On October 25, the Health Care Council of Chicago (HC3), in collaboration with HC3 Member Ziegler, hosted an in-person discussion to share the ways in which they are seeking to eliminate barriers to health care and address social determinants of health with innovative solutions and collaborative partnerships.
Jenny Poth, Vice President, Proprietary Investments at Ziegler
Jeff Bennett, CEO, Higi
Laura Robbins, COO, Advocatia Solutions
Host and Moderator’s Remarks
Jenny Poth, Vice President, Proprietary Investments at Ziegler
(JR) Ziegler is a 120-year-old healthcare-focused investment bank founded in Wisconsin. The firm focuses primarily on debt financing, M&A, and capital raising for health care providers. After engaging with partners and clients across the country, Ziegler realized that there was a shift in how people were thinking about the technologies at their disposal – particularly how they related to people who were using them to provide services. Ziegler expanded into corporate finance in response, and this division now manages capital raising, M&As, and debt for various health care technology and services companies.
In 2015, Ziegler set up a private equity firm and primarily invested in technology and technology-enabled services that serve the older population. As they continue to develop and grow as a business, they are increasingly prioritizing diversity and what it means for their work and the providers, partners, and people that they serve. Their interest in this event’s subject stems from their dedication to thinking about the factors in the social world, built environment, and psychological environment that impact how individuals experience and react to health care.
Laura Robbins, COO, Advocatia Solutions
(LR) Advocatia is a Chicago-based health technology company that exists to make enrollment as easy as possible for those helping individuals to enroll in health benefits as well as the individuals themselves. The company helps payers, health care providers, and health care organizations with benefits identification and enrollment for federal, state, and local programs, including Medicaid, CHIP (Children’s Health Insurance), LIHEAP (Low Income Home Energy Assistance), SNAP (Supplemental Nutrition Assistance), and WIC (Women Infant Children Program). Social workers, financial counselors, health care organizations, and payers have case managers/call centers to help with the enrollment process.
The under-resourced have several barriers to accessing these programs – e.g., having to go to different locations to provide the same information to determine eligibility for programs, essentially having to repeatedly prove “I am poor.” Advocatia prioritizes the consumers’ convenience when developing solutions and embarking on partnerships. They focus on the local level, so if there’s a strategic priority program that is only around for a year or two, they can also include that in their benefit identification and make it available to those in the community helping with the enrollment.
Jeff Bennett, CEO, Higi
(JB) Higi is a digital-first platform designed to be an extension of primary care resources in the community, as well as digital resources at home. Over the past 10 years, they have also deployed health stations that reside in public spaces (e.g., grocery stores and pharmacies) and some private spaces (e.g., employers’ offices and senior living facilities). The platform guides consumers through risk assessments – sometimes they are Higi-based assessments or branded assessments for a customer (e.g., from a local hospital system or health plan). The assessments can be done on other mobile or digital devices with a web browser or app capabilities.
The station also has features that can gather information like blood pressure and weight through. Their next-generation stations will be able to gather things like EKG, pulse, temperature, heart rate, and so on. It will also allow one to talk to a health navigator or doctor.
As part of the station’s platform, they do a lot of screening for chronic conditions and have built a program called Health Reach, which builds in the American Health Association’s (AHA) Life Essential Aid so individuals can get the content through text and email. By screening and finding out what patients or members require, the station essentially enables Higi to reach the community at scale and determine appropriate risk mitigation steps. For example, if someone is at higher risk, they can send cellular-enabled glucose meters to the home and if someone has chronic conditions and needs a lot of care, they send a dedicated care manager. Higi is scaling Health Reach across the entire country.
JP: Can you talk a little bit about what your support services and wrap-around care have looked like over the years?
JB: The business was started to be an extension of the doctor and the hospital. The number one goal was to make sure this tool would connect to electronic medical records (EMRs) and care management systems. However, at the time we started, there weren’t a lot of EMRs intaking patient data.
The first stage of any market implementation is building trust. People don’t know who or what “higi” is but there are other organizations or brands that they do know and trust. For example, Rush University Medical Center, Rite Aid, and so on. We provide the digital front door tool, and these organizations partner to reach the patients.
For the first part of higi’s development, we were a screening platform to navigate people to the right resources. We were navigating people to a federally qualified health center (FQHC) or other community health access points up until the pandemic. We were shut down for about six months during the pandemic. During that period, we focused on moving our risk assessments to other channels such as embedding them into the websites of our partners. And we began working with partners to deliver services at home. Coming out of the pandemic, we are now focused on how we can deliver services to a diverse population including seniors, especially around risk-bearing. We are also supporting our retail partners by being the digital front door and allowing them to become trusted locations for diverse populations to screen for a variety of ailments. Retail partners found that they didn’t have trust in certain areas, which were often linked to social issues going on around them.
JP: How did you both decide to discuss the partnership with Advocatia and higi? Why did you think there would be value there? How has that value story has evolved? And what results have you seen as you get out into the market together?
LR: HC3 made the connection between higi and Advocatia. Advocatia had had some conversations with some retail organizations as potential partners where they could screen for SDOH. By bypassing multiple channels, HC3’s Executive Director made the connection between Advocatia to Higi and they began exploring the ways in which they could work together to use retail stores as access points and beyond.
JB: higi was doing screenings pre-pandemic and developed several programs, including another program called Health Within Reach. Originally, higi was just a navigation company, but we wanted to be more of a connected care company and began exploring ways in which to do this. Higi launched a program with AHA to people with key health information on nutrition, diet, and other components of well-being. Through this program, we collected SDOH data, which revealed:
Twenty-four percent of the people who joined this program reported housing insecurity
Twenty-four percent reported transportation issues
Fifty-four percent said they were unhappy more than half the days of the month
Only 12 percent didn’t have insurance
Looking at this data, we knew we needed to figure out how to do something with the information. This was one reason why higi pursued a relationship with Advocatia: the partnership allowed Higi to connect people to potential solutions (in the form of benefits) to the issues they were facing.
Currently, higi is working with Advocatia in three markets. We launched something similar with Michigan State University (MSU) Healthcare. It is a full stack RPM platform where providers at MSU refer their patients to higi’s platform allowing them to serve as an extension of their primary care doctors. It is uses higi’s resources, but connects to a care manager that enrolls someone, and talks about their issues. From there, higi can help monitor biometrics, blood pressure, glucose, and weight depending on the chronic conditions the provider is managing. Through these partnerships, higi has found that more than 25 percent of the issues have nothing to do with health care. The problem is that people are not really tying these issues together – for example, the fact that someone can’t eat or doesn’t have access to transportation negatively impacts their health outcomes.
JP: In these stories of scaling, Advocatia has been working a lot with hospitals and health systems, this means that you have had to either pivot or maybe even expand the scope of your services at times. Can you tell us a bit about the initial needs you were going after and how that has evolved over time?
LR: Advocatia started working with health care providers in Illinois. Advocatia’s co-founder had been hyper-focused on Medicaid eligibility in some of his previous roles. There, he met patients who didn’t have the “dollar amount” required to go through the process of assistance or to be extensively engaged with by a health provider to support enrollment in Medicaid. He had a patient who died, because of delayed care and coverage. Because they had delayed following up without insurance for 9+ months from their initial symptoms, the patient died three days after having been diagnosed with cancer. It was after this diagnosis, that the organization helped the family enroll in Medicaid because the patient was eligible.
Advocatia started exploring ways they could inject technology into the process to make it scalable, so that people in the hospital and in the community helping with enrollment can see more patients, more efficiently and quickly. It was also important for Advocatia to identify ways they can engage more proactively; letting people know that they are eligible and helping them enroll. This paved the way for Advocatia benefit identification tool, which tells consumers for 60 seconds what benefits they are eligible for. This tool is available for free on a web browser, via text, or by scanning a QR code.
Advocatia started with Medicaid because it is important for hospitals and health systems to receive reimbursements for services rendered. So this is a cost-savings tool, but in the background and in addition to Medicaid, the tool also screens to see if someone is eligible for charity care. From day one Advocatia’s leadership also thought to include SNAP or food assistance programs. After looking at the hierarchy of needs my co-founder and I figured that at a minimum someone might be coming to an emergency room because they need food, and they are not able to eat. So, we eventually added on SNAP and WIC enrollments. Our team quickly saw that in most of the clients these benefits enrollments were siloed, usually, a caseworker was handling SNAP, and a financial counselor was handling Medicaid, and the information wasn’t being saved anywhere.
In most cases, the same questions were being asked across these benefit enrollment applications. Then we looked at how they can help to automate applications for different forms (federal, state, and local programs). We also needed to eliminate duplicative efforts from service providers helping with enrollment. This led us to consider organizations we can partner with to make the enrollment process easier for the enrollee and the person helping with registration.
JP: During your overview, you mentioned that it was important for clients to trust that this was worth their while. Can you tell us about how you have built trust into your platform?
LR: For Advocatia, it was important to ensure that the access points were trusted entities. By white labeling the product tools and having their partners' branding, it created more opportunities to engage.
And while it is possible to build trust using technology, there will be certain people who require face-face engagement, and the team at Advocatia has built that into the model. For example, they will host library events to engage clients and help them through the enrollment process. They also integrate with their clients via EMRs to ensure that the data isn’t asked for repeatedly, which is also a barrier to trust.
JP: For both of you, the work that you do centers around identifying and assisting disproportionately challenged populations. A big part of identifying these individuals and ensuring that they succeed through your programs is in data collection. Tell us a bit about data collection and how you respect the human element of the data.
JB: Higi was designed as a personal health record platform for individuals to own their data. That means the data is owed by the individual consumer, not by higi, a provider, or a health plan. Consumers can go in at any time and delete their information, which will disappear. higi augments the data to help identify programs that consumers are eligible for; that component is what partner organizations have access to. The only time higi will share a consumer’s data with any entity is with a consumer’s consent. Consumers can also stop sharing their data anytime if they change their minds. A large piece of why higi operates this way is to be a consumer-first platform. They prioritize asking questions that lead to navigating consumers to help. For higi, ensuring the platform is consumer-friendly and shareable for the right reasons leading to actionable solutions, is important.
LR: Advocatia develops questions that have many options to opt-in or out of questions, giving people the option to decline and providing responses where appropriate. To avoid repeating questions, Advocatia won’t ask a question if they know something from the EMR system already. It is important that they adhere to purposeful questionnaires and avoid questions not helping identify benefits a consumer is eligible for. This also helps build trust to sustain engagement through the process.
JP: How do we support a sustainable funding source for the work that you do? And what role does value-based care play in that? And what other incentives are necessary for this to work?
LR: Funding incentives depend on the programs. For Medicaid, there is a clear incentive for health care providers because they will receive reimbursement for individuals who otherwise would have become bad debt or charity care. However, for programs like SNAP, it is not clear-cut. A lot of collaboration is needed to realize the cost savings these programs introduce per individual—adding on other programs that help with the whole health of the individual moves the needle and results in cost savings.
JB: It’s probably worth mentioning that the landscape right now is such that you go from zero to 65 years of age having access to an average / below-the-average system of health care if you are poor; and when you reach the age of 65, you have relatively good health care options. What we are doing for the population of people below 65 who are struggling is something we all need to consider and design sustainable models for.
JP: What are you hoping to see change structurally in the next five to 10 years to start to address socio-economic issues at their core?
LR: There needs to be a stronger focus on interoperability, and people should be able to integrate. There are a lot of opportunities for this to take place. While there are many barriers, it would be an ideal goal, especially amongst the safety net or critical access hospitals.
JB: Having a mechanism that allows us to screen people or administer health reimbursement accounts (HRAs) to people below age 65 and being able to distribute bonuses to service providers that do this, as these screenings should include social issues.