What’s Your End Of Life Plan?

What’s Your End Of Life Plan?
Delivery & Logistics

We sat down with Caregoals founder and CEO Blaine Warkentine to discuss how now is the time for US to finally lead the way to better aging

Emily Wasik
  • 7 september 2017

If you were sitting down at a dinner party and someone asked you, “So, what’s your end of life plan?” a cuckoo clock would probably sound in your head as your internal monologue. As humans, we generally like to plan ahead. I know some parents who lock in what high school their children are going to before they are born, and many friends who have a 5 or 10 year plan for their careers. But when it comes to our eventual and inevitable end destination—death—we seem to carry on day by day, preferring make decisions about our Instagram filters or Starbucks coffee orders than how we will spend our remaining days on the planet.

Of course I understand the allure of ignorance being bliss, but blocking off the inevitable forever just means that ultimately you won’t get the best level of care when the time comes—and the time will come. This isn’t procrastinating about a college paper – this is the end of your life, where putting it off won’t mean getting an F, but rather prolonged pain, family feuds or bankrupsy. According to Caregoals founder and CEO Blaine Warkentine, medicalized deaths filled with unwanted care lead to 30% shorter lives and the last year of life now consumes 60% of all health costs (or 1.5T). In fact, more than two million Americans die each year in an hospital or ICU, with an average of $10,000 dollars per day.

We sat down with Blaine to discuss how now is the time to innovate in ways to allow the US to lead the way to better aging instead of lagging behind.

PSFK: For those people out there who are not so familiar with CareGoals, could you please provide a bit of background into what the company does and how the business concept came about?

Blaine: One of the most basic problems in healthcare is that as humans we struggle when considering our own death (or with the death of a loved one). We endlessly procrastinate in taking the necessary steps or in having the important conversations that would lead to a better end of life, with less anxiety and fear.

In America health costs escalate exponentially toward the end of one’s life and quality dissipates inversely to the aggressiveness of care. Over medicalized deaths filled with unwanted care lead to 30% shorter lives, cause prolonged pain and drive families to disagreement, argument, struggle and bankruptcy. Today the last year of life now consumes 60% of all health cost (or 1.5T). More than two million Americans die each year in an hospital or ICU, with an average of $10,000 dollars per day. But this doesn’t have to be the case. We have examples of other countries that do a much better job. Perhaps also now is the time to out innovate in ways to allow the US to lead the way to better aging instead of lagging behind.  

A simple issue to consider, is where you want to be in the end. When polled, 95% of the population prefers to be at home, comfortable, and with family for their last days. If this were what the health system focused on delivering quality of life would double and cost would be cut by more than half. But as of today the healthcare industry benefits greatly from the enormous 1.5T that we spend. Hopefully we can look forward to value-based reimbursements where this unwanted care should be seen as low hanging fruit toward better value.

Meanwhile, if patients were to opt to make these decisions for end of life care known, we would offer them a paper based advance directive and power of attorney. But checkmarks to paper are a poor substitute to the actual conversation. The document if and when completed, is non-binding and generally ignored, often missing or unavailable, and the decisions ultimately remain open to discussion, one that is most often dominated by the loudest family member in the room. Armed with little incentive for doing less, this leads doctors toward a hopeless pursuit of the next and most aggressive intervention without regard for quality of life.

The struggle to adapt and change is a challenge for established brands. Insurance payers fear the optics of “rationing” as health providers are similarly cautious of “giving up”.  Caregoals sees an opportunity to be a brand as a digital platform that can support them with introducing the topic in isolation from their brands.

Uniquely, the Caregoals platform leverages patented multimedia as an advance directive, cloud storage and blockchain to help the system do a better job in supporting caregivers, patients, families, in facilitating the many issues of aging improvement and end of life care. We do this by patented process of capturing conversations to video or audio, year after year, giving health providers via clinic or telemedicine the ability to successfully introduce, bill and code for advance care planning reimbursements. Our tool improves efficiency to $400 an hour, as each engagement generates and stores the compelling content and data that makes decisions easy. We store the data to blockchain enabling powerful security and privacy as well as enabling family and health systems appropriate access. The data then makes aging improvement and better end of life care a real goal oriented pursuit.

Caregoals helps all parties start much earlier in life, like age 65, when decisions are easier. Helping each learn a bit more year after year, and engaging patients toward inspirational aging with more control and humanity.

What are you doing to humanize what is often treated as a medical problem?

Conversations are the important part. They humanize through empathy and compassion. We facilitate these conversations starting earlier and we help make the actual conversations shareable with family to support the decisions that are made. Humanity is improved when we simply talk to one another. Really listen and learn. Focusing on what people want instead of what makes money is a very humanizing approach for the health industry to take. Deloitte did research that says it is 7x more valuable for patients to have their doctor “know” them, than is cost.

What do many patients tend to want for their end of life care?

95% want to be happy, comfortable at home with family. We should be doing everything we can to enable that result with every American. This alone would double quality, extend lives, and dramatically lower overall healthcare costs.

Why is video a powerful tool for patients and their families to create a document of one’s life? What are the components involved in making this video?

Multimedia is how we consume information today. So few see the value in a check mark to some future event filled with medical jargon like PEG tubes. Instead understanding each other is the real issue we need to address and nothing conveys meaning like a video or voice. They say that the soul is stored in the voice and when you think back to your grandmothers voice I think we can all revisit that voice in our heads and understand that it’s simply a better way to understand one another.

What do you see as the current state of health? How is the health industry changing and what do you think it will look like 10-20 years?

We continue to focus on insurance not on health. We focus on how to pay for things instead of what we are buying. This must change. In 10 years we will have a single payer that is crafting a health journey for every decade of life and helping us optimize our health with each step. Most of the care we will receive will be a crafted from some AI tool that helps us organize our lives and our health. I think the role of humans in this process is less to diagnose or plan, and more to empathize and lend compassion and support. Caregoals could be a big part of this future if we execute well to our vision.

How are technology and access to information influencing consumer attitudes towards health and wellness?

I think people are slow to see the value of these things if they still have to go to their doctor and sign in at the front desk and then have no response afterward. But slowly new models of care will be more attractive in terms of cost, convenience and quality. I think the aging population cares a lot more about their health if there was a way for them to do a better job without visiting the doctor I think they would do it. We have lots of proof points for this. Out of pocket choices still flourish but the transparency on cost and value is there for them to shop. This will eventually find its way into every decision a patient, caregiver or family takes.

What are the important consumer attitudes/behaviors around health and aging that you see shaping the marketplace?

Social isolation and social determinants of health must be addressed and government should be equipping themselves to provide these solutions directly not relying on health systems.

When the best predictor of your health is your zip code, we begin to understand that failure to address social determinants of health are more costly than any other item. You can fill the fridge for a year for the same cost as an emergency room visit or hospital stay. Social isolation has the same risk of death as 4 packs of cigarettes a day. Paying a family member to be available to you as a caregiver improves cost and care by 4x. Today we have family caregivers supporting over .5T in cost at minimum wage uncompensated. Things like family and community caregiving and a little amazon food delivery should be the cornerstone of a 21st century health system.

What about with regards to personalization in healthcare?

There is personalized care as in genetics and then there is personalized care as in tailored to you as a person with your wants and needs. Both will play a role. But the later is far more valuable than knowing your genetic code. So much of health is behavior, providing for needs and helping achieve goals. We must first start by listening so that we can even start to address how we deliver such a result. But my feeling is that the community has the resources to do a better job and we need to better facilitate that community approach. That is where we see real progress and success. Lacrosse wisconsin for example has 94% adoption of advance directives and because they have had the conversation costs are down 50%, with 12 fewer hospital days and 5 fewer ICU days in last year of life. Importantly the community is able to utilize those resources to go carbon neutral and more… it’s really not that hard to do the right thing.

What are the challenges the health industry is experiencing? What are the criteria for a sustainable and successful end of life care experience?

Perverse incentives. We must address perverse incentives. Until we do we are simply barking up a tree. There is a thing called the cobra effect. It’s worth reading about. We don’t try and eradicate disease we just farm the treatment of it instead. The most costly approach wins in today’s fee for service system.

What can we expect next from CareGoals? Are there any new projects on the horizon in 2017 and beyond?

I would love to know this. I am hoping to find a great partner to test a community based approach. We have a great vision but without the resources to fully execute upon it. Will see, but please reach out to us if you have any interest in working with us or hearing about our approach.

Download the Future of Health report now!

PSFK Future of Health from PSFK

If you were sitting down at a dinner party and someone asked you, “So, what’s your end of life plan?” a cuckoo clock would probably sound in your head as your internal monologue. As humans, we generally like to plan ahead. I know some parents who lock in what high school their children are going to before they are born, and many friends who have a 5 or 10 year plan for their careers. But when it comes to our eventual and inevitable end destination—death—we seem to carry on day by day, preferring make decisions about our Instagram filters or Starbucks coffee orders than how we will spend our remaining days on the planet.

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