Kalorama Information’s new report on U.S. long-term care, “The Long Term Care Market: Nursing Homes, Home Care, Hospice Care, and Assisted Living,” finds that growth will be fueled by the diversity of services that can be offered. The industry will near the half-trillion dollar mark in the next five years, growing even with cautious payor activities. Plus, the market research report says, the market exerts an influence on other markets — healthcare provision, devices, and pharmaceuticals. And there’s plenty of room for competitors.

The report is available at https://kaloramainformation.com/product/the-long-term-care-market-nursing-homes-home-care-hospice-care-and-assisted-living-2/


The long-term care market is a complex and diverse industry that is evolving yearly. The growth trend is clear and not surprising. The U.S. long-term care industry has experienced steady growth from 2016 through 2018, and this is expected to continue through the forecast period. Aging of the population will increase demand for all forms of long-term care, although ongoing cost containment will continue to pressure the industry. As the demographics of the U.S. population have changed, so have the attitudes toward long-term care. The long-term care industry has met the challenges of the changing industry by diversifying offerings and increasing specialized care.

“There are more than 300 of these providers but only a handful have any significant market share. And the market not covered by top competitors is sizable, so expect new entrants,” said Bruce Carlson, publisher of Kalorama Information, now a part of BioInformatics Inc.

Yet because of the local nature of healthcare services, the scattered demand across the United States, and the variety of established players, there is no one leader in the market yet. Some brands do ring in consumer minds. In revenue terms, Kindred Healthcare led the overall market — and even this significant and diverse competitor’s $5.5 billion in revenues amounts to less than 2% share. Thus, share calculation in this market is impractical. Competitive companies include Genesis HealthCare, Brookdale, Life Care Centers, Golden Living, and Extendicare; others will expand with acquisitions of more large players to pose a greater threat to the leaders.

Baby boomers accounted for approximately 67 million individuals in the United States in 2018, and this enormous group is making decisions about whether senior living is the right option for aging loved ones and themselves.

The industry is growing. Through 2018, the industry overall experienced solid expansion, growing by 4% per year, on average, to reach $344.9 billion. The strongest growth occurred in the home care segment.

Through the forecast period, these trends will continue, with total annual industry growth of 5.1% per year, resulting in overall revenues of $441.7 billion in 2023. Growth will remain steady in all sectors even as reimbursement pressures continue to affect revenues.

The report says the evolution and specialization of residential, community-based, and home healthcare services will continue. The aging of the population, rising rates of chronic disease, longer life expectancies, and advances in public health and medical technology will result in unprecedented numbers of people requiring long-term care services in the near future — even as a shortage of healthcare personnel is occurring. The healthcare industry must begin to work now to reduce the fragmentation that exists both in the continuum of long-term care services and in the system of payment for those services.

About Kalorama Information
Kalorama Information, a division of BioInformatics Inc., supplies the latest in independent medical market research in diagnostics, biotech, pharmaceuticals, medical devices, and healthcare; as well as a full range of custom research services. Reports can be purchased through Kalorama’s website.

We routinely assist the media with healthcare topics. Follow us on TwitterLinkedIn, and our blog on our company website: https://www.kaloramainformation.com/.

MEDICA comes to a close in Dusseldorf, Germany, but not without some interesting developments…more than a few of which could upend healthcare. The MEDICA and related COMPAMED event is one of the oldest and arguably the largest medical trade fair in the world – it attracted more than 5,100 exhibitors from 70 countries in 17 halls this year.  The MEDICA show doesn’t simply focus on one area say pharma or IVD, it covers all aspects of the patient workflow, which means all kinds of healthcare products and services were on display: ambulance manufacturers, diagnostic tests companies, robotics firms and tubing products, healthcare software.  While there is a European and German focus to the meeting, more than a third of the attendees are from outside Europe, according to MEDICIA. EU Regulations were the highlight of a well-attended with Nicole Denjoy of COCIR at Medica Trade Fair.   An Infection Prevention Roundtable with Experts seminar was a highlight of the conferences at the meeting, and there were talks on IT and preventing piracy among others.

Some of the most interesting developments, were on the exhibit floor, where some problem-solving inventions and new products were displayed.  Kalorama information notes the following:

  • Ruling out HIV-2 in HIV Tests –  The choice of antiretroviral therapy for HIV-2 differs from that for HIV-1, underscoring the importance of differentiating between the two. To that end, Avioq launched its VioOne™ HIV Profile™ Supplemental Assay at MEDICA 2018.  The test is an enzyme-linked immunosorbent assay (ELISA) for confirmation and differentiation of individual antibodies directed to various gene products of Human Immunodeficiency Virus Type 1 (HIV-1 Group M & Group O) and Type 2 (HIV-2) in human serum or plasma. The HIV Profile™ is intended as an aid in the diagnosis of infection with HIV-1 and/or HIV-2.  HIV-2 is most common in western Africa and is becoming more common in India, although numbers there are still relatively small. Small numbers of cases have also been seen in Portugal, France, other European countries including the UK and the Americas, largely in individuals of west African origin or their sexual partners.  Kalorama Information is the publisher of such titles as The Worldwide Market for In Vitro Diagnostics, 11th Edition, covers HIV testing markets among other infectious disease categories.
  • Robot Nurse? The Made in Moscow exhibit of Neurobotics company (part of Zelenograd Development Corporation) demonstrated an anthropomorphic robot called “Alice.”  The Alice robot exhibits the ability to read people’s emotions and react accordingly.  The company says It can eventually be used as a nurse, or a physician assistant. Such a robot will be able to perform an initial examination of patients in the future.
  • Wearable “Beat to Beat” Blood Pressure Monitor – The ViCardio device is the world’s first wearable, beat to beat, non-invasive, accurate, blood pressure monitor. It causes no arterial compression, requires no biological calibration and produces an arteriogram equivalent to an invasive intra-arterial line. Using an optical-electronic micro-motion sensor that allows blood pressure to be measured with each beat of the heart in a simple and elegant wrist-based device, ViCardio is a pain-free way of taking regular discrete readings.
  • Using Virtual Reality To Treat Fear of Spiders – Arachnophobia is what experts call the fear of spiders, and a VR/AR system from research-giant Fraunhofer Institute is intended to combat it in a patient-safe way.  Around 3.5 to 6.1 percent of the population suffer from this fear.  Together with partners, Fraunhofer researchers are developing a digital therapy system that will enable treatment in the home environment and provide those affected with a better sense of security. A demonstration of the system was on display during the meeting.
  • A Better-Looking CPAP Mask (Finally?) – ResMed displayed its minimal-contact full face CPAP mask, AirFit F30.  The system sits below the nasal bridge, preventing top-of-the-nose red marks and irritation, and reducing feelings of claustrophobia for some full face wearers. users reduce facial marks, wear glasses in bed and be closer to their partner.    The company also claims that the QuietAir vent included in the product is quieter than ambient noise in the bedroom.
  • Picturing Diagnostics Statistics – A system called Medicus provides a visual interface and translation tools to the often confusing diagnostic statistics.  Diagnostic data is generally one of the hardest types of health data to combine if they’re coming from different sources, due to the challenge of the different standards for clinical data structure, such as HL7 v2, HL7 v3, CDA, FHIR and the different coding standards for health data such as: LOINC, SNOMED, SNOMED-CT, UMLS.   Medicus converts numbers from one structure and provides insight into how to interpret that in other formats while, the company says, preserving as much of its crucial medical context as possible.
  • Know the Patient’s Weight as You Transfer Them – Knowing patient weight is essential for administering treatments and delivering correct care to the patient.  However, with immobile patients this is not easy, with the only solutions being bed weighing scales or hoist scales, both of which can be cumbersome and time consuming.  But often there is no time for a weigh in.  The Patient Transfer Scale aims to fix that – t is a transfer slide with in-built weighing scale, and means patients can be weighed during lateral transfer from trolley to bed, or bed to bed.   The Patient Transfer Scale, or PTS, can be used in the same way as a transfer board with a stop for 3-4 seconds to weigh in.
  • New HIV Rapid – Earlier detection of HIV is essential for survival from the disease, and there is high demand for better rapids.  Owen Mumford Group exhibited its Simplitude™ Pro, what the company claims is the world’s first professional use rapid diagnostic test with a built in safety lancet, blood collection unit, and test strip. The device has been designed to reduce pre-analytical errors and deliver a reliable result.  The Simplitude Pro, planned for 2019, is the result of a strategic partnership between Owen Mumford, a leading player in the medical device industry and Atomo Diagnostics, a product design and manufacturing company based in Australia.
  • Complete FDA-Approved Robot Exoskeleton – Richmond, CA-based Ekso Robotics demonstrated the EksoGT Robot Exoskeleton at the meeting.  The system is the first commercial robot exoskeleton to be approved for use by the FDA in cases of paralysis of one side of the body; usually caused by a stroke-induced brain lesion.
  • Connected Stethoscope – eKuore ONE’s exhibit featured their adjunct stethoscope device and software.  eKuore One allows objective tests using a traditional stethoscope.  The system connects to traditional stereoscopes and turns them into connected devices, that can obtain second opinions and allow for visualization and integration into telemedicine.  Kalorama Information reports on connected devices in the following telemedicine study: https://www.kaloramainformation.com/Telehealth-Patient-Monitoring-11076070
  • Innovative Ear Infection Diagnostic – OtoNexus Medical displayed their ultrasound MEMS transducer that can detect hard-to-diagnose middle-ear infections (Otitis Media) using a non-invasive technology. The capacitative micromachined ultrasound transducer (CUMT) system can determine if there is liquid or air in the ear and distinguish between diseases.   This is important not only for better outcome, but to reduce antibiotic prescription in unnecessary cases.
  • “Gamified” Neuromuscular Stimulation Device – Neuromuscular stimulation doesn’t work if the stimulation process is boring.  That’s the premise behind South Korean healthcare robotics startup Exosystems’s new product.  The firm unveiled its portable product, the exoRehab, a device that helps provide “Personalized Rehabilitation Guidance” for patients in need of neuromuscular rehab.  The exoRehab personalizes its exercises to the patient to make sure the routine is not boring and keeps the patient stimulated.  It allows users to execute rehab training exercises based on their own body data and monitor the health status of their affected area.  Most conventional rehab methods only provide firm, rigid ways to exercise and recover
  • Friendlier Adhesives for Wearables.  The focus on wearable devices and drug delivery systems suggests a need for better skin adhesives, and Dow Silicones Corporation demonstrated its MG7-1020 Soft Skin Adhesive at the meeting.  The company said the product delivers the highest adhesion in the company’s soft skin adhesives — all without the skin irritation and discomfort more commonly associated with the removal of acrylic adhesives.

Kalorama Information is the publisher of such titles as The Worldwide Market for In Vitro Diagnostics, 11th Edition, and The Global Market for Medical Devices, 8th Edition.  The firm will be noting and commenting on events throughout the meeting.   Already of interest are several proposed announcements, new products and displays:

You wake up with an angry stomach, but this time it’s got nothing to do with that questionable leftover poké dish you’d kept in the fridge for a week. No, there’s more to this, but is it enough to put everything on hold to call a doctor and potentially wait all day, missing work, just to find out it’s a minor bug? More importantly, can you really afford it? On the other hand, the notion of consulting internet-based health information services (those that most quickly come to mind will remain unnamed) is antiquated at best, and we have all heard tales of hypochondriacs using such sites to self-diagnose with, in this case, probably stomach cancer. Not only is doing so irresponsible, but it could lead to people engaging in unnecessary and potentially dangerous treatments. So what can you do?

Enter Babylon Health, a London-based firm whose mission is to give everyone across the globe access to affordable health care through an app that combines the expertise of experienced physicians, specialists, and therapists with a sophisticated AI system developed with the latest advances in deep-learning. The company asserts that their artificial intelligence is more than just a database, that it assesses known symptoms and risk factors to provide informed medical information. Babylon’s founder, Ali Parsa, says that the best way to realize his company’s goals is to reduce people’s need to see a doctor, and this technology is engineered to do just that.

In 2017, Babylon ran a trial with a London hospital, in which calls to the National Health Service’s advice line would be handled partly with the company’s AI system. For many less serious conditions, the patients’ needs can be met through self-treatment, and Parsa says that 40% of Babylon’s patients eventually stopped calling for appointments, realizing that they did not need them, three times the proportion of people speaking with human operators. Now available in part from Babylon is GP at Hand, a service in the UK and Rwanda (in which 20% of the adult population has registered) in which patients can consult with Babylon’s chatbot app or talk over video with a human doctor.

Founded in 2011 and based centrally in Berlin (with offices in New York, London, and Munich), Ada Health’s doctors and engineers spent six years developing an AI-based health care app as its primary goal, which is something that company CEO and co-founder Daniel Nathrath says competitors considered an afterthought. From the onset, Ada’s AI was developed to take all of the patient’s information, including established medical history, into consideration, not just symptoms and risk factors. Using machine learning and closed feedback loops, the system acts as a prescreening consultation or to provide a real physician with relevant information prior to a consult, saving time by reducing the need to ask the basic introductory questions. Co-founder and Chief Medical Officer Claire Novorol says that feedback has already proven the app successful in diagnosing both common and rare conditions, and will make further progress as it continues to be trained by real physicians to become a greater compendium of combined medical knowledge.

Just weeks ago, it was announced that Ada Health had launched its Global Health Initiative with partners Foundation Botnar and the Bill and Melinda Gates Foundation; in doing so, Ada will be offering its app in Romanian and Swahili, with the latter expanding its availability to over 100 million people in sub-Saharan Africa.

All this talk in recent years of the advent of artificial intelligence and robots has mostly involved the prospect of humans being replaced by such things, an apprehension that has existed for well over half a century and has given birth to the best (and, honestly, the worst) science fiction. But are we coming closer to science fiction becoming a reality?

Researchers at The Francis Crick Institute recently published a study that used data from over 80,000 patients to train an artificial intelligence to model and predict heart disease mortality, that ultimately proved to be more successful than a model created and used by human experts, being 80% and 70% successful, respectively. The AI-generated model uses 586 variables to assess potential patient outcomes, while the physician-developed model uses just 27, allowing the robotic cardiologist to consider things through its calculations—for instance, the number of home visits to a patient—that may not even cross a human’s mind.

Even Babylon Health has made claims recently that its AI system is as accurate in its diagnostic capabilities as a doctor. The company’s staff fed its chatbot with questions from the official exam for induction into the Royal College of General Practitioners (RCGP), a membership body for family doctors in the UK. The average score to pass in the last five years has been 72%, and Babylon’s chatbot scored 82%.

All that said, while the Crick Institute’s AI has been proven accurate thus far, more studies would need to be conducted and results would need to be replicated in order to claim that it is reliable. And the RCGP has stated that there are flaws in the methodology that Babylon used in challenging its AI system. So there is no need to form the Anti-Robot Resistance just yet.

A major part of the reason that AI looks to be so useful is that there is a worldwide shortage of medical staff—which will reach an estimated 18 million by 2030—particularly among those who specialize. AI would also be quite useful to fill in gaps and cover shortages, especially in regions where the number of clinicians per capita is relatively low, be they in rural regions, low-resource nations, or in remote communities where access may be limited or difficult. Indeed, a third of Ada’s users hail from such places in Africa, Asia, and the Indian subcontinent. Even in more well-off regions, slashed budgets, aging populations, and increases in chronic disease conditions among populations will still place greater strains on health ministries; artificial intelligence will be beneficial by reducing the workload of doctors who can then focus on patients with more pressing conditions. Ultimately, AI should be viewed as a tool rather than a replacement, and it is even possible that its adoption could lead to more jobs being created; people coming to the job market or preparing to change their places in it should train with AI to properly apply it as such.

Finally, according to a study out of MIT, computer scientists say that flesh-and-blood physicians have something that artificial intelligence lacks: gut feelings about a patient’s condition, which researchers have found to influence the number and types of tests doctors order for their patients. Their intuition is especially important in the early period of a patient’s treatment, when there is little data available to analyze in order to make a diagnosis. Researchers also found that how a doctor felt about the patient’s condition affected the number of tests ordered, that if the situation was less than sunny, more tests would be ordered, but a more positive outlook meant fewer tests. To boil it down, artificial intelligence really only serves to spout data and perform rote memorization, just on a much greater scale than we humans are capable of doing ourselves. What AI cannot do, at least not yet, is to think creatively and critically, especially in situations that have never been encountered—after all, how can a computer provide a solution for which is has no data? Martin Marshall, vice chair of the RCGP, stated that, “…[A]t the end of the day, computers are computers, and GPs are highly-trained medical professionals[…] the former may support, but will never replace, the latter.”

Mobasher Butt, Babylon’s medical director, says that that was never his company’s intent, that “[…] AI decisions are supported by real-life GPs to provide the care and emotional support that only humans are capable of.” So, physicians, sigh in relief. Your jobs are not in danger of anything but perhaps becoming a bit easier.


Authored by Julie Kirkwood, Kalorama Information Correspondent

Until surprisingly recently, the connections between laboratory instruments and laboratory computers were based on standards developed in the 1990s. For example, one of the standards, ASTM E1394 (later revised and renamed CLSI LIS2) dates back to 1997, the year before Google was invented, when dial-up modems were still used to connect to the internet and laboratory instruments were connected to computers by serial port cables.

This is a standard that laboratory instruments use to receive computerized orders and to collect and aggregate patient results.

“Seriously,” says Serge Jonnaert, president of the IVD Industry Connectivity Consortium. “I kid you not. And the majority of labs still use that standard today to send information from their instruments, albeit no longer over serial port. I mean, the instruments are now network connected, but it still very much uses an LIS1/LIS2 interface standard.”

The main problem with the old standards is that they do not standardize data, and that makes it complicated to set-up laboratory instruments. When a laboratory purchases a new instrument, it typically costs thousands of dollars to have an IT specialist make a custom connection between that instrument to the laboratory information system, or whatever computer system their institution uses.

As far back as 2005, a group of peers who worked in informatics for major vendors in the in vitro diagnostics (IVD) industry came together to work on a solution. They eventually formed a nonprofit organization, called the IVD Industry Connectivity Consortium (IICC), and they set out to rewrite the standards in a way that would promote easy connectivity. If all IVD instruments used a common communication protocol and referred to a common set of numerical codes for test names, sample types, and other useful information, clinical laboratories could easy connect any instrument from any vendor to any type of middleware or laboratory information system (LIS).

Getting Connectivity Standards Adopted in Clinical Laboratories Has Been an Uphill Climb.

In 2016, the consortium finally succeeded in publishing this new standard, called the Laboratory Analytical Workflow (LAW) Protocol, in collaboration with Integrating the Healthcare Enterprise (IHE). A year later, IICC published LIVD, a digital format that defines the digital publication of LOINC using vendor defined IVD tests associated with a set of predefined LOINC codes.

“Whereas before it would have cost anywhere between $6,000 to $15,000 to connect an instrument to an LIS, now it’s truly a plug and play solution,” Jonnaert says.

Most major IVD vendors, including Abbott, Roche, Siemens, and Beckman Coulter, are members of the consortium and have already adopted the both standards, Jonnaert says. The U.S. Food and Drug Administration supports the effort, and in June 2018 the agency issued a  guidance encouraging the use of common numerical codes for test-related data. The Clinical & Laboratory Standards Institute is in the process of recasting the LAW protocol, to be named the CLSI AUTO16 standard for next generation IVD instrument interfaces.

Yet getting these standards adopted in clinical laboratories has been an uphill climb.

For one thing, the major electronic health records vendors are lagging behind in adopting and promoting the new standards, Jonnaert says.

“Instead of taking an industry leadership role on this and saying, ‘Okay, let’s get ahead of this and roll it out,’ they’ve actually said, ‘Well, if our customers tell us to do it, we’ll do it,” Jonnaert says.

Custom connections between laboratory instruments and their computer systems are still a significant revenue stream for them.

So why aren’t customers asking their vendors to adopt the new standards?

Jonnaert believes that laboratory professionals haven’t gotten involved because they consider this an IT issue, and the IT specialists haven’t taken an interest because the laboratory tends to be a lower priority for health system IT departments, which are dealing with bigger issues such as revenue cycle management, avoiding hospital readmissions, and meaningful use.

Some LIS vendors have embraced the standards, though, including Orchard and Sunquest, Jonnaert says. And support from the FDA and the Office of the National Coordinator for Health Information Technology is another big step forward.

In the new guidance, the FDA makes a forceful argument for standardizing data among laboratory instruments and computer systems.

“Efforts to harmonize and standardize information captured and stored in electronic healthcare systems carry important implications for public health, including expediting access to patient diagnostic information for health care providers, reducing burdens on laboratories for connecting new diagnostic systems to Laboratory Information Systems (LIS), and facilitating the use of healthcare information for decision support tools, in addition to many more potential uses,” the guidance says.

The benefits of the new standard reach beyond cost savings for vendors and laboratories, Jonnaert says. When laboratory data is standardized across instruments and locations, the information can be combined and compared in new ways.

“It opens the door to have all the data flow through in a standardized format,” Jonnaert says. “… That’s when you can start looking at doing some major population analytics.”

Laboratory data from all over the United States could be probed to look for, say, a cross-correlation between a biomarker and a disease state. The test results from any laboratory in the country could be pulled together into a single dataset.

“Right now you would not be able to do that on a national level because every single data point from every single lab from every single instrument comes through differently,” Jonnaert says.

Now that the new standard is available, the consortium is encouraging clinical laboratories to ask their vendors about the IICC/IHE LAW profile and also LIVD, the digital format that standardizes predefined codes for test results.

“It’s like in football,” Jonnaert says. “We keep on moving the ball one line at a time and every time we have a little victory, we’re happy.”

In many ways, the IVD market of today does not resemble the market five years ago.  2018 appears to be the year where a number of trends that had been discussed began to gel.  With that in mind, Kalorama Information will be on hand for UBM’s BIOMedDevice Convention in San Jose, CA next month.   In vitro diagnostics represents a 65 billion-dollar market, according to Kalorama Information’s latest report on the worldwide diagnostic industry.  That makes it a large, competitive and growing market.  But the significance of in vitro diagnostics goes beyond the market numbers.  IVD really is significant because of its reach: testing reaches touches clinical lab services, hospital care provision, pharmaceuticals. These add up to a multi-trillion dollar “Influence Market” for IVD.

Among many trends that Kalorama will discuss at the meeting:

  • Direct-to-consumer testing was a scattered array of projects and small startups prior to 2018.  Now, it is a real factor in the business.  With both Lab Corp and Quest making direct to patient pitches, and 23 and Me’s FDA approval for its consumer-ordered BRCA test, there is an actual market for these products.
  • There are nearly 10,000 locations where a patient now can walk in and secure a healthcare visit with no appointment.
  • Novel biomarkers are being discovered.  The track record of PCT in sepsis treatment and and high-sensitivity troponin markers in detecting heart attacks has been evident from their migration on to large analyzer systems.  This year saw developments in tests for traumatic brain injury and Alzheimer’s Disease, including two FDA approvals for microRNA biomarkers for the latter disease.
  • Sequencing: Clinical systems were introduced and smaller footprint instruments have been developed.  Simplified (NGS in a Box) systems have made gains.   How sequencing will fit into clinical diagnostics is still being determined, but it is clear it will have some impact.

There are many factors causing an increase in the rise of diagnostic services to monitor health, which in turn is stoking the growth of the IVD market. Trends such as technological advancements, rising end-user awareness, and miniaturization is driving the demand for point-of-care products and have increased the access to diagnostic tests near patient site. But with growth comes new regulations and implementation dates put forth for medical device manufacturers active in Europe. Compliance deadlines for 2020 and 2022 are looming.

With this in mind, Kalorama announces that Publisher Bruce Carlson will speak at the BIOMedDevice convention in San Jose, CA, December 4-6th, 2018.  The keynote speech:

The IVD Market Opportunity: Fast-Growth Markets, New Products, Disruptive Trends ( https://bmsj18.mapyourshow.com/7_0/sessions/session-details.cfm?ScheduleID=11 ) will be held on December 5th.

Topics covered include:

  • Retail clinics, Direct-to-Consumer marketing, accelerated aging and trends driving new product development in the IVD space
  • Point-of-Care, digital capillary testing, wearable, and other products moving IVD diagnostics forward
  • Medicare Part B Cuts and New FDA Proposals
  • New European IVDR affecting 80% of IVD products – what you need to know
  • Market Statistics for In Vitro Diagnostics and Contract Manufacturing for In Vitro Diagnostics