NEW YORK CITY— Health plans and employers are flooded with pitches from digital health solutions.
Payers and self-funded employers want to cut through the noise to find solutions that offer a compelling value and lead to measurable outcomes that improve the health of their members and employees.
In an increasingly competitive digital health market, it's important for startups to understand what problem health plans and employers are trying to solve and how their solutions can meet those needs, founders say.
Four years ago, when the Centers for Medicare and Medicaid Services began allowing produce to be offered as a benefit to health plan members, FarmboxRx founder and CEO Ashley Tyrner said she initially pitched her company's services to health plan executives to address food insecurity.
"A health plan told me, 'That's great, we would love to feed all of our members but we just don't have the budget.' So, I surrounded myself with healthcare executives who helped us build a strategy around what payers care about, which is engagement; getting members to go take that self-efficacy journey in their quality outcomes like getting your mammogram, your diabetic eye exam and colonoscopy, because those are bonus premium dollars as well back to the health plan," she said during a recent panel discussion in New York City hosted by HLTH.*
Tyrner added, "We quickly moved from just food-as-medicine to engagement by using food as medicine."
FarmboxRx touts itself as a member engagement platform that partners with healthcare organizations to improve member health outcomes via customizable nutrition solutions and health literacy.
The company now works with about 90 health plans to deliver healthy food boxes while also including education, nudges and reminders to get members involved in managing their care through preventative actions like health screenings and lifestyle improvements.
"When we talk to payers now, the foot in the door is really with the quality team. It's really explaining to the health plan that we do more for their dollar; we check off a lot of boxes like a health equity box, for your food insecure members, we check off that box and we also will get members to go take those quality measures that plans desperately need members to engage in," Tyrner said.
Los Angeles-based Bold, a company focused on healthy aging, saw an opportunity to engage health plans on the idea of using movement-as-medicine as part of preventive care, according to Amanda Rees, the startup's co-founder and CEO.
"More than 85% of older adults are not sufficiently active, despite having access to it. We wanted to make the case of, how do you activate and engage the individuals who aren't exercising and what is the clinical value of doing that," she said during the panel discussion. "There is a corpus of research that balance and strength training reduces falls, which is both a pain point for an individual, who really doesn't want to have a fall and fracture despite how common or prevalent they might seem, and it's something that plans care about because falls are a top driver for admissions.
Medicare Advantage plans and providers are investing in programs and services to support healthy aging as falls and injuries drive high healthcare costs. More than one out of four older people falls each year, according to CDC data, and that results in $50 billion in medical costs. Medicare plans spend more on falls than on cancer, Rees noted.
The startup developed personalized, evidence-based virtual exercise programs for Medicare members to help prevent falls, reduce musculoskeletal pain and disability and increase physical activity levels.
"Our focus was could we build a belief and a case that if you engage older adults in these evidence programs that used to just happen in a senior center here and there, inconsistently and not scalably, could you deliver that digitally, get the same outcomes or better and actually increase the uptake and access. A lot of our work was actually doing a feasibility study, the sort of the burden of proof was on us to say, 'Yes, we can deliver clinical outcomes.' And I think that's got the attention of our payer partners."
Bold, which raised $17 million in series A funding in September, continues to expand with national and regional Medicare plans, accountable care organizations and provider groups. More than 10 million Medicare members now have access to Bold’s platform, according to the company. "The organizations that we work with reflect about 50% of all Medicare Advantage members," Rees said in an interview back in September.
Bold published a study in the Journal of Medical Internet Research that showed a link between participation in Bold's program and a 46% reduction in falls as well as a 182% increase in members' weekly physical activity levels.
Summer Health, a pediatric telehealth messaging service, also recognized opportunities to partner with enterprise customers to offer its 24/7 pediatric care to their employees.
"We find that while there is a huge need to reduce ER visits for kids—71% of ER visits for kids and teens are preventable and treatable from home. That ROI story is compelling but actually is not the 'hair on fire problem' for these plans. When we look at the 'hair on fire problem' for plans, it's mostly around well-child visits and closing HEDIS gaps for kids' vaccinations so by building a highly engaging platform, we then build trust with families and have license to then go and recommend they get the well-child visits and the vaccine in a similar way to how FarmboxRx is doing it, so that's been a big wedge for us," Summer Health founder and CEO Ellen DaSilva said during the panel discussion.
Summer Health, which launched in 2022, has serviced more than 30,000 pediatric virtual visits to date. The startup picked up $11.65 million in series A funding in April to help build out its technology platform.
Startup founders say they are then able to build on these strategies using their tech-enabled engagement platforms.
Tyrner said FarmboxRx works with health plans to address their specific population health needs.
'It begins with a conversation and talking to the plan about, 'What keeps you awake at night?' We take a really consultative approach to how we engage with a pair so no FarmboxRx program looks the same. Maybe a plan needs to move the needle on three different quality measures and maybe another plan needs to the needle on six. There's a tremendous amount of behavioral science that goes into what we do," she said. "Everybody gets box one because you can't miss what you've never had. And, inside of the box, there's a call to action, so maybe we're trying to get a member to go move the needle and go get a flu shot or a mammogram. You want to start with something small that they don't have to leave the home for."
She added, "We call it strategic utilization of other benefits. The health literacy that goes out in our boxes is educating members on other services that have nothing to do with FarmboxRx, maybe it's transportation, maybe it's utility benefits or if they are housing insecure, and then we connect them to that care. So, if they call in and say, 'I'd love to go get my mammogram, but I don't have transportation.' So, we say, 'No problem Mrs. Smith, did you know that you have 16 rides and no co-pay if you go to the doctor provided by your health insurance provider, let me connect you to that transportation service or let me connect you to that care management."
For Bold, health plans are interested in the touchpoints that the company has with older adults, Rees noted.
"When somebody is engaged in exercise, we have more frequent touchpoints and more clinically relevant insights than a typical provider or clinician visit because you're exercising on your healthy days and maybe even your unhealthier, recovery days, not just when you are seeking treatment or care. Every plan that we talk to was like, 'How else can we leverage this engagement?' What I think I'm sensing is really top of mind for Medicare is that budgets are tight and so they're looking for how do I get the most value out of every dollar spent?," she said.
"I pay attention to what happens at the CMS level because ultimately Medicare Advantage, every year, depending on what is top of mind and how their businesses is being influenced, that has downstream implications. The Health Equity Index and understanding shifts in how bonus payments are happening and what is top of mind, it varies from plan to plan. So, being sensitive to that and being a good partner is important. It can't be a one-size-fits-all solution. You have to be able to adapt and be flexible," Rees noted.
Flexibility to adapt to the changing needs of health plans and employers is critical to a successful partnership, DaSilva agreed.
"You start in one place but understand that you can continue to build around what the needs are," she said. "For us, in 2025, we see a lot of changes on the Medicaid side in terms of virtual visits being reimbursed. For us, it's thinking about how do we actually integrate with real-world sites of care and expand sites of care with a completely virtual solution."
Children are losing Medicaid coverage during the unwinding. Children’s Medicaid and Children’s Health Insurance Program (CHIP) enrollment declined by 5.5%, or 2.3 million children, from March 2023, before the unwinding began, to September 2023, according to KFF data. The company is exploring opportunities to help bridge these gaps in care, she said.
All three founders agree that building a highly engaging, easy-to-use platform or service that members and employees frequently turn to is critical to scale partnerships. That engagement then enables the companies to connect users to care and services that can drive meaningful clinical outcomes and healthier behaviors—such as a reduction in ER visits or an increase in mammogram screenings.
For FarmboxRx, the foundation of their service is sending families healthy food and that unlocks engagement with those families, noted Tyrner.
"There's a really common misconception that just because somebody is low-income, that they don't want to eat healthy and they don't want to be healthy. They do. They do not have accessibility, they cannot afford it and they don't know what to do with the healthy food or how to access care," she said. "If you solve those three things for an individual, they will take that self efficacy journey. For us, the health literature that goes out in every single box, it's customized for whatever plan we're working with for their market and whatever gap we're trying to close. That's our secret sauce. Getting them to understand other services that are available."
Bold designed its platform with a focus on dynamic adjustments and sophisticated behavioral science to engages members continuously with a goal of building sustainable habits and not just short-term recovery.
"We think a lot about skill building. Half of the members that are engaging on Bold and spending hours on our platform in a matter of months and being retained on their plans as a result of it, don't have a history of exercise when they join Bold. That is really awesome. That is activating someone who was in that 85% of the population that wasn't giving sufficient activity or building that habit of exercise," Rees said.
"We think heavily around designing features that support and enable that. If you don't have a habit of exercise, asking someone to do two hours of Tai Chi for fall prevention is a gap too big to jump. So much of it is making it relevant and fun and building the skills so that it's sustainable. They should not be reliant on text reminders for their next class forever because it should become self-regulated and intrinsic, but in the beginning you have to adapt and grow with the member and you have to be thoughtful about that journey," she added.
That engagement leads to higher retention to the exercise programs. "The beauty of movement-as-medicine and using exercise as engagement is that when you are exercising, you're not thinking about yourself as a patient, you're doing this as investment in my health. When you cross that gap to make it fun and something that people seek out, then that is adding value to their life and the reason why they keep showing up," Rees said.
Summer Health’s service resonates with parents looking for real-time medical guidance and access to care.
“The answer for us is very simple; it’s build a great product that engages people and that people love,” DaSilva said.
Summer Health’s team includes executives who have worked at WhatsApp, Uber and other tech companies, she noted.
In November, the company expanded its longitudinal primary care model with lactation support, sleep training, developmental milestone tracking and long-term pediatric care.
* Note: The panel discussion was moderated by the article author.