COVID-19 has changed everything.
After any war, cities need to be rebuilt, national economies restored, global communities re-established. Due to the pandemic shutdown, Louisville Metro may face a $30-40 million deficit. And now after the recent public protests, that price tag may be even higher. The city has assets and aspirations, however.
Among those aspirations is Louisville’s goal to become the aging innovation capital of the world. The aging-care segment of health care is worth about $8 trillion—meaning that if Louisville captured even 1% of the market, it would represent some $80 billion annually for the city.
Some of that is already happening, but creating a collaborative economic ecosystem netting just 1% of aging care would mean a cash flow of more than a third of Kentucky’s current gross domestic product (GDP), creating significant opportunity. A flourishing Louisville aging-care cluster could rebuild a strong economy by supplying the rapidly growing new demands and needs of an aging world.
As the source of more than 40% of Kentucky’s tax revenues, Louisville’s economic importance to the state is already great. Yet, imagine what becoming a major aging innovation capital could be worth to a city in financial distress. A health care renaissance could resolve economic burdens that we haven’t seen since the Great Depression.
“In times of crisis, you go to your strengths and we have that strength in health care aging innovation,” said Mary Ellen Wiederwohl, chief of Louisville Forward. “And while U.S. cities begin the recovery from both a health pandemic and a reckoning from institutional racism in this country, we need to think about how we’re going to build back our economy in a way that benefits all of our residents. By going to one of our core strengths, we have a greater opportunity to do so.”
Anthony Ellis, the Kentucky Cabinet for Economic Development’s acting executive director of KY Innovation—the agency’s entrepreneurship office—underscored the importance of Louisville’s efforts.
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“We are extremely excited about Louisville’s continued growth in the entrepreneurship and startup sector. With strong leadership in its support organizations like LHCC (Louisville Healthcare CEO Council) and the RISE office (a nonprofit that supports refugees and immigrants), a vibrant and active sector, and collaborative mentors, Louisville is primed for explosive growth as we head into this economic recovery. Aging care is a clear sector for our startup community to target, as Louisville and the commonwealth generally have a robust health care and long-term care industry, and have been a driving force in developments in these segments,” said Ellis, who is also the Cabinet’s general counsel.
“As a cabinet, we work to grow jobs, recruit talent and generate business investment in all 120 Kentucky counties. When our largest city and so many of its community leaders come together to collaborate on a project like this, it’s exciting for the commonwealth as a whole. We at the state are committed to this effort and supporting these innovation activities.”
Gov. Andy Beshear is also behind Louisville’s initiative.
“The pandemic and recent protests have created both urgency and opportunity in ensuring we build a more equitable future for all Kentuckians, including our older citizens. The partners working to grow Louisville as an aging-care hub are exactly who you’d want on your team,” Gov. Beshear said. “We support the aging-care vision for Louisville and consider the commonwealth a committed partner. Whether in our recruiting, marketing, helping existing businesses grow or by partnering to create a strong startup and innovation culture, Team Kentucky is working toward that same future.”
Health care has changed. Health care will change. Leaders of a health-care consortium in the city of “bourbonism” (a term the city has created to define the tourism draw of its many bourbon-related sites) and horses believe aging innovation can be the front-line of its future. They see it creating trends to solve and fill gaps, evolving solutions to needs and demands in a new health care world while also improving wellness and driving new care models—if Louisville can create the framework to support innovation.
There are significant building blocks and cornerstones, some new, some having emerged over years:
• The Microsoft Digital Alliance Partnership and Future Work Initiative in partnership with the city, the University of Louisville, and the Brookings Institution was created in 2019 to build a regional digital ground zero for artificial intelligence (AI) and the internet of things (IoT).
Much of the thrust is centered on digital transformation of the workforce for a tech future. It is no coincidence that Louisville—home to multiple champions of aging health care, from insurance to post-acute care to hospice—attracted this partnership. Together, all the above could be a natural alignment to lead aging innovation.
“We are grateful to Microsoft. They see an opportunity that has some unique advantages to be driving innovation in the data economy, which is connected to our aging cluster,” said Ben Reno-Weber, director of the Microsoft Future of Work Initiative. “Louisville, like no other city, has a reservoir of data resources that can trace data across an entire company’s lifecycle. There’s not a place where you can do that everywhere.”
Reno-Weber urges a reframing of how to see data. He imagines shifting its current view from that of a “cost center” into an integral part of doing business, especially with the aging “silver tsunami” now arriving.
“Once we build that infrastructure,” he said, “because health care concentration is such an important part of our industry, success in the data economy is not about the technical shift but a cultural one. If a company in the health care space is going to be successful, it must change the way it sees data as a corporate asset.”
• The aggregated power of the Big 12 companies now known as the Louisville HealthCare CEO Council (LHCC):
Some key partnerships are evolving within the LHCC, whose companies (with $100 billion in revenue) represent the length, breadth and complexities of the health care ecosystem, from payor to provider to those on the front lines of solving health care problems. Those initial discovery labs will likely evolve now based on the new normal, such as the need for elevated infection control, the emergence of telemedicine, and a first line of defense against a second COVID-19 wave.
Post-COVID aging innovation solutions will center around the need for intense infection control, says Dr. Arif Nazir, immediate past president of The Society for Post-Acute and Long-Term Care Medicine and chief medical officer at Signature Healthcare, a LHCC member.
“We all need to be better stewards of infection control patterns,” Nazir said. “Just think about what’s possible here with new competencies in infection control like face recognition and the ability to trace one’s steps and who used the sink last, how long hands were washed.”
With one in five Americans soon to be 65 or older, LHCC is stepping into the leadership limelight in aging innovation with its upcoming Global Healthcare Summit, now scheduled for Sept. 2-3, 2020. One of the goals of the summit is for national and world leaders and communities to take note: Louisville is solving global problems and community health issues.
• International pharma is focusing on Louisville and the power of real data-sharing. Pfizer Inc. and the University of Louisville’s Division of Infectious Diseases have an established history of collaboration. Their synergistic alliance now will become the basis for one of the first of eight adult population research centers being placed globally—and the only one in North America. UofL will “play a significant role in epidemiological research related to vaccine-preventable diseases affecting adults, including the elderly,” a recent UofL news release states.
The reason for the selection, Reno-Weber said, “is that nine hospitals that treat in Louisville are willing to share their data. At least one of the senior physicians was trained at CERID (The Center of Excellence for Research in Infectious Diseases).”
• Aging2.0 partnership and relocation to the city:
Anticipating the next chapter for boomers, Aging2.0 was founded in 2012 on the West Coast to address the need for aging innovation with a public-private approach and international reach that “has grown to 40,000 innovators across 31 countries, with a chapter network that spans 120 cities and 700 events around the world.”
Aging2.0 moved its headquarters to Louisville in May, announcing a strategic alliance with LHCC that enhances the city’s recognition as a global epicenter.
Ecosystem emerged from Humana
The city’s culturally rich aging-care hegemony has its roots in Humana’s early history in the 1960s, when it became the largest nursing home company in the U.S., then transformed into one of the largest hospital companies, and next launched its own health insurance plan in the 1980s. As the American health care system changed, so did Humana. The company’s alumni spun proficiencies they developed there into new companies that today are an ecosystem.
“When an industry has thus chosen a locality for itself,” the great 19th-century economist Alfred Marshall wrote, “it is likely to stay there long, so great are the advantages which people following the same skilled trade get from near neighborhood to one another. The mysteries of the trade become no mysteries; but are as it were in the air, and children learn many of them unconsciously.”
Louisville might next evolve into a driver of expertise in staffing advancements; cures; the tech embrace of data realities; precision medicine; virtual care; the social determinants of outcomes; and the power of the one-on-one to deliver personalized health care that has never existed before.
LHCC members want real data share opportunity that can link with and push statewide advances out through the university system. They imagine Louisville being the pandemic crusader and COVID-19 killer for the world—especially as the leader in aging innovation, saving the most vulnerable among us.
“It’s that cultural piece that is potentially powerful,” Reno-Weber said. “Either we take advantage of it or we don’t.”
Louisville still needs money and trust
The finances of funding startup innovation and sustaining those start-ups through pivots and evolution to achieve sustainability are complex.
Entrepreneurs do, indeed, raise real money locally. In 2019, $70 million in capital was invested in Louisville. Investors often want the company to remain local for obvious reasons: community investment, access to the build, future growth implications, proximity to health care or pilot companies. They want companies to access ongoing local support and the navigational advantages of newer organizations like Louisville Entrepreneurship Acceleration Partnership (LEAP), and stalwarts like XLerate Health. There is growing a sense that having the money in Louisville and keeping it here is not the disadvantage that it may have once been.
But those involved in the Kentucky funding community have long said there still is not enough of it. There are, indeed, a lot of angel and venture groups out there and a “robust smaller investment category for super start-ups for $1 million or less,” says Gill Holland, a community leader and developer who launched reinvigoration of the NuLu area just east of downtown. “What we’re lacking is the $1 to $5 million for a $10 million raise. We need to get better at attracting out-of-town money.”
One local innovator, for example, received an investment from a Columbus, Ohio, incubator but then had to move his company there. And other startups don’t need large amounts of money, Holland said, because they’re more centered around “the ones and zeros of computer programming.”
What Louisville lacks and does need if it is to attract and encourage creative entrepreneurship–especially when solving for the aging care and innovation gaps–are the bigger dollars of serious equity investment and the funding that can take a solution to manufacturing and be able to see it through an FDA approval process, Holland said.
Such a robust investment community could support, for example, an innovator like Crestwood, Ky.-based Liberate Medical, which is being recognized for its external electrical neuromuscular ventilator technology, which can speed patient liberation from mechanical ventilation. Due to the increased need for ventilators caused by the COVID-19 pandemic, the technology now has the sudden opportunity to be fast-tracked by the Food and Drug Administration (FDA).
Kelby Price, executive director of Venture Capital at Kentucky Science and Technology Corp., agrees.
“Growing Series A investment activity will require more talent, more new companies or starts, and more successful exits,” Price said. “Simply said, in order to do it here, the source of the deal or local investors needs to be successful.”
Instead, says Larry Horn, director of LEAP, there is “a sucking sound from the venture capital community outside of the state,” looking to take away companies with good ideas.
LHCC aims to reverse that financial draw by creating not just opportunity for aging care-based innovation but new capital dollars from pre-seed to Series B. In 2019 it launched the LHCC Strategic Investment Fund in partnership with an already-established investment committee. The fund’s goal is to deploy the type of dollars that can scale innovation and generate financial momentum and wider revitalization.
According to Horn, Louisville investors can protect their investment and its value by maintaining it right in the city where it’s being developed, grown and piloted. A lead advantage for Louisville, he argues, is that the community’s “density of knowledge is offering more than just money but mentorship and inroads to potential customers.”
Louisville’s health care industry offers comparative advantages to leverage early-stage companies faster: validating that a problem has a possible business solution, pilot-testing strategically with first customers, a willingness to assume the risk of trying new things, and the market in which to do it.
“There are a lot of ingredients there,” Price said.
Holding them together will require a culture of trust, which is necessary in order to believe that collaboration can create more value, not competition. Potential impediments to success could be inadequate trust among the Big 12 LHCC members on the data share; navigating 12 unique corporate cultures for early investment dollars; a well-developed pilot that never lifts off; or a stalled opportunity in early adoption phase due to compliance or other legal burdens in an over-regulated HIPAA nation.
Solving for the new normal
“Now is the time for Louisville to take the lead in AI based solutions,” LHCC member Nazir said, “including the automation of wearables so when a doctor logs in, he or she already has 1,000 readings from the pulse rate and we can then start to see trends in their health.”
By automating data gathering for significant health determinants, personalized health care evolves. It allows matching community resources with the background of the patient, enabling clinicians to offer better patient care and services.
With wearables, Nazir said, there are more eyes on his patients—digital eyes that do not tire. And he can focus on responding to needs better and faster while being able to adapt care plans or pathways.
He and other LHCC members see a health care that could involve the following:
Wearables—a new kind of technology that fulfills the need for a better understanding on what is going on in the patient’s body. For instance, simple matters like how any times a patient is turned in a hospital bed can be significant. Human resources make it impossible for a one-on-one clinical patient ratio but with wearables and real-time data, might feed AI for a type of robotic nurse.
Personalized medicine through genetics—giving the patient what they need via a personalized medicine, which links to the data-share opportunity between the Big 12 and the city’s digital alliance with Microsoft. The COVID-19 experience is accelerating the arrival of a new landscape of digital medicine that the world is increasingly ready for.
Technology with a human touch—Telemedicine and broader-based telehealth solutions are all the rage with their urgent adoption due to the dual needs of preventing transmission and getting care to elders who are the most vulnerable to the coronavirus. But it cannot replace the care given face-to-face. While doctors and clinicians are embracing it for many reasons, social distancing is still considered a temporary practice, and care delivery remains a very organic relationship.
Specialties will begin to expand—Technology is creating an opportunity to push more specialist care out into the system. The medical community already is curious after this spring’s telehealth regulatory waivers to see where health care licensing rules go, as well as interstate commerce of physicians and specialists across state lines.
Creativity in financial controls—Payors are embracing technology for prevention, compassion and lowered costs. Insurance is granting more flexibility of services. Rebranding American health care, with new codes, new waivers and new requests will become a necessity for driving quality care into rural areas, for preventing COVID-19 for patients and staff alike, and making distance care an option.
Filling the need for a new normal
The new normal almost forces a new philosophical framework overlay that has ruled this country since its foundational pillar of capitalism and individualism.
Deficits at the city, county and state levels will demand a new economy with new economic realities. Meeting budgetary shortfalls and bankruptcy threats may be solved by the density of health care knowledge right in the heart of Louisville—if pooled into a post-COVID strategy to revitalize an economy that drives job growth, tax revenues and repopulates hope.
Greater Louisville’s health care leaders think they have the goods, the expertise, the brilliance, the industry respect, the global outreach and the existing infrastructure to figure this out. And a billion people need it. ■
Dianne H. Timmering is a correspondent for The Lane Report. She can be reached at [email protected].