Healthcare Tech is Bridging the Gap in Member Engagement

Yes, this is the Health Care Rethink podcast. I'm your host, Brian Urban, and today we are talking all things healthcare technology startups. We're very fortunate to have the co-founder and CEO of Reciprocity Health join us today, Matt Swanson. Matt, thanks for joining our show.

Really happy to be here. Brian. Thanks for having me.

This is going to be a lot of fun. We had the opportunity to meet at the Innovation Summit and saw you on their Inside Health podcast, that that I did later in the week too. So it's just like the the podcasting continues. So I'm very fortunate that I think we crossed paths when we did and really excited to learn about reciprocity, health and what you're doing there today. So let's jump in first with Matt Swanson. So your background is awesome. Didn't get to say the praises I wanted to when we first met about your Vermont background. I'm in love with Vermont for so many reasons, but, uh, Vermont University of Penn, you are also an adjunct professor shaping young minds outside of reciprocity. But did you ever think that you'd get to this level? You'd have all this type of impact and influence? And, I mean, how did you get into all this? Where did it start from? Matt.

Yeah, it's a pretty chaotic, nontraditional path, especially ending up in health care, which is such a specialized industry. You have so many wonderful people who have 20, 30 years experience in the sector or in the field they're in. I'm not that I'm a sort of a basket of lots of different experiences, and hopefully that adds a perspective that can bring some innovation and some change. I think it takes a lot of people with a lot of different opinions to bounce around new ideas and come up with the right path. So I'm definitely coming into health care more than a decade ago, but still sort of a non traditionalist and trying to think outside the box a little bit.

I think you are involved in a lot of the early development of Cityblock health too. So you were in the, uh, addressing Sdoh through alternative data sets before it became more in our face every day. So you've been involved in this work before? That curve started to peek a little bit too. So, I mean, is is that something that took you your experience there? And then aside from your business development experience, too, did that take you into the path of standing up reciprocity? And we'll get into who reciprocity is in a moment. But does that that take you down that path, that types of experience?

That was a big development point, but it wasn't the start. So very quickly at a very traditional corporate start, corporate finance start to my career and then had a great opportunity to build and grow an e-commerce company during the big e-commerce boom of the early 2000. And so those are things I draw upon now. But particular to your question around social determinants of health and the challenges that a lot of vulnerable populations are facing that started in the education field, actually. Really? Yeah. I was lucky enough early in my career to get involved from a governance standpoint and then directly involved in a nonprofit organization that launched inner city charter schools. So during my tenure with this organization, we helped launch four inner city charter schools. And as part of the development of those teams and the governance for each of those schools, I got very involved in attending the schools every day, helping stand those organizations up. And I would sit with families and, you know, parents and kids together really trying to understand what the challenges they were facing in just someone in middle school or high school trying to keep up with their education when in their neighborhoods there's violence and and lack of nutrition, so much instability. Those challenges are so vexing that you can't expect a teenager to show up and actually absorb an education at that point. So that was my first really firsthand experience with what social determinants challenges can bring you. I guess you would phrase that the social determinants of education, but it was really understanding and sitting with those families day to day understanding, how do we get these young people into a place where they can actually not just attend school, but actually learn and succeed in school? And that had to do with food, nutrition, housing, but then also mental health. And so how how did a lot of work trying to connect the public school system with the wonderful resources that we had in the community in terms of mental health care? And that was my first toe in the water with really understanding what health care challenges were, were being faced by these families.

That's amazing for you to even say your first toe in the water, because that type of grassroots. Roots in-person in the community experience the way you took that and put it through application of a lot of innovation that you're doing now. It that's that's where I think a lot of leaders today are gapped. I think they come up with different innovations. And it's a siloed nature. And it's tackling these very big mountains. But they may not have the perspective from that type of experience that you just shared that you had. I had no idea of that. So that that's quite beautiful, that that stuck with you and a lot of the work that you did, and it went through your career as well. So that's really a big part of part of it.

It was fortuitous as well that that's a happy accident that I really had that to draw from, because when I got pulled into health care back in 2011, it had nothing to do with that. I wasn't drawn by that to to jump more formally into health care, because I'd been doing pretty aggressive systems change with the launch of these charter schools in, in, you know, across the state and in the city of Wilmington, Delaware. I had been working very closely with the governor and his Secretary of education to really understand what academic innovation looked like and how to drive that. Systems change. And it was out of the blue that the governor came to me and said, interestingly, I am starting a very deep initiative for our health care system across the state of Delaware that is going to involve massive systems change, which is parallel to what you've been doing in education, but is also going to involve the leadership from our entire health plan and payer community, our entire health system and provider community, and my own administration all working together towards a singular goal of moving our system towards value based payment. And to do all of that, I need two things.

I need to put together a strong a compelling application to CMS and get statewide Innovation Model Grant funding to do this. But I also need somebody who can play Switzerland and can sit between all of those constituencies that typically are not that collaborative. They're typically sitting across the table from each other negotiating over a contract or something along those lines. And so getting everybody rowing in the same direction for this application to be successful. He asked me to go in and lead that work where I could be that neutral party that didn't come in with legacy mistrust from either side, and could try to just take an objective view on what needed to get done and drive a pragmatic approach. And we did. We put an application in it was we were able to rally some really amazing support from all of the leadership organizations in our health care ecosystem, and we got nearly just under a $40 million grant from CMS to basically pursue this very rich, very intense five year, which became a ten year journey to move from fee for service to value based care. And it takes that level of effort to really move a system like that.

Wow. Yeah, it does it, not just from the funding standpoint, but from the strategic planning, the buy in, you playing that type of Switzerland role. I love that you said that. So Matt I'm curious. So this was probably your entrance and longer term tenure at the Delaware Center for Health Innovation. It sounds like and guess from this, the things that you stood up and and actually going into more of the payment, the actual business model of health care, this was probably a huge influence for you to actually be able to make some of those big changes in education transformation, making it not just a universal type of education, but a more a more culturally aligned, flexible education system in the state of Delaware. So I'm imagining a lot of your interactions with this center for Health Innovation spurred a lot more innovation. So tell us a little bit more about your time there.

Yeah. So changing a system to that extent, it's an entire orchestra of activity. You had the health tech it built, making sure the health information exchange within the state of Delaware, called Din, was was a partner in this work so that it could help inform data connectivity across all of the plans. So you had the entire technology effort. Then you had workforce development because you really needed to build a capacity for care, navigation and other supports that did not exist in a fee for service world. Then you needed to obviously align all the payment models between payment payers and providers and get into the contracting and and all of that. And then there was another component equally important, which we called the population health component. And I naturally fell into getting more involved in that committee. I chaired that committee of work. We called it Healthy Neighborhoods. It was all about connecting more formally the community with the health care resources that were available. And because of that work I had done with families and education, I was very familiar with the communities that we were serving and the challenges they were facing, much like what they were facing in education. And so through that work on the Healthy Neighborhoods Committee, we we really dove into those challenges and where patient engagement really played a role in value based care. And and it was from that work and the work around payment models between payers and providers that the original idea for reciprocity health sort of was born.

That's where I was wondering the track to reciprocity and well, so first of all, thank you for the deep dive in that because there's a large part of your background looking at it as an iceberg type of analogy here, that surface level. You've been in an executive position for a long time, but below all that was a lot of your community health engagement, population health initiatives that took place not just in those neighborhoods, but the state level too. So it had to be like that for a lot of the movement and change to happen. So love, love to know that part of your background that's very new for me. I think that's very intriguing for our listeners as well. So let's get into reciprocity. I think this is a very unique model in terms of engagement and in terms of connection and understanding different cultures of health. So the social dynamics, gamification, financial incentives is kind of this the bedrock of your platform. That's the intersection of behavioral health economics. And health care is what is what your firm stands for. So this is a very interesting take. It's not just a UI experience that you've you've built, but it goes a little bit beyond that. And you seem to integrate really well with a lot of different health plans. So that's my view on it. But it's so much more than that. So what's reciprocity doing today?

Well, it came from a couple of different angles for it to all come together. The first was really in this shift towards value based care and convening all of these stakeholders about what that shift meant for them. I learned directly from providers primarily that they understood strategically and with an industry focus, why value based care was so important, and why it was inevitable that the industry would go that way. But as a practitioner, they were saying, this is challenging for us because you're now asking providers or health systems to take on risk, but their day to day experience with patients is that I can do everything right. I can tell them what they need to be taking in terms of medication, how the changes in lifestyle that are important, how the follow up visits with specialists or lab screens are important. But the minute the patient leaves my four walls, I have absolutely no control over what they do. And yet I'm being held with the risk now. So I heard that over and over and over again. And that bothered me, because here I was sort of advocating for this shift, and we had probably the most important stakeholder group in the room really questioning how it was going to hold water. So that was first. And then the second piece that I began to appreciate from an outsider and trying to really understand value based payment in all its complexity. For the first time, I broke it down to some very simple elements. I saw we were shifting into a world where the payer was being made comfortable with delivering financial incentives to drive a behavior change.

And the behavior change here was with providers. We were now asking providers to take cost into consideration and to now adopt these care navigation components to their practices. And so financial incentives from payers to drive a behavior change within the health care system. And then at the same time, I married that to the provider saying I need patients more involved because they need to be a part of this solution. So I put all that together and said, well, why can't I get payers comfortable with paying financial incentives for behavior change, but to a different stakeholder group to the patients? And can you build an actuarial construct that took ROI into account? Can you really embrace the complexity of the behavioral economics of financial incentives, and can you bundle that all together to create a way for financial incentives to. To change behaviors, change those health decisions at the patient level that are going to make everybody win. If you build a stronger partnership between a patient and their provider, that is the on ramp towards healthier outcomes at lower cost. And that's really what we're trying to drive. So it was sort of trying to piece all those bigger moving parts together. Early days while we were in the midst of this transformation work. And the other piece of the puzzle for that is recognizing that. Even for financial incentives to work. Even for that being a motivating factor, you need to drive awareness and engagement of those programs.

And where was that going to come from? Where is that expertise around outreach and awareness going to come from? Because we don't want our doctors and our specialized care providers to be excellent at outreach and engagement. We want them to be excellent at clinical care. Equally, our payer community, they have members that they serve, and there is a certain amount of outreach and work that they need to do well. But traditionally, their financial organizations who are a clearinghouse for the payments between patients and providers and all the important work that goes on there. So they're not the natural home for outreach and engagement. So neither of those aspects of our health care system naturally grow this excellence, this expertise, this center of excellence around outreach and engagement. So who's going to play that role? And it takes a lot of work to understand what that looks like and what that work needs to be. And so that's where my co-founder comes in. John Sullivan 30 years experience in consumer engagement coming from consumer packaged goods world, understanding the worlds of segmentation and consumer journeys, and analysis around omnichannel messaging. There's a consumerism component of health care that has such a huge frontier ahead of it, and that's another component of what we're bringing here, where we're bringing consumer science and behavioral economics, science of financial incentives together in the platform we've built, because it's only if you do all that in a very coordinated fashion that you're going to be successful.

I like that you said two things in particular with your description here, Matt. One, the incentive, I guess you could say flow of the world of health care in the contractual side of it, it's a payer and provider developing kind of the rate sheet, what you're paid for. And then it's going beyond that and doing now pay for performance and saying, if you can control spend in this population, you'll get X amount of dollars per head per month, etcetera. And then there's the full capitated risk. There's all those levels that are very straightforward business plays. And we've been incentivizing one stakeholder, but not the person that's actually being treated for health care. Yeah. So I always thought it was interesting back in the day, the gold carding methodology of contracting physicians, if they can control spend in a certain population, then they get, you know, X amount of additional dollars. Top line. I think that's great, but I love that your technology pulls in the person that's actually having the services or seeking the care. And from the consumer behavioral side, your your partner in developing this, it just makes sense because it's it's a part of the human condition, the behavioral economics side of how you all see this engagement play, I love that, and I think that kind of leads me down to the path of this, the gamification side of your platform. So incentives are one thing. Like you get a gift card for doing your wellness checkup. You know, that's been around forever. But tell me a little bit more about the gamification side of what you all provide with reciprocity. That's really intriguing.

Yeah. And and gamification is a very broad term. And people immediately jump towards the sound effects and confetti that you get on your phone when you know you're playing Candy crush. And there's certainly there are elements to the development of your UX UI that you want it to be fun and engaging and sort of dabble in that aspect of it. But that's a 10% play for us. The 90% of what gamification means for us is really around clarity, clarification. When you really understand the nonadherent or inactive population, which is predominantly coming from our most vulnerable populations, you really understand that it's the intimidation or the confusion or sometimes mistrust. Those are the things that are causing someone to not take those first steps in their health care journey. And so what we try to do is we take something that can be as complex as a long term diabetes management program or a high risk maternal health program, and we're trying to bring those modes of care into this financial incentives world instead of what's very transactional. Today, you see a single activity, like getting a mammogram. You get a $25 gift card from Amazon. We're trying to actually leverage the power. Our of financial incentives into much deeper areas of care where the real cost lies. So when you take someone and you give them, you know, a preview of what's ahead for them when they have a diabetes diagnosis, it's intimidating, it's overwhelming.

And some people just check out at that point. So gamification for us is taking that complex care journey and breaking it down into simple steps, breaking it down into what are the next three things that are on my roadmap, and then what are the rewards that I can earn if I just get started and start this journey and trying to make it less intimidating, less overwhelming, and then gamification for us can be as simple as delivering that in someone's native tongue, right? The clarity of it all. It's astounding, just with the digital world that we live in, that we're not leveraging that to the point where we can deliver all of this, this, this messaging, this encouragement and these roadmaps in Spanish and let people step into that journey in a way that that before for them trying to learn about, you know, the first steps on treating a chronic condition in a language that you're not comfortable with, that's enough to stop you in your tracks. And so how do you build that friendlier on ramp? How do you get to a point where you're drawing people towards their care in a way before, where they just were not willing to take those steps? And then then you build from there? It's an on ramp, right?

It's the on ramp. I love that you you kind of shared that example. I think it's interesting because I saw gamification as, hey, there's different components of interaction, but the part of it that you alluded to is, is the health literacy, literacy side, the guiding of someone toward what they can do to better manage their new diagnosis or a condition they've been managing for a while in a very digestible way. It sounds, because not knowing your platform in terms of, you know, playing around with it individually here, it sounds like it is a it's a it's a more understandable, relatable, universal way of having someone understand where they can go next for their next care steps and how this will interact with their body, things like that. So that's that's way better than a pamphlet of hey, you got diabetes too. What's next? Right. Exactly.

So you want to try to facilitate. It's so our design team, we're we are a tech enabled service. So we're not selling a technology to clients. We are a partner with them to build this specialized capacity for their current outreach operations and hopefully bring some level of further outreach, further engagement from what they're they're doing currently. So they'll look they'll identify for us. Here is an excellent high risk maternal health program that we love. We love the outcomes. We love the cost trajectory and the ROI that it drives. Our only problem is that we do not have adoption and adherence across our population at the level that we want it to be. So our team will take that curriculum, break it down, gamify it so it is broken down into these easy to understand steps. And then we build across that. Our behavioral economics team will say, okay, these are the appropriate rewards. This is the appropriate reward design. Sometimes you're going to want to bring in very different behavioral economics tools on how you frame, describe and set up those rewards. So our team does all that. And then we launch that through our platform. We design on on an internal platform. And then it launches on the therapy app which is where the members receive iOS, Android or web. Here's my new campaign. Here's my new opportunity. It's 30 steps over the next three months.

And here are the first three. And then where you can we have an incredible suite of tools in the app itself that allow people to get those early wins and some of those steps in a care journey right there on the phone. So we call that the facilitation phase. How do we make it easier for someone not just to understand what these next steps are and understand the motivator of a reward, but how do we help them complete that? So okay, go get a lab screen is great, but now they don't know who to call, where to go. But if there's a if there's a button on that that immediately pops up. The six Lab Corp's in your area with links to set up the phone call and appointment that you're helping them close that gap. If it's to watch a two minute video on diabetes nutrition, if you can, click a button and watch the video right there and then get a reward announcement the minute the video finishes, you just earn $5 for learning more about your diabetes. That builds trust, confidence, and momentum for them to continue on. That longer journey. And so whether it's surveys or educational content or steering people towards a care navigation resource, such as a phone call, that's all built into the app so you can build those early wins.

So you're your tech is easily woven in within the workflow of a care management team, a health coaching team at a health plan, it sounds like pretty easily. So the engagement I'm curious on the measure side of the impact your tech has had with programs, have you seen just right off the bat, tremendous boost in engagement, capturing incentives, and then connected to improved health journeys in terms of preventative care health outcomes? Have you already started? I guess you start to see that in a very quick fashion with what your tech can do going into workflow, if I have that right. But I mean, have you seen some very significant uptake in engagement?

Absolutely. So this is where the beauty of the funnel that we work in, the beauty of consumer science is really at the front end of the funnel, because that's outreach and awareness for people to understand what the opportunity is and then giving them a really easy way to get involved. Then signing up and registering and getting that rewards card that becomes their lifeline to each and every step they take. Being rewarded. So we start with a very robust omnichannel messaging platform that that takes this opportunity out to market and lets them see that and then giving them this very easy onboarding experience, because we typically have a lot of that member data. These are plan members. We are extending a benefit to them. So we are just making them aware that this opportunity is there. Sign right up. We already have your member file all filled out. You can change any data that's here. Click click click and you're in. So making that easy is incredibly important. The digital outreach and the sophistication is important. We've we've been operating with one major Mid-Atlantic blue and shown a ten x increase in the monthly enrollment rate for this type of reward programing. So that so that's the front of the funnel. Are you engaging more people and drawing them towards their care, so that that's a great indicator that this platform can really, really move the needle in terms of the initial engagement.

And then from the outcomes standpoint, yes, we've we've for that same client across hundreds of thousands of members, we've we've tripled cervical cancer screenings. We've tripled or almost tripled mammograms. And we've almost doubled primary care visits and then go down the list, all these these measures that are part of a care journey. We've been able to really impact that. We've been able to drive huge engagement in diabetes management programs. We've been able to and these are across multiple clients and multiple states. So what you really need to wait a bit longer on is to really understand that whether the higher levels of involvement in these preventative programs, diabetes management, trying to avoid the hospitalization and utilization down the line. Those take a bit longer to really understand the outcomes, but typically that's where we want our clinician partners, our care journey partners, to really be the experts. We're not a clinical provider. We really want people to bring us best in class care programs that already have. Clinical evidence on the outcomes rate, visibility on the ROI, and we just look to accelerate those. We want to be the accelerant of excellent programs.

That is the word I was immediately going to say, Matt, is you accelerate these existing programs to to make them more high performing. And it's great that you're seeing that the plan and the clinical expertise within the health plan is a partner on that end, because you're front and then you're all the way to middle with the impact of your tech engagement and then the actual, you know, delivery of incentives using preventative care. And, you know, any program that you're affiliated with with your tech. And then the back end of it is the actual clinical help, the clinical aid, the clinical outcome view. I would think a lot of the value realization comes probably less than a year. And then you kind of replicate that across other programs that need accelerating. So yeah. And the best thing is you're across multiple states. I was going to ask, is it just specific to, you know, where we're at here in the northeast, or have you had this type of success with other geographical cultures of health across the US? And you clearly have, but that was I was going to ask that too.

Yeah. So naturally, being headquartered in Mid-Atlantic, you sort of build an ecosystem of partners and potential clients that are already aware of you early. So our we're sort of blooming from the Mid-Atlantic, moved into West Virginia, north to New York, south to DC. And so those are our that first wave of clients. And then having only launched commercially with these Blues programs and others in late in mid 2022, we're now at the anniversary of kicking off those programs and have that data, have that performance to share. And now we see that second wave of bloom. So we're now contracting into Arizona, Texas, Tennessee and nationally. So we're at the early phase of getting excited about all these different programs that are being brought to us. I would say the first two years of the company, when John and I started this journey, was a technology build. We needed to build that platform, very sophisticated platform that sat on our side of the fence, where our design team could take in any care journey, any transition of care, any episode of care and and build that communications and incentive overlay for that. So the flexibility that was necessary in that platform was pretty daunting. And then it also needed to have all the flexibility of being able to be consistently optimizing and building these these communication programs for the what the consumer science was telling us. This segment needs to be talked to this way. You know, this program actually performs better with this behavioral economics approach and how you really are nimble enough to adopt and optimize over time. So we're now now that we're in the market, we're so excited when new payers and health systems come to us with programs to. It's like a new puzzle to be solved. Like, here's a preoperative protocol that we're struggling with, here's an addiction program we're struggling with, and then we bring that in and we spin that up with our design team, and that becomes this new avenue for expanding that type of program.

I love that your tech goes across the whole human condition continuum, not just a particular set of chronic management based disease, but also the example you said there a substance abuse disorder list probably goes on and on for you all. I love that your tech is becoming so hyper personalized in terms of engagement. That's that's what I love. And and Matt, I want to take a glimpse into the future here. So you've clearly had a very fast, meaningful impact. So over the next five plus years, let's go out a little bit more. You know, there's probably going to be different regulations that come into CMS through the influence of social needs screening, not just capturing, but applying the data that they capture from surveys and other third parties. What do you think is Reciprocities biggest contribution going into this new wave? The next five years of different policies around or different requirements as far as collaboration with payer and providers, what's reciprocity biggest contribution? Going to be as these new things happen across our policy landscape.

Yeah. So. First of all, it's important that we recognize that CMS really has been leading this work and leading the industry towards this type of work for years. In the mid 20 teens, they did a ten state study, $85 Million in Chronic Condition Management and Medicaid showing what the power of financial incentives can do. Sadly, all of that work hit the roadblock of it being very difficult to commercialize. And so we really see ourselves as trying to commercialize this excellent work that CMS already started a long time ago. And then as CMS starts to steer us towards health equity and understanding and making that more part of what what is understood in the medical community, we think we provide a tailwind to that in a lot of different ways. So first off, on the data side. Because we build this very trusting relationship and dynamic with our members as they sign up and earn rewards. There's a great opportunity for us to be getting updated information from those members as they register and as they participate in the program. So at registration, it's shocking. But focusing on Medicaid, you're maybe not surprised over 90% of our members, as they register, they change something in their contact information, whether it's email, phone number or physical address.

And that's a that's something that we collect and then obviously share back to our clients because they need to have those important touch points as well. But then it goes beyond that. We can be collecting information on all the real and health equity data that's now being required in the years ahead by CMS. So really understanding members better. I think we're an excellent touch point for that. And we have collection points and can share that back on a regular basis. So that's incredibly important. And building a much more transparent and human dimension to the members and patients that we all serve. So that's important. And then the other piece is on. So you really want to be thoughtful about how we design our programs in a way that can impact that as well. And so we look to get to levels of utility out of every reward dollar that that flows through our system. And the first is the prospect of a reward changes a behavior, it changes a health decision. You get people involved. And completing these activities on a care journey that they previously had been abstaining from. That's one. The second piece is we've got Medicaid families that are earning hundreds and hundreds of dollars of rewards across their entire household when you've got multiple family members.

And so there's a real opportunity to help those families spend those dollars in a way that can address social determinants of health. And we've got this great mechanism of a rewards card. We've got this great opportunity to build partnerships. And so we intentionally offer our clients this ability to build programing that can help those dollars go towards access to nutrition, nutritious food. Food is medicine, access to transportation to get to clinics that they previously were seeing as too far across town and just skipping, and then in some cases, helping that be an on ramp into financial services. A huge percentage of the Medicaid population is unbanked and household liquidity is suffering from that. And so if you can get people into the financial services industry where they previously had been sort of left out, you're helping the liquidity and financial opportunities for that family as well. So, yeah, that grand vision of humanizing the population, motivating dollars through the system that has those two levels of impact and really trying to champion what what CMS has laid out as a very powerful tool set. I think there's a lot of utility and a lot of corners of the industry that we can get involved in going forward.

I, I am extremely excited. We talked to a lot of healthcare tech startups on our little show. But Matt, yours supplies that really intimate touchpoint, and being woven into a program that is already in play for a health plan is even more exciting. You're not building things from scratch. You are accelerating. You truly are. I'm just so excited to see the continued success, growth and impact that reciprocity health is going to have over the years to come. So I'll tell you, Matt, this has been a true pleasure. Love getting to know you. Thank you for joining the show.

Yeah, thanks for having me. I really love the conversation. And I love what you're doing because by highlighting the innovation, we're just a small part of a lot of different pieces that need to come together. So highlighting all of that is really important work and I appreciate that.

Thank you Matt. Thank you truly. And for more exciting insights and excerpts, please visit us at findagrave.com.