Introducing Our Newest Advisor, Healthcare Strategist R.J. Briscione
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Investing in founders and companies defining whole person health has been a priority for us in 2022 as we look to democratize access to a healthier future.
In addition to catalyzing this initiative through capital deployment, we’ve also been keen on adding strategic talent to our platform to better streamline access to ecosystem stakeholders such as payers and health systems for our portfolio company founders as they build.
This access is pivotal as companies test into various go-to-market motions or look to explore strategic joint ventures or distribution partnerships with larger healthcare organizations.
Given this desire and our emphasis on care accessibility and health equity, we were grateful to have been connected with R.J. Briscione back in January of this year. R.J.’s recognition as a national expert in social determinants of health (SDoH) and patient/member engagement across government-sponsored plans from his time spent at Anthem, CVS/Aetna and Centene aligns nicely with many aspects of our thesis. Note that R.J. is now a Principal at The Focus Group, a boutique healthcare consulting firm focused on strategy and transformation.
Since being introduced, R.J. has added significant value to the Next Ventures platform, including portfolio company advisory, thought leadership via content, and investment theme development – so much so that we couldn’t be more excited and grateful to announce that we’re formally partnering with R.J. as an advisor to the fund, helping to bolster our platform and the services we make available to founders.
While we could go on and on about R.J.'s pedigree and value-add, we figured that the best way to introduce him is to give readers a peek into where he sees opportunities and challenges within healthcare today, highlighting core themes to collaboratively pursue going forward. So without further ado…
🗣 Q&A with R.J.
We’re seeing more and more states adding requirements for managed care organizations (MCOs) related to Social Determinants of Health (SDoH). What are the pros and cons of linking financial incentives like performance bonuses or penalties, capitation withholds, or value-based payments to quality measures related to stratifying social risk?
We first started seeing states ask some generalized questions (which are scored on competitive RFPs) to MCOs about how they are addressing (or are planning to address) social determinants a few years ago. Many states now require MCOs to do one or more of the following:
Screen enrollees for social determinants
Some take this a step further and require provider reimbursement for these screenings.
Adopt closed loop referral networks (e.g., Unite Us) and, in some cases, predictive analytics for social needs (e.g., Socially Determined)
If not requiring closed loop referral networks, nearly all states are requiring coordination with Community Based Organizations (CBOs).
Include SDoH in their Quality Assessment and Performance Improvement (QAPI) programs
These are currently fewer but are a recent trend worth watching.
While I would like to see some incentives for well planned and executed SDoH interventions, it is probably a little early and there is not quite enough standardization around what the social measures would be to do so (more on this below).
At a systemic, statewide level, we have seen two forms take shape in recent years, both of which can be instructive for future states/entities contemplating this work:
Both New York and Massachusetts have implemented Delivery System Reform Incentive Payment (DSRIP) Programs, which provide monetary incentives to providers for undertaking delivery system transformation efforts. In order to receive DSRIP funds, eligible entities (providers) must meet certain milestones or metrics. These outcome metrics are typically tied to population health improvements often related to SDOH.
North Carolina’s Healthy Opportunities Pilot is an innovative effort using Medicaid Dollars to fund evidence-based interventions that target SDOH. Through the waiver, the state will receive $650 million in Medicaid funds over five years to support its endeavor to connect patients to social services - $100 million of which can be used for capacity building. The pilot will target adults with two or more chronic conditions or repeated ED use or hospital admissions, high-risk pregnant women, and infants and children at high risk with one or more chronic conditions. It includes the following services in a defined fee schedule to address their needs and to potentially improve health outcomes and/or lower health care costs:
Homeless and housing insecurity
Tenancy support, housing quality and safety, legal referrals, financial support, and short-term post-hospitalization housing assistance.
Food support and meal delivery.
Non emergency health-related transportation.
Risk of witnessing or experiencing interpersonal violence
Interpersonal violence-related transportation, legal referrals, and parent-child support.
I am a big fan of this model as an important leap forward in whole person care, and I cannot underscore enough the work that it has already taken to get them to the point they are at now, having launched all of the services throughout this year. I look forward to tracking their results and I would highly recommend others to study both what this program does and does not contemplate tackling, as any good strategist should (shout out to my North Star, Prof. Porter).
We’ve published at length about the importance of trust and community-based care when serving the Medicaid population. When thinking about designing care models to meet more complex patient needs, how do you actually craft engagement motions that land in front of a beneficiary and prompt utilization?
Anyone that has spent any time with me knows that the issue of true member/patient engagement has been my soapbox for a while now. After so many years of working really hard on these topics, I‘ve come to a realization: “We” (the industry as a whole) so often miss on the last mile, or really, the last few inches of engagement for members/patients.
In a very busy world with lots of noise, engagement has to be designed to be relevant, convenient and easily accessible for the member/patient. This is especially relevant right now in Medicaid with the end of the Public Health Emergency (PHE) in sight and the need to engage so many regarding their Medicaid eligibility options – a largely nebulous topic to most. In order to build engagements that fit these criteria and that reach members where they are, they must be:
This can have different meanings to different people, but at a minimum, it must be culturally competent, which means much more than just simple translation. Doing so requires an investment in research and culturally competent tools and people delivering these messages.
Targeted (i.e., right channel)
To truly make members/patients part of the conversation, and to be effective, the message has to reach them how, when and where they prefer. Member preference for live agent, texting, interactive voice, email, etc. is important here.
There are some really exciting developments in research and data on these fronts that can and should be employed. In my experience, it's also been extremely helpful to get feedback from real members/patients in qualitative engagements and dedicated advisory panels. I’ve learned so much from real member advisory panels and have made a conscious effort to observe how members experience what we’ve put out there (and made a lot of changes after doing so).
When and where possible, engagement can work extremely well in the community with trusted partners or local clinics like Federally Qualified Health Centers (FQHCs) and CBOs. These can be as big as events and ongoing community based programs, as simple as a co-branded outreach channel delivered by a trusted partner, or as personalized as providing opportunities for one-on-one navigation - especially for complex topics such as enrollment/benefits navigation assistance for programs such as Supplemental Nutrition Assistance Program (SNAP), Women, Infants, and Children (WIC) or other public benefits for which members/patients may be eligible but not utilizing.
Aging-in-place has become quite an en vogue theme within the older adult population. What opportunities do you see here, especially as it relates to MA subsidization?
With the overall rise in MA membership, health plans have increased their offerings in Supplemental Benefits for MA. Two recent CMS shifts are the catalyst for many of these offerings:
The 2019 expansion of the definition of the “primarily health related” benefits to include “quality of life”.
The 2020 allowance of the “not primarily health-related” benefits to address social needs, known as the Special Supplemental Benefit for the Chronically Ill (SSBCI).
This has allowed MA plans to structure Supplemental Benefits to contribute to the overall goal of aging-in-place with services that address Activities for Daily Living (ADL). These changes, combined with plans looking to address both the bottom line (i.e., ROI) and top line (i.e., Member Growth and Retention), has allowed for the beginnings of some real aging-in-place innovation - both from a consumer and new markets/investment opportunity perspective. For example:
Transportation, including “socialization” transportation - think rides to Senior Centers, grocery shopping, etc.
Caregiving support, including respite support.
“Food as medicine” both in the medically tailored category and as an opportunity to support daily needs/aging-in-place.
These changes, combined with recognizing the need to address social isolation, which I believe is one of the great challenges of our time, has led to a whole new category of services. Papa is a best-in-class example here. I’ve known founder Andrew Parker since nearly the beginning of Papa and am bullish on their team and approach.
Another exciting innovation for aging-in-place is Upside, which takes one of my favorite ideas of “meet them where they are” and improves the “where” for supportiveness and opportunity for both social and health. I met Jake (a Papa alum) and his team early on and am looking forward to seeing how their approach can begin to affect health outcomes.
One note: since these benefit opportunities have been made available by CMS, there is some hesitation in going all-in on them early, generally due to funding availability (also could be its own topic). The linked survey from RWJF provides insights into real world issues that plans are grappling with, and I witnessed first hand.
Finally on this topic, while aging-in-place may be the goal for many, we should always caution that it may not be the best for all. Depending on the type of care needed and availability of caregivers, it may not be right for all in every situation. I wouldn’t dare attempt to be more eloquent on this topic than the always thoughtful and on point Sachin Jain, but I highly recommend reading his recent post for anyone interested in digging deeper.
What theme are you most excited about in healthcare right now across either services or IT?
Using equal parts of my “dad of three kids” (one teen and all growing) persona and my “healthcare improvement eternal optimist” persona, I believe there’s enormous opportunity in behavioral health (BH) as a whole, but specifically, child and adolescent BH.
Even before the pandemic, the system was difficult to navigate and access – pain points included long provider matching times, insurance coverage difficulties and friction around achieving the right provider fit, just to name a few. This made it plenty difficult already for adults/caregivers.
Now layer on the effects of the pandemic - kids missed at least a whole year of not only in-person learning, but also social and extracurricular activities. This results in a cocktail of complexity for parents/caregivers to manage.
I’ve seen some encouraging progress here already and I think this is an area that many who want to be able to deliver quality, accessible care will continue to innovate on.
If you are building or investing within health & wellness, we’d love to chat! Please reach out to firstname.lastname@example.org or head over to our website.
Consulting client of The Focus Group.