Dementia is a devastating disease that affects people’s ability to think, remember, and perform daily tasks. Nearly seven million Americans are living with Alzheimer’s disease, the most common form of dementia, with many failing to receive consistent, high-quality, coordinated dementia care. Their families are left to navigate the complexities of healthcare alone, and as a result, experience poor outcomes, high rates of hospitalization for the patient, and stress for the caregiver.
With the number of U.S. dementia sufferers expected to reach nearly 13 million by 2050, the future looks dire. But there are glimmers of hope, thanks to entrepreneurs like Kris Engskov. As a former senior executive at Starbucks, he is an unlikely warrior in the battle for change, but as CEO and cofounder of Seattle-based startup Rippl, his company is pioneering a new approach to dementia care.
After 16 years at Starbucks, when founder Howard Schultz left, Engskov also felt ready to do something different. With his own ageing parents having had near misses with the long-term healthcare system, that sector became the ‘something different’. He invested in and became president of Ageis Living, a large, assisted living company on the West Coast.
He says: “I must have been the naivest person globally in healthcare when I stepped into that job. During my three years of running that company, I had a front-row seat watching the battle of trying to care for the frailest people. It accelerated my learning, and I realized that if you really wanted to change outcomes for seniors, you weren’t going to do it from that seat.”
Value-based dementia care
The catalyst for the creation of Rippl was Engskov’s shock at seeing how many times their Aegis residents were sent to the Emergency Department, almost always because their dementia-related symptoms could not be managed. “It opened up this labyrinth of learning about how deficient we are, particularly in the U.S. in being able to help people with this disease and importantly, keep them at home,” he says.
Launched in 2021, Rippl raised a sizable seed round and served its first patient in January 2023. Crucially the business was developed around a value-based model, where the incentives are quality and outcomes, as opposed to the traditional volume-based model, incentivized by quantity and services. The model on which Rippl is based originally came from the University of California in San Francisco.
“The clinicians who developed it realized you didn’t have to see these patients in person to be effective at helping them stay at home,” says Engskov. “Dementia care is such a labor-intensive business, yet our model is virtual. We can get to anybody anywhere, which is incredible for access.”
Support for patients and caregivers
Rippl’s telehealth-based care offering involves a nurse practitioner, a licensed clinical social worker, and a care navigator who work together to wrap around a patient and their caregiver.
Engskov says: “The care navigator has a relationship with the caregiver who, for example, is living at home with her mom, who’s in mid-stage dementia, and starting to exhibit erratic behaviors. However, because that relationship has been established we can predict those behaviors and our care navigator will recognize this as a red flag for a med calibration issue. We would then call in a nurse practitioner to recalibrate the medications, and often that solves the agitation problem.”
Rippl also provides psychotherapy resources aimed at supporting caregivers who may never have seen this disease before, equipping them with advice on what to do when problems arise, and also on managing their own mental health.
Better access to dementia care
The company currently operates in five states, working with several major insurers, provider groups and health systems. Springfield Clinic in Illinois started working with Rippl last summer. Director of operations Becca Summers says: “Our time with them may have been short, but there are several patients who have been accepted into the CMS (Centers for Medicare & Medicaid Services) GUIDE program, which will drastically help to provide financially covered resources that were not available years ago.”
Rippl has also partnered with several local organizations to ensure that patients who either are or are not accepted into GUIDE have access to care within their community.
“Some of these resources are unknown to medical providers as well, so it has been a huge help for Rippl to build partnerships and help educate our teams and patients on the available resources,” adds Summers. “At last, dementia is receiving the recognition it deserves, and the patients are receiving the extra care and support they deserve.”
Nevertheless, a tidal wave of rising dementia cases is fast approaching. A new study shows that the risk of developing dementia at any time after age 55 among Americans is 42%, more than double the risk reported by older studies. New drugs have been developed, but are intended for people at an earlier stage in the disease. And putting people into care isn’t an option due to a huge shortage of beds.
Scaling up
Last April Rippl and the Alzheimer’s Association announced a partnership designed to revolutionize access to high-quality dementia care across the country through the launch of the Dementia Care Navigation Service (DCNS).
Monica Moreno, senior director of Dementia Care Navigation at the Alzheimer’s Association, described Rippl’s virtual care model as a game changer, making needed care, support and resources available to individuals and caregivers regardless of geographic location.
She says: “By leveraging telehealth, the model offers a cost-effective, efficient way to deliver care and services to areas of the country without reasonable physical access to comparable services. In addition, the model helps bridge transportation challenges, which can be a major barrier to care. The model helps reduce costs as well by significantly reducing or eliminating the time and coordination required for either the individual to travel to an office or a provider to travel to someone’s home. Studies have shown virtual care models not only reduce costs but can improve patient outcomes as well.”
Last year Rippl raised $23 million in Series A capital to fund its multi-state expansion from investors that include Rippl’s seed investors ARCH Venture Partners, General Catalyst, GV (Google Ventures), F-Prime, Mass General Brigham Ventures, 1843 Capital and JSL Health.
“It’s still early days in the U.S. for value-based healthcare, and dementia care is the perfect playbook for it,” says Engskov. “You have to deliver. And the outcome has to be better. The care has to be delivered less expensively. We can do it virtually and we can do it quickly.”
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