Personalization in health care: Why, how and when

November 09, 2021 SmartBrief Season 1 Episode 5
Personalization in health care: Why, how and when
Show Notes Transcript

There’s nothing more personal than health, but industry stakeholders have not always excelled at personalizing the experience of health care. That’s changing, say Oscar Chief Operating Officer Meghan Joyce and Wellframe co-founder and Chief Innovation Officer Dr. Trishan Panch, who argue personalization of content and experience matters because it is critical to empowering patients and building the trust needed for great health care. They say organizational commitment and alignment are key to enabling personalization. Meanwhile, technology enables health care personalization to be executed effectively at scale. Joyce and Panch share recommendations for starting out, building on progress, and ultimately democratizing access and improving health outcomes.

This episode is brought to you by Wellframe.

A pragmatic methodology for the evaluation of digital care management in the context of multimorbidity, Journal of Medical Economics

Melissa Turner  0:03  

Hello and welcome to Touchpoints, a conversation about care, connection and costs in us health care. I'm your host Melissa Turner. I'm content director for healthcare and life sciences at SmartBrief. SmartBrief is a publisher of digital newsletters for professionals and creator of this and other shows in our series of SmartPod podcast. In addition to overseeing production of SmartBrief healthcare content, I'm of course also a consumer of healthcare, just like those of you listening. Together in each touchpoints episode, we'll explore the issues that make healthcare hard for all of us, and we'll discuss how health plans, healthcare providers and their partners in the healthcare ecosystem can make it easier. Thank you for joining us.

Melissa Turner  0:55  

Touchpoints is sponsored by Wellframe. Wellframe works with health plans to reimagine member relationships. Their team believes that health plans are in the best position to lead the charge into the world of digital health management. Let Wellframe be your partner in improving member engagement and outcomes. Learn more at 

Melissa Turner  1:15  

Today, our topic is personalization. Digital transformation has enabled a new level of personalization in healthcare. Widespread use of personalization and other industries has set a new standard that health plans and health systems sometimes struggle to meet. Here to talk about this topic are two experts in this area. First, I'd like to welcome Meghan Joyce, chief operating officer at Oscar. Oscar brought disruption to the health insurance industry with digital and consumer first mindsets. Megan has also held roles at Uber, the US Treasury Department and Bain Capital. welcome Megan. 

Meghan Joyce  1:48  

Hi, it's so wonderful to be here.

Melissa Turner  1:50  

Really appreciate your time this afternoon. I am also pleased to welcome physician and artificial intelligence thought leader, Dr. Trishan Panch. Dr. Panch is Chief Innovation Officer and co founder at Wellframe. He's also an instructor in Health Policy and Management at the Harvard School of Public Health, and a lecturer in Health Sciences and Technology at MIT. He's the founder and co-director of Harvard Public Health's most popular online executive education course titled Applied AI for Healthcare. He practiced medicine for 17 years, and led a large risk bearing primary care group in London. Welcome Dr. Panch.

Trishan Panch  2:26  

Thanks for having me. So nice to be here. 

Melissa Turner  2:28  

Okay, well, let's go ahead and jump into our conversation. This should be a good one today. I want to start by defining personalization. I think we all have some idea of what it means. But I want to ask each of you to share how you and your organization think about personalization. So what is it? And what are the benefits? Let's go ahead and start with you, Meghan.

Meghan Joyce  2:48  

Yeah, absolutely. This is a subject that is near and dear to my and Oscar's heart. So when we think about personalization, it's really ensuring that we are meeting our members, our customers where they are, and ensuring that they feel seen for who they are. It comes down to, I think, two very tactical things. Number one is content that is relevant to them. And number two is how the content is delivered, ensuring that it's delivered with a tone and approach in a format that's relevant to those people. And I think the benefit of helping people feel seen for who they are, helps build trust. And at the end of the day, we believe that the only way to truly transform healthcare is to have deep trust between its constituents, between the payer, which Oscar is and the patient or the member, as well as the provider, there needs to be three way trust between those three parties. And that's not a given. But if we can use technology to scale personalization, and to help members feel that we are there for them, that we see them for who they are, and we're going to meet them where they are in their journey and how they what they feel is relevant for their life in that moment, we can start to build that trust that is so essential to bringing members along in their own healthcare journey to helping shift their behavior in the direction of healthier alternatives, to have a united front with their provider and in what needs to be done in order to ensure optimal health care outcomes, and really to transform the system into something that works for all three parties.

Melissa Turner  4:27  

Well, thanks, Meghan. Dr. Panch, what's your take on this question?

Trishan Panch  4:30  

Yeah, it's an important question. And yeah, of course, I agree with what has been said before. I think there's meeting people where they are and seeing them for who they are. I think that's the kind of essence of it and I think you know, that piece of like, who they are, right? In thinking about personalization, it is easy to go down the kind of somewhat technical route thinking about how services are delivered and segmenting them for like different groups of people. But I think it's correct not to lose sight of like, you know, that piece of like seeing people as they are. And I think, you know, that's something whereby solely for Wellframe and I think, this is a set of insights that I think a lot of providers will chime with that there's kind of two aspects to managing long term conditions, right. I think like everyone who has a long term condition -- all of us, at some point, inevitably, probably -- you know, you're asking yourself a few kind of almost existential questions like, what is going on with me now? Is it normal? What do I need to do about it? How do I do those things? Is someone going to catch me if things go wrong? And those aren't necessarily questions that people articulate explicitly, in fact, the vast majority of people won't, but inside in terms of meeting them where they are, it's some constellation of those questions that people are asking themselves in consultations, or when they walk out, and they're trying to manage these conditions themselves. And of course, there's a lot of work in managing these long term conditions. I mean, that's one thing as well, if you look at it, from a time emotion point of view, the vast majority of the work in managing one chronic condition, and it compounds when you have more, is done by a patient, people, all of us ourselves outside of appointments. And like most of that work, at least historically, in spite of the best will in the world, from the provider side of things, which is kind of my background here, people have to do largely unsupervised. So I think in terms of meeting them where they are, it's about being cognizant that people are asking themselves these like fairly existential questions. And then the second thing is that part of the value of healthcare services is not just in the technical answers to those questions, what's the diagnosis, what's the management. What do you do? What do you look out for what to do next, if things go wrong? But he's actually, you know, I think Meghan really appropriately mentioned the centrality, the importance of trust. And I think that's right. And I think if you look at the clinical delivery system, you have trust, which is built on confidence, people have confidence in individual clinicians in organizations, and that trust allows a relationship to be built. And that relationship is itself, I believe, therapeutic. But secondly, it is also is kind of instrumental in when things go wrong, as they're going to these really complex systems, people come to you or come to the service provider, they have a relationship with to try and put these things right. And hopefully, they will do that before things go really wrong. And that's a lot of the effect of these kinds of technologies is that you build trust, exactly as Meghan said, that allows you to build a therapeutic relationship, that allows you to kind of do work with the patient with the member to do things that are good for their health. Also, it gives you a fighting chance of being there when things go wrong, because they're going to go wrong. And it's amazing, it's so complex that you should go into it with that mindset. So I really believe like part of the value or part of the rationale for personalization is that it builds that trust that builds a relationship, which not only empowers patients. But it also gives you a really a much, much better chance of being like the safety net when in these complicated situations things go wrong.

Melissa Turner  8:03  

That's a really interesting point and kind of begs the question Dr. Panch about outcomes. So as you think about establishing this kind of relationship where you are then there when things go wrong, what's the relationship between that trust and outcomes?

Trishan Panch  8:18  

Yeah, I mean, it's a fantastic question. And it actually honestly cuts right to the chase have a lot of issues with structuring health systems overall. I think most people would agree, I think the way to answer this is to just forget about technology for a bit and just look at, say primary care. You know, primary care is obviously a structured prevention service. How do you know if primary care works? And it's actually a really, really complicated question to answer because patients have multiple conditions, they see multiple clinicians at the same time, they have environmental factors, social factors that are going on with them at the same time. So it's very difficult to know what the specific ROI of primary care is over time. And is that due to the primary care service or due something with a patient or due to something social, due to something genetic or environmental, and you know, you have pandemics every so often, unfortunately, that, obviously skew outcomes. So it's very difficult to know like what the specific attribution is. So this is one thing that we'll be looking at a lot. Last year, we published a paper, it's kind of not the most succinct title, unfortunately, "Pragmatic methodology for the evaluation of digital care management in the context of multimorbidity," that wasn't meant for a tweet, because it was basically around answering this question. So to cut a long story short, and the methodology, I mean, it's open access, so anyone can read it, and it probably interests me much more than anyone else. But the headline is that there's a whole heap of work in this kind of just theoretical methods work in how you attribute outcomes to an intervention when there's lots of things going on. At the same time. There's very complex evaluation work that's sorely necessary in this space. 

Trishan Panch  9:54  

But the shape of the ROI is in three parts. One is there's essentially an efficiency argument Which is basically that you can, and this kind of following on for somebody that Meghan raised, with the same number of clinicians, you can see more patients, you can see them more often. Or, of course, you can have less clinicians and see the same number, depending on where the organization is and what you're looking for. There's effectiveness, and that partially is in quality metrics, and partially in total cost of care. And I think the balance of those matters more for some organizations, and for some groups of patients and others, and I can go into kind of what that is. And then there's a kind of, I guess, from the health plan point of view, a revenue argument, you know, for employers who are looking at different health insurers or different health insurance options, those that can provide more personalized services, which are higher touch that create these relationships that Meghan described, are going to be seen as better than others. And there's multiple examples. I mean, certainly, you know, as we've seen the trajectory over the last few years, it's that argument, like in the early days, it's like efficiency and effectiveness. Does this influence social factors, improve quality metrics? Does this improve my staff efficiency? But that then transforms or kind of molds into does this help me as a health insurer retain x desired account? Because this is like a differentiated service, there's more like a differentiation argument. So the ROI is generated in those three ways. But I feel, you know, as a part time academic, I have to say that like, figuring out and attributing that ROI to an intervention is complex. And very interesting.

Melissa Turner  11:34  

Meghan, I wonder if you want to comment on this, I guess Oscar came in with this mindset of personalization from the beginning. So maybe you can't look at how at Oscar's model was prior to personalization. But how do you think about outcomes?

Meghan Joyce  11:44  

It is exactly the right question to ask. Because if we are not focused on outcomes, what are we focused on? Right? We know that the most efficient systems, the most cost effective systems, are the ones with the best outcomes. And often the most expensive care is care where things went wrong, or where care didn't happen until too late in the process that were complications, or where things got so advanced, that there was actually quite complex care needed. And so Oscar was founded on the basis of, you know, some principles that really drew from consumer tech, where we can use personalization to drive trust and trust to drive engagement. And the premise of Oscar is once you have member engagement, what can you do with it, and in our context, it is about delivering superior health care outcomes. As Dr. Panch alluded to, quality outcomes is notoriously difficult to measure in health care, which is its own kettle of worms. But assuming you have some rubric for quality outcomes, which we do, we have both external and internal data to that at least give us some sense of what facilities or physicians providers deliver higher quality, lower complications, better care, then we can actually use member engagement to help shift business and shift procedures and shift care to those providers and to those facilities. So through years of investing in building that member trust and engagement. At this point, 68% of Oscar's surveyed members say that they trust Oscar to advise them on how and where to get their health care and 75% of subscribing members for the medical visit use our Oscar tooling to search for providers. And we're able to then when they when we have that trust of members, and when members are using our tooling to search for where they should go, we can direct them towards at least who we believe and have evidence to suggest are the highest quality care delivery providers and facilities out there. And so with that trust comes in ability to influence behavior to influence where the care takes place, getting it at the right time, that preventive moment well before things get complex and hairy. And in doing so we're able to increase the likelihood that the outcome there is an excellent one, and reduce the cost of the system while we're at it. You know, we believe deeply from the evidence that we've seen and the feedback we've gotten from members that that trust does have a high relationship with better outcomes, and we hear it back in the feedback that we get from members and providers every day.

Melissa Turner  14:30  

Well, certainly those numbers are compelling in an industry where trust isn't always abundant. I want to step outside of healthcare for a moment and ask you each to kind of think about, you know, conversations about connecting with consumers, consumer centricity and personalization are typically informed by experiences in other industries. I wonder if either of you see kind of a gold standard outside of healthcare that is a nice model for folks inside of health care. Dr. Panch?

Trishan Panch  14:59  

yeah, is it good question. I think, you know, if you look at stuff like net promoter score, right, then, if you look at, like the disparity, say, between typical health plans and say Apple, it is huge. So I think like simply kind of looking at the quantifiable metrics of net promoter score, you would have to look at like those kinds of consumer tech companies. I think the problem with that, of course, and I don't want to kind of single Apple out, such consumer tech companies are kind of dealing with a much, much more simple problem. And you could argue, a much more homogenous set of users as well. I think one of the challenges of healthcare typically is that like, well, it's very complex processes, and lots of different people with lots of different preferences. But I think going back to what also what we said before, it's, you know, wherever you look to as your North Star, it's very important to kind of set some kind of baseline here. And historically, organizations have just typically not been looking some of the things that Meghan brought up, you know, level of trust, things like net promoter score, I mean, those are only really been measured at scale for like, the last decade or so. So I think we're really at the beginning of this journey of personalization and consumerization of healthcare. And I think whilst it's important, you know, I think the logical thing to look outside healthcare would be the large consumer tech companies that kind of live or die by this. And I think, in fact, there was like a specific Steve Jobs, there's a quote -- Well, it certainly won't be a quote, because I can't remember it -- but just paraphrasing, you know, he said, if you look at enterprise technology, you know, one person can dictate whether your product works or not, and that person is typically not a user. Whereas you look at, like, consumers, consumers vote with their feet, so you kind of have to get it right. And you live or die by whether you get it right. And I think health plans are tending more towards that, and they understand they have to engage consumers. And a lot of the work we do is taking health plans on that kind of journey from this not necessarily having been part of their core skill set, maybe only starting to measure and look at these things, recently, having a number of different departments that look at this in some kind of way, to making this much more central, and strategically important. And I think, actually, I suspect, we're gonna come up with this later, like, part of that transformation from an organizational point of view, in terms of putting these kinds of issues central is the key to getting this done. But I don't want to kind of go into that too early, but that's where I am.

Melissa Turner  17:23  

Meghan, what do you think?

Meghan Joyce  17:24  

I think those points are excellent. You know, when it comes to the gold standard, that's a really high bar. And trust is a very fragile thing. So I'm not so so naive to think that there's any single example I would point to, but let me give you an example from my past life, my background is actually not in health care prior to Oscar, it's in tech. And prior to Oscar, I worked at Uber. And I was there at a period of time when Uber had sky high trust. And I was there a period of time when Uber had rock bottom trust, and I was very gratefully part of helping rebuild that trust, along with many, many other people for whom that was the number one priority. The reason it was so critical to us was because of just what trust gets you in the form of engagement, and making the system work. And what we found at Uber, and what I think a lot of well regarded consumer tech enterprises would tell you is that technology actually does extraordinary things, unlocks a whole amount of stuff that you can do in scaling trust. When you think about, you know, the sources of trust, and what brands and organizations you trust, historically, you know, I think a lot of people think about maybe their local primary care, physician, you know, they've known for ages, maybe their parents saw this doctor on Main Street, maybe a local restaurant where you're a regular and and you know that every time you go in, you're going to get a great experience. That's a very personal relationship. And how do you actually deliver a personal relationship at scale? What I've experienced and I think we've seen in consumer tech and Oscar is that you can actually use technology to help create a trusting relationship by being there for the member, by using data and AI to identify core themes of what what your users care about, to be there for them, either by picking up on signals in the noise, or by triggering certain events when things emerge, and immediately outreaching to members or actually getting ahead of the signal and the noise and anticipating what event is going to happen and getting ahead of it and intervening in scalable ways. And by using technology we can actually use machines to do that in a way that can then filter to a human and get the very best of what machine learning and automation bring to bear, which is picking up on signals in the noise, scaling, outreach, CRM all the benefits that CRM has brought our world, I think what technology and personalization allow us to do is take the very best of what AI and automation and machine learning can do, which is filter the signal from the noise intervene either when that signal is identified or even before it takes place. And then allow humans to do what they do best, which is critical thinking, dealing with edge cases, dealing with that face to face interaction, where really there is nothing better than a human. And if you bring the best of what technology has to bear, along with the best of what humans have to bear, you get something like Uber at its best, which is an extraordinary driver who's powered by technology to get around their community in a really efficient, safe way. And a system in the middle that helps provide belt and suspenders and a lot of ease for the consumer in accessing a ride. Likewise, on the healthcare side, you can use AI and technology to create really thoughtful workflows to identify high quality outcomes to intervene when extraordinary events do take place to anticipate when a patient is on a track for for something that we don't want them to have to encounter. And we can intervene with preventive measures. And then the best of what humans bring, which is a face to face physician interaction, actually leveraging a concierge or a nurse practitioner to ensure that you have all of your all of the care and procedures you need at home to ensure that you're taking the best care of yourself, even between those visits. And I think that's really what consumer tech has taught us. And we are now bringing into the healthcare space.

Melissa Turner  21:44  

That's a good segue to the next question I want to ask, which is sort of what is the state of personalization in healthcare today? You know, where's it being done well, where can it be done better? Dr. Panch?

Trishan Panch  21:57  

yeah, this is great question. So I think I think there's two kind of aspects there. So I think one is organizations, I think there's kind of two sets of challenges, right, or two sets of investments that there needs to be made. One is essentially kind of organizational transformation, strategic alignment, you know, having the priorities that this kind of thing, a unified member experience, being member-centric is important, right from the top and cascade that down through the organization. I think a part of that, of course, is that to do these kinds of things, you need cross functional working. I would argue that those technology companies that we discussed earlier on, I'm sure this will be Meghan's experience as well, with respect to this journey towards personalization. And I think you know, for many is it is a North Star. For some it's something where they've made meaningful progress already. For others, it's something where they feel like, wouldn't it be great if we can move in this direction. And of course, health plans typically are very large organizations with a lot of people working for them with existing departments, existing investments. So I think the first part of this journey and organizations that have done this successfully, we've all done this, is basically aligning priorities right from the top. So making personalization being member centric, meeting the member where they are, seeing them for who they are, and organizing services around that, making that a strategic priority for the whole organization, and then cascading that down in the set of priorities and incentives for managers as you go down. But that also is not enough. Unfortunately, like, you know, if you look at these consumer tech organizations that do personalization and member, consumer experience very well. They are all used to cross functional working, as well as being kind of consumer centric. And I think that for healthcare organizations is typically be difficult, because we're typically in organizations that have been somewhat siloed. And obviously, there's a lot of kind of risk and regulation and good reasons why things have to be siloed, historically, but that needs to be broken down. And that's also an intentional investment. And alongside so I think like, it's really important to get that because any amount of clever technology without that kind of organizational reengineering is just basically not going to work. And that's true on the provider side, as well as the payer side. But then in terms of like, where organizations are, then it's okay, cool. Then it's about like then looking at a platform approach, because I think one of the things is that people who you most need to engage the world, the people who have the greatest burden of disease who had the most needs, they typically have multiple conditions. So having one app for this and other app for that. So if you're going to go digital is simply not going to work. And even if you're going to do these things telephonically having like one call about diabetes and other one about hypertension, another one about depression. And there's three different people calling out different times, the member just loses trust and gives up basically, very quickly. So you have to take a platform approach to do that. And that's, I would argue, much more interesting. It's arguably also much more complicated, and it's more of an intentional investment. And I think, you know, that's the key term -- like this stuff takes time. And it takes real commitment. I think our approach to this is really as a partner for health plans in particular, provider organizations in as well, in going through this journey. We specifically started off taking care of the technology part. And there's an approach to doing that. And there's tons of really interesting problems and lots of really interesting ways you can use different forms of software and use the data with machine learning techniques. But at least 50% of our work, I would argue more is in assisting plans with this organizational change and change management, and evaluating these interventions to see if they've actually worked and building the case to go further. And I think that's actually that kind of build, measure, learn -- to kind of borrow the quality way of looking at this -- like start relatively small, show that something works, produce these ROI numbers that you very correctly highlighted as important before, and then use that to increase the scale. I think, as you say, all healthcare organizations are on this journey towards personalization. And in order to get there, there's investments that need to be made organizationally, and also investments in terms of technology. And they're very intentional, and they take time, and they have to be seen in that way. And the organization has to make an explicit commitment to move in this direction, with the foreknowledge that it may take a year or so to show meaningful results, but that you can get meaningful results. And exactly as Mehgan said earlier with technology those results can then scale, which is not possible with more kind of human centric approaches that historically is how we've done things.

Melissa Turner  26:42  

Touchpoints is sponsored by Wellframe. Wellframe works with health plans to reimagine member relationships. They believe health plans have the knowledge and resources to support more people across more touchpoints in their health care journey. Wellframe solutions for care management and advocacy empower members and health plan staff to achieve their best in the most wonderfully human way possible. Make sure your members feel confident, cared for and supported by their health plan. Don't miss this moment, see how a digital health management strategy would benefit your plan at 

Melissa Turner  27:19  

Thank you Dr. Panch, I want to talk some more about some of these themes you've just brought up regarding how to operationalize these ideas. But first, I just want to go back to the first part of our question, which is is really looking at some bright spots in healthcare regarding personalization. Meghan, what do you think? 

Meghan Joyce  27:37  

You know, I think there are actually amazing examples of personalization in health care, the biggest problem is they're inconsistent. So if you look at, you know, real personalization, take tech out of it for a second, I think personalization in healthcare has been happening for decades, and if not centuries, where the best providers will know their patients deeply, and will understand really what makes them tick, and what is going to set them up for the best health care outcomes over time, and will really understand you know, the combination of interventions, prevention, lifestyle decisions, support, in order to help increase the likelihood that they get those excellent outcomes and that their patient is living a happy, healthy life. I think the concern or the problem is, those are not universal. And if you are one of these many people who don't have a regular primary care physician, or don't have a trusted relationship with a provider, or have been spotty in your in your health care over time, or don't have access to care, because it's expensive, it's exceedingly expensive, then you don't necessarily benefit from all of the personalization of that relationship. And so the mission of Oscar and so many other organizations at this stage in the game is how can we ensure that everyone has access to a personalized healthcare experience such that they are able to benefit from all of the upside of having a personal relationship with your provider and in your health care journey? And so that's where leveraging technology can be extraordinary. And I think there are some real bright spots around how a lot of organizations are using technology to provide a personalized approach to population health management, identifying even just basic information about pre-existing conditions and chronic conditions and being able to get patients and members on a preventive plan or on a chronic care treatment plan. I think again, those are few and far between and are often clustered around well funded health plans paid for by employers. Not everybody is so lucky. And so what Oscar is trying to do is democratize access to a personalized healthcare experience. 80% of our members are subsidized. We operate largely in the ACA space. And we believe and are working to ensure every day that everybody no matter where you're coming from, or what your healthcare history is, or your relationships with providers, you are getting as personalized and experience as someone who has a gold plated health plan or a long standing relationship with a provider, and that there is no difference in the healthcare outcomes that you can expect, then that person down the street who may have a much different history and experience.

Melissa Turner  30:40  

Well, thank you, Meghan. So I want to talk about bringing these ideas to life. Now. we've alluded to some of the themes that are important, but let's just try to get concrete for our listeners who who are surely working on these issues themselves. I want to ask you both about the back end of personalization, really the systems that underpin it, you know, we've talked about this kind of really interesting dichotomy of, of building trust, and this really human focused experience. But to scale, of course, you need technology. So what are those technologies? And how do you keep it personal? Meghan, you want to start us off? 

Meghan Joyce  31:16  

Yeah, so you know, we recently launched plus-Oscar, which is an enterprise business based on the technology and services that Oscar has been using for years and its own health plan. And this is battle tested, frankly, custom built technology and software that was meant to bring a next generation approach to both health insurance and health care for our members. And what we found over the last several years is that our network partners or peers in the industry have outreached to us and said, Gosh, you know, I would really benefit from pulling some of that technology and services into our ecosystem, and the health care system, and our patients would be so much better off if we could bring some of that member engagement, or some of those Population Health Initiatives, or some of that kind of integrated AI to our system. And so what we're doing is actually bringing our technology and services to bear in third party settings. And we find that almost immediately upon implementation, our clients get real benefit in bringing that technology and services into their own systems. And what a transformation it can drive just by introducing, you know, an automated system to run your pop health campaigns that is predictive and is analytical and is run on on an AI based foundation, they get real benefit from introducing a truly member centric member engagement engine and front end, they get real benefit from having a fully integrated stack. So that claims and information that we ingest from customer support calls and data from providers is all put into a single view of the member so that anybody who's talking to them, whether it's their provider, or someone on the phone, from their payer, has a sense of where that member is and exactly what they need in the moment that they need it or even better, a few minutes before they need it. So we can anticipate and get ahead of that. And we've just seen extraordinary response to these kinds of technologies and are excited to even expand our offerings even further.

Melissa Turner  33:27  

Really, as we think about operationalizing, these ideas that we've been talking about today, what are the systems that need to be in place? 

Trishan Panch  33:35  

There's technology systems that need to be in place, but I think in developing those or thinking about them, it's really important to go right back to what we discussed at the beginning. And actually just looking at the word of personalization. So the person right, and thinking about, like, you know, what is effective? And we've discussed a lot of these themes in the conversation, as far as I think the thing that really reaches out to me and why I went from primary care into technology actually, is the using technology to scale relationships, using technology to scale therapeutic relationships. And Meghan described really beautifully, like how we know that primary care works, at least when it's done well. But it's very difficult to scale. And technology historically has been very, obviously very scalable. We all use technology products that are delivered at massive scale. But typically, they haven't really necessarily created health outcomes. And I think one of the things that we've always focused on is that how do we put technology in the context of therapeutic relationships, to scale those relationships. And so from the member side, or from the person side, that's how we look at it. But we also accept that for organizations to move in this direction, there's a lot of very intentional investment that's needed and really incredible leadership from at the executive level, at the operational level, on the health plan side to actually kind of realize the gains of these technologies. And I think, you know, we shouldn't look past that work. And that leadership that's needed. And really, I mean, we see this as like a hybrid of a technology problem and an organizational change problem. And both of those need to be supported. And both of them drive value. But I think on a on a positive note, we've talked about the importance of measurement, and what's the ROI and all those things. But you can see with these kinds of digital investments, you can see results in a relatively short time. And that's incredibly encouraging. You don't get that in any other kind of technical services, it takes so long to stand up and so long to get to scale. But but with technology, for example, this kind of net promoter score that we discussed before, you can see health plans go from single digits to somewhere between halfway between where, say, an Apple or other pure consumer technology companies and where a health plan was before. And so for a few months of investments, that is a radical return, then you can also see, as we talked about before, in terms of impact on total cost of care, if you use these technologies with the most complex patients, you can also see a total cost of care argument, and an efficiency argument and rationale for doing this. So you can see those things within like a six month period, which is relatively short for these kinds of initiatives. And I think organizations that have done this successfully, organizations that will continue to do this successfully, are really clear about looking at those outcomes and are really clear about making the organizational investments as well as the technology investment, and use those outcomes as they come through in relatively short order to make a case to expand things and do a greater and greater scale. And that's the way of actually achieving the results that technology promises.

Melissa Turner  36:36  

Dr. Panch, that's a good lead into my next question. Although I wonder if if it's quite the right question to ask, I really want to ask both of you to think about if you're a health plan leader who's early in your personalization journey, in adopting these ideas, you know, where are the easiest places to integrate personalization? And then does that jive with this kind of platform organizational change message that you've underscored, Dr. Panch? Like, can you commit? And then can you start small and scale?

Trishan Panch  37:11  

When we first started Wellframe, one thing that really leapt out in health plans is looking at care management, looking at clinical services. So historically, and I'm sure this is not too controversial, to say, in this regard. But typically, clinical services were seen as like a cost center. And did they really add value? Do they really work for all those reasons that we discussed before? It's really difficult to figure out if anything works when someone's got, like 10 conditions over a long period of time. But then also, it was very difficult for all the reasons Meghan said before, like, you can only make, say one phone call every six months, how much difference can that really make to someone with like six conditions and 12 visits in that period and 20 minutes, the kind of patients that we were seeing. So these were kind of I wouldn't say unloved but maybe not as loved as they could be services. So I really felt the opportunity here with these organizations. You know, this is why we started Wellframe was like, well, what happens exactly as Meghan says, if we could take those same services, same clinicians who really want to help members and support them over time, and there's a clear business rationale for doing this, because obviously, the health plan is bearing the risk bearing the cost. And also trying to differentiate themselves with employers who are buying health insurance for their employees, this seems like a really big opportunity. Maybe we could say, well, let's take these clinical services. And exactly as we've described in this conversation, use technology to make them scale and then not just scale them to make them even better, make them predict to make them massively personalized. And so our kind of investment of our kind of time and lives for the last decade at Wellframe was been in like well, within a health, health plans being risk. So they have a clear set of interests here in managing members over the longer term. And particularly addressing these people with multiple multi morbidity, multiple concurrent chronic conditions. And then they have these clinical services already that are already trying to do this job. But they're doing it with a set of tools that were the best tools available, like maybe a decade or so ago. But what we've got now is this whole new basket of tools to solve this problem. And so at Wellframe, you know, we've built the organization, in working with those care management organizations within health plans and helping them make the transition from doing a synchronous telephonic workflow, a relatively small volume, being somewhat unloved -- I hope that's not controversial to say -- within the organization, to an asynchronous digital workflow that can scale massively, that can show results quickly and build organizational momentum. And dare I say, increase the love so you know. That's our experience and that's where we feel the opportunity has been, and we feel once you're there, there's a load of opportunities afterwards. There's a lot of organizational mentors built in integration of customer services, a unified member model for low risk members, or more transactional needs, customizing things for different employee groups, all of that stuff comes into play. But we really believe that, you know, just start with those patients who are multimorbidity with existing clinical services, and use that as the springboard to transform the whole organization, but doing it in an iterative way. And each step, clearly demonstrating value.

Melissa Turner  40:25  

Thanks, Dr. Panch, I want to ask Meghan, similar question. You know, Meghan, you mentioned how plans were coming to Oscar, asking how do you do what you do? How do we get that, too? When you're working with plans, where do they start out? Where do you recommend that they start out? And then how do they scale for impact?

Meghan Joyce  40:44  

Yeah, it's such a good question. And I love what Dr. Panch was saying about, you know, show your patients the love, show your members, the love, you know, there are some really basic things that you can layer on just to put a more human face on your organization. And I think, you know, we see our member experience modules that we bring to bear in our own insurance business, and then in other payers and providers who use them as an incredible starting point, even just to set up something as basic as introducing yourself as a plan, introducing the basic functionality or how your plan and this members health plan works. You know, what is the deductible, what is the MOOC, these are relatively complicated concepts, and helping us that engagement and the personalization of that individual person's plan to help bring them into that journey. You know, something as basic, it's gonna sound really silly, like, recognize their birthday, use that moment, to, to start a conversation with them. It is a well known thing that within the space of consumer health, birthdays are a time to really engage customers and members because people feel seen, gosh, this brand, this company remembered me and recognized me. And I think they're even just really basic things like that, it can very quickly dovetail into far more complex, far more clinical interventions, like intensive pop health campaigns, like predictive analytics, like proactive things that we can do to ensure that the members are getting the care and information that they need to ensure the best health care outcomes and the most affordable choices. And I think really starting with the basics, as Dr. Panch so beautifully said, showing them the love is an incredible starting point. 

Melissa Turner  42:40  

Well, I want to close by stepping back a bit. We've talked about how personalization fits into this larger picture of digital transformation. As you look five or 10 years from now, what do you think members and health plans can expect? Meghan?

Meghan Joyce  42:57  

Well, I am an optimist. And I think things are going to look meaningfully different for the better. You know, I think it's very difficult in industries and products of rapid change and transformation and disruption to predict the future. And we as humans, and our linear brains almost always systematically underestimate the pace of change, especially when it comes to technology. And so I'm actually really excited about the progress that we've made to date and what is possible in the coming years about how we can use technology to really transform the patient, the member experience, even just the penetration of smartphones means that so many people across the socio economic spectrum across different age brackets have a supercomputer in their pocket and what you can do with that, whether it comes to virtual care, whether it comes to proactively reaching out when a member is in the emergency room, or in their doctor's waiting room, and intervening even before care takes place, or right after it's taken place to follow up and make sure members and patients are getting the care and follow up and prevention they need is immense. And I think with the development of both consumer technology like smartphones in everybody's pocket, and also the technology that sits on that smartphone and actually brings rich clinical and medical care to people wherever they are, can help really crack open healthcare to one that is more accessible, more equitable or affordable with better outcomes and goodness knows we need it.

Melissa Turner  44:41  

More equitable, more affordable, better outcomes. Certainly something to look forward to. Dr. Panch, what do you see when you look five or 10 years down the road?

Trishan Panch  44:50  

I think there's kind of you know, there's two aspects here again, so I think, you know, for health plans themselves as organizations, historically the levers that health plans have to actually kind of modify health have been somewhat limited, right, you can change the reimbursement incentives to clinicians, you can invest a little bit in prevention, you can provide some clinical services, but it's been very difficult to scale them. That means that, you know, health plans have had to be like very disciplined in managing benefits and managing costs and those kinds of things, I think we're really at the beginning of a really exciting shift where shift where health plans can see themselves more as like investors in the health of populations, you know, like, you could look at like, premiums collected essentially as like, well, there's a large pot of money here. And that's going to have to some of its a large amount of it is going to be spent on patient needs, as they arise member needs as they arise and through the healthcare delivery system. But we also have this opportunity to do prevention, improve experience and increase coordination. And we now have a scalable means of doing it. And I think we're relatively early innings in that journey to mix metaphors a little bit. But you know, you can really see that play out and something I'm super excited about. And that's kind of why we do what we do, I think from the product point of view, you know, just bringing together a few of the themes that were mentioned during this conversation, is not crazy talk to think that like every patient, every person could have something equivalent to a health GPS, you know, like a system, you know, whether it's on a smartphone or on your watch, or on your glasses, or interacted with through speakers in your house, or maybe like I don't know, like projected into your visual cortex that tells you for your condition or combination of conditions for your needs, what you need to do and look out for. And then as you do those things, it kind of measures how you're doing, and when things go wrong, recruits the health system to come and see you. And exactly as Meghan said before can be predictive rather than like picking up things when they go wrong, advising you before it goes wrong. And I think all of the trends to reach there are all in play. You know, we have massive growth of cloud, we have the we have the maturation of machine learning techniques. Exactly as Meghan said, every patient, every member now has a computer pretty much as those things all come together and organizations go through this transformation. I think it's really exciting. And like, exactly as Meghan said, I don't think if you just think iteratively, from our current promises and extrapolate them forward, it seems very unlikely that we're going to get there. But that is not the right way of thinking about it. I mean, if you just look at these trends play out over time, they're huge investments of the tech industry and like the enabling computational infrastructure to do this and the massive change in consumer preferences. I think we've got the potential to do something really exciting here. But not to sound like a broken record with all this like I think it has to be done in partnerships, like you know, there's technology organizations, and provider, payer organizations working together.

Melissa Turner  47:52  

Exciting stuff. Thank you so much to our guests, Meghan Joyce at Oscar, Dr. Trishan Panch of Wellframe. It's been a pleasure talking with you both.

Meghan Joyce  48:02  

Thank you so much for having us. It was a total joy.

Melissa Turner  48:08  

Thank you for listening. I hope you enjoyed today's conversation and learned something too. You can check out SmartBrief healthcare newsletters by going to and hitting the blue subscribe button, be sure to spread the word and subscribe to the Touchpoints podcast. Finally, a huge shout out to our friends at the Shift.Health content network.

Melissa Turner  48:33  

Touchpoints is sponsored by Wellframe. Wellframe works with health plans to reimagine member relationships. Their digital health management platform empowers members and health plans to achieve their best. Let Wellrame be your strategic partner in providing innovative solutions that improve the member experience. Learn more at