Ep. 72: Furthering Healthcare's Digital Revolution

The promise of digital integration in healthcare has come a long way but remains a work in progress. Currently, digital tools give providers and patients secure access to health information, help improve communication, provide personalized care and education, and allow for remote monitoring by providers and self-management by patients. To have all of this in one place, well, that's the future state. But the future may be here sooner than we think.

In this episode, we examine two digital health platforms — Xealth and Unite Us — whose goals are similar: to use AI and big data to bring together digitally, behind the scenes, information allowing providers to not only monitor your vitals and medications but also "prescribe" information, disseminate education, and even refer you to social services directly from an electronic health record platform. 

Guests:
Mike McSherry, President & CEO, Xealth
Dan Brillman, Co-founder & CEO, Unite Us

Views expressed by guests do not necessarily reflect the views of the host or management.

Subscribe, review or let your voice be heard at NemoursWellBeyond.org.

Transcript

Carol Vassar, podcast host/producer:

Welcome to Well Beyond Medicine, the Nemours Children's Health Podcast. Each week, we'll explore anything and everything related to the 80% of child health impacts that occur outside the doctor's office. I'm your host, Carol Vassar. And now that you are here let's go.

Music:

(singing)

Mike McSherry, CEO, Xealth:

I got into healthcare to try and see what I could do to improve the stasis, the moribund, and the bureaucracy. How do you use automation? How do you use technology to improve healthcare for the country and, hopefully, the world?

Carol Vassar, podcast host/producer:

That's Mike McSherry, President and CEO of Xealth: a digital education integration platform available in the electronic health records of hospitals and healthcare systems across the nation.

The promise of digital integration in healthcare has come a long way, but remains a work in progress. Right now, digital tools give providers and patients secure access to health information, help improve communication, provide personalized care and education, allow for remote monitoring by providers and self-management by patients. To have all of this in one place: well, that's the future state. But the future may be here sooner than we think.

Today, we examine two digital health platforms, Xealth and Unite Us, whose goals are similar: to use AI and big data to bring together digitally, behind the scenes, information allowing providers the ability to not only monitor your vitals and your medications, but to prescribe information, disseminate education, and even refer out to social services directly from an electronic health record platform.

Later in this episode, we'll talk with Dan Brillman, co-founder and CEO of Unite Us, whose platform began as an outgrowth of his work to efficiently and effectively connect veterans like himself to local health and social services but has since expanded to connect nodes of service for everyone.

Right now, though, we're talking with Mike McSherry, who has a long history of successful digital startups, most notably Boost Mobile, now part of Dish Wireless. Xealth came about in 2017 after McSherry sold his sixth digital startup, Swype, to Nuance and joined the board of a hospital system in Washington state. Here's Mike McSherry.

Mike McSherry, CEO, Xealth:

This is my first healthcare startup. Providence Hospital in Seattle hired me as an entrepreneur-in-residence and said, "You've been clever in other industries. What can you do in healthcare?"

Anything was on the table. We could start a wellness company, a gym, nutrition, whatever. And we literally cycled through 70 different ideas, probably the first 30 illegal, immoral, no one will pay for.

Take, for example, yield. You pay differently for an airline ticket whether you buy it in advance, or you want the premium seat, or you have a last-minute purchase. You do the same thing for hotels. The prices could be jacked up if there's a conference in town or Taylor Swift's in town, whatever.

"Oh, well, why don't you take that same model and bring it to healthcare? Why don't you charge more for the 8:00 AM appointment slot on Monday?" Oh, there's health equity. It doesn't work.

So what business models might translate in just the normal tech consumer capitalist world don't play in healthcare, due to equity and equality, so you have to learn those nuances.

The other element is healthcare is a little bit like four-dimensional chess. If it's good for the hospital system, it might be bad for the insurance company. You have to understand the payer, the provider, the employer, the government-

Carol Vassar, podcast host/producer:

The patient.

Mike McSherry, CEO, Xealth:

... the patient, and what business model, because it's like a balloon. You squeeze in one area, and it's popping out at another. So, you just have to look and analyze things from this four-dimensional capacity. It's like whether this idea will actually fly in what you're trying to introduce into the healthcare ecosystem.

We saw that clinicians had a certain set of tools. They could prescribe meds. They could suggest someone go see a specialist. They could prescribe labs or X-rays. But there was this whole world of digital health. And there was no easy way for clinicians to recommend patients download an app, get a device, read an article, watch a video, answer a question digitally.

So we built a platform to enable clinicians to give these recommendations to patients, i.e., prescribe, and then email/SMS the patient to watch it, read it, answer it, download it, and use it.

Then, we integrate to all these third-party solutions and show the data stemming from the patient's usage or completion or ongoing device RPM diagnostic data, and show that back to the clinicians and their interface so they can remotely monitor these patients' lives.

Our goals are to hopefully become the default platform for America, if not the world, on digital health prescribing. We don't choose what app or device or tool or content or platform that the clinicians want to prescribe to patients. They understand their patients and their patient needs best.

They tell us what vendor solutions, what apps that might be relevant for behavioral health or diabetes management or COPD, or devices that remotely monitor someone's cardiac, blood pressure, or their pulse rate.

So we integrate dozens of different third-party apps, devices, tools, content catalogs that help patients better manage their care, and the doctors to remotely monitor the patient's usage of these tools.

Carol Vassar, podcast host/producer:

So it's almost a 360 view of a person's life, based on the information that's been pushed out and the data that's coming back.

Mike McSherry, CEO, Xealth:

Correct. And where the EHR, the traditional source of truth about a patient's life, only captures patient data when the patient sees the doctor, maybe gets a lab, but that's it. And we capture daily a thousand x more data points. We've integrated CPAP devices. We've integrated glucometers. We've integrated n number of third-party apps and devices that are continuously capturing data. And that's a better real-time assessment of someone's health.

Carol Vassar, podcast host/producer:

Is that information going right back into the EHR? Is it going directly to the physician in some way? How does that work?

Mike McSherry, CEO, Xealth:

It goes back into the EHR. Like when they prescribe a med, they're in their EHR. When they prescribe an app, they're in their EHR. We are deeply embedded into the EHR along those lines.

So much so in fact, we work with 30 large provider systems. 20 of them are in Epic, Cerner, or Oracle now, is an investor in Xealth. They resell us to their provider base. So, we're becoming the default platform amongst Epic and Cerner for enabling this digital health prescribing, if you will.

Carol Vassar, podcast host/producer:

What kind of difference does having this information make, both for the physician and for the patient?

Mike McSherry, CEO, Xealth:

So physicians want patients to do the right thing for their care, better manage their care, come in prepared if they're anxious before a procedure or a consult. The clinicians have ideas that they think patients should better receive care.

And I think we're all a little tired of being handed photocopies, or getting things in the mail, and using Dr. Google because your doctor's not telling you anything about what's going on. So clinicians have ideas for better engaging, enabling patients to do the right thing. And these tools help the patients do the right thing.

So the patients: Someone who's a diabetic, they have to manage their A1C. Are they taking the right dosing of insulin? We enable that for the doctors to help that patient get on that correct path.

During COVID, huge, huge efforts around behavioral health. We've prescribed out several different behavioral health apps. These are apps that help a patient manage their stress, their anxiety, their depression.

There are multiple different digital health tools that the clinicians think are important for the patients. The patients might be getting introduced to it for the first time. But with that clinical oversight, they trust their doctor, and that is the most constant trusted source in their healthcare journey.

It's not the insurance company, it's not your employer, it's your doctor. We enable the doctor to suggest something to the patient and then for the patient to easily consume and use those things.

Carol Vassar, podcast host/producer:

And through these apps, people can receive a video, maybe about how to monitor their glucose if they are diabetic, maybe about how to handle stress if they're feeling anxiety. Am I on the right track here?

Mike McSherry, CEO, Xealth:

Exactly, exactly. We've integrated easily half a dozen different mental health solutions, apps that help patients better manage mental health conditions.

I mean, surgery is a great example. When you think of prescribing a med, you think a doctor has to click a button. But the bulk of things we actually push the to patients digitally are automated. So, we intercept all the appointment scheduling feeds, the surgery scheduling feeds, the discharge feeds.

Again, surgical procedure, in many cases, there's a consult: should the patient do the surgery or not? So, pre-consult, we send out shared decision-making tools to patients. These are tools that say, "Here's the risk/reward for a hip surgery or a shoulder surgery."

It's not elective, but there's pros and cons to what you might be able to achieve post-surgery, but also alerting you to the risks. Even pre-consult, we send that out. We might send a video out pre-consult. Patient has an appointment with the surgeon, and they decide to do the surgery.

Then, we enroll the patient in digital tools that send out reminders: "Stop eating here. Make sure you bring this. Don't do this. Take these meds. Make sure you bring your CPAP device to the surgery."

There's a bunch of tools that specifically lay out pathway procedures for patients pre-surgical. In some cases, we physically send patients pre-surgical kits. That could be specific sterilized soaps and things for wound care related to incision-based surgeries.

So patient has the surgery. And then post-surgery, we send out PT exercise videos to the patient. If it's like a cardiac surgery, we send out an RPM platform kit that might be tracking more of the vitals of the heart rate and blood pressure and pulse ox and other kind of systemic clinical data points.

We enable all of that transition seamlessly with multiple vendors to better digitally prepare that patient against their anxiety, their prep, their questions. Make sure they're doing the right thing so it's not a delayed procedure. The patient didn't do the right thing; the patient ate when they weren't supposed to prior to coming in. So we try to alleviate all the burden friction so that the patient comes in prepped, ready, and then hopefully on a journey to a better recovery.

Carol Vassar, podcast host/producer:

Does this take some of the burden off the doctors, the nurses, the other clinical staff?

Mike McSherry, CEO, Xealth:

Massively. You still see tons and tons of nursing staff photocopying pieces of paper, handing it to the patient, assembling multiple things, logging into third-party websites to pull down things and prepare it, stuffing envelopes to mail things to patients prior to procedures. So we just digitally enable all of that seamlessly.

And again, we don't choose the tools that are beneficial for the patients; the hospital systems do. So you don't have to have the nurses clicking multiple buttons. It's automated. We have a huge focus on reducing clinical workloads in the work that we do with our provider customers.

Carol Vassar, podcast host/producer:

But there still is the opportunity for any patient at any point along the line to call a doctor, go into MyChart, email them securely, that kind of thing.

Mike McSherry, CEO, Xealth:

Absolutely. I was given the stat: almost every one of our hospital systems, not children's, uses pregnancy apps. They want to prep the mom through a nine-month journey on what to expect when you're expecting. Increasingly during COVID, now includes an RPM solution for high-acuity-risk moms and low acuity. That's blood pressure and scale, so you can do a telehealth visit.

If it's a low-risk mom, telehealth every once in a while, that's fine. You don't have to come in. I can remotely monitor. You're good on the healthy mom checkup.

High-risk mom: you do more active monitoring against that. A pregnancy is a lifetime customer value. The moms see it as a household medical spend; you've heard all these phrases in healthcare.

But I have been told that 50% of calls to a nurse hotline or to OB-GYNs are just product-related questions. "What do I use for back pain? I am having carpal tunnel. What product should I buy off the Walgreens shelf?"

Many, many, many of these things could be done through education. So, the usage of an app and an additional related content; it's not just the app, but hospital systems produce their own custom content or own custom videos, what to expect in the first trimester, second trimester.

This is all meant to also try to alleviate some of the calls to the nurse hotline, which is sometimes repetitive. You don't want to [inaudible 00:13:34] an anxious mom that she can never reach a doctor or nurse. But to the extent that you can help educate them, that's beneficial to everybody if it reduces some of the workload and call volume for repetitive things that could have been done through education.

Carol Vassar, podcast host/producer:

10 years from now, pushing out this information, how do you see it changing? And how do you see Xealth changing along with it?

Mike McSherry, CEO, Xealth:

I wouldn't call Xealth; I will now; clinical CRM. You've heard of Salesforce. It engages with individuals, and it tracks individuals. They might take credit card data into account, or they might understand how many different accounts they have with an insurance company or a bank. And so they try to cross-sell, upsell. It's how to engage that person to do more with your company.

I'd like to think we're way, way more benign in how do you get a patient to do the right thing for their care. What do you send the patient to get them to watch, read, enjoy, understand, answer? What do you do to get the patient to do the things that clinical teams want?

And then what is all the data stemming back from the RPM data or the completion? Or patients that watch videos prior to surgeries or procedures, do they have more effective outcomes? Do they utilize the system more or less? Do we have lower readmits? So, ultimately, I got into healthcare because I wanted to improve the quality of care.

Carol Vassar, podcast host/producer:

What you landed on sounds like a fabulous program and lots of potential for many, many years to come.

Mike McSherry, CEO, Xealth:

Oh, we'd like to think so. We saw the rise in digital health. And there was no easy way to aggregate, orchestrate, integrate these tools into clinical workflow. And as we're Providence employees, we were able to figure out how to integrate it into their Epic instance. Prov actually had five Epic instances. So before we even spun it out of Providence, we had to get Xealth working across Providence's many, many Epic instances.

So the very first time when we spun it out, we actually had a lot of experience at, "How do you integrate and get this operationalized inside of a provider workflow?"

And back to Nemours, we're super-excited that we've started working with children's hospital systems now. And the app ecosystem, the content ecosystem, the vendors that are appropriate for adult populations are different from pediatrics. In pediatrics, you're not always working with the child in the digital solution; you're working with the adults. There's proxy access and there's some complications, but you work through those.

Again, KidsHealth is a vendor that we've worked with; it's specific to the pediatric population. We're doing work with Freespira, which is a digital therapeutic related to pediatric-specific mental health behavior, more adolescents and teens, but still falls into the children's range of care. We're working with specific RPM solutions that are focused on pediatric-specific responsibilities toward those vendors. Locus is a vendor we're working with there.

And there's something that I'm really excited about. The Center for National Shaken Baby Syndrome: nobody wants to see that, right? Nobody wants to see that. But it's a broad-based awareness campaign. There's a digital program that can be prescribed. And we're launching that at several systems related to how parents/caregivers should think about how to handle the stress that comes with raising infants sometimes. So very specific, and it's a digital program.

Again, when we sign up to a new health system, in the case of pediatrics, the range of downstream vendors that are appropriate in pediatrics are different than our more normal IDN or academic medical centers and things like that. It's a little bit of a two-sided marketplace. We work with provider systems, and then we work with the range of downstream apps and tools and services they think appropriate.

And so when we keep adding to both sides of the equation, hopefully it's creating more and more of a flywheel that becomes helpful to both sides of that equation.

Carol Vassar, podcast host/producer:

Mike McSherry is the President and CEO of Xealth, a digital education integration platform.

Dan Brillman, Co-founder & CEO, Unite Us:

Once you connect all the nodes of care in a community, the possibilities are unlimited.

Carol Vassar, podcast host/producer:

That's the voice of Dan Brillman, co-founder and CEO of Unite Us, a HIPAA-secure digital technology platform that connects medical, governmental, and social service agencies together across 46 states.

Like Xealth, it allows providers and others to make those connections securely, providing referrals to health and mental health services, government agencies, and nonprofits providing housing and fighting food insecurity, just to name a few.

It was born of the experience Dan had as a veteran, trying to refer fellow veterans across the nation to relevant resources locally, much of which remained analog and time-consuming. Here's Dan Brillman.

Dan Brillman, Co-founder & CEO, Unite Us:

When I came back from my first deployment, I went to Columbia Business School. I went to get my MBA. And in my second year, veterans that I served with that we all created trust in each other, came to me to try to solve their health and social service issues. And it was never just one need. It was always multiple things going on.

I became very frustrated with the process of helping others that I served with. And back in 2011, two years prior to the company being formed, I was trying to help them myself. And what was available then was more just lists of resources out there that may be digital. But it was on me to call those agencies.

And typically, when I call those agencies across the country, they would say, "Oh, I can't help them, but call my friend down the street who may be able to do this."

So they all kind of knew each other across different services in housing and food and mental health or primary care, but it was very manual and inefficient. I ended up writing a paper about it, and met my co-founder at the same time who was doing this in a volunteer status for a nonprofit, and had an Excel sheet of all these different needs and services that veterans need.

And we came together to build a real technology that brought together these sectors to really improve people's health outside of the four walls of the medical setting.

Carol Vassar, podcast host/producer:

So there really wasn't for veterans a single resource that you could go to and say, "Hey, I need mental health services. I have health issues. I have housing issues, I have food insecurity." There was a patchwork, it sounds like. And you have brought this patchwork together-

Dan Brillman, Co-founder & CEO, Unite Us:

Yep.

Carol Vassar, podcast host/producer:

... to put it together to make it digital. Is that a good summary?

Dan Brillman, Co-founder & CEO, Unite Us:

Yeah. Absolutely. If you think about the what is needed for any of us getting services, I want to be able to walk into any point of service. That may be me getting my veteran benefits from a government service provider. But if I need other services, I want them to have the right software and the tools to communicate in real-time with those other agencies, versus handing me a pamphlet and I have to go navigate myself and tell my story over and over again.

And so what we've brought to entire communities is this software that connects all these different nodes of care together so that they can communicate in real-time. They can track the outcomes that are happening outside their four walls so that they don't have to figure out to call me or the patient, "Hey, what happened? Did you ever get there? Did you get denied? Did you get accepted?" Whatever happened, we've built that into a real technology that has brought together over a million services now.

It's very local. It's a lot of relationship-building in communities across the country, standardization in how they communicate: a hospital, a homeless shelter, a food pantry, how they all work with one person.

Carol Vassar, podcast host/producer:

And you have scaled this beyond just military personnel and their families?

Dan Brillman, Co-founder & CEO, Unite Us:

That's a great pivot. Yeah. Yeah.

Carol Vassar, podcast host/producer:

Tell us about that scale-up.

Dan Brillman, Co-founder & CEO, Unite Us:

So the good news, what I'm really proud of, is we built the company for the first six years focused on the military population. And that was really with amazing partners that helped us shape the product. It's very complex in how all this information works and how it gets standardized.

About six years into the business, I remember we were at a meeting. And someone said the term, "social determinants of health" in this collaborative meeting.

I said, "That's a pretty cool term. What is that?"

They explained it, and our communities were already doing this work. And they were doing it more effectively, and Unite Us was saving them all time, the client time; we were improving people's health. And so it became something that became a known term in the industry.

And at the same time, our organizations in the community that were serving veterans had programs that served all populations. So a housing organization had a veteran program, but they also served all populations. And they were being asked by insurance companies, by governments, by health systems, "Hey, can I connect my patients with you?" And they were already on Unite Us.

And so they said, "Why don't we bring these health systems and hospitals and governments into our ecosystem?" And that's when really we expanded in 2019 to be an infrastructure across entire states, across the entire country, which has obviously gone fairly well.

Carol Vassar, podcast host/producer:

It sounds a lot like a digital medical home.

Dan Brillman, Co-founder & CEO, Unite Us:

Mm-hmm.

Carol Vassar, podcast host/producer:

Am I on the right track there?

Dan Brillman, Co-founder & CEO, Unite Us:

Yeah. I mean, it could be a lot of things. What's interesting is once you connect all the nodes of care in a community, the possibilities are unlimited. There are clinical referrals being sent through our platform now because we've connected two nodes where they were faxing still. And I see the eye roll; that's real stuff. I don't want people picking up the phone when they can communicate in real-time because the patient has to experience that ultimately.

And so many use cases: we've gotten states and thousands of organizations to agree on a standard on what an outcome is for every type of service and share that standard across every state. It's almost like the new EHR for the entire community. Or it's the infrastructure software that allows everyone to communicate together in a more effective way, including the patient.

One thing we just deployed, which has been really successful, is real-time chat between our users. So now, a Nemours user in the EHR can communicate and chat, like they do on their phone, in real-time with a homeless shelter or another clinic outside the four walls because we're all connected through Unite Us.

It can be so many different use cases once you connect the nodes together, from not just a delivery of care perspective. But also because we're all on the same page of data now. And it can make data-informed decisions together where our hospitals, our community, and our government come together to invest in things together, versus their own way of doing things before, which may not produce the right results. Might produce the right results, maybe for the organization, but not for the community. And now we're all centralized around that investment as well.

Carol Vassar, podcast host/producer:

How hard was it to get all of that-

Dan Brillman, Co-founder & CEO, Unite Us:

Hard. Hard!

Carol Vassar, podcast host/producer:

... data to sing together?

Dan Brillman, Co-founder & CEO, Unite Us:

10 years-

Carol Vassar, podcast host/producer:

Wow.

Dan Brillman, Co-founder & CEO, Unite Us:

I remember 10 years ago building our first network in New York City. It took months to get these organizations to agree on what to share in an electronic system. They were already working together. They were called collaboratives. They met every week because there was housing, it was employment, it was mental health, it was substance use, it was hospital. They were already working together to actually meet about shared patients, to case manage them together. They figured out that they were working together somehow.

And so I remember those organizations battling through what that outcome, what that data is going to look like. "What's a care plan that I send to a food pantry? What are they going to send me back every time? And not just they got help. Did they get six days of food? Did they get 30 days of food? Did they get six boxes? I need to know what happened to that." And standardizing that across 150 types of services was very hard, and took 10 years.

And we're still continuing to make changes based on the feedback of our communities, because the world has changed. There's virtual delivery now. There's food delivery right to your home now. This is very different ways in how we continue to meet the needs of our communities.

But the point of that is it's not Unite Us making that decision as a company. It is with our communities and our hospitals and our insurance companies and, our government partners. Because ultimately you want everyone to adopt that together across states. Otherwise, you're building more silos,

Carol Vassar, podcast host/producer:

Access to community services: be it health, be it behavioral health, social services, addiction services. This all goes right to the heart of the issue of what you referred to earlier as the social determinants of health. Why is that important on a community level?

Dan Brillman, Co-founder & CEO, Unite Us:

For many different reasons. One, at the highest level, is how are we investing in our communities. And how are we supporting our populations as a whole? If we're talking about the healthcare context, we're not thinking about the community context. We're not talking about the City of Portland and how we ensuring everyone has access to what they need. Because some of it is medical, some of it's non-medical.

So it's important at the government level and at the community level, we're all doing this together, and at the real delivery level every day, people walk into organizations to get services. And it's not only that one service. They walk into the emergency room, and you need five different things. The real-time need for that has never been greater, and how technology can change that.

It is not the end-all, be-all. Technology is a way to catalyze this work and to measure the work, and to make it go faster towards the investments that are now being made across the board in non-clinical services.

But we know that sitting in a doctor's office, the rest of our year is not about that visit. And everything that's happening in my community setting is about what's making me healthy, or my parents or people in need, every day. And it's not the healthcare setting that's going to figure it all out. It's the community as a whole.

Carol Vassar, podcast host/producer:

Let's talk about how you've quantified this. What evidence-based information from all that data that you've collected has proven/disproven that Unite Us is working?

Dan Brillman, Co-founder & CEO, Unite Us:

Yeah. We just did a control study that took several years, specifically around maternal health. And we did this in partnership with Sarasota Memorial Hospital and the public health system to reduce maternal mortality, reduce readmissions, reduce the cost of care for pregnant mothers. And it's called the First 1,000 Days. So it's as soon as the mother is pregnant through the first 1,000 days taking care of the family, we're providing wraparound support in a community-based setting.

The hospital is obviously doing the screening if they're providing their prenatal care on what the needs are. Individual and family support and mental health, and healthy food: that's being delivered by the community partners. And we just finished that study. A couple data points from that.

One is we intended to serve the Medicaid population, but everyone can walk into hospitals. About 30% were commercial that were in need of social care. And at the end of the day, we almost pushed to 70% reduction in readmissions, postpartum readmissions, and total readmissions for that study.

And so that's been a really impactful study to say, "We know when we empower our community-based organizations closer to people's homes, provide them that wraparound support if they have other needs, they're all connected. The hospital doesn't have to do the hard work. It's the community that does the hard work, and we can invest in the community to do more of that."

Carol Vassar, podcast host/producer:

I'm glad you brought up maternal child health because we are a pediatric healthcare organization.

Dan Brillman, Co-founder & CEO, Unite Us:

It's a good time. Good segue.

Carol Vassar, podcast host/producer:

Good, good, good segment to put this in. Talk to me about how children are impacted by the work done through Unite Us.

Dan Brillman, Co-founder & CEO, Unite Us:

Yeah. Children are obviously a huge priority for the company and our mission. It's so intertwined between children and their families. If the family doesn't have the support they need, the children are much worse off as well from a health perspective.

And so where we do this in real practice is at all different levels of age. And so First 1,000 Days is that first 1,000 days of life. It's just, "How do you provide support for the baby, for the family throughout that first 1,000 days?"

The next examples we've done is we work with the Department of Children and Family, which is a government agency. Their sole focus is to provide support for families throughout their entire lives. They become a catalyst in communities like Louisiana, where they are almost like a hub in our network to be at the forefront of support and wraparound support with the hospitals, with Ochsner, with community partners, with the payers, around children, but also supporting their families.

And then, really, where we've catalyzed and seen a ton of success is we're in several thousand schools. Schools are where kids go every day. This is where they present their needs. Would you much rather have them present their needs in a trusted place like a school? Or the one 15-minute doctor's visit where they're getting their wellness check? I will pick the school every time.

And so, providing that technology infrastructure for schools across the board allows us to identify those needs early on to provide that wraparound support. Again, not in a medical setting, but allowing the medical community to know what's going on so they don't have to duplicate their work.

Those have been all different levels from zero to 18, and it's really important that the most important thing is you're bringing these sectors together to support kids and children. It's not just the children's hospitals we work with. It's everyone together to making sure we're driving the right results.

We're de-duplicating work because we're all trying to do the same thing. We all want better health for our children, my children. But we're doing it together as a community with the social services sector, the government sector, and the medical sector.

Carol Vassar, podcast host/producer:

Let's widen the lens a little bit and talk about the importance of digital revolutionaries like yourself being involved in the healthcare setting. What is that like presently? What's the future of that?

Dan Brillman, Co-founder & CEO, Unite Us:

Sure. I think we all in the healthcare context understand we cannot do this ourselves. We know we need technology to help improve people's health. We know we need to, most importantly, meet people where they are. And it is not in the medical setting anymore. It is where they live, where they work, where they play. We, as consumers, demand a lot more than we used to because of technology.

And so as a technology company, we always think about being several years ahead of the market. And when I know we're several years ahead, people think I'm crazy, which is a good thing. Every product we brought to this market, people thought we were a little crazy.

When we brought our payment solution, which was reimbursement for social services, actually writing a claim: the first claim for social care was sent through Unite Us to a payer for 30 days of food for children and their families, because Medicaid now reimburses it in several states. People thought we were a little crazy, building that in 2019. But now here it is in 12 states. The regulatory environment has changed that allows any payer to pay for these types of things, which is amazing. A couple of years ago, it was zero.

39 states mandate social care. Social determinants of health are addressed by managed care, and not just giving them a list. It's about providing the right outcomes. That means they need to work day-to-day outside their four walls with community-based organizations. They need technology for that.

So, our job as technologists is to stay several years ahead of the market. And one of the things we're pushing the market on is much more standardization of how January 1, we're all going to be screened for social needs. It's a mandate. Center for Medicaid and Medicare Joint Commission is mandating screens for social needs in every hospital we walk into now. That's amazing. That's great.

However, we don't want to be asked that same question everywhere we go. And so, how can we get everyone to work together? These are the things we're getting ahead of so that we don't end up in a mess where we're all on different data sources, we're all on different pages.

In Unite Us, we're all connected in that way. We don't have to de-duplicate. We can see that screening was already done at a food pantry, so Nemours doesn't have to ask that question again.

And on the payment side, our goal is to push $300 billion. Not just from the medical community; I want to make sure we're clear. This is philanthropy, government, and the medical community coming together.

There's plenty of funds out there. We're just misaligned in how we use dollars to support the right answers. But we use the right data to be able to effectively invest in health together, especially children's health and for all Americans.

Carol Vassar, podcast host/producer:

What about underserved communities? How are you reaching out to them?

Dan Brillman, Co-founder & CEO, Unite Us:

Yeah, one of the great things that we've invested in a lot is our analytics that helps us understand at the population level, but also at the individual level, who needs help before it's an emergency.

It really catalyzed our community partners to outreach to those members, or to those people, proactively in a place of trust. Not necessarily the healthcare setting or their payer reaching out to them and saying, "I think you need food." But community partners reaching out, which is really, really important.

When we talk about vulnerable populations, they're all people. They have different needs at different points in their life. And the important part of that is we are providing the tools, the access, and the analytics to our partners to be able to effectively engage them in a community-based setting, as a much more trusted setting.

We've done this work in North Carolina with one of our partners focused on the military population and using those analytics. And the engagement rate is so high because they're a community partner—a trusted missionary organization in the community.

And when they reach out and say, "Hey, we're here to support you if you are lonely." They might know that they're a little bit more lonely or food insecure or need income support. They engage much more quickly in that process and engagement with that community partner.

By the way, we just saved the healthcare system and delivery system a lot of time and effort on that work. But that's how you have to do it. It's local in nature, and it's in trusted sources closer to your home.

Carol Vassar, podcast host/producer:

Dan Brillman is the co-founder and CEO of Unite Us.

Music:

(singing)

Carol Vassar, podcast host/producer:

Thanks to Dan and Mike McSherry for talking with us today about this important aspect of the digital health revolution in healthcare.

Are you a digital developer in the healthcare space? Share your story with us by leaving a voicemail on our podcast website, nemourswellbeyond.org. Who knows? Maybe you'll hear your voice on an upcoming podcast episode, perhaps even your story. That's nemourswellbeyond.org, where you can also subscribe to the podcast and leave a review.

Our production team for this podcast episode includes Che Parker, Cheryl Munn, Susan Masucci, Lauren Teta, and Adonis Vera. Join us next time as we take a close-up look at the problem of physician burnout and why it should concern all of us.

I'm Carol Vassar. Until then, remember, we can change children's health for good ... Well Beyond Medicine.

Music:

(singing)