Inside CVC: Katharina Janus on Longevity, Caregiving, and Building an Aging Economy That Works

Longevity is not just a healthcare issue. It is a workforce issue. It is a competitiveness issue. It is an everything issue.

In this episode of Inside CVC, we sit down with Katharina Janus, founder of Fourth Quarter Life and a longtime healthcare leader across managed care, hospitals, academia, and consulting. She shares the personal moment that changed her work forever. Navigating her father’s Alzheimer’s care showed her how opaque and unfair the system feels, even when you know the system inside and out.

We dig into why aging is the next defining mega trend for markets and society, and why the “care at home is cheaper” argument often ignores the real cost. The unpaid caregiver. Usually a woman. Usually sacrificing income and retirement.

Katharina explains what is breaking first. Staffing shortages. Fragmented care. Incentives that turn care into transactions. And she makes a clear prediction. By 2030, systems start to buckle under the math.

We also explore what corporate leaders and investors tend to miss. The productivity drain of the sandwich generation. The loss of experienced talent. And the social risk of fear and desperation spreading through a population that sees what aging looks like up close.

Her answer is relationship based care. A return to the human motivations that make integrated care work when incentive schemes fail. For CVCs and corporate boards, the takeaway is direct. Stop funding isolated point solutions. Connect the dots. Build portfolios that integrate tech with human care, and treat eldercare support as a strategic advantage, not a nice-to-have.

Transcript

Steve 0:04

Welcome to Inside CVC, the podcast that brings together leaders in innovation and capital investment to explore the trends shaping the business of corporate venture capital. I'm your host, Steve Schmidt, and together with Philip Willigman, we're speaking with corporate investors, entrepreneurs, and ecosystem builders driving the future of innovation. Inside CVC is brought to you by UPath Advisors, helping corporations and startups unlock sustainable growth through strategic partnerships. To learn more, visit upath.com. That's the letter U, hyphenpath.com. And to catch up on all of our episodes, search InsideCVC on your favorite podcast platform or visit upath.com forward slash podcast. In this episode, we explore longevity and aging as a systems challenge and why the next decade will force governments, employers, and investors to rethink how care is coordinated, funded, and delivered. Our guest is Katerina Yanos, a healthcare strategist and founder of Fourth Quarter Life. Katerina has spent more than two decades across healthcare delivery, managed care, academia, and global health strategy. And her work is shaped by lived experiences navigating long-term care for a parent. In this conversation, we discuss why aging is becoming a defining macro trend for markets and competitiveness, the hidden economics of caregiving and its impact on workforce productivity, why systems begin to strain sharply around 2030, and what relationship-based care can teach us about designing models that work at scale. Here's our conversation with Katerina Yanas. Katarina, thank you for joining us on Inside CVC. How are you today?

Katharina Janus 1:54

Very good. Thank you. Thanks for having me.

Steve 1:57

Absolutely. We're going to have a wonderful conversation, a timely conversation. Why don't we start, however, why don't you tell us a little bit about yourself and some personal experiences that led you to found fourth quarter life, focus on aging as a system and societal change?

Katharina Janus 2:14

Yeah, thanks so much. With pleasure. So healthcare has been my close-to-heart topic all my life. I've been in different uh positions, uh taking on different uh perspectives and wearing different hats and healthcare for 25 years. So starting out really in managed care, uh, working in hospitals, negotiating, bringing people together in organizations, then moving into academia as a professor at Columbia University for many years in the US and also then across Europe and in Asia, founding my own institute, Center for Healthcare Management, and my consulting company. And most recently, a fourth quarter life, also a close-to-heart topic that grew out of experience. I would say experience a hard way because I started taking care of my dad when he was getting into mid to advanced stages of Alzheimer's. And that showed me that all my 25 years in healthcare, considering myself an expert, uh, still I was pretty helpless and felt lost in the system. And uh, you know, I considered everything to be well very intransparent and injust. And I and my role had, of course, many contacts I could call, organize care, coordinate everything. But I started asking myself, well, what do other people do who had not spent all their career in healthcare? And so that's how me and my co-founders who were in the similar situation came together, helped each other, started building a wealth of knowledge and setting up a community that should help our generation to better coordinate care for their loved ones and also then help us getting ready for a better aging in the future. So that's how this came to life. We just kicked it off and we are hopeful that we can move ahead and we are hitting the nerve of our time.

Philipp 4:14

Katarina, it's a pleasure to have you on. Uh, would be great if you could share a little bit with our audience what are the facts and trends which make longevity the next defining mega trend for societies and markets?

Katharina Janus 4:26

I mean, of course, that's the background information, and I think a lot of players have already jumped on that train. Although, from my perspective, very few see the core issues. And those are, for example, the the in general the shortage of stuff that you see in the industry, especially if you really talk about long-term care. And also, you know, technology has its limits. It's hard to admit because we're all excited about innovation and all the new things that come up every day. But we have to balance in a smart way tech and the human side of healthcare. And if we think we can do one without the other, we will fail. So that is that will be a key question and a key trend, finding the right balance. Then, you know, it's a numbers game. It already is, but it will be more so. If you look back in the last 10 years, the number of people in need of care, for example, in Germany, has doubled. Just imagine that. Uh, you will see an exponential growth in this field. And at the same time, people are getting more and more into the responsibility to pay out of pocket. Um, at the same time, you see an erosion of the middle class. Um, and that will very soon mean um that government has to kick in and get back in this whole game. Because basically there are limits what people can pay. And if you don't put kind of a um a spending limit in in you know in place, then at some point people will just say, yeah, we can't. So government will have to take over. It's already happening in many countries. And then you have this discussion around care at home, taking care of people at home, which is of course desirable, depending on the condition. Um, but the key argument and policy is that um this is much cheaper than institutional care. And I love these discussions. Whenever that comes up to me at a conference or reception, and then I'm I'm uh curiously investigating how they made this calculation. It is it can only be cheaper if you don't count the primary workforce, and that's usually a female caregiver. Talking about inclusion and you know discrimination, that means most of the time that these caregivers have to give up their job. They cannot pay into their own retirement anymore, and they, when they get in the old age uh situation of being frail and and you know needing care, they will be, you know, they they will not be able to pay for it. Um so old age poverty is um the direct result. So these trends show us that we have to act and that yeah, you know, societies are uh will be shaken, are already shaken by this development. And markets should react if they want to get back into the driver's seat at this point in time and not, you know, in a situation that is maybe uh less advantageous to deal with.

Philipp 7:52

Katarina, um you obviously raised some very important points, and we both connected also on a very personal level, because when we spoke first met, um I shared with you that uh I have a sister who sits in a wheelchair, and I agree a lot of a lot of the care uh in the last uh 40 years uh was was done by by my mother and a lot of females involved. Um I personally got much more engaged in the last 10 years, and uh finding good people who take care is a massive massive issue here in Germany. So it's at the individual level uh definitely a big topic. You already mentioned the government obviously is uh has to step in. But can you share why why does this topic actually also is important for corporate boardrooms and ambassadors?

Katharina Janus 8:38

I think in general, you know, it it has to be a joint effort because this touches all all elements of life, private life, but also corporate life. The productivity loss that's some corporations already see because uh especially their employees might be in a so-called sandwich situation. So they are taking care of their children, and at the same time they get into the situation that they have to take care of their parents. That basically results in sometimes up to 50% of productivity loss. And I can give you my own example. Uh, when I got in the situation very often at 12 noon, uh I hadn't done anything for my real job. And I mean, I'm in a good position because I'm the boss, I have my own company, I could do that. But of course, you know, it also means you have half of your income. And many people in the same situation, they just have to resign at some point because their uh their companies do not understand this. So they have to completely resign. And it's it's just uh it's not only productivity loss, but it's also you're losing senior, experienced workforce that has all the knowledge that you need to run your company. That is important also to develop to educate the next generation. So that is, you know, it's a huge productivity loss. And many companies nowadays, and also took a long time, it's accepted that you take time off for childcare, but not for for elderly care. If you say that, you say, What do you want? Uh so anyway, I think this we have to change, change, or we have to shift the paradigm here. And then also the other thing that is underestimated, I think, by yeah, by markets, I would say, and that of course is represented by corporates and and large large companies. Um this desperation that might um occur and that is already there if you look at people coming in this completely overwhelming situation. Um, desperation is dangerous. Uh, and um you see it already in the US and some other ways. Um and also people living in fear is dangerous. Uh and people start living in fear if, you know, like they are taking care of their parents, their children, and they are asking themselves, oh my God, you know, what will happen to myself when I'm old? Uh so you know, fear and desperateness, I think, is something that might that will shake up societies. And that, of course, um is not good for the economy and for for business as well. So that's my more the external perspective, and the internal is really uh, you know, the productivity loss that you might see, and that is already being seen, um, which requires immediate action on the corporate side as well.

Steve 11:33

So, how do we address all of these these challenges? What's the missing link? You know, where exactly do current healthcare and our social systems fall short?

Katharina Janus 11:45

That is a short question and a long answer. Could be a whole episode. Um, I boiled it down basically when I was thinking about um this topic recently to three three areas. One is is um I'm always baffled looking at or acting also in healthcare systems, um, about the lack of, you know, let's say classic management uh rules and procedures, processes, quality assurance, certification, you know, everything that we know from other industries um are very often missing, um, but would ensure a wise use of existing resources. Um so that is one point. And also what you see in healthcare is just um historical fragmentation of all different elements that should ideally work together, and they don't. Um and uh so this idea of one-stop shopping would be important. So this is kind of the classical, you know, take the good sides of management and actually apply it to healthcare. But then also healthcare from my point of view is, and and especially also long-term care, aging with dignity is a public good. So you need some regulation where where necessary. And I think that's another problem. We have deregulated everywhere, with good intentions maybe, but sometimes it just didn't work out quite well. Um, and it basically meant that, you know, some were kind of zif siphoning off resources um which should have been put to better use. Uh so from my perspective, also the you know, the state, the system needs to get back into the into the game and regulate where it is necessary to ensure the good use of resources. And then um, third, and I think important most importantly, because there will always be quite a few tasks that cannot be taken over by technology, even if we would love to, and even if technology is great, we need human beings. So we need to actively work on the recognition of caregivers. Um be it at home, be it uh be it uh, you know, as a profession, uh the nursing profession and social workers and so on. Um, that is really key. Uh, giving you an example, you know, for our um, you know, adventure adventure fourth quarter life, I'm interviewing a lot of caregivers who are in this situation. And they get a certain, you know, uh compensation, but it's you know, it's it's uh too little to live, too much to die. Uh but they said, well, you know, if it was twice the amount, it would be kind of okay. So it's just, you know, money is one aspect, but it's also the recognition um that is not uh not there for the hard work they do. And that's key if we want to have more people in this workforce that we uh desperately need to happen.

Steve 15:02

And you have coined the term relationship-based care. How does that bridge some of these challenges, some of these shortfalls that you're describing?

Katharina Janus 15:12

The term relationship-based care came out of many of my projects that I've done over the last couple of years, because I have always tried to um, you know, any kind of research or project work, to work on the ground, on the shop floor, talk to people. Then you understand what is really going on. Uh, and very often it is very different from what you hear and and what everybody talks about, the wonderful incentive systems and uh, you know, pay for performance and all of that, uh, which has been introduced to um to healthcare. Uh, and but when you go at, you know, go to the shop floor, you talk to people, um, you realize that the old saying that human beings are social animals and they they naturally contribute much more than what you can actually enforce. Um, and that's an interesting, you know, um it's a it's a general, it's a ground rule, it's a human rule, humanistic approach. Um, but it also means once you start changing the rules, they might uh change their behavior. Um and we have seen in many um situations and uh different healthcare systems, no matter what kind of political system, uh, that wherever there is a culture of this, let's say, intrinsic human motivation, intrinsic action, um, the integration of care works much better. Um and you know, because this relationship-based care basically overrides any kind of other incentive system where you you pay for a certain thing, a certain transaction to happen. Um, because then of course people start gaming their system and they just do this, but they don't do anything else anymore. And before they were all there for their, you know, according to their natural predisposition, which is doing the right thing, right? It's a professional pride. Uh, I became a doctor because I wanted to help people. Um, and if you kind of trigger this original intrinsic motivation, why people first took on the job, why are they getting up every day? What is something that money cannot pay for? Um, then you realize that there is this initial, you know, intrinsic motivation of uh focusing on the contribution to you know a certain community or a certain cause. Um, and we saw that especially in cultures like the French culture, for example. Um, we looked at uh you know integrated uh systems in some of the regions of France uh where there was actually no extra budget, but there was um relationship-based care happening because people were just picking up the phone, doing the right thing for the patient if they thought this is the right thing to do. Uh, and of course, the culture helps, right? Um if you have a more um social way of interacting and having lunch together and you know, um having an aperitivo or so, it's it's it's very useful. But it's also this um this human predisposition that helps making care work in an integrated way. Um, and that's what we you know uh we try to push forward because it's also something in long-term care and aging that we need to we need to get back to basically. We need to abolish any kind of incentives that destroy the human aspect of care.

Philipp 19:10

So I wondered from your work, how can corporates move this into a strategic advantage for them, not only on the workforce side, but in general?

Katharina Janus 19:18

I think it depends on in what what what field they are. I mean, first, of course, uh if they are um actually also acting as investors and looking at at technology, um it always um helps if you put yourself also in the role of the integrator. Um and you bring together different technologies, different people, uh, and you make it uh uh you know part of the communication strategy and and uh you spread the word. Um I think that is, I mean, the whole awareness and coordination of this topic is extremely important because it's not there. Um it you know for childcare it yes, it it has entered large corporations, a topic, but not for any kind of um any kind of uh yeah, care of parents or loved ones, or you know, that there's no understanding for that. Um so I think uh especially uh yeah, it it needs to, you know, the stigma has to be uh worked on. So it's part of communication, but it's also then part of investment that uh yeah, companies can think about if they intend to invest in technology. And let's face it, uh, you know, demand will very soon be exponential. So it's also a numbers game you can leverage. It will be an important point when you search for talent, when you try to recruit. Um, I know that many of my friends, when they look for uh new jobs, um, this is important for them, that they have this flexibility. Absolutely. Um, and as soon as we hit hit 2030, I can guarantee you systems will collapse. So the the general you know healthcare system will not be able to uh to kind of yeah, cover what is happening in what way ever it will be to a large part on the individual, on the uh and and with that within the corporation, because that's you know that's the life of the individual. That's where where the um the performance and um also the productivity loss will be experienced if there is no action.

Philipp 21:41

Kalerina, can you can you explain why 2030 specifically?

Katharina Janus 21:46

Uh that is um, well, of course, uh you know, a result of statistical simulations. Um I mentioned already um the increase in people in need of care um over the last 20 years, uh over the last 10 years. Just take 10 years. It has doubled. And then you can just simulate that further on. And you, you know, just looking at the number of people, you look at the workforce who is providing that care. You look at the budgets and the facilities. Very often there are facilities, but they cannot operate at full capacity because they have no staff. So it is basically a simulation based on what we've seen over the last 10 to 20 years, that in 2030 we will have the first big meltdown. I mean, I don't want to draw the picture too dark, but still it's it's it's very close. And whether it's 2030 or 32 or so, you know, but it will very soon affect us quite substantially. I think that is the key message.

Philipp 22:56

And and if you think about, you know, you've you know done a lot of work on the innovation side, but also building ecosystems. What what is needed and what kind of ecosystem do we actually need to build and create uh in order for innovation, this space to scale?

Katharina Janus 23:15

Um yeah, a little bit what we talked about earlier. So uh what would be fantastic would be a truly integrated perspective and action. So also getting back to the topic of relationship-based care, uh uh rediscovering the original values, the original human sense of collaboration. Um, integrated care, you know, I've been in healthcare for 25 years. Uh integrated care has always been a topic. Uh, there are pre-PowerPoint slides on integrated care that are 50 years old, that's still the same as today. Um, and still we haven't really made it reality. Uh so, you know, and there are different reasons for that. Um that would be another series, um, looking at you know all the professional cultures and the incentives and so on. But ideally, of course, to make this happen, we would have to redesign incentive systems from scratch, uh, reimbursement systems. All of that is preventing that we have truly integrated care. This, of course, is not possible, or not easily, not easily possible. Um, but what we can do uh on a small scale is better understanding human motivation and professional cultures. Um, because as we know, culture eats strategy for lunch every day, and that's the same for professional culture. Um, and uh very often, you know, I'm acting in between all those different cultures to generate first understanding and then change in behavior because we we spoke we speak different languages. Um doctors don't speak the same language as nurses and so on. So we need to moderate. And then we need to apply the right approaches to the right problem. Uh I mentioned earlier that it's important to implement some basic management knowledge. Uh the problem is the healthcare system has taken some management knowledge that is actually not applicable. Uh, for example, paper performance. Uh, we need to realize that we are dealing with knowledge workers um and uh you know, and that certain elements will always require a certain human touch. Uh we cannot put, you know, and that's and that's important so that we are not uh you know employing the wrong theory for the same problem.

Philipp 25:53

And and how do you how do you see like corporate venture capital, right? And how can they become important players and system connectors and not just you know be isolated investors from your perspective?

Katharina Janus 26:08

Yeah, I think if you have the power, um, and many of those do, and they are looking for smart investments, uh, what would be super super good and uh yeah, is is actually also an integrated approach. So building portfolios or even reuniting fragmented solutions, connecting the dots. Uh I think they will realize that the results are even better and uh not only for their return on investment, but also for their their own workforce and well-being. Um I I mean, whenever we we act in these kinds of innovation and integration projects, we try to build consortiums and we try to align all the different incentives. It's maybe more work in the beginning, but I think the payoff is and and the impact is is much larger and much more long term if you try to create integrated solutions.

Philipp 27:11

How do you hope the summit in Berlin and also other summits will move the conversation forward?

Katharina Janus 27:16

From my perspective, uh you know, being in strategy for many years, any sane corporate strategy should be based on foresight and not reactive. The example offer opportunities for not only engagement, but also how they can be leveraged. The time to act is is now. And uh, if you have examples you can understand and you see the return on investment, it makes total sense. I think the problem is in this field, there are so many uh, let's say, non-evidence-based uh innovations where people just say, yeah, it's some well-being, some nice to have, uh, whatever. That is not selling with corporates.

Philipp 27:59

Caterina, such a pleasure. Thank you so much for your time. Looking forward to many more conversations and also working on some concrete action. Thank you.

Katharina Janus 28:06

My pleasure. Thanks so much for having me. It was a lot of fun.

Steve 28:10

That's today's episode of Inside CVC. As always, thanks for listening. To hear more episodes, search InsideCVC on your favorite podcast platform or visit upef.com forward slash podcast.