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      Great Tech, with Good Heart… Uber Health & DUOS Bring the Love

      Healthcare Rethink - Episode 79

      The latest episode of the Healthcare Rethink podcast explores the intersection of technology and compassionate care. Host Brian Urban welcomes Caitlin Donovan, the Global Head of Uber Health, and Karl Ulfers, the Co-Founder & CEO of DUOS, to find out how great technology is enhanced by a good heart. The conversation illuminates healthcare tech’s current and future state, particularly within Medicare and Medicaid services.



       

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      Brian Urban:
      Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban. Today we are talking great tech with a good heart, and who else to have this conversation with than the leaders across the space here. This is the Global Head of Uber Health, Caitlin Donovan joining us, and a Co-Founder and CEO of DUOS, Karl Ulfers. Thank you both for joining our little show here today.
       
      Caitlin Donovan:
      Thank you so much for having us.
       
      Karl Ulfers:
      Really excited to get into it.
       
      Brian Urban:
      This is fun because I literally just rerecorded that six times. I try not to mess up too much, but maybe it's my excitement to have you two on our little show here today.
       
      So with every show, we like to have our audience get familiar with our guests. So Caitlin, I want to start with you here. You didn't just wake up and become the Global Head of Uber Health. You've done a lot of infrastructure work around addressing interventions relative to social determinants of health, and I want to know what your path is, so take us through it. Why have you gotten into healthcare and healthcare tech as we see it today?
       
      Caitlin Donovan:
      That's such a good question and I think maybe like most people, I had no idea what I wanted to do when I graduated college, so ended up being an investor so I could learn as much about the world as humanly possible. What I realized from doing that is, one, I like operating where I like being in the weeds, as well as understanding the way companies work. Two, I really gravitated toward healthcare and healthcare tech and services specifically because not only do you know you're helping someone at the end of the day, but the ecosystem and problem set is so sufficiently complicated that you'll never get bored. That combination is really fun for me and I think where I've ended up spending time over the past 10 plus years sitting between payers and providers trying to impact population health and service delivery across at CareCentrix, it was home healthcare and durable medical equipment, at Circulation Logisticare, non-emergency medical transportation. Now at Uber Health, really how to optimize multiple supplemental benefits to drive better outcomes using tools that exist and are underused today.
       
      Brian Urban:
      It's fascinating that you said that you'll never get bored. It also seems like we'll never ultimately get to a utopic vision of solving all of the challenges we have across healthcare, but you'll never get bored, you're right. I love the beautiful story that's unfolding with Uber Health since about 2018. So it's just so much growth we're excited to talk about here today.
       
      Karl, you didn't just wake up and become CEO, you didn't just co-found a company, you had a starting place. Take us back a bit and tell us who Karl is today and what your path was.
       
      Karl Ulfers:
      Yeah, the short story of it all is like Caitlin actually, while I was still in college, I worked at an institutional equity trading floor and was actually going down the path of being an institutional trader, which really meant that I was making extremely rich institutions and individuals just a little bit richer every day and trading stocks for them. So my senior year I realized that was not what I wanted to do with my life, and that led me down the path of actually going into the health tech and consulting world, working for a company that was called Stockamp and Associates that was one of the pioneers in the revenue cycle management space, and did that for about four or five years. Then from there actually joined the very, very early crew at Optum when it was way smaller than what it is today, and did that for about four or five years. Then from there it got really big, as everybody knows.
       
      In both those experiences, I really developed a lot of knowledge around the intersection between how to help populations, payer information and data, and the intersection of technology and digital health technology. So I actually went from there and joined a company that was called Audax right after their series B. That company then became eventually Rally Health, and in 2018, end of 2017 into 2018, UHG actually fully acquired that company. So then I was back at Optum in UHG for just a couple of years, and that really made me realize that I wanted to take that skillset again. It's the intersection of populations in need, insurance information and data, and technology, and apply all that knowledge I'd gathered over that last 20-year period and bring it into the older adult space where I was personally inspired because I'm fortunate enough that my parents are retired, but my dad's parents are actually both still alive. They're getting up on 95 years old.
       
      So for the past decade, I got to see firsthand what it was like for them from an aging experience perspective, dealing with Medicare Advantage, and a really ideal situation with a lot of kids and grandkids and still having it be really challenging. So that really inspired me based on that firsthand experience to say, you know what, I think we can take knowledge and awesome group of people I've gotten built in a network around in this health tech space and apply it into this category and hopefully do a lot of good.
       
      Brian Urban:
      That is a deep cut on Karl Ulfers. I did not know that you both had investment banking in your background, so now I could see it, but the evolution of you both as leaders is fascinating to see externally and as well as it is in your work, in your daily impact here too. So it's beautiful to know that, I mean, your grandparents are in their 90s, such an outlier in terms of a statistic when you think about now the life expectancy that was given out. Some global reports just last year, US men 76, and you compare that to Scandinavia and other parts of Southeast Asia, very, very different. So that is a true statement of family health, community health there and I can see the inspiration to carry that forward in your career, Karl. So you said you were going to do the short description, but that was good.
       
      Karl Ulfers:
      I did the long description. Yeah, I just got into it.
       
      Brian Urban:
      It was better that way. Speaking of aging populations, you both serve Medicare Advantage, dual eligible as well, Medicaid. We've seen a growing clip not only in the Medicare Advantage space, but across the spectrum in terms of coverage. The benefits have changed substantially with the expansion of SDoH supplemental benefits, so many different changes has happened.
       
      Caitlin, I want to start with you in regards to looking at the Medicare and Medicaid space in particular, and we could break them up as you like. You have these non-emergent delivery services and rides as well, food now on top of that, there's so many different things you're deploying to a high need population that it's fascinating. I love that Uber Health has extended this and continued to invest in this space. So I'm curious, with all of these new lives that you're seeing, probably more rides and more deliveries, what are some of the social health needs that you're starting to see unfold?
       
      Caitlin Donovan:
      That's a really good question. Just to take one step back to describe what Uber Health is and what we see. A lot of folks think of Uber Health as, you take out the Uber app and you use it to get to your doctor's appointments. Yes, you can do that, but it's actually so much more than that. Where we're, as you mentioned, Brian, a supplemental benefit platform that focuses on benefits that have existed for a long time. So transportation, prescription delivery, which actually is a way to use your transportation benefit in a more effective way, grocery and over the counter delivery. When you think about how long these benefits have been around, transportation has been a mandated Medicaid benefit since 1966. It's increasingly used in Medicare Advantage, to your point, now that social determinants of health benefits have been allowed and piloted since right around 2020, a little bit before. On the food side, you regularly see grocery and over the counter benefits in the Medicare Advantage space. With the Biden administration's recommendation that states apply for 1115 waivers for food, also we're really seeing that in Medicaid as well.
       
      What we've observed, to your point on who needs these benefits, is just how far-reaching the need is, but how the structure of the way these funding sources have historically been administered, it does not reach the right population. So just to give a couple of examples here, starting with on the transportation side, for those that don't know, the way that you know if you have a benefit, find it, etc, typically was you had to read your whole handbook, find the number, find the person to call, etc, wait on hold, etc. What that meant is the folks that had the wherewithal to do all of those steps were the ones that had access to the benefit.
       
      So we ran a pilot in Washington DC, Medicaid population had access to a transportation benefit, and the utilization of that benefit prior to our program was less than 10%. What we did is we said, there's probably a better way to find the patients that really need to use this benefit, and we embedded Uber Health at two federally qualified health centers. What we found is when patients presented and are having a social risk screening, the provider's in a really good position to say, oh wow, did you know you have this benefit available? Do you need to use it? We found that 44% of patients needed to use the benefit at least one time. So again, I think the takeaway for me is incredibly far-reaching, two is the entry point really matters to make sure that you're deciding who to access, where to spend your marginal dollar. The third part of this that is really important is the clinical results, or at least the leading indicators of clinical results are following through to make sure that you're using those dollars in a wise way for the ecosystem.
       
      Brian Urban:
      I love the metrics you just shared there, Caitlin, because I even think about when I started my little career on the private fee for service side of Medicare Advantage, which does not exist anymore, but it was so funny that we would send these huge books, the explanation of benefits, and that was the main way we would communicate what you have available to you. But look at the gap that has existed for such a long time, I think a lot of us forget about that. For someone to individually take that task on and find it themselves in a manual process is very cumbersome.
       
      Now in terms of the gap closure that you mentioned there, working with federally qualified health centers in your example here, that's the point of access, the point of service. So if you're able to line up better visibility, education on the provider side, trickled it down to the patient, magic can happen in terms of getting needs met. So that's just fascinating. FQHCs are just so positioned to be able to make the biggest impact and there's so many big and small ones across the US that now are still recovering themselves from a recent cyber attack that trickled down and impacted them. So it's now more than ever. I love to hear that story.
       
      Karl, your work in particular with DUOS, your tech is really centered around eliminating barriers and you also have experts, in terms of care coordination and helping people navigate, which I think is the nice sweet spot there. You're not just providing a surface level tech that can do things, you have the people and the know-how behind it. So I'm curious of what you're seeing in terms of addressing whole person needs with all the lives that are coming in through DUOS today.
       
      Karl Ulfers:
      Yeah, yeah, you said it well, Brian. I mean, we really focus at DUOS on the navigation and engagement layer of this system. It's one of the areas that, again, with my own personal experience I just saw was incredibly fragmented. So hard to find the resources for older adults, especially you take in Medicare Advantage, you stack government programs, and then you stack in for-profit companies that are trying to help older adults. It's very fragmented and it's very confusing.
       
      We simply think about the way that we approach that world as doing two main things for older adults. One, is help them get connected to the programs that will help them pay for the services that empower them day to day. Things like food, things like transportation, things like helping their house be a safe place to live in, everything from heating and cooling to home modification. So that's one big bucket of things that we do. The second is, once we've sort of dealt with that problem set for an individual, we'll then help them get access to the quality care that they need as well.
       
      What we've done over time is we've taken the experts that we've had and we've used all the learnings from the experts and the interactions that they're having with older adults, and we've actually then put that back into our technology to do two things. One is we've aggregated government programs at the state, federal, and VA level. You might've just seen the press we had between us and Humana because of that work as an example.
       
      Brian Urban:
      I did on LinkedIn two days ago, I think, yeah.
       
      Karl Ulfers:
      Yeah, yeah.
       
      Brian Urban:
      [inaudible 00:15:04].
       
      Karl Ulfers:
      It got [inaudible 00:15:06] super excited about it, but again, it's this unification of the VA benefits, state, federal, plus Medicare Advantage benefits, and we've brought all that together into a singular platform. Then we've built a really powerful digital engagement and matching criteria underneath that that makes it easy. It shouldn't be hard for the older adult, for the caregiver, for somebody at one of our payers, customer service and care management teams to find this information because at the end of the day, it's a pretty standard set of needs. The hard part is matching that need, say include as an example, up with the Snap EBT benefit, the Flex Card benefit that's available on the Medicare Advantage side, and then any other supporting resources we need to pull together for the individual. So yeah, it's been we've taken a lot of learnings and we've been able to really focus them into that tech platform that then makes that orchestration a lot easier for the people we serve.
       
      Brian Urban:
      One thing, Karl, that you mentioned, subtle but critical and I think one of your biggest differentiators in terms of the services you provide and your approach, the insights that your team is gathering from the interactions they have is fed back in. So you're continually advancing and making progresses with your technology and then how you send that downstream, others that might be interacting with the lives that you serve as well. That right there is a throughput thoughtful model that I think a lot of other players right now maybe don't have the vision just yet that they're entering the space. So I think that's a good tip, professional guide to those that are coming into this space. I love to hear that.
       
      Karl Ulfers:
      Yeah, Brian, I'll just add to that. Yeah, it starts with first understanding who the people are that we're serving. From there, then we've been able to get really smart about all those insights and how to feed it back.
       
      But here's what we've learned over the last three-plus years of building DUOS. The first is the average person that we interact with, 88% of people to be exact, they make less than $28,000 a year. So you might've heard me earlier mention the importance of helping them earn money to pay for these services. That is absolutely critical because it's not that the older adult doesn't want to leave their home, it's not like they want to be socially isolated. It's that there are key barriers that are preventing them from getting out of their home, like the ability to get a ride, like the ability to be food secure, like the ability to feel safe and moving around their home. So that's where we really focus on, how do we actually get money in the hands of these individuals through these government programs, through these Medicare Advantage benefits to then provide them the services that they need to be able to live the best life that they can.
       
      Another data point that I'll give you and it actually matches up almost to the percentage point of what Caitlin shared earlier. So we find that about 40% of our members don't have the transportation they need to get out of their home and back into the community and into the medical appointments that they need to. So that's where we've always been super excited about our partnership with Uber, is that this is such a clear barrier that we see time and time again. It honestly, lots of things in healthcare and health are local and geographic, that trend is consistent. Every population we deal with, it's about 40% of the time they just don't have access to the transportation they need to get into the community and get into the medical appointments that they require.
       
      Caitlin Donovan:
      I was just going to say, something that you said, Karl, I think is super interesting about how we're collectively solving this problem and how we make it great tech versus just good tech, is making sure we're solving the right problem. It's not that folks don't want to ride or don't like the option that they have been given. It's really around the coordination of those benefits and funding sources that I think you and I have both invested fully in, versus just building a better mousetrap and repeating the same problem over and over again.
       
      Brian Urban:
      The funding sources, I think that always comes back to the wrong pockets or whose pockets or the economic boil down, that's always been a conversation in terms of health plans, healthcare, and then bridge players in between. Myself being with a few very large health plans in my background, we always had the theme of healthcare is local but we never did anything about it. We just contracted differently. That narrow [inaudible 00:19:39] objectively of course, but I love to see that the impact is being made in terms of finding the funding sources and actually applying it to the individuals so you're not just meeting their needs, but you're actually elevating them in the socioeconomic ladder as well.
       
      $28,000 a year, Karl. Yeah, you're getting on the line of federal poverty and you think about generational poverty as well and how that continues and it's very difficult to break for a family, let alone a community. So man, I love this. This just gets me so jazzed up. But I want to switch perspectives for a moment and talk about the expanding space of that is healthcare tech. So you both travel a good bit, different conferences on my side as well, and I'm seeing so many different vendors come into this space, whether they've just got their seed money or they're on their second round, they're looking for traction. To me, I'm wondering how many of these healthcare tech players are going to be around in 12 or 18 months?
       
      So Caitlin, are we starting to get very crowded relative to tech being applied to Medicare Advantage population specifically when we talked about the SDoH supplemental benefit expansion? Is it getting too crowded now that all these players are trying to vie for their spot working with health plans, or we're just starting to see who's really going to be the big impact makers? Where are we in this time right now?
       
      Caitlin Donovan:
      Oh, that's a good question. I think three thoughts there. One is, tech companies that are solving the root cause of the problem versus a piece of it I think will be the ones that succeed. I think that's a big reason that at Uber Health for example, we've made the conscious decision to invest in supplemental benefits that are already Uber's core competency. So not trying to build a better way to get a ride, a better way to get your groceries delivered, but really invest in that data layer around coordination of benefits that is the reason to Karl's point, that people aren't getting what they need. So I think tech companies that focus on that versus taking a blank sheet of paper and trying to reimagine the world, will likely succeed first.
       
      The second thing that I think is important to your point on, is it getting too crowded? I've observed that a lot of tech companies really care about owning the end patient relationship, whether or not that's their place. I think that that is not good for the ecosystem because one, the poor patient is now going to have 20 different apps to manage. Exactly. Two, if there's a thought, in some of the data Karl and I just shared around when you meet patients where they are, they get better results. Thinking about what brand leads and what brand follows, I think can create room in the ecosystem for companies that are doing well. Then with those two things being true, if you contextualize where you fit in into the broader system, I think there is room because to do things well in a hyper regulated, hyper complicated, need to be local industry, you probably do need point solutions. You just need to have a plan to string them together following those first two observations.
       
      Karl Ulfers:
      Yeah, Caitlin, I would just add to that, I think what you're really hitting on there is the importance of understanding the ecosystem both from the payer landscape but also from the older adult perspective. So much of that comes down to trust. I think about trust in two different ways as we think about that landscape. The first way from the older adult standpoint is if you... And by the way, we've done tests on this, so I can actually speak to data. If we just market an older adult population with the DUOS branding and about the program without any mention of the payer, we only get about five to 7% of the older adults activated. The payers are like, well, that's still pretty good, that's about average what we see with other programs, but if we understand that we are being brought in and the older adult understands that we're being brought in by one of the plan partners that we're working with, and so their brand leads and DUOS is a program that's brought to you by them, that activation rate goes up to 15%. It's all about... When I say activation, I don't mean just simply that they respond, that they actually become part of the technology and experience that we support and it's really about trust. So Caitlin, I think that that point is incredibly true.
       
      Then the second thing I'd say on the trust side of the payer relationships is you have to build, in my opinion from a tech perspective, things that are going to align very closely to the value that the plans care about. You've got to be able to draw a clear line, point A to point B for the payers, so that they can understand what you're doing. Yeah, it's novel, it's cool from a tech perspective, but that it does and creates real value for them. Otherwise, you're not going to get their trust to deploy to their solution because they're not going to get the return on investment that they're looking for.
       
      So for us at DUOS, that comes down to two things. It's one, helping these members be more satisfied so they retain in the plan and we actually measure that with our plan partners. Then the second is helping them improve their preventative care screenings, everything from annual wellness visits to their open HEDIS gaps. Those two things, those two domains then are what gives our plan partners the trust that we are going to not only create a great experience for the older adults, but we're going to deliver real results for them as a plan as we go forward.
       
      Caitlin Donovan:
      One other quick thought, just to your point of trust and understanding the ecosystem. What I've observed about a lot of tech companies that I think both DUOS and Uber Health do differently, is the assumption is to get trust you go straight to the payer and straight to the end customer, forgetting that there are a lot of different entry points along the way. So we find from an engagement standpoint, pharmacists are phenomenal engagement points, primary care providers, etc. So we encourage a lot of those tech companies to think about building for those parts of the ecosystem as well. Candidly, that's why Uber Health started as a provider facing tool. That's the entry point where you get really solid trust for high acuity patients. Now we've extended the other way through our relationships with Optum Financial Services and other flexible spending card providers, you can use your benefits directly on the Uber app, but not forgetting about that provider and other entry points we think is really critical to driving adoption throughout the ecosystem in a productive manner.
       
      Brian Urban:
      I love that you both went there. You went grass root, in terms of trust as a big, I'd say currency, in terms of individuals seeking care or wanting to find the right person to work with for their needs being met. It's amazing because we talk to a lot of different tech companies on our show here and some do have a point solution, some do fight over the end patient, but we're finding more that are sticking around longer, doing exactly what you both are speaking about, is providing value that connects back to the providers and can help the health plan. So bridge tech in a loose term is needed now more than ever because we can't just point the fingers at health plans or large healthcare systems. We need tech to be able to enable all the different coordination that happens lower and in between. I just love that you both went there, especially the pharmacist is a fantastic example.
       
      I do want to hit policy now, let's shift gears completely. I want to start with Karl and get your perspective on a couple of things here. So we talked about this a little bit off recording the other week here. The Inflation Reduction Act is a gigantic challenge that's come in front of us. So, well intended to cap expenses for prescription drugs out of pocket to help the end consumer, but that's really not what's happening. So let's dig in a little bit more here. I know you have great insights, so I want to get your perspective on this.
       
      Karl Ulfers:
      Yeah, I mean, these policy changes we track really closely at DUOS because again, we're focused on the fact that these older adults don't have a lot of money. So anything that's going to impact them from a financial perspective, we really watch like hawks so we can understand how to mitigate it and how to help older adults.
       
      Yeah, one of the more recent changes is the Inflation Reduction Act and what the Inflation Reduction Act did is it basically brought down the cap of when older adults have to stop paying for out-of-pocket expenses on their medications. It's now just over a couple thousand dollars they don't have to pay anymore, which in theory, that sounds great. The challenge that that is now starting to ripple through the industry on this is that that cap really helped out about 15% of the population was paying out more than a couple thousand dollars a year in out-of-pocket expenses. If you only make $28,000, a couple thousand dollars a year, it's a lot of money. So that's the theoretical side of it.
       
      The practical side that has now come out is that the insurance plans themselves are now capped on those expenses being paid by individuals. So what's happening now is the premiums associated with those prescription drug plans are just going up and they're going up in pretty big jumps. So to make that real, this year the average prescription drug plan roughly from an out-of-pocket per month perspective from an older adult, is about $45 of premiums that they got to pay to the insurance company. Next year at the very minimum the projections are that it's going to jump up another 20%, somewhere around upwards of high 50s to 60s, there's some numbers that are even higher than that. So what that now means is that all of the population that's on those prescription drug plans is paying a lot more per month for that prescription drug plan than they were previously. It 100% just ties back to this cap that was put on the prescription drug expenses.
       
      So it's going to create a really interesting market dynamic where if you're an older adult and you're on a prescription drug plan and there is a Medicare Advantage plan and a prescription drug plan over here, you're basically now in a lot of cases it's going to be cheaper for you to be on a combined Medicare Advantage and prescription drug plan than it is to be on a standalone prescription drug plan. So we're really interested to see how that starts to play out in open enrollment this fall and going forward because it is making these prescription drug plans a lot more expensive for the older adults that we see.
       
      Brian Urban:
      It's interesting the ripple effect that we'll see and other insurances that might step into play too, secondary supplementary insurances as well. I'm curious, in terms of navigating this and also the delivery side of it. Caitlin, what are your thoughts here layering on top of what Karl just broke down for us?
       
      Caitlin Donovan:
      Yeah, we also focus on the intended or unintended consequences of well-intentioned policy. The one that we are really focusing on right now, V28 as it relates to Medicare Advantage and how thinking through the impact of what that means for stars and pricing, etc, it means that plans have to be quite creative around how they think about utilizing the existing benefits they have, the existing programs they already have.
       
      So where we are seeing some really interesting innovations is actually plans thinking about their quality teams not as a separate standalone budget, but as a team that can utilize existing benefit dollars and run structured programs on top of them. Again, coming back to you, how are you solving the real problem? That should be the intention, if you're trying to keep your population healthier, your benefits should be used to do so versus simply attract membership. Like the intention of the way that advanced notice was written, the best plans are really starting to take action and do that by letting quality teams not run out of an administrative budget, but use a platform like Uber Health or pick your favorite platform to make sure that folks are using those benefits in an appropriate way that drives real return.
       
      Brian Urban:
      I think that is so interesting when I think backing into the trust and the experience that people are having with health plans in coordination with strong tech partners like yourselves. We looked at last year's change 23 to 24 in star ratings, it was a dramatic change. Relative to cap surveys being a big component of that measure as well, there's also some negative trickle down, in terms of CMS announcing payment reductions as well by about 1.24%. Then now we're looking at a premium in terms of benefits. I'm sorry, benefit premiums are decreasing as well, about $400 per beneficiary per year. So this is a big impact as well. Thinking about, there's so many economic stories here, but Karl, let me shift back to you for a moment. What's the real impact here in terms of the actual benefit premiums decrease?
       
      Karl Ulfers:
      Yeah, I mean, just to take a step back for a second, I think Brian, if you were to think about this from an end older adult perspective, there's two financial waves that are going to hit them in this space that depending on if they're on a fee for service plan or if they're on a Medicare Advantage plan, is going to make the earth a little bit or make the surfing a little bit challenging for them if we stick with that metaphor.
       
      Challenge number one is what we just talked about on prescription drug plans. Then challenge number two is what Caitlin just hit on, which are, there's changes in risk adjustment models, there's changes in star ratings, and the net result of those challenges for Medicare Advantage members is yes, the actuaries are predicting that roughly the total benefit to an older adult, whether that's in the form of premiums or in the form of supplemental benefits, is going to go down on a year-over-year basis by about $400. So that's going to mean that individuals at our Medicare Advantage plans either have less rich benefits or that they're paying more from a premium perspective to receive those benefits. So I think it's just important to think about that from an older adult perspective because the prescription drug plan impact really impacts older adults that are in fee for service Medicare, and the changes that we just talked about really impact older adults that are on Medicare Advantage, Medicare Advantage benefits.
       
      So with that sort of landscape, talking about the Medicare Advantage side and the impacts of that, whatever ends up being roughly $400 of decrease in benefits. Yeah, I mean as we've hit on, it's going to be become more challenging in terms of the benefits that are made available to older adults because there's going to be fewer dollars to pay for them. So this is where we think the one-two punch of orchestrating Medicare Advantage benefits coupled with state, federal and veteran programs is so important. I think it's super important to the plans, but I think it's really important to those older adults as well, because there's many places, and I love the waiver program that Caitlin started out talking about as an example, but there's many places where we can get these dollars. The hard part is if you're an older adult, you might talk to a social worker about Snap EBT, you might talk to your health plan about your Flex benefit. It's just really complex. So that's why we're so focused on this orchestration layer so that as money ebbs and flows, we can try to keep as much continuity as possible for the older adult in helping them get those critical services that they need.
       
      Caitlin Donovan:
      We're totally in the same boat, Karl, where it's, how do you take the existing funding sources because there aren't going to be new ones and make them more effective. I think just to give a couple tactical examples of what we've seen, we've seen three different approaches from plans. One is absolute panic and cut benefits. I'm not sure that that's the right answer. The second is the opposite, let's assume other plans are going to do that, let's go for a bit of a land grab in year one and catch up to it in year two and three. That doesn't sustain. Then I think the most interesting things we've seen are plans that are keeping their benefits the same but trying to make them much more effective by really leaning into orchestration layers. How do you run programs on top of them, etc?
       
      Just to give some really specific examples, I think we all know caps had been over weighted, transportation for those that don't know, tends to be the worst caps performing benefit, partially because people know if someone showed up or not. So doing simple things like, how do you use an Uber where I can track if they show up or not, really big impact to make better value out of existing benefits, spending fewer, not more dollars. Same on the prescription delivery side. Med adherence is going to be triple weighted. How do I, if I know someone's not adherent, use an existing benefit to deliver them their prescription? Or with grocery and OTC, that's a really well-loved benefit that currently is on a flexible spending card that's divorced from clinical decision making. How do you combine those two things so that programs that you're running, you can use those dollars to drive the right clinical efficiency, is what we're seeing from some of the more creative plans.
       
      Brian Urban:
      I love the examples you made in those three there, what some plans are doing in reaction to. I think that's a traditional, probably easy to predict. The first one, you said panic, let's cut stuff up, let's be as conservative as we can. But the last example you made, I feel like those are the ones that are going to start leading the way that others will begin to follow in more of a strategic, long range planning. Let's still serve the lives that we have here today as best we can and not panic. I love those examples. Now I can see the other side of your brains respectively here from the investment banking worlds, now flipped over and taking that economic savvy wisdom that you curated those earlier years in your career into this space, which is extremely needed.
       
      So I want to wrap us up here and take a look into the future a bit here. So Caitlin, let's stay with you for a moment here. What's next on the horizon for Uber Health? Things that you'll turn into over the next five years, barriers that you see in front of you. Take us into anything that you like here.
       
      Caitlin Donovan:
      Oh, good question. So I joined Uber Health about three years ago. What we've spent the past three years doing is trying to solve the root cause of the problem, which we viewed as supplemental benefits did not have the appropriate utilization because they were really hard to access. So have built the backend pipes so that any entry point along the ecosystem where a patient happens to be, you can use those benefits. Makes administration easier, makes it easier to decide where to spend the marginal dollar. Now you can access those benefits at traditional call center, via provider's office, directly as the patient with a Flexible spending card. I put it as the pipes are built and now we're figuring out, how do you make that even more effective? In some early signals we're getting around the engagement you naturally see from using these benefits, I think is really interesting and what we will likely invest in over the next, call it three years.
       
      A couple of examples, I don't know about you, but anytime I'm going to the airport in an Uber or a doctor's office in my Uber, I'm staring at my phone because I'm bored. Sorry, I realized that that... I'm staring at my phone because I realized that I'm bored. That is really highly engaging activity if you know there's a benefit, patient is in the car, etc.
       
      Similarly, on the food side, we're running a program right now that we announced with GCPA and a large MSO of federally qualified health centers in Georgia, and a wraparound nutrition services company called [inaudible 00:41:32]. Engagement results with food are off the charts even when you're not just staring at your phone. Patients are calling us to use the benefit, are complying with a risk screening. We're finding that 70% of patients need some form of intervention that was not yet identified. Then 90% are adhering to that recommendation with the promise of grocery delivery on the other end. So right now, those two themes I think are subscale, but we have the infrastructure to do something special with them, and excited to see exactly how we lean over the next three years.
       
      Brian Urban:
      That is a good tease. I feel a follow-up coming on in the future. I am just over the moon excited for the impact that you're continuing to make at Uber Health.
       
      For DUOS, Karl, same question. What will you turn into over the next five years, some of your biggest contributions or maybe some challenges that you foresee in the way?
       
      Karl Ulfers:
      Yeah, I mean, if we go back to the original thesis of what we wanted to get done with the businesses, is we really wanted to create a system of aging that brought together all of these disparate programs and benefits and just made it easier to connect people in to the final mile services that they wanted to go after.
       
      I think as we think about the future for our business, we always like to think about the future in terms of, how can we increase the accessibility of our platform? Meaning, how can we serve additional populations that we don't serve today? I think there's some really clear areas that we'll continue to grow into that we don't serve today. We've already started to grow into the Medicaid space because what we're finding is a lot of the needs of the older adult population are very, very similar to the needs of Medicaid members. So we will continue to grow and go after that space.
       
      The other area that we're learning a lot about right now and because of that regulatory upheaval that's hitting it, is traditional Medicare in the prescription drug space. Those individuals are going to have a very unique set of challenges and needs that we feel very confident that we can meet and help get them to the right place from a benefits and coverage standpoint. So that's the next area.
       
      Then the last piece, going back to the virtuous loop of taking the learnings that we're gathering from our technology and our experts. We really do have a clear set of five, six things that we know these older adult populations need. Food, transportation, helping them feel safe within their home, medical appointments, medications. What we're going to continue to do is we're going to go deeper on the piping and the technology connections into third parties that can make those connections as seamless and easy as possible.
       
      So it's funny, Caitlin and team started from the transactional level and are going back that way, and we are coming from the engagement and technology into the same direction. I think that's ultimately what's going to really, at least in this little part of the world, allow us to make our dent, is to have both the technology that can navigate and engage somebody into that right service, but then also connect them to that final mile of the actual service that they need.
       
      Brian Urban:
      Well, you two together have one of the biggest shining beacons and I'd say value across the healthcare ecosystem. So, not too much of a corner, but definitely a big space, and I love that you're both leading the way with that. Just the care coordination in between that, insight loop, and then back into helping members, patients use their benefits to the highest degree of effectiveness like that. That is where I think the magic is happening here. I love your insights, I'm so happy that you could have both taken time out of your day to join our show here today. So, Global Head of Uber Health, Caitlin Donovan, and Co-Founder, CEO of DUOS, Karl Ulfers. Thank you both for joining our show.
       
      Caitlin Donovan:
      Thanks so much for having us, this was wonderful.
       
      Karl Ulfers:
      Yeah, Brian, thanks for all the work you're doing to get visibility into this space. We greatly appreciate it.
       
      Brian Urban:
      Oh, you made my day with that one. Thank you, Karl. For more exciting insights and excerpts, please visit us at finthrive.com.
       

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