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As aging is a “living/evergreen” process, we provide a way to create living processes that enable constant adaptation to bone healthy living

Photo of Ann Ting

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What challenges or opportunities are you trying to address within the problem? (200 characters or less)

We address two challenges: 1. Bringing care information & resources together when it's needed 2. forming & coordinating a personalized care team of providers, caregivers, patients and their families.

What is the problem within the the two opportunity areas we are seeking to solve and the evidence we have that this is a real problem?

The problem we are seeking to solve is patients and their family caregivers lack information, time, and money to find, make a decision, and access the right care, especially in-home care, for older adults. In particular as the population ages, there are many research/survey or newspaper articles pointing to this problem. Due to lack of assisted living and nursing home beds and cost of such care, "age-in-place" will be one of hallmarks of senior care in the 21st century. The burden of "age-in-place" will fall squarely on the 65 million or more affected families. This concern has been reinforced for me as I conducted focused group surveys, and had conversations with potential individual users, long-term care organizations, prospective partners, and even doctors for chronic diseases. It is not only a real problem in the U.S. that most people run into at some point in their lives, but also a growing problem worldwide. 

The solution in the case of "Healthy Bone Health Aging"

An individual recovering from a fracture is particularly vulnerable when transitioning from hospital or skilled nursing facility to home care. This transition can be difficult for both the patient who finds her life and home disrupted and any family caregivers who are anxious to help but are uninformed and uncoordinated.

Especially in the case of patients diagnosed with osteoporosis, the care plan created after a fall needs to promote the range of actions for minimizing bone loss and strengthening weak bones. These include nutrition, exercise, mineral and vitamin supplements, and specific medication for treating the condition.

When I was taking care of my parents’ osteoporosis condition, I found adding all these actions into their “usual daily living” plan very challenging because these new actions made their “usual” daily living routine a lot more complicated as well as created even more stress in the lives of both patients and caregivers.

This personal experience inspired us to create a solution that not only supports healthy bone and healthy aging but also ensures the care experience is as positive as possible for everyone involved.

A Cloud-based CareXc Solution

The CareXc ( platform is a new health care platform designed to transform the chaotic daily routines for caregivers and older adults in need of care into a streamlined, patient/caregivers-centered resource.

It enables patients and family caregivers to easily lay out and follow step-by-step instructions for managing, the recovery process, including connecting to support resources for caring for osteoporotic bone fractures or other health conditions (e.g., stroke, diabetes) that might exist before the fall or have developed during recovery.

By laying our solution on the CareXc platform, it can be used for investigating the cause and connecting dots, identifying people at risk, and be able to Intervene for prevention.

As an Internet based solution, the CareXc platform’s capabilities are available to authorized caregivers and healthcare professionals, local or remote, so all information, including past and current health records can be integrated & made accessible for investigating the cause, connecting the dots, and planning an intervention.

This solution consists of three modules built using CareXc: 1) curating and providing access to a library of care plan templates specifically for bone health conditions and fall prevention, 2) customizing care plans and forming a personalized team/community of people to carry out the plan, and 3) enabling various ways for patients and caregivers to easily acquire a list of products/services associated with the personalized plan.

The library of care plan templates, organized by health conditions, is sourced from medical and in-home care experts and institutions. Some are augmented with the direct input of individuals who have experienced similar conditions. We believe patients and caregivers connecting with others can achieve better outcomes when they gain information and recommendations from other individuals who have faced similar situations.

All templates are information rich, containing a list of tasks, with a description section, the allotted times and cost estimates, a list of products for each task, and a discussion board to post questions and answers among the team members who can be medical professionals. All are displayed on one web-page with three tabs to create a “one-stop-shop” style user-interface so users do not have to switch to other web-pages to further navigate for the information  or products they need. The description section can contain additional research, data, or examples provided by healthcare system's experts. They may be directly included if space permits or a direct link is provided to their organization’s page. In either case, users do not lose the CareXc page that they have been on. The following screen shot gives an example of this information-rich page.

These templates can be augmented easily by a medical professional, a case manager or other caregivers who have the privilege to change templates; for example, incorporating new treatment options can be done by using the Edit Care Template capability in CareXc.

A care plan template can be adopted and customized by using the Customize Plan capability to create a personal care plan. A plan is the foundation for forming a personalized "care team" comprised of, everyone involved in a patient's care, from doctors, nurses, therapists, coaches, and case managers to family caregivers. Their skills and availability are captured and used to create schedules for carrying out the tasks they agree to do; for example, take the patient to her physical therapy session between 11:00 to 12:00 by car. The following is an image of the "Customize Plan" capability.

Each patient’s care plan is evergreen because it can be revised as needed; for instance, to address health issues which arise because of an adverse drug interaction. This Customize Plan capability enables a healthcare provider to intervene promptly, accessing the plan remotely from the convenience of his office. The revised plan can be used immediately by the patient or her caregiver at home.

Patients have or develop multimorbidity are very common in adults with osteoporosis. Our Merge Plan capability can be used to have one plan including tasks of preventive care for other diseases and improve the quality of life with Osteoporosis. 

Merge Plan function can be very useful for coordination and we marked it on one possible time of using it on the Journey map uploaded.

Each plan includes links to qualified product suppliers. Integrated sourcing of equipment and supplies saves time, reduces stress, and can lower costs. The discussion board can be used for rating products, tips and tricks of carrying out plan tasks to save more time and cost, etc. These capabilities as well as making requests to alert caregivers in situations like supplies are running short can be further automated with AI. All these are built in to motivate users to return to the solution even after they already found a care plan when they first used the solution.

Devices that enable voice activation, or telehealth sessions can easily integrate with this platform to lower the barrier for a patient to use the solution. With these devices plugged in, the care plan’s tasks can be carried out by patients at home with family, coaches, and health aids, or with doctors at a remote location for ensuring care plan adherence.

Since osteoporosis is not recoverable as older adults continue to age, a solution like CareXc is already valuable for managing medication to reduce bone loss.  Maintaining a personalized community even after the patient is recovered from the fall will significantly help in preventing falls from happening again.

We believe this level of flexibility in helping people living with a disease like osteoporosis makes our solution an extremely strong response from the following perspectives:

- Any health condition can change over time, and even the same condition, such as osteoporosis, varies from person to person. No one size fits all or is of fixed length. Consequently, any solution offered needs to be flexible in multiple dimensions which is built into the platform. For example, with a remote device, the patients can feel much more assured that someone is there for them even if no one is staying with them, especially in the initial period after discharge.

- For patients and caregivers who lead busy lives and aren’t “into” computers, reducing the burden of tracking and managing all the variables (e.g. time required, cost, etc.) encompassed in a care plan is paramount. CareXc will provide the intelligence to automate some of these tasks to reduce the burden. For example, when a change is made to a patient’s care plan, e.g., a new medical supply item is added, CareXc queries designated 3rd party websites for pricing and, using cost parameters previously defined by a patient/caregiver enables patients to still meet their financial constraints.

- CareXc has been designed in a way which recognizes that the world doesn’t stand still, and more ideas combined makes an even better idea. We expect other companies and healthcare consortium to create tools, solutions, and data repositories to enhance caregiving. The open architecture of our platform enables integration of 3rd party tools and the sharing of data collected through those tools. This capability extends to the ideas included in this Challenge. CareXc solution can grow and get upgraded without having to build more capabilities only by ourselves.

How We Tackle Bone Fracture and Osteoporosis

The following illustrates a time based journey of daily living.

We also added the CareXc care plan modules from the "In Hospital" period to "Out-patient Experience", and then to "Reestablishing Routines" period of the Health Bone Health Challenge Journey Maps included below. 

However, if people already have been using CareXc for their daily living plan, their in-home care records would have been stored in the CareXc data repository. and the health systems' ER can be granted to have access for determining if the fall is indeed caused by an osteoporosis condition.

We plan to simultaneously work with other solutions that are focusing on each of the three above mentioned missions to constantly elevate the quality of healthy aging life and reach a higher degree of falls prevention and unite a strong community of people with the same health concerns and similar circumstances to be the most accessible, understandable and inexpensive approach to solve the "first fracture is their last" challenge.

Additional details of where CareXc touches the Challenge Journey including the "Living in Community phase (with CareXc)" is in the uploaded Journey map.

Who is your target end user and why will they be interested? (650 characters or less)

Our target users are the patients, the family caregivers, and the providers: When the patient goes home after a fractured bone, they would soon realize that their life is drastically different. And the older adult's family caregivers will also find out their daily life have been turned into chaotic, sporadic routines with their own risks of having social isolation and health decline. Our solution can transform the chaotic daily routines into streamlined, patient/caregivers-centered care resource network to automatically connect the dots in the on-going activities of daily living. This will save them time, reduce stress, and even optimize cost at no cost as we are offering free membership for individuals. For patients, families, and providers, our solution helps closing the gap in provider-patient communication and meet their common goal of successful recovery. Product or service providers can use the platform to develop, test, and market new products to a motivated group of buyers.

How is your idea scaleable? (650 characters or less)

We started this idea using the content-community-commerce business model. We learned 3C-based business succeeds by scaling up the number of times the same user returns more than just scaling up community size. So, we have been focusing on providing content & capabilities based on a scalable architecture that give users additional value for each return even to the same plan. e.g. Both patient and her caregiver can benefit from one plan and tasks for their own healthy living, but through tips we offer for them to carry out some tasks at the same time to further reduce time and share cost. Once they realize tips are good, they will return to use the same plan but to get other tips or more plans and tips whenever they need to manage their own health or their family and friends’ health. CareXc solves Health Systems' top business priorities: reduce cost, reduce payment penalty, patient satisfaction by having their patients with chronic diseases and their caregivers in the CareXc community.

What do/will you measure to know if your solution worked? (500 characters or less)

• Fewer return admissions for treatment of original injury- Medicare providers already measuring this and we can share their finding to validate • Patients and their families can better understand their options using the prepared care plans, so health system staff can have higher efficiency and customer satisfaction – a health system’s discharge case manager and hospitalist validated this • Patients and their family caregivers feel they reduce time and stress, and everyone has better quality of life – according to our prototype survey • Improved monitoring of compliance with care plan from the provider side – a potential partner had shared their survey • Greater capacity of case managers to handle more cases – we can survey case managers

What is the current stage of development of your idea?

  • Pilot: We have started to implement the idea as a whole with a first set of real users. The feasibility of an innovation is tested in a small-scale and real world application (i.e. 3-15% of the target population)

If you were to become a Top Idea, would you want to actively participate in piloting your idea?

  • I want my idea piloted, and I prefer to do my own piloting in collaboration with the health system and with assistance from the Challenge partner
  • We are also interested in only participate partially for a pilot that a health system has.

Company / Organization Name, if applicable (140 characters or less)


Website (if applicable)

Tell us about yourself or your team (500 characters or less)

CareXc has been focusing on a set of the most common senior health problems as a base for helping the aging community. Bone health and prevent fracture has been one of them from the start. Both my parents had many Osteoporotic fractures so I started paying attention to bone health early on from my direct experience of caring for them. I became a family caregiver when I was busy building my first start-up and quickly learned that a family caregiver is constantly required to multi-task under tremendous emotional stress that their own health becomes compromised. A tool for all family caregivers and patients/older adults themselves to support each other, navigate and share information is desperately needed. That was why I started CareXc. We talked to many potential users about this idea, what their challenges are, and what they’d like to have. Information, save time, save money are three things people always asked for. As an entrepreneur, I love the idea of building a tool that I need.

Location (50 characters)

CareXc is headquartered in Los Altos, CA.

What is your legal / organizational structure?

  • We are a For-Profit Startup or Startup Social Enterprise

Innovator/Organizational Characteristics

  • Female-led organization
  • International/global organization (implementing in multiple countries)

How did you hear about the Challenge?

  • OpenIDEO announcement email

Why are you participating in this Challenge?

I was very excited about the challenge because bone fracture is one of the most common health problems that not only severely impact their living but also shorten people's lifespan. CareXc provides a platform that integrates with and helps others develop their new solutions to create higher quality solutions. I am very interested in following up others'development in this challenge and will be reaching out to other participants for possible collaborations. Pilot opportunity is also a reason .

How does your idea help more people who have had a first fracture either 1) discover they have osteoporosis or 2) access/navigate care?

Our solution includes both Discharge plans and Recovery & Daily Living plans. If patients had Osteoporosis when they had a fall, our Discharge Plan will lead them to a recovery & daily living with Osteoporosis Plan. Otherwise, their plan after discharge has the following ways to watch out for it: - Identify & intervention: patients use the links in the plan to calculate their osteoporosis risks, daily diet nutrition scores to identify risks. When scores are alarming, the logic in our app will alert the patient and their care team for an intervention. The intervention can be a text discussion provided in a plan or a connected telehealth device for face-to-face meeting. Data from either session are recorded in patient’s EHR for future analysis. - access/navigate: Each plan task has cost, time requirement, product list, and discussion at their fingertips. They can investigate, navigate, compute cost, purchase products, and discuss with team members directly without leaving our app.

How is your idea new in the world or how does it build on existing interventions?

This question is best answered by contrasting what isn’t new to what is. What isn’t new is when a team carries out a set of tasks according to a plan and process enhanced by AI & other technology in order to facilitate coordination. To apply this capability to healthcare also isn’t new. What is new is to apply technology to coordinate resources, which include trained and untrained people who possess varying amounts of knowledge, skills, and time, to deliver quality care within financial constraints in both health systems setting or in-home setting. Our solution attempts to solve this multi-variable problem at the level of a core platform which is built using various existing interventions and can be quickly extended with useful new or existing tools/methods/ideas/technology invented by others. The uniqueness of our approach is the reason a U.S. patent was granted in 2018 and why this solution was the 2017 Champion of the AARP Innovation Award for Care Coordination.

Please upload your journey map. Be sure your journey map shows when your user is introduced to the idea and when/how they access it, and illustrates which moments in the Challenge Journey Map your journey map touches.

From the map, it is clear CareXc can start protection when people are still in community living, and hospital can better diagnose if patient has Osteoporosis by the record collected from daily living. If patient is not CareXc member but hospital is, patient is still covered as hospital wants to track post-discharge using CareXc. We offer three plans for Discharge, each for a special period so patient gets proper discharge - a good start to go home with without risking return to hospital in 72hr.

Who did you test your idea with, what did you learn, and how did you evolve your concept?

We conducted more than five iterations of testing. After each time, we evolved our concept with what we learned: 1. We surveyed a group of 25 family caregivers, to understand the problems they faced, their needs in priority, the devices they can use to access such a solution. We then began the initial prototyping of CareXc platform. 2. We selected 10 people from the first survey, and a discharge coordinator, to test the UX for usability and content. With the learning, we adjusted the priority of the functions, and began the real development of a minimum viable product (MVP). 3. With MVP, we conducted several rounds of testing with a group of professional caregivers, a dentist, a geriatric doctor, and individual, non-professional, family caregivers. We learned a variety of things: they like cost calculator, navigation can be improved, and appreciation for products list and to shop directly for medical devices and supplies without leaving our app or the need to search Amazon. We upgraded MVP with the UX for navigation and plan customization. 4. The second-generation MVP was our beta product publicly available on website for anyone wanted to try, and for experts we invited to critique. We continue to make functional and content changes with new feedback. In parallel, we are enhancing the platform and creating solutions for people who are living in difficult diseases. 5. This Challenge's UX prototype was tested and they liked the ease of getting all needed products & DME.

(Optional) Share documentation of your solution prototyping and testing, such as photos.

Since we picked a new UX for accessing our solution using a disease-centric view but compatible to the CareXc platform UX. Uploaded images show the process is from initial few sketches on paper to eventually the final prototype web pages that is testable. Prototype was very useful for two family caregivers to test run and give us feedback. Both liked it a lot. url for user's comments video here:

Please upload your Business Model Canvas

From the get-go, we wanted to build a “Content, Community, Commerce” business for the most important “consumer business” segment - healthcare where everyone is the ultimate customer. This is also the model most millennials are comfortable with and millennials are fast to become family caregivers. In healthcare, care plans with touchpoints are the “virtue queue” and we “modernize” how each healthcare group use this queue. The attached canvas is built under this overall business model.

Please upload your team video.

I tried to use the add button but this error kept on showing up "we are sorry something went wrong there, Try again or select another video." I tried many times, but of no help. Here I am sharing the link of the video for our team same error for the prototype video, here is the link to share the prototype video


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Photo of Susan Jackewicz

Congratulations, Ann, on being selected as a Top Idea for this Challenge! Seeing how you've moved your idea through the iteration process with feedback from this Challenge is impressive, and further refinement as a Top Idea will advance your ability to impact lives. Great job!!

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