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An Innovative Approach to Aging and Caregiving

After earning a bachelor’s degree in science, technology and society and a master’s degree in management science and engineering from Stanford University, YPO member Lily Sarafan was fairly certain that she would attend law school and then work at the intersection of technology and policy. However, her dream career path to becoming the technology advisor to the President of the United States took an unexpected detour 13 years ago.

While completing her honors research during a gap year before law school, Sarafan met with a couple who provided senior home care services in Palo Alto, California, USA. Intrigued by their conversation, she began researching the aging services market. “This massive audience of individuals had essentially been neglected,” says Sarafan. “The space was incredibly fragmented and the companies that did exist were mom-and-pop businesses with no one going about it from a more sophisticated or data-driven standpoint.”

A few weeks later, she joined the couple for what she thought might be a one-to-two year venture to build and scale a company. “My early efforts in the industry included building an operating model around home care for seniors and seeing where we could apply technology and efficiencies, where we could expand the model to other geographies and replicate the blueprint that we were seeing at that time just in Palo Alto,” says Sarafan.

Aging together

Over the course of that first year, Sarafan successfully took Home Care Assistance (HCA) to disparate U.S. locations including Georgia, Michigan and New Jersey. “I recognized that this industry was ripe for 21st-century thinking,” says Sarafan. “The statistics continued to be staggering and I felt I could really make a difference in a high-impact space.”

According to Pew Research, one in four American adults serves as a family caregiver for an aging loved one. With half of the fast-growing octogenarian population suffering from some form of dementia, the majority of them women, the need for caregiving solutions has never been greater. As of 2015, there were about 4.7 million senior citizens using home-health care, 730,000 in assisted living facilities and 1.4 million in nursing homes, according to the National Institute on Aging. While the Centers for Disease Control and Prevention estimated there were more than 12,000 small home care providers in America, no single company had emerged as a national player in the market. Enter HCA, which was able to scale, develop infrastructure and secure investment to innovate in the sector.

Today, HCA is the leading consumer health company in the USD100 billion home care industry. Under Sarafan’s leadership as President and CEO, HCA has grown from startup to more than 7,000 employees across 170 markets. HCA’s mission is to change the way the world ages and to improve senior quality of life to enable happier, healthier aging at home through high-touch care, digital health and data analytics.

At the intersection of health and technology

Part of HCA’s success hinges on its innovative approach. “We deploy a lot of out-of-the-box thinking which allows us to look at our care delivery model differently and to draw insights from other industries,” says Sarafan.

Traditionally, home care has consisted of small, local businesses that receive referrals almost exclusively from health care providers. HCA harnessed the power of the Internet in order to create a company at the intersection of health care and consumer services. By moving outside the confines of the traditional health care ecosystem, Sarafan explains, HCA was able to direct market to consumers and identify its most valuable consumer: 40- to 60-year old females, often the adult daughter, who is making health care decisions for her family, including her parents, and who is looking for reliable companies with online reviews, consumer education modules and answers to general wellness questions. HCA was able to grow exponentially faster through its access to this untapped online audience.

Developing strong operations powered by great systems in every market was critical to ensuring HCA’s national success. “No matter how large of a company we are, there is a care team in every market that is usually within a few miles of where a client lives,” says Sarafan. “We have retail storefronts in 170 communities across the country so that you can walk into a site, speak with a care manager and meet your staffing team. We bring a concierge approach to this where you have a consistent care provider team, and you have the caregiving plan and high-touch caregiving services for your loved one at your fingertips.” In order to maintain a high level of oversight and accountability, team members are full-time employees, rather than traditional contractors, and are rigorously vetted, trained and managed by HCA.

An aging world

Home care is no longer considered a niche service operating on the outskirts of the health care ecosystem. HCA’s home care teams partner with health care providers to ensure continuity of care, follow treatment plans and assist with improving health and quality of life. Another aspect that is changing this dynamic, Sarafan says, is data collection. A home care provider working with a client day in and day out — often for months or years at a time — has a lot more insight and visibility into what’s going on with a patient’s wellness than a doctor who may only see the patient a few times a year. Partnering with caregivers gives health care providers a wealth of data about a patient’s moods, diet, cognitive state, sleep habits and more that is valuable not only for the individual patient but also the larger aging population to determine what leads to healthier outcomes.

To go beyond the tactical home care service to create mindset shifts around the way the world ages, HCA developed a scientific division that researches lifestyle factors contributing to aging and cognitive decline. As Sarafan says, “that’s not something you would typically find from someone whose aspiration was to start a home care company. All of these things have allowed us to go beyond the typical growth trajectory of a company in our industry and have played a big role in the level of investor and entrepreneur interest in the longevity space.”

Sarafan wants more sophisticated players in this space. It’s better for older adults and ultimately for the country as a whole as some 4,000 Americans turn 85 every day. “The more entrepreneur and investor interest there is in an industry the better outcomes, the better models and the more innovation you’re going to have and it’s going to be a rising tide,” says Sarafan.

Making innovation happen

A 2018 Young Global Leader and a Henry Crown Fellow at the Aspen Institute, Sarafan finds the intersection of seemingly disparate disciplines to be “where all the magic and innovation happens.” Sharing her knowledge of health care and technology as a board member for Counsyl, a genetic screening company, and Entefy, an advanced AI solutions provider, as well as for high-impact nonprofits including the Stanford Alumni Association, the Freeman Spogli Institute for International Affairs, the BerkeleyHaas Center for Innovation Economies and the Women’s Alzheimer’s Movement, helps her run HCA more effectively as well as bring unique insights to the other organizations. What is most important to her is making a meaningful difference in the world by working with first-rate teams on huge problems with innovative solutions whether in civil society, global economic development or precision health.

“In an era where there’s so much attention on the new industries of tomorrow it’s been really rewarding to bring tomorrow’s innovation to such a traditional and classic space,” says Sarafan.

Melissa Fleming has previously worked for Catchafire, Fast Company, Harper’s Bazaar, Stanford Social Innovation Review, Time Out New York Kids, Town & Country and Vogue, among others.