Healthcare in a Box: A Transformation for Dementia Care Across the Nation
Bankers Healthcare Group
Aging is a natural part of life. But as we live longer and our needs change, the conversation about aging swiftly turns to the topic of dementia. The World Health Organization (WHO) reported in 2017 that 50 million people worldwide have dementia, with 10 million new cases being reported each year.
In the United States alone, approximately 15% of adults aged 70 and older have dementia, with the numbers of those affected—and the associated costs—skyrocketing with each passing year.
Even if you’re not aware of the statistics, you’re probably well aware of the impact. The fact is, most of you reading this either know of someone or have a loved one who suffered from dementia.
A Family Struggle, a Messy System, a Vision for Change
Despite learning more about the causes and ongoing research into curing such a devastating syndrome, the American healthcare support systems are inefficient and disorganized. How do I know? Both my parents suffered from dementia, and my family had to navigate a complicated and challenging system.
The struggles began when we sought out diagnosis and prognosis for my parents, both in their 90s. Neither they, nor my two brothers and I, had good support throughout the care journey.
My younger brother is an architect who actually designed the long-term care facility where my dad spent his last years. My older brother is a superior court judge. I'm a physician with a lot of administrative experience in medicine. But even with our backgrounds, we struggled with the system. I thought, "My goodness. How do people who are even a little bit less technically equipped get through this mess?"
There’s a striking disconnect between what exists and the services people actually need. And I want to change all of that.
A Lifetime in Medicine
I was a family physician until the mid-1990s. After that, I held major executive positions at healthcare organizations. I’ve been chief medical officer at Humana Military TRICARE and Humana Arizona, Molina Healthcare, and was lead medical director of Anthem Medicaid for a time.
Lately, though, I've been working on developing a mental health clinic focused on dementia treatment: a one-stop-shop opportunity for families. This is an exciting opportunity to do a world of good in the healthcare industry. The idea is to create a franchisable, multidisciplinary approach that could be either hospital- or clinic-based. It would offer support to patients and families as they travel down the road of progressive dementia.
This gap in dementia care is an unmet need—a real hole in our healthcare system—and I don’t want others to experience what my parents, brothers, and I went through.
My goal is to allow someone to go into a facility that offers these specialized services. When the patient, their family, and their support team come out, they will be prepared with information like: an understanding of their current situation, helpful guidelines, and suggestions about what to do to cope with the loss they’ve sustained. They’ll learn the awareness of the danger signals for the next steps, and find ongoing support to help them make decisions about care structure. This knowledge will help guide them through complicated, tough decisions.
Doing Better: The Cost—and Complications—of Transforming a Broken System
Making a change in dementia healthcare services isn’t easy—or inexpensive. It requires startup capital and institutional partners like hospitals, medical centers, and clinics; it needs the expertise of trained professionals and—most importantly—the grit and dedication of the medical community.
After all my years as a medical professional and my personal experiences with dementia, I feel like I've got something to bring to this industry. But to get this business off the ground, I needed the funds to pull together the other experts and consultants to help me formulate testing protocols.
On top of the fees for consultants, I estimated needing about four to six months of upfront capital to run a clinic, even in a barebones configuration. Unfortunately, even in my financial position, securing these funds wasn’t easy.
Give Me a Break: The Financial Roadblock to Building the Dream
I started out trying to do a cash-out refinance on my house. Despite the fact that I have a lot of equity in my home, and an excellent income, I was turned down. I simply didn’t qualify, even though it wasn’t deemed a high-risk loan.
My immediate reaction was surprise. Give me a break—if I can’t qualify for a loan, who can? This result reflects the atmosphere that we live in after the 2008 crunch. Underwriting rules are strict and severe.
I then explored a reverse mortgage, but the numbers just didn’t pan out. I only had a small first mortgage and the reverse-mortgage system is not well designed for high-value homes because they cap the amount you can borrow. Then I went to several companies that were marketing jumbo reverse mortgages, but we ran into the same underwriting restrictions.
Funding the Future of Dementia Treatment with BHG
Six years ago, I used BHG for some working capital requirements, so they reach out to me periodically. It was perfect timing. I’d had a great experience with them in the past, so I became a repeat customer.
Working with BHG is unbelievably easy, straightforward, prompt, and supportive. It’s the complete opposite of working with banks and underwriters. The old loan applications for the traditional vendors are an inch-and-a-half thick. But with the banks, I didn’t even get the loan despite my good credit, strong income, and all the hard work of putting the applications together.
With BHG, the process was completely different. Compared to what I'd gone through in the past, it was a snap. Working with BHG was refreshing, to say the least. I'd been a prior customer, so it felt like they had faith in me and my vision, and that they'd get paid back, just as they had before. When a lender has confidence in your vision, you feel validated and motivated to achieve your goal.
Since receiving the funding from BHG, I’ve hired a neuropsychologist to help me design the testing protocols, both for new patients and for ongoing monitoring of patients as they move down the path.
I’ll use the working capital to fund the natural next steps. Most of the expense will go toward preparing the materials and shopping the concept, finding a sponsoring institution to partner with, and then finally opening the doors and keeping it running until revenue flows.
Healthcare in a Box
My ultimate vision is to create “healthcare in a box,” where you can take a healthcare concept, package it, and move it around and set it up—irrespective of location, challenges, and institution. This is what makes healthcare more accessible and gets it to the people who truly need these services.
The inspiration for this system came from when I worked with Humana Military, a military healthcare provider for TRICARE Region 3 and 4 (Midwest and Southeast). Humana is a civilian healthcare provider that interfaces with military healthcare. It takes care of retirees as well as active duty folks who can't be accommodated in the traditional military treatment facilities. At one point, we served 40% of all of the TRICARE system.
What they were able to do—and what I want to mimic and then improve upon—is build systems and services that are easily transferable. They set them up to run on the existing technology, so they can thrive within any healthcare provider’s system.
The idea is to put dementia care in a “box” that you can basically just plug into an existing care system and provide this specialized kind of care, removing the strain of building a new program from scratch.
My vision is that it will support both the patients and the families who are dealing with a very difficult and emotional problem. This idea will blossom just by sheer force of demographics.
Living with dementia is an overwhelming, confusing, and exhausting experience for the patients, caregivers, and family members. If we can make their lives easier as they navigate the healthcare system, we can alleviate the social and economic strains on our lives, making aging just a little easier for everyone.