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Will We Make Good Ancestors?

Two powerful forces will transform every aspect of delivering healthcare. The first, the mass aging of our society (and others throughout the world), may very well be the defining evolutionary event of the last 100 years. In 2006, the first of America's 80 million Baby Boomers begin to turn 60 at the rate of 10,000 per day. Healthcare is unprepared to care for a mass population of aging and older people.

Simultaneously, the genomics revolution has begun. Medicine's inventory will be filled with a wide range of newly fashioned genetic services, many targeted on older, demanding, more affluent consumers seeking health enhancing, and potentially life-extending services.

These are the factors—genomics and an aging market in search of higher performance, delayed disability, youth, and longer life—that will dramatically reshape your hospital over the next 10 years. It has never been more important for the leadership and boards of healthcare organizations to address the strategic and management implications of these transformative issues.

Leadership Challenges
Consider for a moment the following new realities that we are about to confront in the emerging era of genomics medicine.

A pandemic of chronic disease. We are heading toward a future in which chronic disease, frailty, and a variety of long-term health problems will be pervasive. A challenging question emerges: will elders live lives of grinding chronic disease, or of robust old age? Add to this recent predictions by some researchers: life span extension through genetic services. They assure us this is not science fiction. Extending lifespan by more than a third is achievable, though the science needed to produce that result is far from mature. Increasing longevity will not only postpone the arrival of old age, but will also cause all of the stages of life to stretch and shift significantly. How will we redefine "old?" Is our delivery system designed for this future?

Mass dementia. Today, more than 4.5 million people are over the age of 85; it is our fastest growing segment of the population. The dementia rate for the 85+ population is a staggering 47 percent. The frequency of Alzheimer's in the elderly population continues to grow steadily. Clearly, genetic science holds some cards in the campaign to address Alzheimer's: will there be breakthroughs? What will the therapy entail? What resources will be required to meet this unique healthcare challenge?

A Synthesis: Genomics and the diseases of the older population:
The real breakthrough related to aging due to genomics will be three-fold:

to target drugs for better treatment, raising efficacy and cost-effectiveness overall;
to offer health and life enhancement services including many drugs that enrich life, not just prolong it;
profiling, with great particularity, over time, just how we get sick—the diseases of the heart and organs, the cancers, immune deficiencies, mental illness, and degenerative conditions.How we use this knowledge is up to us. Will we be good ancestors?

From treating disease to maintaining functionality. Today, most of chronic care is maintenance care for those who have been afflicted and survived. This is true in cardiology, diabetes, Alzheimers, mental illness, and increasingly cancer. So the hospital business will begin to look like the long-term care business. A genomics breakthrough, however, may be a powerful factor cutting the other way—reducing the need for long term care models.

The caregiving crunch. Thirty-eight percent of Americans have caregiving responsibilities, and the average American now has more parents than children. Traditional healthcare provides little help to those trying to navigate this difficult lifestage. But the story gets scarier as medical science becomes more effective at managing chronic disease. The burden of caregiving becomes enormous.

An inhospitable marketplace? An overwhelming obsession with youth persists in the U.S. marketplace. From the perspective of a 60-, 70- or 80-year old, the world is a long way from being aging-friendly. "Ageism" is likely to worsen with the impact of genomics. Medical genetics to date has been the province of reproductive and early childhood medicine. However, as genomics medicine evolves, its yield will apply to all of us, raising questions of relative resource allocation and generational conflict.

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