Wall Street Journal: Startup Could Improve Senior Care by ‘Predicting Death’

Aspire Health, a high-profile startup recently featured in the Wall Street Journal, has garnered significant capital and attention for its “death-predicting” algorithm to identify patients who could benefit from palliative care. The company already has provided care to about 1,600 residents in independent and assisted living and is exploring deeper partnerships in the space, CEO Brad Smith tells Senior Housing News.

Co-founded by Smith and former Republican Senate Majority Leader Bill Frist, Nashville-based Aspire in October secured $32 million in funding from GV, the firm formerly known as Google Ventures. So, it’s safe to say investors see a bright future in the Aspire model.

This model is based on that “death-predicting algorithm,” to use the WSJ’s language, which flags patients at risk of dying within a year. Aspire’s caregivers then can provide interventions for these patients in their homes—including senior living communities—to keep their quality of life high and their costs of care low, such as by preventing unneeded hospitalizations.


Currently, the company contracts with health systems and payors, such as Medicare Advantage or Medicaid managed care plans. These entities typically pay a flat monthly fee to Aspire, calculating that the cost savings and improved patient outcomes are worth the price. Aspire estimates it can save these health plans $8,000 to $12,000 per patient, the WSJ reported. Aspire is operating in 19 states, managing care for more than 20,000 Medicare Advantage patients.

If these patients reside in an independent living or assisted living setting, Aspire does provide palliative care in those places, Smith says. Close coordination with the senior living community’s caregivers is part of the approach in these cases.

“It’s really important for us to communicate and be in close contact with the caregivers in those settings,” Smith says.


This can include making sure the senior living staff members have the Aspire nurse practitioners’ phone numbers, get records after each visit, and know that if there’s an emergency they can call Aspire.

Although it’s “early on” in the process, Aspire is exploring partnerships with senior living to provide services to all residents in a community, not just those insured by an organization contracted with Aspire, Smith says.

Probably, this would take the form of the senior living provider paying on a fee-for-service basis for those residents not on the Aspire-contracted health plans. Aspire sees this approach working because its caregivers can see more patients in a shorter period of time when they all live under the same roof.

“As long as we could see three to four patients in a half day, we’d be able to provide those services [to an entire senior living community],” Smith says.

Some concerns have arisen regarding the Aspire approach, including that its life-expectancy projections are based on data from people’s medical records, such as their diagnoses or hospitalization history.

“Medical ethicist Arthur Caplan of New York University says that ‘a private entity snooping around’ in patient records and consulting their doctors without prior consent seems like a violation of privacy,” WSJ reporter Melinda Beck wrote. “Aspire says that working with health plans to coordinate patient care is an approved use of such data under Medicare rules.”

Furthermore, Aspire’s payments often are tied to certain quality metrics, including patient and family satisfaction, Smith says. This helps ensure that care remains patient-centered, focused around their own goals, and is not driven too purely by cost containment motives.

Patient-centered care, reduced hospitalizations, and increased family satisfaction are key goals for many senior living providers. So, while it may be too early to say that Aspire will certainly be expanding its senior living partnerships, the company seems to be speaking in terms that will appeal to the sector.

Written by Tim Mullaney

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