Technology in Healthcare–How Technology Can Drive People to Preventive Care & Telehealth

 The consolidation of benefit programs and applications to combat "too much tech."

Transcription:

Alyssa Place (00:08):

I am Alyssa Place Executive Editor at Employee Benefit News, and joining me today is Nancy Jester, a Senior Manager on the Walmart US Benefits team. Nancy has been with Walmart for 21 years and has a vast experience across the benefits spectrum. Today, Nancy focuses her efforts on emotional and physical wellbeing, including Walmart's most recent Centers of Excellence, expansion with kind body to include coverage for fertility services. And I'd also like to welcome Dr. Madhavi Vemireddy, CEO at Cleo, where she is responsible for clinical and product strategy as well as program outcomes. Madhavi is board certified in internal medicine and she also founded Care Tribe, which was acquired by Cleo in 2022 and provided expert support to family caregivers of children with special healthcare needs all the way through adult loved ones. So thank you so much for both joining me today. We're on a bit of the healthcare beat this morning, so it'll be good to dive into the tech side. I think a great place to start, as much as we might be fatigued or talking about this is Covid and how that was perhaps a turning point for technology and healthcare. So I would love to hear your experiences for how the healthcare access has shifted and the way that there's just been really this total embrace of tech in the healthcare experience. What's that been like?

Madhavi Vemireddy (01:41):

Well, I mean I think from a access perspective, I think thinking through about the pandemic and workers being at home and work life sort of integration and the blurring of the lines, it's like a lot of folks lost access to care that they were receiving, right? On the one hand have a child with special needs and didn't, all of his therapy just stopped, right? And he couldn't go to school. And so from that perspective, it was how do I try to bring back, find therapists, have easy access to them, figure out who's available through virtual sort of visits. But I think essentially what the pandemic did was really make employees think about how can I get access to care and information that is specific to my needs so I don't need to go out figuring it out by myself and piecemealing together this plan and also access to experts that doesn't require a live call, like easy access messaging. And so I think that was definitely an area of convenience, make it easy for me to get the information that I need. I think the other thing that obviously happened during the pandemic is just our definition of health expanded. So it wasn't just about my physical health, but my emotional wellbeing, especially the strain of now being at home and caring for loved ones in my house as well as outside of my house. And so thinking more about family health and social health alongside financial wellbeing. And so just broadening our concept of health and wellbeing.

Nancy Jester (03:40):

I think coming from an employer perspective or a retailer perspective, people learned how to access everything differently during Covid, whether it was Zoom calls with family members, whether it was online shopping and grocery pickup, and healthcare was no different. People out of necessity had to go to more online visits. I was a caregiver for my mother and she had several specialists. She had never done a Zoom or a FaceTime call in her life, and she became an expert at 70 plus years old because out of necessity, that was how she got healthcare. And I think now once healthcare is returned and the same for other retail experiences, people now expect to be able to shop for whatever they want however they want, and that includes healthcare services. So digital and virtual solutions are no different in that space.

Alyssa Place (04:39):

I mean, I think that brings up a good point of the instant necessity of having something and the speed at which people adapt to these new technologies. I mean, from a product perspective, how did you adapt to that at Cleo? How do you keep up with the pace of how much people want things like five minutes ago?

Madhavi Vemireddy (05:02):

Right. Well, I think it was important for us to step back and say, how do we support our families? So at Cleo, we're supporting families across all life stages, everything from planning for parenthood through pregnancy care, parenting of all ages, and then caregiving for a loved one or a child with special needs. And so with that, it became really important for us not only to have services that really would appeal more to those that are dealing with an urgent need, those are the folks that are more likely to pick up a phone or to message with an expert to say, okay, I have this critical problem that I need to solve. But we wanted to also leverage technology to enable this population health approach to say, how do we drive more prevention? How do we support families no matter where they are across those life stages, especially knowing that families might be going through multiple care journeys at once.

(06:05)

When we talk about the sandwich generation prior conversation was talking about the silver tsunami. So we know that sandwich generation's only going to grow, and so it becomes really important for us to understand what is the makeup of your family? So it's not just your immediate family members, like the ages of your children, your spouse partner, but also are you taking care of a parent or another relative or maybe it's the neighbor next door that you keep a close eye on. So your definition of family, our goal was to be all inclusive of really understanding of who are you taking care of and then understanding, well, what's the situation that you're in? So leveraging technology to say, are you dealing with just really a normal, typical experience and you just need to be educated about what are the common milestones, common issues that you may be coming across versus you need specialized support taking care of a child on the autism spectrum or your parent has dementia or you have a baby in the nicu. And so you can leverage technology to, essentially what we did is create these support plans to say, based on who you're taking care of, what are the things that you need to be educated about so you understand early on what are those warning signs I need to be aware of? Or if I'm seeing some of these warning signs, what should I do that I think allows us to go beyond just supporting those with the acute need, but helping to drive prevention. So hopefully mitigate some of those acute urgent needs

Nancy Jester (07:51):

And get out in front of things when you can. I think right to that point, technology has a vast span from accessing care and actually engaging in it and then being educated on resources and providing the tools wherever they go. And so we have a employee website and we have apps that we provide our associates that are directly for them, and we're delivering tools and resources to them digitally so that they can access it whenever they want, however they want, and really adapting. We heard loud and clear from our associate population that they needed certain, they wanted to access certain things digitally. And so over the past few years, and you mentioned something earlier with the mental health, we've waived our copays for digital mental healthcare. We've announced a few months ago a partnership with Lyra Health for virtual, our EAP services. So we provide all associates as of their date of hire, 20 free therapy sessions in-person therapy sessions, regardless of their medical plan enrollment. And it's really just to provide any kind of tools and resources to them wherever they are, and adapting to the time people want things differently and the needs are different of families across the world.

Alyssa Place (09:20):

Yeah, I mean, it's interesting that you are both providing technology solutions. I would love to know how you're using technology yourself to figure out, for example, who's using with in Cleo, how do you know where to perhaps boost support or at Walmart? How do you know that the 23 sessions are being used? So how are you yourselves using technology to provide more technology essentially? Okay.

Nancy Jester (09:47):

Yeah. So we are, and so Melissa and Peter mentioned we do have access to that data. It's really partnering with our partners, our vendor partners, and asking for transparent to tie back in their call asking for transparent reporting and really getting into the weeds good enough is not great. Good enough is not enough. It's always pushing the status quo and using the data and technology to continue to evolve programs. One of our taglines recently is tech empowered people enabled or tech enabled people powered, and we use that. So we use the technology, the data, the reporting. We have some really phenomenal data scientists on our team actuaries, and we are looking at the data to make decisions on because prior to May, we had 10 free sessions. So using data, we doubled that whenever we launched our new partnership because of the needs of our associates and really to be competitive within the retail population. So it's just using it and not resting on our laurels and absolutely continuing to push the status quo on things.

Madhavi Vemireddy (11:04):

And I would say at Cleo, one of the things that we wanted to do was not only track utilization of like, okay, who's engaging with us? What type of expert sessions are they having? What content are they viewing? But we wanted to deploy advanced analytics so we can really understand what are the needs of the family when they first come to Cleo. And then using that same measurement over time to track are their needs, are they improving, right? Where can we then deploy different interventions if we don't see their needs improving? And just really trying to understand different cohorts and what works best for them. So one of the things that we deployed earlier this year was called the Family Health Index. And our thesis is we talk a lot about Whole Person Health, but I think what we're missing is thinking about family-centered health and that being a critical pillar for Whole Person Health because behind every care recipient is a caregiver.

(12:11)

If you think about that family unit, if the care recipient is not doing well, either their health is declining or their needs are increasing, that's going to have a material impact on that caregiver. And we know that in this country, majority of caregivers are working full or part-time, so they're doing this off the side of their desk. But if that health of that caregiver declines because they're at that stage of burnout, then the health of the care recipient also is impacted. So it's really thinking about that full family unit and the connections between the caregiver and the care recipient. So we deploy the family health index to say, well, how do we measure the overall health and wellbeing of this family unit? We looked at seven dimensions of your emotional health, your physical health, how confident are you, your connectedness, your family support, and your caregiving balance.

(13:07)

Are you able to balance your caregiving responsibilities? And so what we found is actually because most of our employees and members who are engaging with Cleo, they're coming to us first to get help for their loved one. I need help because I'm seeing these behavioral challenges in my teenager or because my mom just fell and now I need to figure out how to keep her safe at home. But they don't come to us necessarily for themselves. And so we use the family health index and provide them the results in real time as soon as they take it to say, well, here's the areas you're doing well, but here are the areas where you're not doing well. And that has been a great way a call, almost a wake up call for that caregiver to understand, oh my goodness, I didn't realize I failed that PHQ4 and I'm at risk for depression or anxiety or that I see now that my self-care is being, I'm not taking care of myself and I need to focus there. And so providing the tools so that they can understand where they need that specific help, but also helping them understand that others like them are going through similar challenges. And so really leveraging the technology to enable that.

Alyssa Place (14:35):

Yeah, I mean, I think so many of these things have such a personal element too. And we talk about caregiving. I mean, you both have very personal caregiving experiences when you're talking about mental health. These are all things you mentioned. So how do you keep the human element in that where you're not just saying, all right, I'm going to look at my reports, I'm going to look at my technology. How are you finding the right balance between having that human element and providing the empathy and listening support that can help the technology really shine?

Nancy Jester (15:11):

So from a people perspective, the technology is great, but behind that has to be the empathy, the sympathy, the human component. Just like you said, I think part of it is we start by listening to the needs, finding the right solution, but then making sure that it's not just a screen or just an app that's not truly got me to it, I should say. You can't lose the human component because that's what, well, that's what makes this humanity. And I think coming from a caregiver's perspective, I can relate to a lot of what you just said. Yes, it's all fine and good to have tech and powered devices to manage a blood pressure or whatever it might be. But if it doesn't go anywhere beyond that, like my mom, she had a lot of medical issues, and if her blood pressure was up, I was all on top of that. It would be great to have had a technology to support that, but not if I'm still managing it right. There has to be a human behind it with that engagement from a technology device standpoint. And technology's come so far in that space. I mean, the human component is there and it's evolving. It's exciting to see different solutions coming out on the market to help with healthcare with the human component not left behind. So it's important for sure.

Madhavi Vemireddy (16:46):

Yeah, I mean, it's definitely a critical part of our model. We have a global care network of allied health professionals with expertise across different stages of life. So if you're going through pregnancy care, you're most likely going to be working with a doula or a midwife. We have lactation consultants, sleep consultants, because you use the technology to really help enable and empower the services that you're providing so that we can really have our experts, what we say, practice at the highest level of their licensure so that they are solving issues that you really can't solve with technology. I mean, you're dealing with complex, sometimes you're dealing complex family dynamics where maybe an individual's taking on all of the caregiving responsibilities and you need to figure out how do you empower that individual to have those difficult conversations of saying, I need help. And so the experts I think are critical, but I think it's also really important to say, well, I think part of it is preference because not everyone wants to speak with somebody or feels like they're in that stage of their journey where they need live support.

(18:11)

So obviously if they prefer to work, you want to make that available to them, but if they don't, you don't want to not have support for that individual. But at the same time, I think it's really important that for those that are further along in their journey, that whether they prefer it or not, you need them to understand there's support for them. And these are the things that are where an expert can help them in that journey. And I think we definitely see great engagement and support because that guide is dedicated to them throughout their journey. So it's not a one-time sort of concierge, and then you come back with another need and you're talking to somebody else, knows someone. That's almost like your life guide that's there as your journey evolves.

Nancy Jester (19:11):

One thing you said was individual, it's individualized. Some people don't want that level of engagement. Others want to go out and find their own resources. Just give me the tools. Others need that daily video call. I mean, it just depends on what that is. Another thing I thought of was the AI conversation we had yesterday. AI is a great tool that's coming along, but you have to remember it's not perfect and it doesn't have that human component that is absolutely critical in validating the AI output. So I think that goes right along with technology and people to make sure that there has to be a good balance between the two.

Alyssa Place (19:55):

Yeah, and I mean in terms of that, we're talking about ai, there's new technology, there's so many solutions. It could almost feel, and I think especially perhaps in the mental health space, there's this real oversaturation of options and things like that. Nancy, how are you picking benefits when you're looking at hundreds of options? How do you decide what's the best for your group? How are you making those determinations?

Nancy Jester (20:25):

It's not easy. I could probably, I'm speaking to the choir, it's not easy to make those because there's a lot of solutions. There's a lot of solutions out there. I don't think we're to the point of oversaturation yet. I think it's great to have competition. It's tough whenever we have a need. There's one company out on the market doing it. There's one company out on the market doing it whenever there's multiple. And I think a lot of the musculoskeletal space has really the digital physical therapy. That's an example. We launched a partnership with Omada Health a few years back on a pilot basis. We're in 21 states now. And that was an example. I had 11 different companies in my RFP. That's a lot. That's a big RFP, but there's a lot of variety of what solutions are out on the market just for that. And then you take that times all the other chronic conditions that are out there. It's tough. But fiduciary from a fiduciary responsibility, we are self-insured. Don't make those decisions quickly by any means. I tell companies, Walmart's kind of like the Titanic. It takes forever. We don't sink. Maybe we're the lusitania.

Nancy Jester (21:48):

It takes forever to move sometimes because we're 1.6 million people strong in the US. I mean, we don't make decisions overnight. We really truly vet them. And a lot of it comes down to we understand the responsibility we have with that one from our associates and their families, but two for other employers that are looking to us to see what we do. We don't want to go the wrong direction and inadvertently hurt another employer by making that same decision. So it's really deeply vetted time. Yeah, it's definitely not easy, but there is a lot of solutions out there. But I am excited about that too.

Alyssa Place (22:35):

And to counter that, Madhavi, how do you then stand out in a field where there's so many, how do you differentiate yourself when you're coming to a Walmart or another big company when the competition is pretty fierce?

Madhavi Vemireddy (22:48):

No, that was an excellent question and obviously something we think about all the time. One of the reasons why Cleo acquired Care Tribe last year was because they realized that it didn't make sense. If you thought about a member's journey. I mean, these are universal life experiences that we're talking about having children, taking care of your parents, raising children, and you think about how individuals are going through multiple care journeys at any one time you're pregnant and then you have an older child you're taking care of, you're taking care of a sick husband or a partner and you're raising children, or you have parents that you're worried about or maybe something or they're dealing with a chronic health condition that you are supporting while you're raising your children. And so as you think about those universal life experiences, you realize, well, why are we expecting them to go to multiple point solutions to manage their family and thinking about family more broadly?

(24:01)

Because then A, it's not a good experience. B, you are missing critical information that will have an impact on their ability to care for themselves or care for their loved ones. And so really it's important to have that full picture. So that's where I think it's thinking about there are point solutions that might have expertise in a specific area, but does it make sense from a member experience perspective if it's really tightly connected with other solutions? But I think the other key piece where we see partnership being really critical for us is just thinking about from the lens of a parent or a caregiver, especially knowing that, for example, we see 44% of our families failing the PHQ4 when they come to Cleo. And so that's just highlighting the significant impact it's having on their emotional wellbeing and high risk these families are for eventually burning out.

(25:08)

Well, then we need to have a very tight partnership with our mental health partners in that employer's ecosystem because they tend to be one of the highest mental health and wellness tend to be the vendors where we're doing most of the referrals out to as we are working with their families. And so we look at opportunities where we can do other activities with that vendor so that we are creating that better holistic experience. So it's not like I'm going to refer you to Lyra, right? And say, hopefully you show up there. No, I want to know that you actually showed up there and I want to know how that is now impacting your ability to care for your family. And so I think those connection points I'm hopeful, will actually become stronger and have a more leveraging technology, having a more integrated experience because I do see so much synergy between family health and mental health, family health and driving wellbeing and self-care for that employee all in the hopes of decreasing that burnout.

Alyssa Place (26:25):

And you just brought up a couple of different trends, family health, the continued focus on mental health. You mentioned MSK. What are some other areas that you anticipate? I'll start with you, Nancy, as you're looking ahead toward the next year, where are some areas where you're looking for solutions or you think you're going to be investing for employees?

Nancy Jester (26:45):

Sure. So I would say definitely related to access to care, chronic condition management, quality of care is important. So we're not just looking at the solutions at face value, but looking at the quality that they can provide and really move the needle on trend on healthcare spend as, yeah, everybody's looking at that. But I would say definitely from a mental health perspective is something we're looking at. I'm personally invested in maternity care and improving health outcomes related to women and children from a fertility standpoint, that's something that really is passionate to me personally. But I would say chronic diseases, diabetes, hypertension, and anytime we can increase access to care wherever someone is getting it, whether it is a digital solution or even self-care, providing a person may not be ready to engage with a provider or ready to engage with the medical system and they want to just improve their own health before they have to do that. I think that's important too.

Madhavi Vemireddy (27:58):

Yeah. I mean, I think from the Cleo perspective, I mean we see a huge opportunity to partner with the carriers. We just have a partnership with Optum where we're part of their women's health hub. And so now we're having conversations around that tighter integration with their care management, with their maternity case management, with behavioral health. Again, really trying to connect the dots between family health and the health of the care recipients as well as the caregiver. And seeing, okay, well what services are available? How do we make those referrals? How do we really create almost a cross-functional team so that our care team that's focused on improving the health of that family is working closely with the care manager or their mental health coach and really driving that more holistic approach to supporting that unique needs of that family unit. We're also obviously looking at even partnerships with care delivery systems because again, I think there is the opportunity to really educate the market on in adjacent to, in addition to Whole Person Health, you have to really help enable this family-centered care model by bringing in the caregiver understanding is the caregiver equipped to take care of their loved one.

(29:42)

So I do see opportunities there of just helping our healthcare ecosystem evolve to think about family health as a critical component of Whole Person Health. I would agree.

Alyssa Place (29:56):

And I think there's obviously going to be so much more evolution, especially when you consider the role of technology and how that's ever changing. Thank you both so much for your time. This was so interesting. Please feel free to grab either of these experts when you see them in the hall. And that concludes our panel today. Thank you all.

Madhavi Vemireddy (30:15):

Thank you.