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Juniper Communities and its CEO Lynne Katzmann have earned a reputation for senior living innovation, thanks to efforts such as the Connect4Life integrated care model, leadership in Medicare Advantage through The Perennial Consortium, and fresh approaches to resident experience such as Broadway Senior.
Now, Juniper is at work on a senior living model for the next generation of consumers, and Katzmann is sharing key parts of her vision and describing some of the initial steps that the company is taking to achieve ambitious goals — including harnessing genomics to create what Katzmann is calling a “lifestyle prescription” for residents.
Katzmann holds a Ph.D. from the London School of Economics and has always rooted Juniper’s innovations in research. While still relying on a scientific evidence base, she is also drawing on her own experiences and self-reflections in steering Juniper.
That’s because she was born in 1956, making her part of the baby boomer generation. Many members of her generation are currently seeking out senior living communities for their parents, and boomers will become residents themselves in ever greater numbers in the years ahead.
“We all seem to all cherish our individuality and seek a life that is not only true to ourselves but delivers on our unique needs and desires,” Katzmann observed in a presentation she prepared for the recent Senior Living Innovation Forum event, and which she shared with Senior Housing News.
Indeed, personalization is at the heart of Katzmann’s vision for the future. And she believes that by taking a more personalized approach, senior living providers not only can attract a greater number of consumers and enhance older adults’ quality of life, but change health care paradigms to improve clinical outcomes and drive down costs.
Writing a ‘lifestyle prescription’
Katzmann’s approach to personalization has been influenced by the work of Eric Topol. A cardiologist, Topol has emerged as a leader in the field known as personalized medicine or precision medicine.
Topol believes that genomics — driven by the ability to map complete sets of DNA — is likely the most significant health care breakthrough of the last 50 years. That’s because an individual’s genetic profile contains powerful information about susceptibility to particular diseases and other health conditions, and offers clues about what treatments and interventions are likely to be most successful.
Katzmann is “bothered” by the typical allopathic medicine approach of trying to cure disease, and honed in on the potential for genomics to support a more preventative approach.
“Curing someone after they get sick is expensive and frankly, not what I would want. I would prefer not to get sick in the first place,” she stated in her SLIF presentation.
Beyond her own preferences, Katzmann cites statistics showing the enormous burden that chronic disease places on the U.S. health care system — for instance, people with one or more chronic conditions account for $1.5 trillion in annual health care spending, according to research from Michael Pignone of the University of North Carolina at Chapel Hill.
Katzmann’s interest in genomics took on even more urgency as a result of the Covid-19 pandemic. Juniper’s Covid-19 testing partner, Dascena, was sequencing positive results to determine what variant was present — and Katzmann confirmed that Dascena could also use the same samples utilized in Covid testing to sequence residents’ DNA, with their permission.
Now, Juniper and Dascena have drafted the legal documents needed to obtain that resident permission. So, the pieces are nearly in place to begin to gather genetic information about Juniper’s resident base, which will be an innovative step toward creating a more personalized senior living model.
However, having genetic data about residents is not enough, Katzmann emphasizes — traditional health data, and data related to individual behaviors and preferences, are also needed.
Such data sets are available through electronic medical records and the resident profiles that many senior living providers create. In Juniper’s case, those resident profiles are captured in “My Life Story” documents that focus on the lifestyle and health-related activities that residents used to engage in, currently engage in and would like to engage in.
Once all these types of data are normalized and pooled, algorithms can be created that will produce the “lifestyle prescriptions” that Katzmann wants to provide for each resident. Such prescriptions would be highly personalized, based on each individual’s past experiences, lifestyle habits and goals, and genetics.
Katzmann acknowledges that “a tremendous amount of work” needs to be done in order to bring all this data together in a way that can inform an algorithm. However, she believes that natural language processing and other evolving machine learning and artificial intelligence disciplines can facilitate the effort, and that a lifestyle prescription could become a reality within two or three years.
Enacting a ‘lifestyle plan’
Creating a lifestyle prescription would be a breakthrough for senior living providers, but only a first step.
Providers must then be able to enact a “lifestyle plan” that will include interventions related to a resident’s risk profile and programs to help residents thrive, Katzmann said.
She envisions a variety of innovations related to how lifestyle plans could be structured and enacted, including:
— A lifestyle coach who will work directly with residents, providing support and encouragement to pursue their lifestyle plans
— A technology infrastructure that will empower residents while alleviating burdens on staff — for instance, a system that will recognize what types of activities a resident frequently engages in, suggest other relevant programs, and allow residents to easily sign up for these activities and manage their schedules
— Innovative partnerships with a variety of organizations beyond the walls of the senior living community, to create intergenerational experiences and exciting engagement opportunities that appeal to the specific needs and wants of particular resident populations
Juniper is already evolving its approach to resident engagement according to these principles.
For example, Juniper’s work with Music Theatre International (MTI) to bring Broadway Senior to fruition exemplifies the power of partnerships. And every Juniper community has until the end of 2021 to develop partnerships so that once a week, the communities will have a different partnership-based program happening.
“We’re shifting the model of how you provide activities … and it’s beginning to really work,” Katzmann told SHN.
She also cites The Mather Institute’s new person-centered wellness model as a helpful framework for how to “empower individuals to choose the types of fulfillment that match their aspirations.”
In particular, Mather has cited research showing that residents’ wellbeing is closely tied to the “3 As” of autonomy, achievement and affiliation. A strong lifestyle plan might involve programming that supports the 3 As — Mather CEO Mary Leary described shinrin-yoku “forest bathing” as one example.
While Katzmann will no doubt continue to refine her vision, and Juniper is still in the early stages of operationalizing on some novel concepts, the company’s track record suggests that other providers should take note of where the organization is headed.
Juniper was an early mover in pivoting its health care approach in response to the Affordable Care Act, and the resulting Connect4Life model has become an industry touchstone, licensed as a blueprint for other senior living organizations to use as they enter the Medicare Advantage space. Katzmann herself was inducted into the American Seniors Housing Association (ASHA) Hall of Fame in 2020.
As she sees an imperative to meet the boomer generation, Katzmann is beginning to share her latest ideas, her inspirations from across the industry and from other fields, and the lessons that Juniper is learning on the ground. And she is not the only senior living leader to recognize the trend toward personalization, with Discovery Senior Living’s “experiential living” model and Watermark Retirement’s “precision wellness” approach being two examples of how other providers are moving in this direction.
While various organizations will take different approaches to serving the baby boomer generation, Katzmann believes that future success will be underpinned by a few fundamentals, which she summed up in the conclusion to her SLIF presentation:
“We all need to understand that integration of data and experiential programming — a high-tech and high-touch approach — is our path forward to the next generation of senior living.”