The Importance of Outsourcing Lay Navigation

Friends,

The topic today is one that is near and dear to my heart, and what I spend a fair share of my time working on. We’ll be focusing on the challenges that seniors face in navigating our complex healthcare system. This is a critically relevant issue for all of us in healthcare – now and for the next few decades. The population of Americans over the age of 65 is growing at a much faster rate than the general population. By 2034, there will be more Americans over 65 than under 18 years old. It’s a segment of the population that carries a tremendous amount of chronic disease and is in need of medical attention across the entire continuum of care – from preventive primary care, to specialty care, to surgeries and hospital care, and onto long-term care and more intensive palliative care.  Over 75% of seniors have 2 or more chronic diseases, and over 50% have 3 or more chronic diseases. The annual medical expenditures of seniors has surpassed $750B and is expected to double by 2030. Layered on top of this is the epidemic of social isolation & loneliness that seniors experience, and the marked issue of health disparities. In this interview we’re going to hear what our guest, Alex Harb, has discovered about the challenges that seniors face in navigating the healthcare system, and what he has created to address and mitigate those challenges.  

Alex was born in São Paulo, Brazil and raised in Santa Cruz, Bolivia before immigrating at the age of 9 with his mother. He received degrees in Biochemistry and Economics from the University of Texas at Austin and pursued post-baccalaureate training in software development from UT-Austin; followed by a Digital Health Biodesign Fellowship at Texas Medical Center’s (TMC) Innovation Institute. During his tenure at TMC, he observed, first-hand, some of the challenges that seniors encounter in their healthcare journey. It was from this experience that he launched Lena Health, whose mission is to simplify and improve the patient experience and outcomes for seniors, utilizing a tech-enabled, concierge-like, personal health assistant solution for navigating their health needs.

In this interview, we’ll hear:

1. How and why Alex pivoted Lena Health’s focus from social isolation to healthcare navigation.
2. Some really interesting and important understandings Alex and his team have gleaned about what seniors actually need in regard to their healthcare journey, and the communication channels they prefer.
3. The very consumer-oriented, effective and efficient approach that Alex has taken in organizing this concierge-like healthcare navigator solution. 
4. The outstanding value-based outcomes Lena Health has produced to date in terms of reducing ED visits, hospitalizations and readmissions, as well as off-loading nearly 20% of nurse navigator time.
5. How Lena Health achieves a Net Promoter Score of 94 and a monthly usage of nearly 90%

A dominant theme has been emerging as we continue to explore the home-based healthcare journey.  I would characterize the theme in four ways.  First, it’s a profoundly consumer-oriented approach. Second, it’s a profoundly contextual approach – actually exploring & uncovering the context of the individual & their family’s health journey – not an industry-centric health journey. Third, it’s an approach that could be labeled ‘whole person’ or ‘whole health’ – pulling in the entire context of a patient’s life as part of the healthcare experience and intervention. Fourth, it builds the technology around the consumers’ needs rather than forcing the consumer (both patient and provider) to bend themselves around onerous technology. 

In this interview, we’ve discovered another visionary healthcare entrepreneur – Alex Harb – who is reframing and recreating healthcare from this contextual, whole-person perspective. And, as in every interview, Alex Harb shares with us a few really key learnings that he’s gleaned.

• Over 90% of the requests made by seniors were not clinical and not related to social isolation; but instead were logistical, task-oriented needs around navigating the healthcare system.
• These care tasks included: (1) care coordination – such as scheduling appointments, referrals, medication prescriptions & refills, insurance & payment issues, and (2) social navigation – such as housing, food insecurity, transportation, access to medical equipment…
• 80 – 90% of these logistical task-oriented needs could be conducted either through an automated chatbot or through SMS texting with the majority being readily addressed via an AI-enabled automated chatbot channel. 
• Seniors were incredibly comfortable with the ease and convenience of SMS texting. (As a related aside, Alex shared a stat with me – over 80% of seniors do not log onto electronic medical record websites.)

When I did some back of the napkin calculations, it appeared that 60 – 70% of the Lena Health interactions are occurring via chatbot, 20 – 30% via text messaging, and 10 – 20% via phone call with a human personal health assistant. The implications of this are astounding for a number of reasons. 

First, it begins to really break down the myth that seniors can’t or don’t respond to automated chatbot communications. This point is validated by the incredible utilization Lena Health is achieving (nearly 90% monthly usage) and a NPS (Net Promoter Score) of 94. 

Second, it begins to demonstrate how automated channels such as chatbot and asynchronous channels such as texting can really leverage and preserve synchronous in-person communications for the moments and needs that really matter.  

Third, Lena Health is a spectacular example of what Roy Schoenberg, the co-founder & CEO of Amwell refers to as the third domain of healthcare.  As you might recall from that interview, Roy painted a picture of healthcare occurring in three domains or clusters: in-person, virtual & automated.  He was particularly excited about the transformation that automated healthcare will bring. In his opinion, this will be a significant part of our healthcare experience in the near future. 

When I queried Alex about his notion of a concierge-like experience, his response was that the personal health assistants would not so much be out-sourced as “near sourced”. His approach is to hire a team of personal health assistants that are local to the healthcare system client, and therefore local to patients and their families. An individual patient would be assigned to a specific health assistant; but the entire team would also become familiar with the patient, and would get to “know” that individual, providing that relationship-based, concierge experience.  

Adding to the seamless care experience, the Lena Health team also connects directly to patients’ providers and clinical care team, acting as a care team extender. Healthcare systems have the option to allow the Lena Health personal health assistants access to their EHR, so that the team can actually communicate directly with the patients’ providers.  

The advantages to healthcare systems are obvious. First, they don’t have to stand up and maintain an entire health navigator program. Second, they do not have to hire, train and manage these navigators. Third, they don’t have to attempt to develop, purchase and maintain the chatbot technology and platform that Lena Health has created and is continuously improving upon.  

I am super impressed with Alex Harb and the empathy-driven approach that Lena Health is taking in understanding and supporting seniors. While the focus is on the logistical care navigation & coordination needs of older patients, and while the under-the-hood product is highly tech-enabled, it’s clear that the fundamental purpose is to humanize healthcare. As Alex so eloquently states, “For me, it’s about how do we improve the aging experience of our seniors; and how do we build solutions that are based on human touch and connection that can be maintained throughout their experience”.

Until Next Time,
Wishing you Whole Person Health

Zeev Neuwirth, MD