3 Executives, 1 Mission - Improve Member Lives!

Brian Urban:
Yes, this is the Healthcare Rethink Podcast. I'm your host, Brian Urban, and today, we have a star-studded podcast round table event here today. Joining us on our show is CEO of Sunshine Health, Nate Landsbaum, CEO and I'd say a returning veteran to the show, CEO of Papa, Andrew Parker, and rounding us out will be CEO of Free Market Health, Joe Cardosi. Gentlemen, thank you for joining our show here today.
 
Nate Landsbaum:
Thank you for having us.
 
Andrew Parker:
Thanks for having us.
 
Brian Urban:
This is going to be a lot of fun. We have your expertise from around the healthcare ecosystem, and before we dive deeply into our conversation, so many good questions ahead, want to have you all tell us about yourself a little bit more and have our audience get familiar with you. So let's start with Nate here. Nate, the last time I saw you, you were interviewing an NFL legend on stage, but you didn't start there. You didn't start as a CEO in your career, so take us back. Who's Nate Landsbaum before you stepped into leading a big health plan in Florida and serving a lot of lives, millions of lives in the state?
 
Nate Landsbaum:
So I've got a finance background. I've done equity research, mergers and acquisitions, and that's actually what brought me to Centene Corporation, which is the parent company to Sunshine Health. So I started with Centene back in 2005 in mergers and acquisitions when Centene was a growth through acquisition company, and eventually, I mistakenly felt that Centene would stop acquiring companies at one point and I'd need to acquire other skills, I was wrong about that, but I made the leap to the help plan business unit and that brought me to Florida as the CFO of Sunshine Health back in 2010. I was there in that role for about five years, moved into the chief operating officer role and then eventually moved to the CEO role at our Missouri Health Plan where I spent four years there and then hopped back down to Florida to be the CEO of Sunshine Health in 2021. So I've been here for a little over two years now. So finance by trade, health plan leader by choice.
 
Brian Urban:
I love that. I think you rarely hear that phrase you just said, and it's a combination of many amazing skills you've curated over the years. So Nate, so happy to have you here. Andrew, last time we talked, you were in big time growth mode. I've seen you on NASDAQ Podcast. You're quoted in everything everywhere almost every week. So catch us up-to-date. What have you been up to since the last time we had you on the show?
 
Andrew Parker:
Thank you so much. Thanks for having me back and couldn't be here with the rest of the crew. We've been really focused on what we're calling phase two of Papa. So Papa is a end-to-end human care platform. We connect older adults and younger adults as well, individuals in Medicare and Medicaid and employers to Pals around the country and we've done a really good job at that, but phase two has really been where I've focused over the last couple of weeks, at least, and hope to continue to do that, which is what we're calling phase two, which is actually being able to positively influence the activities that the Papa Pals are doing in the home so that we can help to achieve goals that a health plan like Sunshine Health may have for their members.
 
We announced three new programs. One is Stars Enhancement Program, one is SDoH Navigation program, as well as our digital health literacy program to align to some recent CMS requirements. So we always intended to do this. It was very hard to do phase one, which was to get a friendly human in the home across 7,300 cities in the US is how many cities we did visits within in 2023 alone. We've just passed about 2.5 million in-home support visits.
 
So now that we've been able to figure that out, and I believe we're the only company to have done that, we want to positively influence our Pals. So these new programs allow us to leverage other capabilities that we have, including our social care navigators, which are like the quarterback support for the Pals while they're in the home, as well as technology to make sure that we know that we did the thing we said we were going to do and we get credit for it and we could actually track our ability to move the needle on measurable objectives.
 
Brian Urban:
I love the big focus on quality in terms of Stars and SDoH navigation. I think those are two very complicated, high end value in terms of what health plans and a lot of others across the ecosystem are looking to tackle. I didn't hear those stats last time we talked, so those are fresh, and it's amazing to hear that.
 
Andrew Parker:
I got a lot of stats.
 
Brian Urban:
You do have a lot of stats. I'm excited to hear more of them because they're big time. Speaking of big time really from an emerging space, CEO of Free Market Health, Joe Cardosi, Joe, I've always loved your tech and you are at this amazing growth point right now. You serve a ton of lives. I don't want to get into your tech more than we're going to now, so I just want to introduce you a little bit more into the crowd here because we have a very consistent Medicaid serving theme here as we can see Medicare Advantage as well. So Joe, you have this amazing company. You're growing by resources, by people. Tell us who Free Market Health is today and tell us about yourself.
 
Joe Cardosi:
Sure. Thanks, Brian. Really appreciate the opportunity here today and great to be on with you guys, Andrew and Nate. So I think, especially pharmacy, for those that don't know, obviously, high cost, high complexity, it's this niche of the drug channel that is generally about in the Medicaid space, probably 1 to 1.5% of the population but driving upwards of 50 to 55% of the cost. So I was fortunate to stumble into this space as a intern in pharmacy school working at a small specialty pharmacy and then spent my whole career. As a Pittsburgher, born and raised, I think there's a parallel story there of it's also the founding place or at least we like to think so in Pittsburgh of specialty pharmacy. So a pharmacy in the early '90s started to deliver special care to special patients, and that was the essence of specialty pharmacy. So what we're trying to do as a technology platform today is really enable that same exact mantra that birthed this industry.
 
So the experiences that I had in various settings in the channel really informed the problem set, but it's a founding story that hatched as a Medicaid any willing provider network problem set. So I was leading a team at a managed Medicaid plan here in Pittsburgh, and it was at a time when specialty pharmacy was really starting to boom. So this was probably 2010-ish. The number of specialty pharmacies were proliferating, the number of drugs being approved were proliferating, number of drugs being approved in specialty. The problem set from the managed Medicaid space was how do you deliver a consistent member experience across this broad network of any willing provider. So any pharmacy independents were turning into specialty pharmacies, seeing the puck move as traditional drugs were largely turning into generics.
 
How do you efficiently capture data across that broad network that's meaningful and structured and can be actionable back to the payer, a broad set of capabilities across that diverse network of pharmacies? Some couldn't even put data together in Excel and deliver a file back to you. Then at the core there is how do you ensure affordability when you can't exchange volume for reimbursement rate, which was the traditional mechanism in the drug world to drive affordability.
 
So that was the core problem set that hatched the idea. Then knowing that a number of problems also existed on the specialty pharmacy side around accessing referrals and being able to serve the patients that you excel in delivering care for, it was right for a two-sided network model, this problem set, this market. So that's exactly what we brought to market about three years ago.
 
So we call it a care-driven marketplace platform. It's essentially strengthening the connections between payers of specialty drugs and providers of specialty drugs, whether that's specialty pharmacies, home infusion providers, et cetera. Our goal as the platform as a service provider is really to just strengthen that connection, orchestrate the steps of the process, and deliver value to both sides of the transaction. So we're at a great place in the journey here, three years in, and of crossing the chasm, so to say, of really taking the story across the country. We got a broad network of pharmacies that participate in the model all across the country and growing with payers all across the country as well. So exciting time at Free Market Health. Appreciate the opportunity to be here and talk about the story.
 
Brian Urban:
It definitely is, and thank you, Joe, for elaborating. I think it's fantastic not only that you're doing a new model of patient by patient specialty drug contracting, but you're unbundling these huge bundles that have so much cost and complexity and don't always help actually improve adherence to medications, and you're doing that with your platform not just at the rate level, but all the clinical care coordination as well. So we'll get into that. It's so exciting to have you all here.
 
So I want to get into the deep theme of serving Medicaid lives today. So Nate, your plan alone, I believe, has over a million Medicaid lives covered today, and in your career, you've seen a ton of change, pre-pandemic, through the pandemic, and now what is more or less the normal state of being able to address member needs, improve engagement, and really start to build authentic trust. I'm curious, of all of the lives you see across Florida in Medicaid, what are some of the interesting trends that are popping up and what are some things you're starting to put together as a strategy to tackle?
 
Nate Landsbaum:
So even before the pandemic, we saw that folks were obviously becoming more difficult to engage, more difficult to find. As people have moved around, addresses become obsolete, people no longer have landlines, the need for us to connect with them digitally through their mobile devices, over 95% of our members have a smartphone. That wasn't the case five to 10 years ago, now it is, and this is how they want to communicate. Fast forward to the pandemic and you've got this explosion of telehealth. So not only do we have adoption by the members for use of telehealth, we had adoption by the provider community. Even though we saw a huge spike during the pandemic, that has not gone down. It's gone down just a little bit, but that use of telehealth has been widely adopted, and not just by historical behavioral health providers, but by physical health providers, and it's been a huge impact on our members and the providers that we serve.
 
We've also employed additional digital tools, digital care management, video care management. We need to meet the members where they're at, how they want to be engaged, and we've got to have different modes in order to meet those needs. Now, we still do that in-person, touch, but we are definitely moving more towards digital touching because that's what our members want to see.
 
Lastly, in order to get them more engaged in us, we've got to hit them from multiple directions, which is where social determinants of health really comes in. So we've been able to partner with hundreds of organizations across the state that address housing, food, workforce, other social needs that they have so that we can engage those members through the organizations that they have frequent touch with. So that's really helped us from an engagement standpoint.
 
Brian Urban:
You bring up a couple of really interesting points, Nate, and I think it's overlooked these days that health plans are being pointed at to solve everything. You all can't do that. No one can do that, hence the best partnerships that you've developed. It takes truly a healthcare village and an agile one at that. So I'm really curious how you balance the blend of human touch and technology. I know, Andrew, that's kind of your shtick. It's always been like that, but is that something that made your-
 
Nate Landsbaum:
I was going to say that. We use Papa.
 
Andrew Parker:
Nice.
 
Nate Landsbaum:
The business model for Papa, you wouldn't have dreamed it 10 years ago, but we've been able to fill that void with innovative companies like Papa that address the unique needs of certain members within our populations, and that's what we've been increasing in terms of our utilization, reaching out to companies. Of course, those companies are coming to us too. There's a good business model there and there's a return on investment. There's a need there, and if we can utilize those companies to fill those needs, we will do it.
 
Andrew Parker:
Just to add to that, what I think is your point exactly is it's like those that need it, some people need a digital solution and that's great for actually a good portion of the people. Some people need more than that. What Papa finds is that we are really good at helping those that we engage. We're not trying to force a Pal or a service on everyone. So we try to understand your needs and effectively socially prescribe you, and then try to make sure, "Hey, did you know that you do have a food bank available to you? We'll drive you and we'll actually take you there." This is like our SDoH program, which is many of these health plans, including Sunshine Health, have CBOs and referrals and partners, which is great, but if you are a person that maybe is a distance from technology, maybe you're alone, maybe you're lonely, maybe you're isolated, maybe you don't have a car, it really is a good fit.
 
We find that in the Medicaid population, when we focus on the right people, we actually save money. We've lowered ER utilization by 33%. We improved readmission by 14%, one in every seven admits reduction among other things. So it's really exciting. The thing that I'm most excited about in the Medicaid population is something that I don't think we realized would happen, but I actually come from telehealth. I was part of the founding team at MDLive, and you can't just become a doctor. Some people do and they go to school and they go through their process and there's a shortage of care and we need to think about these new kinds of care, and we think that's what Papa does, but you can actually just become a Pal if you're friendly and you have a car and you want to support people.
 
Interestingly enough, the Medicaid population we have, this happened completely organically, in our users we had members that were using Papa because they had a need, get back on their feet, want to do more, want to get a job, they apply to be a Pal, and they're paying it forward. So we believe we're one of the only platforms in healthcare where the user can be the provider, and it's really a human connection system. It really gives me the chills.
 
There's this woman, Felicia, who became best friends with her Pal, and then she inspired her to become a Pal, and then now she's like queen of the Pals in Michigan in her market. So those are the cool things that I think are really powerful when our whole mission is to empower human connection. When you actually see it working in that type of a way, especially in ways you wouldn't have assumed, it's something we're proud of.
 
Brian Urban:
You know what's so interesting that you're touching on here that I think is very difficult to measure, I get this question asked a lot every month, is how do you measure trust or trust is really a currency when you think about a member need and where they would go for care, where they will not go for care, and who they'll engage with. It seems like you're putting more trust as a currency back in the pocket of these big players that need it. I think that's starting to change the perception and change the engagement. I think from a health plan perspective, are you seeing that, Nate? Is that trust index starting to shift a little bit now that we're outside of the height of the pandemic?
 
Nate Landsbaum:
Yeah, no doubt. We're getting much more engagement than we did coming out. Even '22 was a down year from our perspective in terms of our engagement with members. So we measure that with medication adherence, PCP visits, certainly their interaction with our care management staff and, of course, utilization with organizations that we partner with like Papa. So we are absolutely seeing that a lot better in 2023. We're really returning to pre-pandemic levels, and so it's really up to us to make sure that we maintain that momentum going into this year and beyond.
 
Brian Urban:
That's extremely important is it can't just be a point in time, a noun, you did this then and it was great. How do you continue that fluidly throughout the journey for every life that you serve? So Joe, I'd be remiss if we didn't talk about a very challenging population, those that are taking multiple medications, managing multiple conditions, and that are generally high cost drugs as well when you think about limited distribution drugs, drugs that are newer to the market or drugs that biosimilars like we were talking about before. So there's so much to dig into in the specialty drug world. Looking at your platform, you could say, "Hey, it's a specialty drug referral bidding site." That's one component of it, but the coordination of care downstream, I think, is an amazing story.
 
You all did, I believe it was a study on Medicaid lives with a health plan. I think that's been released, and I don't want to spoil it if it hasn't yet, but I'm quite certain it was. Can you tell us a little bit more about that study, and if you can't, would love to dig into the details of your care coordination that is post prescription of the drug.
 
Joe Cardosi:
Thanks, Brian. I think a marketplace model, some of the first elements that people remember are like, "Oh, there's competitive bidding happening," and that's a small component of what Free Market Health is about. Really, our goal, our mission is this specialty drug ecosystem is oftentimes meeting an individual member in some of the most challenging times of their life, they just found out they have cancer or they just found out their child has cystic fibrosis, et cetera. The system itself and the complexities between prescribers, pharma, who's bringing these products to market, payers, pharmacies, the patient oftentimes is stuck in the middle, they're confused, they don't know who to call, they don't know who's in network, the prescriber doesn't know. So it's an ecosystem laden with challenges like other parts of healthcare, but the mission of our company is never let the process fail the patient, and that's what drives us.
 
A marketplace is really a tool or means to the end. What we've done in that marketplace is truly strengthen the connection of the payer who has to say, "I manage a formulary. I need to ensure that these drugs are critically appropriate and payable for my members, and then on the other side, we have to ensure we have high quality specialty drug providers that aren't just national and scale, but are local and in the communities where the members are," which is I think of critical importance as we're partnering with Medicaid plans specifically throughout the country where there are a large number of specialty pharmacies that are either embedded within health systems, embedded within the community, their independents, they're serving prescribers in their community, they're serving members in their community. So we need to be the orchestration layer that can help a payer connect their member and their specialty drug referral to the pharmacy that's best suited to the care needs of that member.
 
Then I think what oftentimes in the current state can be a miss is payer does their job, which is great. We got to ensure this is clinically appropriate and payable through our auth process, which is I think a bane of some people's existence, and I understand that.
 
Andrew Parker:
Some people.
 
Joe Cardosi:
When these medications at times can be 200, 300, $400,000 a year, cell gene therapy is now exceeding a million dollars, you understand why that's a necessary tool in this particular aspect of the drug channel, but what the miss can be is the payer does their job and then they have this network of specialty pharmacies and they expect them to do their job. They're specialty pharmacies, they're supposed to deliver special care. No one's really watching that in-between space of what happens. The payer authed it, did the member ever get it? Is there a claim? Was a phone number bad? Do they have a phone that month? Does that member have stability in their housing? Can the pharmacy get in touch with them?
 
So Free Market Health, the service model that wraps around the platform, the technology does the heavy lifting. We have a really important service model that's today engaging with the pharmacies, engaging with the prescribers, first level triage. If that pharmacy needs help, finding that member, getting the doctor's phone number, getting the member's phone number, we're working back and forth with the plan to ensure that happens. That's led to meaningful reductions in abandonment rate, which I think was one of the studies that you referenced there, Brian, we saw.
 
That's a polarizing stat at times, abandonment rate, because that could be broadly viewed of, are you working around the payer's thought process and is it a manufacturer viewpoint on abandonment rate? This was a payer aligned viewpoint. So Doc wrote it, said it was necessary for the member, payer authorized it, said, "We agree. This is clinically appropriate and payable." The incidents in the specialty drug space of those referrals or prescriptions going abandoned for any variety of reasons is meaningfully high, to the tune of upwards of 40 to 50% no-go rates in this space because you can't get in touch with the member, there's affordability issues on the member side, any variety of reasons that we don't want to get into too much detail here.
 
Having a third party that's totally agnostic to who's going to dispense that, but totally mission-oriented to that member needs it and we want to make sure that that process isn't going to fail them, so that oversight model has led to meaningful reductions in abandonment rate, which we're super excited about and doesn't always get the headline of a two-sided network, but I think it is that the services that can wrap around modern technology companies at times can be just as valuable as the software as a service or the platform as a service that you're delivering.
 
Brian Urban:
It's interesting because as you're describing your technology and some of the processes and where you sit and you mentioned triage, I've always thought of your tech as a very athletic middle infielder in baseball. Whether there's a short stop or second baseman, you're there for an exchange and you're there to finish off the play to ensure the patient member gets what they need when they need it and being able to track them from an engagement standpoint going forward. So there's my baseball analogy in midwinter, but I think the theme that I started to pick up from you, you mentioned affordability, you mentioned contact information. Those are absolute pieces of social determinants of health that are really a variable in someone's life that determines their decision-making and barriers or lack of access to certain things they need.
 
So I'm curious from the health plan perspective, Nate, health equity addressing the whole person, addressing social determinants of health has been in our face rightfully so the latter part of this decade, and we're starting to put more programs in place from tech vendors, obviously from a social care person and tech space like Papa. I think there's a great growth opportunity in terms of addressing SDoH and Free Market Health, but from a health plan perspective, Nate, what is the philosophy right now for Sunshine Health with health equity or addressing social determinants of health at the member or household level?
 
Nate Landsbaum:
So first, engagement, wrapping our arms around the member and not obviously just not just their healthcare, but all of their environment, their social environment, ensuring that they've got a consistent and safe roof over their head, good food, childcare, education, welfare, social welfare services that they need in order to live safely and healthy in place because if they don't have that, they're not going to have time for their healthcare.
 
So this is why we have continued to engage community organizations, charitable organizations. We've got offices throughout the state called Community Connection Centers, where folks can come into our office and seek assistance for anything that they need. They are gathering spaces for local organizations to meet and, of course, engage with the community and, of course, our members.
 
So our job is to ensure that where there are disparities, and those disparities are increasing, unfortunately, in areas where our members live in the underserved communities. Our job is to get as many services within those areas that break down that disparity so that they've got a shot, a good opportunity at living a happy, healthy life and moving out of those areas because a lot of those folks that live in those areas don't feel that they've got the opportunity to break free, and we need to ensure that they've got the resources that they need and the education to know that they can succeed and break out of the cycle that they and their family are in with our assistance.
 
Brian Urban:
I love that you said that. You didn't overpromise. You didn't say, "Hey, we're going to fix everything. We're trying to fix everything. We have solutions for this, that," and et cetera. You said give them a better shot, a better chance. Progress being the key here, I think we're never going to be perfect in our society. There's always going to have a lot of fissures that exist in different socioeconomic rungs, but I love how you said that, give them a better shot. I think that's what it's all about.
 
Andrew, similar question. You mentioned earlier SDOH Navigator as an organization that's daring to reimagine the community as the cure to loneliness. I love that on your site. Obviously, social determinants of health are top of mind in your strategy for 24 and beyond. So the programs you're developing, very focused on the DSNP populations in terms when we think about Medicaid and high need populations or is it just more of a custom cut for different lives that you serve and populations as well? So tell us a little bit more there.
 
Andrew Parker:
Papa started off going real broad. It's available to everyone in a plan, and we still very much do that, but what we found is some people need it much more and some people engage with it much more. Then you're also going to see a bigger ROI from a cost reduction perspective because they just, frankly, are over utilizing or utilizing other services well beyond what a typical Caid member may or Medicare member or what have you. So we've developed specialized programs for certain populations. High needs is one that we're really focusing on for this time being, and we expect that to be a really critical component of our business going forward, which is how do we use this friendly network to help the members and also help to help plans. So it's got to help everyone involved. Health plans also have a business to run. They can't just spend money on things just because it has to actually have an impact.
 
Nate mentions engagement. I used to joke, I mentioned I was in telehealth, we used to joke the number one way to drive telehealth adoption was to get everyone sick at the same time. That was not some evil plan, I had no clue, but we realized there would be a need for a behavior change. What's unique about Papa is we're not in other healthcare services. We're by design not what you would traditionally experience in healthcare. Frankly, that's why I started it, which was effectively not that I was tricking my grandfather per se here either, it sounds like I trick people a lot, was how do we get Papa to engage with a service where he doesn't feel like he needs care, he doesn't want to feel like an invalid or a person in a low income community or what have you, he wants to feel like a human just like we all do.
 
So how do we provide individuals with what we call true independence? What we originally came up with, which is what we do today, which is, frankly, it's empowering people like me or people like you all that are friendly and caring and thoughtful and maybe have some experience. Maybe they were on Medicaid. Maybe they've cared for their own family member. Most of our Papa Pals are what we call former family caregivers. Then it becomes engaging because now it's not this healthcare service begging you to go to the doctor, it's Andrew, your buddy, your Pal as we call it, spending time with you on a weekly or bi-weekly basis both in-person and virtually, so you build a real relationship.
 
Then through that relationship we could say, "Oh, did you know that your health plan offers these two or three other things?" or, "I noticed that you're in a bad mood this month, and I also noticed there's medicine all over the place. Have you connected to your health plan's telehealth service?" Part of what we're doing with our digital health literacy program is showing people how to do telehealth visits.
 
Papa is unique, frankly, in the sense, I believe, we are probably one of the most engaging healthcare service that is maybe ever existed. I'm not saying that lightly. Again, it's not for everyone. My dad is about to turn 65. He's not low income. He's good with technology. He doesn't need Papa even though he is on Medicare Advantage. My grandmother is 87 years old. She doesn't drive. She's lonely. She unfortunately has an illness that she's caring for, and so she needs to go to appointments and she's confused and she's lost and she needs support. We see that across different spectrums.
 
We are dealing with adolescents, we're dealing with mothers, with new babies, which we don't really talk about as much publicly as it's somewhat of a product that we've been maturing over the last few years. At the end of the day, we are humans helping humans for those that need it. Again, this is about socially prescribing. If I call you and I'm part of Nate's health plan and you're on a care management routine and you're fully engaged, we don't need to throw a Papa Pal at them. It's not for those individuals necessarily. Maybe they have an episode where they do need something all of a sudden and they need to get to the appointments more often or something like that.
 
So it's to strategically leverage the resources that a health plan has, including Papa as one of them. We're not a panacea. We do not solve all problems. Oddly enough, I don't need a Papa Pal in any way, shape or form, frankly, outside of every once in a while. My grandmother does use it more recently because she's gotten this illness. So it's about being there for people when they need it, if they need it. It's not about forcing them to do some healthcare service that they don't really get value in.
 
Brian Urban:
Two key things I love that you said, Andrew. One, and I think everyone's commented on this in a different manner, rightsizing services to the needs that are identified and then doing that in a meaningful ongoing manner, so not overextending your services and burying someone with too much information, but finding the sweet spot of what someone needs when they need it, and then how to actually educate them going forward. Nate said that, you're having that integrated into your digital health literacy program.
 
The other component of it, I love that you use your family members as examples. That shows not only that you're invested into what you're deploying as a CEO with your own organization, but your family's heavily involved in that. Rightfully so, I love that you share that about your grandmother because it's a fine example, but also shows how things are interconnected in your life, Andrew. So I absolutely love you for sharing that.
 
I think the next big step here, I think, is on the drug side of our industry. I think there's so many barriers not only to access, but to staying adherent, to understanding drugs, having trust and sharing the interactions or symptoms someone's having from new drugs they're taking, especially pediatric drugs. So Joe, when I think about addressing social determinants of health, your platform has a stratification layer to it where you see different needs at the patient member level and how they're addressed not only through adherence but through other means. I know maybe you're not there yet, but are there some future plans into integrating an SDoH strategy that outwardly helps the health plan and the prescriber or pulls in insights or shares them in a meaningful way? I'm curious of where you all are with that type of planning.
 
Joe Cardosi:
Thanks, Brian. No white paper on this one yet, but definitely some work that we're proud of. Want to jump off of what Andrew said on really about focusing on the right members. That's historically been a challenge in how a payer would manage a pharmacy network. You probably have performance guarantees, and you want to look at population-based statistics and draw some conclusions and shift your network accordingly. I think one of the premises at Free Market Health is we want to identify the specific care needs of specific members. As you described, there's a stratification process. When you're working referral by referral, as our platform does, as opposed to population, book of business, market basket, list of drugs, you can do that.
 
So what we do is empower the payer to say, "What are the most important things that you're after?" because what we have is this connected network of specialty drug providers that might be the individual talking to your member the most because on chronic specialty med, they're engaging on a monthly basis, sometimes more frequently. So we think, and being a pharmacist and having a leadership team of other pharmacists, we overindex towards that as a real big capability, connecting payers and their members to high quality specialty pharmacies that are key to their care delivery.
 
So the stratification process enables a payer to say this unique attribute of a member who's being started on a specialty drug maybe it's new start with recent hospitalizations. Maybe it's a specific therapeutic category or a specific indication that they want to trigger off of and say, "Hey, because of this stratification reason, we want to attach specific requirements that are specific to that member and that referral, make them transparent to the pharmacy before they accept that referral so they know exactly what's expected from that payer for that member in their care."
 
So tying this to an SEO use case, we have a payer that's leveraging that same stratification and dynamic referrals or requirement attachment process to say they have an SDoH robust team that is implementing a variety of tactics, and the way that they're seeing this model and how it can augment some of the things that they're doing is they have barriers assessments that they want to deploy on all of the right members, and they're viewing the specialty pharmacist as an opportunity to augment their internal efforts around administering SDoH barriers assessments.
 
So how we're using that technology-driven process is we're balancing that member zip code up against the SVI index and saying, "When you're below a certain threshold, we're going to attach the SDoH barriers assessment." So we embed that payer's specific barriers assessment, we make it slick and the pharmacy can click through all the questions and answer it in realtime. So that pharmacy is the recipient of that referral. They're going to administer that barriers assessment to the right member and they're going to do it in the question set that the payer wants. They're doing that in the Free Market Health platform. We're organizing that data, we're streaming it back to the SDoH team at the health plan, and it's a augmentation model really for that payer's team.
 
This is the Eutopic use of free market health platform because that payer is also incentivizing the pharmacy or the successful completion of that barriers assessment. So they're putting real dollars on the line for the pharmacy to administer that. They're saying, "This is valuable to us. You're in a great position to execute it. You're talking to my members and we want to reward that valuable behavior." So great use case. We're about six months in on that and we'll be excited to read out data, but just one of the many use cases where payers are executing unique strategies with that stratification framework.
 
Brian Urban:
That's exciting. You're already six months deep into this, so I'm going to absolutely follow up with you on that, Joe. I'm just putting my mind back into your pharmacy days when you're behind the counter. Could you have imagined having insights like this when you were going into a conversation with a patient picking up a medicine in a actual physical location, what that experience could have been like for yourself and for the patient? That would've been a game changer back in the day. I don't even know if it was being considered, but it really was a part of your normal routine and the interactions and insights you would've gathered through a conversation, but if you would've had that ahead of time, how much that would've changed, I guess, the patient experience and outcome and trust and everything else? I would imagine that would've been a big time change for you as a pharmacist back in the day.
 
Joe Cardosi:
Absolutely. I think one of the problems in our domain is this asymmetry of information and the docs got some, the payers got some and the pharmacies got theirs, and there generally isn't a really good orchestration layer to pull that upstream data downstream to the pharmacy user that can meaningfully synthesize that and apply it as they are talking to the member on a month by month basis. So again, one of the value props of a orchestration layer in this specialty drug ecosystem, at least, is pulling that information downstream, making it available to the pharmacy at the point in care. I think that's just one of the areas we're super excited about.
 
I think it's a thing that didn't exist in pharmacy, and we're not the only ones trying to crack that nut, but I think the more information that any clinician can have at the point of care that is somewhere upstream, I think that's a huge opportunity for any technology provider. It's working with payers, working with other care delivery participants on the other side.
 
Brian Urban:
This is fascinating. I love where you're going. So another six months plus, I'm definitely going to poke you. We're going to catch up on how that progress has been made and what else is happening in your world. So hey, let's get a big finish here with our executive round table today. We'll start with Nate here. I want to get a glimpse into the future from all of your respective organizations and your leadership view here. What's next? 2024 and then a step beyond that as many years as you like, what are some of the big contributions your organizations are going to be making? What are some of the big challenges that you have in front of you for some of the things you want to be able to make a real impact in the lives you serve? Nate, what's coming up for Sunshine Health?
 
Nate Landsbaum:
So I think I'll start with the challenges first because we're addressing those today and we've got a long way to go, and that's really the supply and demand imbalance. The demand for healthcare resources and services and all of the wraparound services that we need to engage our members and help them live happy and healthy lives, that demand is growing at a clip greater than the supply of those resources, not just healthcare, but in the social supports area. So we are making significant investments in those areas with the partnerships that we've got.
 
Then our own programs, such as our workforce development program. So we've got a workforce development program called Sunshine Health Works. These are collaborations with Florida-based community colleges. We've got them set up with several so far, and we've graduated over 500 people through those programs, and so that is allowing them to work in the healthcare field and address the healthcare needs of the people in their community. So those are folks that otherwise wouldn't have access to be in the healthcare field but then now getting a job. In some of them, in some of those cases, those are actually Sunshine Health members that are getting those skills through those community college partnerships and getting those skills to go out and earn a really good wage.
 
Then to Joe's point in terms of connectivity, we still need a lot more connectivity and collaboration within the healthcare space, the pharmacy, the physician office, the hospital, the social welfare system, the state. We need to be sharing more information and data. We are still fragmented. It's getting a lot better, but we've still got a long way to go. So that interoperability between multiple systems that our members touch so that we all have as realtime information as possible when we interact with a member in the community to know who are they covered by, what services do they have available, what is their plan of care, how do we address those needs as that person is right in front of me, and that right now we don't have that.
 
Brian Urban:
Wow. It's so amazing to see your honesty and the leadership that you have, Nate, in terms of what you're doing really well and the challenges that still exist. I love the education investment program that you just mentioned. There's only a few of those that I've ever heard of throughout the rest of the country, UPMC being one of them, and it's added a tremendous amount of value to not only the patient and their lives, but also to them trusting that health plan, that healthcare institution as well. So I love to hear that, but connectivity is the big thing that's needed across a lot of the ecosystem.
 
Andrew, I think that plays into a lot of the work that you have playing out in phase two here for Papa. So what are some good things and some challenges coming up for you all?
 
Andrew Parker:
Very excited to be at this moment. It was incredibly challenging just to get through phase one, frankly. You couldn't imagine how difficult it is to have someone show up on time in a house anywhere in the country pretty much every time. So I was reading this thing the other day that founders have this thing where, "If I knew it was so hard, I maybe wouldn't have done it," but I was blind to the difficulty of it, and so I just pushed forward and was fortunate enough to bring the right people around the table to help to do that. I'm just one person for the Papa team. So really focused on phase two, which is really allowing us to ultimately get to this configurable social care force, as we call it, that can help to hit on the specific goals that you or a health plan would have, and a member would have across the country, which varies.
 
So some members may have one objective versus another, but to have this new network of care, and to Nathan's point about supply and demand, we feel that telehealth and better connectivity and leveraging resources like pharmacies is an amazing thing. We also feel it is necessary to bring in a new, as we're calling it, social care force, which is for those that need it. So now you can as a health plan, we imagine a future where a health plan can be like, "Okay. In this area, we want this. In this area, we want this. In this area, we want this," and we deploy the Pals and the core platform layer is companionship, trust.
 
By the way, we've figured out a way to measure trust. About 75% of our members choose a preferred Pal, which is a pretty good indication of trust because they're literally saying, "I want Nathan to come to my house every week, and if it's not Nathan, I don't want to do it." We say, "Oh, please, what about Joe?" "We hate Joe." No, they don't say that, but we tend to build a small Pal pod around them and these become their preferred Pals, but how do we leverage this network strategically across an organization to support the various social needs you have in these areas and help with the connectivity as well?
 
So we're excited about that. To have a configurable network that could solve some of the biggest challenges of populations is, in my opinion, very, very powerful, and we're just barely getting started. So I'm excited to see where we go next.
 
Brian Urban:
I am as well, Andrew. I think your model should have existed for maybe the last 50 years. Maybe we'd be in a different place in our healthcare-
 
Andrew Parker:
I'm not that old. I'm not that old. I'm getting older running this company though.
 
Brian Urban:
I did notice a few more gray hairs in the beard this time, but I just couldn't imagine if your model would've existed many decades ago, how different our healthcare economy would be now and our society as well, but that could be the promising future of what's ahead with a lot of the work that you're going to continue to pump out in phase two here of Papa. So love to hear that.
 
Joe, round us out here. So what are some big things coming up for Free Market Health in this year and beyond, and what are some of the big challenges you see in front of you as well?
 
Joe Cardosi:
Thanks, Brian. Appreciate the opportunity to round things out here. Less about Free Market Health, more about challenges facing the pharmacy community, which I think really are facing us all as humans, as health plans, as folks that are engaging in the Medicaid and Medicare space. This one might just be on my mind because of a recent activity here in Pennsylvania, and I know, Brian, you're familiar with rural Pennsylvania, but it gets rural really quick when you get outside of Philadelphia, when you get outside of Pittsburgh. News story dropped this week, and these are plentiful, but this one hit home to some degree of a small chain of 10 community-based or they're traditional pharmacies, but are active in the specialty drug space closing their doors for a variety of reasons.
 
I think drug reimbursement is probably paramount to that, but you see these stories happen and I try to run that through the lens of our company and our mission and how we want to differentiate and this no referral left behind service model. For that to be true, it's critical that the right care providers in the right locations even exist. So I think receiving medications through the mail, which sometimes happens in specialty, oftentimes happens in specialty, doesn't do much good if you don't have stable housing. Being clinically managed over the telephone doesn't work if you don't have access to a good phone or a clinician that speaks your language.
 
In the underserved populations, oftentimes pharmacy might be the central way they engage the healthcare system. When you see this happening in these communities where that might not only be the way in which those people engage the healthcare system, it might be the way in which they engage the community. You go there to shop for bread and milk and lottery tickets and you run into your neighbors, and those independent rural pharmacies closing their doors feels like a problem for all of us, not just those in the pharmacy profession.
 
So I think that's a real opportunity for a number of stakeholders and the drug supply chain specifically like pharmacies operating at the top of their license and capturing value for the role that they play in care delivery. I think they are supporting reimbursement models that do empower those high quality or geographically important pharmacies. Then I think call to action on Free Market Health and technology enablers of use your past like SaaS, like economic model and your ability to drive process efficiently and actually streamline connectivity, as Nate called out. That's the call to action for the technology providers. Legacy technology systems just don't enable that.
 
So it's incumbent upon us to be the connector, be the enabler, and do that in a way that collects a fair fee for the service and value you're creating, but not extracting too much value as a connection layer, as another middleman in the ecosystem. So I think it applies to Free Market Health, but I think more importantly, it applies to us as members of our communities, as healthcare leaders. So small example in Nanty Glo, PA, which is really important to the people in Nanty Glo, PA, but I think more broadly speaking, important to all of us.
 
Brian Urban:
It is a great example, Joe. Nanty Glo is right on the way to Happy Valley, Pennsylvania among other places that I'll be heading to next week to get a little bit of hiking in. So it's just so interesting that you bring that up because retail pharmacies of a smaller size, privately owned, family-owned in a lot of ways are the lifeblood of a community, clinical touch point for a rural community. When you see that close or a community-based hospital, there's a lot of questions that come up in terms of the economics and healthcare and how things are negotiated contract and how things are supported holistically so we don't lose these really important touch points in these communities. So a great call out, and I think it's a great rally to really get everyone solving a lot of challenges, but working together in a collaborative way, which you all do from an executive seat and also a doer seat. You've all done so much in your career.
 
So thankful to have you all on the show here today. A big thank you to CEO of Sunshine Health, Nate Landsbaum, CEO of Papa, Andrew Parker, and CEO of Free Market Health, Joe Cardosi. Thank you, gentlemen, for joining the show today.
 
Andrew Parker:
Thank you.
 
Joe Cardosi:
Thanks, Brian. Thanks for having us.
 
Nate Landsbaum:
Thanks, Brian.
 
Brian Urban:
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