Seniors Thrive

Market Failure # 1 (the demand side): The US healthcare system is beset with inequalities that disproportionately impact 30 million people of color out of which around 5 million are seniors. These disparities in access to Senior Care services are exacerbated in: (i) situations where the senior is unable to interact with the care system due to their lack of fluency in English and (ii) cultural contexts where seniors are highly discouraged from living in nursing homes or assisted living facilities (and are therefore more dependent on home-based, ‘assisted living’ support provided by working relatives/children, etc).  

Asian Seniors are particularly susceptible to both of the above problems. While Asians comprise 6% of the national population, and ~60% of the world’s population, less than 1% of NIH funding targets Asian health in the US.  Despite recent improvements in Medicaid, the Affordable Care Act (ACA) and CHIP, significant disparities persist in care coordination and care navigation for the Asian elderly. 

Market Failure #2 (the supply side):  Over 30,000+ female healthcare providers (HCPs) are not participating in the US health workforce full-time either due to: (i) part-time child-care responsibilities, (ii) socio-cultural barriers that discourage them from working full-time or (iii) not being actively licensed to practice their profession (medicine, nursing, dentistry, etc) in the US (e.g. they may be international medical graduates (IMGs) who are preparing to take their USMLE Step exams over a period of 2 to 5 years. Over 50% of this available workforce is of Asian ethnic origin (Bangladeshi, Chinese, Indian, Nepali, Pakistani, Philippino, Sri Lankan or Vietnamese). 

Seniors Thrive blends the exponential power of technology with human empathy, by training, equipping and deploying Senior Care Thrivers (SCTs) from among the large pool of available frontline health workers (predominantly nurses and doctors) who are not currently participating in the formal US health workforce. These ‘Thrivers’ (as we like to call them) are equipped with 4G-wifi-enabled tablets, and digital diagnostics (e.g. BP monitors, pulse oximeters, handheld Ultrasound, portable EKG, etc.). They provide non-diagnostic nutritional counseling (in the same native language as the Senior) and assist Seniors with home-based physiotherapy (where needed).  In addition, they serve as trusted intermediaries, communicating with the Senior’s formal healthcare providers (i.e. Primary Care Physicians (PCPs) in English. The PCPs are usually unable to spend more than 12-15 mins per Senior per quarter in primary, preventive or promotive healthcare) so it makes this precious time far more impactful for the Senior when the PCP is interacting with someone who has an informed, clinical background. Thrivers also help to coordinate home-based care on behalf of the Senior, simultaneously communicating the entire senior patient journey to the Senior’s next of kin in English or native language.

This model matches the needs of senior people of color residing in the US by not only bridging cultural barriers but also utilizing the capacity of otherwise unemployed (or underemployed), skilled, healthcare workers.

Asian elders are the key target demographic for this solution. As per the 2018 US Government estimate, 17% of Asian Americans (AA) aged 65 and over lived alone while around 80% lived with their families.  The poverty rate for Asian Americans aged 65 and above was 10.8% as compared to 9.2% for all older Americans. 

The top leading causes of mortality and morbidity for Asian American (non-Hispanic) males aged over 65 were Non-Communicable Disease (NCDs) including heart disease, cancer, stroke, chronic lower respiratory disease, and diabetes. For their female counterparts, stroke, cancer, heart disease, diabetes, and Alzheimer’s disease were leading causes of mortality and morbidity. 

With over 30% of AA Seniors living with disabilities in the country, our solution aims to bridge major gaps in care coordination. A study published in the Journal of the American Board of Family Medicine, drawing on the 2018 data from the California Health Interview Study – the largest state health survey in the US, identified that Asian American elders tend to experience lower life satisfaction and receive less emotional support than peers of other races.

The COVID-19 pandemic has further exacerbated social isolation and loneliness among Seniors that may lead to even lower levels of life satisfaction and deteriorating health. COVID-19 marks a major inflexion point for the US (Care) economy along with a major opportunity to reintegrate 50,000+ female HCPs into the US health work force.  Underemployed or unemployed, skilled workers can step in and coordinate (complex) care for Seniors – while enabling PCPs and other specialist/consultants to focus their limited time on patient diagnosis. This is a major opportunity to revamp and retool the US healthcare system both for future pandemic preparedness as well as to address the immediate or near-term needs of millions of Seniors of Color.

The CoFounders of doctHERs are both ‘Asian Americans’, i.e. US citizens of (South) Asian descent who are extremely familiar with the challenges of the US healthcare system. For one of the CoFounders (Sabeen), this problem directly impacts her own family as they continually strive to arrange/coordinate care for her elderly father in Toronto, Canada.

Aside from the CoFounders, the rest of the doctHERs’ team is an eclectic mix of doctors, nurses, pharmacists, MBAs, social entrepreneurs, design thinkers, anthropologists, research, advocacy and policy academics, financial ‘quants’ and ‘techies’. This cross-functional, multi-disciplinary, ‘melange’ enables doctHERs to deliver ‘integrated innovation’ - social, financial and technological, in collaboration with both the public, development and private sectors.  

One of the CoFounders (Asher) is a US trained Medical Doctor (MD) with over 15 years of experience in the US healthcare industry. The other CoFounder (Sabeen) has accelerated over 200 women-led businesses via Ladies Who Launch (a US-based SME accelerator) and the World Bank’s WomenX program. 

This will be our first ‘reverse replication’ where we adapt a customer-centered innovation (that has already been introduced and scaled within the emerging world - South Asia in our specific case) and where we now apply this innovation to the US market.  We hope to share our learnings, insights and synergies with like-minded SOLVERs and corporate partners who have expertise in replicating models in different cultural contexts. 

Our solution is entirely new in conception, planning, and prototyping. This solution does not pertain to any previous solution.

The solution addresses core gaps in: 1) provision of qualified care workers, 2) matching them to the elderly/their families, 3) promoting cultural and logistical compliance of the care workers and the elderly. The very limited data studying care delivery in elderly people of color shows that health promotion services and older adults do not bode well together. For instance, the perception among the older adults is that healthcare is neither accessible nor acceptable as far as health and psychosocial needs are concerned. Our solution builds trust, proximity and the presence of fundamental factors required to improve accessibility and acceptability of care coordination services. 

Next Year:

1) Growth: Year 1 is about launching the Seniors Thrive service in the US and growing it to a small target population of no more than 50,000 Seniors of (brown) Color whose care is coordinated by ~500 HCPs (also Women of Color) so that the model can be fully ‘pressure-tested’ prior to a full-scale commercial launch.

2) Engagement: doctHERs will enlist and engage a community of at least 500  (mostly brown) female ‘Thrivers’ i.e., Healthcare providers (HCPs) who serve as Senior Care Coordinators. This engagement will entail (i) CME/CPE on relevant topics, (ii) preparation classes for USMLEs and (iii) 1-on-1 mentorship with practicing US physicians

3) Product and technology: The proprietary technology that undergirds the Seniors Thrive platform already exists. An intuitive customer-friendly, User Interface (UI) will need to be developed by a front end developer with an API that can link interoperably to other data systems. 

4) Platform: A platform that digitally matches Supply (of Care Coordinators) and demand (for Senior Care) will be piloted in Year 1   

3-5 Year Vision:

Our 3-5 year vision is to enable this model to scale in the US 1000x fold (i.e. to 50 Million Seniors) regardless of whether this amplification is implemented by doctHERs or by other companies. Our measure of success will be to ensure that no Senior of Color is deprived of access to high quality Care Coordination.    

SDG 3: Ensure healthy lives and promote well-being for all at all ages

SDG 5: Gender-Equity; reintegration of women into the US workforce

SDG 8: Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all

SDG 10: Reduce inequality within and among countries

We believe that the smart use of AI-enabled technology to re-integrate women Care Coordinators (inputs) into the US workforce will make Care Coordination Services (outputs) more easily available to Seniors of Color. These services will yield: (i) improved quality-of-life outcomes for Seniors of Color as measured by QoL indices as well as (ii) increased economic empowerment for women healthcare providers who are currently unemployed/underemployed (also outcomes) which will ultimately lead to increased returns for both society and our participating corporate/business partners (Impact). This theory of change is based on compelling evidence cited by Dalberg (1) and the Cherie Blair Foundation (2).

1. Dalberg: "The business Case for Women's Economic Empowerment"; 2014

2. Cherie Blair Foundation: “Women Entrepreneurs in Mobile Retail Channels”; 2011

Our digital care platform sits on top of robust data architecture, designed and developed on top of  AWS. The platform has APIs with software linked to handheld, digital diagnostic devices (e.g. handheld ultrasound) as well as APIs to EHR, patient-facing payment portals, etc. 

We extensively use WhatsApp for non-HIPAA related information exchange with our customer-beneficiaries. 

Our long-term objective is to build a predictive analytics model that takes advantage of AI and is trained on psychosocial inputs/determinants of inferior health outcomes in elderly people of color, our target cohort). It is especially important that our training dataset for the AI model be representative of our target population (which means in plain English that it should be composed of Senior Asians of Color).

We have an inclusive hire policy that ensures at least 10% of the workforce comprises people with special needs. In addition, our company was founded by a person of color and is predominantly managed and serviced by people of color. From service providers to customers and employers, doctHERs strives for diversity, equity and inclusion. 

For every dollar we receive from a Payor (corporate, employer, government, etc.), 60% covers the expense of the doctor and/or frontline health worker (FHW), 20% covers our operating expenses, yielding a 20% surplus at the unit economic level. 

We are in the midst of raising a $12 Million round which will enable us to scale our work in the developing world while also launching/growing Seniors Thrive in the US, UK and Canada. This investment will enable us to build high-quality, engagement teams on the ground in the US, UK and Canada who will partner with Asian-American ethnic associations, clubs, etc. to recruit Seniors (and their caregivers) into our program.   

We raised $800,000 from UKAID and Unilever to help co-finance the Transform project, delivered by doctHERs during 2019-2021 which enabled us to achieve cash flow positivity during the fiscal year ending Dec 31 2020. We have previously raised equity seed funding from a US-based impact fund and are now raising our Series A round.  

Incubators/ accelerators/ programs participation and awards: 

• 2016 – MIT Inclusive Innovation competition (Judge’s Choice award) - $25,000 - doctHERs

• 2020 – Million Lives Club selection (by Grand Challenges Canada, UKAID, etc.) – doctHERs