurance companies will see an even higher burden of disease and having to pay surgeons and hospitals to manage it.
Nursing homes, assisted living and rehab facilities are far too few in number to support the over 100 million elderly Americans who will need assistance.
Medicare and other government services will look towards innovation, likely bridged by technology to help assist this population.
Hospitals and the outpatient medical system will be overburdened by the frequent visits of the elderly which will drive more and more of the healthier, younger patients towards telemedicine options.
Skilled caregivers are already in short supply. Open Craigslist and look at how many caregiver jobs are posted.
Opportunities For Entrepreneurs
In the next few sections I will talk about some specific geriatric healthcare business ideas, focusing on market needs and identifying specific opportunities for business-minded healthcare professionals.
1. Burden On The Caregiver
Whether it’s a partner or a family member, taking care of an elderly individual with medical conditions is incredibly exhausting, physically and mentally. The attention exhaustion alone is burdensome, much less having to intervene constantly without having adequate caregiving knowledge.
Having just a few hours a day where the caregiver can get some time away from the patient can be a valuable service. This could be in form of adult daycares with shuttle service to get the elderly individual to and from the center.
I could see a need for a temp agency which hires part-time RN’s to offer in-home services or hires foreign healthcare workers who are in transition, trying to obtain their US professional credentials.
Insurance companies or government agencies are likely to pay for mental support for caregivers due to how well this phenomenon is documented. This could be counseling sessions, on-site training, or video courses to help the caregiver better cope with the difficult task of caretaking.
Beyond coping mechanisms and psychosocial support, a family member may know very little about caregiving. Caregiving courses, whether in-home or online, could be lucrative.
2. Support With Living Alone
Quite a few of the elderly population can be safe at home, waiting until the caregiver arrives from their other responsibilities such as a job or their own family obligations. However, during the time away, the elderly individual may need help with home maintenance, home cleaning, and meal prepping.
A full-service, in-home support wouldn’t be hard to establish which could offer the elderly person some company, help with cleaning, prepare meals and take care of other house chores. Since no actual caretaking would be needed, I suspect the liability in such a business is far less.
3. Technology For The Elderly
There are quite a few inexpensive and effective tech tools out there in the market which can help monitor vital signs, check hydration levels, monitor vital blood values and even offer video support. The amount of R&D money that’s being dumped into this industry is impressive just in 2017.
It’s unlikely that the older generation will be able to use advanced technology the way it’s intended. However, simpler tech devices can be safely installed in the home by trained technicians.
At a party, about 5 years ago, I met a guy my age who had a very lucrative business installing ‘smart tech’ in the home of the elderly. He said that he had to get quite creative because most of the technology that we have today wasn’t around 5 years ago. And yet, he managed and he had quite an impressive fleet of installation vans that would go all over San Diego, outfitting such homes.
You don’t need to invent new technology. You can work on existing tech. You can work on delivering the tech to the potential patient. If you can decrease readmission rates or decrease healthcare utilization – you will have a case to present to an insurance group.
4. Outpatient To Homepatient
Think of everything that would require the patient to be brought to your office such as taking vital signs, doing urine tests, IV fluids, IV antibiotics, cerumen removal, disimpaction, nail care, diabetic foot assessment, blood tests, PFT’s, sleep studies, EKG, imaging, etc.
Now imagine you could emulate that from the outpatient setting to the home of the patient. True, at first it would be adopted by those who can afford paying out of pocket but for the sake of cost savings, insurance companies would soon follow.
The need is there because the amount of resources needed to bring an 80-year-old patient from their home to the medical office would far exceed the $8 spent on the urine dip during their visit.
Inventive individuals have started contracting EMT’s to go to the homes of the elderly in order to take blood, place IV’s etc. EMT’s are far less expensive than RN’s.
5. Home Safety Assessment
I can think of 20 different things that can pose a risk to an elderly patient at home. One could market a home safety inspection either directly to the consumer (high reimbursement, costly marketing, low volume) or you could offer it as a service for health insurance groups (lower reimbursement, minimal marketing, high volume).
Even without making any recommendations, there are many groups which will want to know what the living situations of the elderly patient is like. Collecting data is very lucrative even if you only collect it.
6. Data Collection
Investors are spending top dollar on companies which are collecting data. We’re talking multiple standard deviations above what’s spent on advancing healthcare technology or EMR or patient care.
Data, clean data, is like selling maps to the gold miners. How easy is it to collect data from the elderly? Terrible. They don’t spend as much of their time online or on their phones where data is collected. If you are wondering why Gmail is free or why your iPhone, which is more powerful than some laptops, only costs $700, the reason is data collection.
How do you collect data from the elderly? You can imagine that any technology or contact with the elderly would create data – if it’s disregarded then it’s a wasted opportunity. If it’s collected, then it’s incredibly valuable.
7. Coordinating Care
In our current medical model it’s very easy for an elderly patient to fall through the cracks. They are likely to take the wrong medication, get forgotten about by a specialist department, not be followed up on or get their care in an interrupted fashion. This creates mistakes, which creates poor outcomes, which causes patient complaints, which leads to lawsuits.
A telephone service that checks on patients regularly and whose staff has access to the patient’s healthcare records can follow-up on the patient to make sure certain things are done and followed up on which the healthcare team simply may not have the resources to do.
I envision contracting a large call center in Philipines or Indonesia to make such calls and follow-up with the patient as well as the caregiver. Remember the data collection? That too.
8. Alternative Care
This will vary quite a bit from individual markets. But you can expect that States like mine (Oregon) will have a huge and unmet need to have their elderly parent taken care of by healthcare professionals who aren’t going to prescribe simvastatin to their 93-year-old demented grandfather (wtf!?).
Acupuncture, aromatherapy, dietary changes, help with weight management, chiropractic care, physical therapy and other non-medicine and non-surgery interventions which can be demonstrated to be genuinely helpful to patients, will be in very high demand.
This will include legal assisted suicide. Because this is a taboo subject, it can be very lucrative.
9. Legal Navigation
Our elderly patients won’t be able to advocate for themselves quite as well and it would be incredibly taxing on their caregivers to manage their ADL’s, healthcare, and, on top of that, their legal issues.
Think of reverse mortgages, bank accounts, health insurance navigation, getting access to services they are entitled to but aren’t offered or denied, transitioning to medicare, to Medicaid, getting bills paid, having nursing home services covered and managing their insurances.
This group will be very well served by a team of competent geriatric lawyers. Got a partner who is a lawyer? You won’t need to run this with a large law firm; most of this stuff could be handled by an ex-billings specialist, by paralegals and law students.
10. Community Integration
Everytime I read my local newspaper or visit the library I’m pleasantly blown away by the amazing number of social outreach programs, most of which are free and available for our elderly neighbors.
There are huge volunteer groups which handle meals, grocery shopping, and social support. These are often subsidized by private companies or government agencies. But because they are so numerous and scattered, it would be great to have a middle person who can make the proper connections.
This can be done by hiring individuals or operating a profitable website which lists and ranks such services and blogs about how to best gain access to them.
Even a social outing for seniors can be a really delightful business to run. If you have someone in your family who is sociable and responsible then you could hire a van, go around picking up suitable elderly individuals and haul them off to new destinations.
Interested in consulting? Think you have a good handle on what the unhealthy elderly population needs? Offer a bid to one of the State-run elderly services to help them either reach more individuals or to cut expensive, unnecessary services.
11. Geriatric Consultant
I love my geriatrician colleagues, but some have practice styles leaning more towards longevity than quality of life.
I could envision a group of internists, family doctors, NP’s or PA’s, surgeons, geriatricians who could offer a consulting service for large insurance companies to decrease unnecessary surgical intervention or medication prescribing. Yes, I realize that this could go south really quick if it’s tied to incentives – I’m sure you can come up with a more sustainable model.
12. Longevity Consulting
I must add that from a wide enough perspective I’m not really a fan trying to extend someone’s life – it’s easy to overlook the quality factor. But I realize that it’s the right of a human being to live their life anyway they choose, however long they can.
Focusing on the elderly who are healthier, some are going to want to consult with a clinician knowledgeable regarding extending their lives. If you’ve followed this field you know that there are an exhaustive number of lifestyle changes and even interventions used in order to extend someone’s life.
13. Virtual Dementia Psych Services For Geriatric Individuals
Okay, I know, the title sounds schizo but it’s actually quite helpful, hear me out. First, the majority of the elderly in America will not have easy access to healthcare. If you live in California or New York or other well-to-do States then your view might be skewed. Second, there are still very, very, very few psychiatrists or geriatricians who can comfortably manage patient who have a combination of the following: 1) geriatric 2) have dementia 3) have no access to follow-up.
What often happens is that there is too little time during the office visit to discuss depression, vision problems, hearing problems, concomitant pain disorders, polypharmacy and a handful of other issues, all of which exacerbate dementia.
Telemedicine platforms are plentiful. But there aren’t any good ones out there which could integrate with already available technology in the patient’s home such as TV’s. There aren’t any that can provide constant stimulation to engage the patient. There aren’t any good ones (from my research) that focus on such a niche population.
14. Polypharmacy Consulting
Very few of the business ideas I have mentioned so far require a medical doctor to be at the helm. Everyone from an occupational therapist to a pharmacist can play a role to transform the lives of our geriatric patients and pursue a business in the process.
I have discussed the sad state of pharmacists before and just in the past 1-2 years I am seeing pharmacists clamour for residencies and hospital jobs. Automation is coming and our task-based colleagues will suffer. They may not lose their jobs but they will have to take on menial tasks on top of supervising a computer.
Pharmacist have so much to offer the medical community. It’s a shame they don’t but that’s what happens when you unionize or let your knowledge slip (oh no, he didn’t!). As a traditional pharmacist, you likely wouldn’t be able to do much. No offense, but critical thinking and analysis has been bred out of outpatient pharmacists long ago. But, it can be learned!
Every pharmacist has the doctorate level education needed to know when a geriatric patient is on way too many fucking pills. And who better to tell a family member that the patient is on too many medications than a pharmacist.
I would have to think it through well to know how best to achieve this. I could see an intelligent software being written which could do the evaluation. I could also imagine a group of pharmacists doing the analysis, maybe under the supervision of a nerdy internists just to make it look legit.
I just did a search and couldn’t find any blogs that focuses on the elderly and medication side effects, specifically, polypharmacy. Here is an opportunity for you to build your brand.
15. Mini Healthcare Centers At Geri Homes
Remember the little Target clinics that started popping up early 2000’s? Well, that died down pretty quickly. And then came a wave of mini urgent cares which didn’t do too well, either. It’s obvious that there is a need for inexpensive physical healthcare delivery locations – but that nut hasn’t been cracked, yet.
There are a few really promising pods being developed which are like little igloos with smart devices which can measure all sorts of shit. They even have probes that can enter various orifices. Delicious.
16. Physical Products – Medical Devices
For a few months I was following this one dude who was a nerd and loved taking medical devices apart and emailing the engineers who designed them as to why they did it this way or that way – suggesting improvements along the way.
He eventually ventured out and started finding poorly engineered medical devices on Amazon and took the exact item, shipped it to India, told them why it sucked and how he wanted it to function. If one company couldn’t figure it out or charged him too much, he’d take it to another.
Think of all the medical devices that an elderly person uses and imagine one small change to it and there you have your product. I’m making it seem easy but if you like tinkering with stuff then this might be for you. And since such companies can do the engineering and prototype production for you, you’d be taking on more of a director role.