April 24, 2023 • 21 mins
The drivers of health (DOH) play a significant role in health outcomes, yet most existing health care business models are not equipped to address them. In these episodes, we explain why a health care entity would, and should, tackle the drivers of health, and how they can go about doing so effectively and sustainably.
Join Ann Somers Hogg for part 1 of this series as she speaks with Mini Kahlon, an innovator who has built a new business model to address the DOH.
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Episode Transcript
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Ann (00:01):
A lot of leaders and innovators talk about disrupting health care,
but what does that really mean and how does one
actually do it on life centered health care? We dive
into these questions and more talking to innovators who are
leveraging Clay Christensen's theories to transform our health care ecosystem.
I'm Ann Summers Hogg, senior research fellow of health care
at the Clayton Christensen Institute. And I hope these stories
(00:23):
help inspire you along your journey to transform health and care.
Hello listeners. Welcome back to another episode of Life centered
Health Care. Today we'll talk about the drivers of health
and the fact that while they play a significant role
in health outcomes, most existing health care business models aren't
(00:44):
equipped to address them. Now, this will be a two
part episode. And today we'll talk to an innovator who
has built a new model to address the drivers of health.
And then in part two, we'll speak to an incumbent
transforming their business to better address drivers of health. Wherever
you are and your drivers of health. Journey, you can
learn from both of these perspectives and am thrilled to
welcome Mini Callan to the show today. She is a
(01:07):
founding vice dean of Dell Medical School, the founder and
director of Factor Health and an associate professor in the
Department of Population Health. Many has her PhD in neuroscience,
was previously the CIO at UCSF'S Clinical and Translational Science
Institute and is an award winning technology leader. She is
among the most forward thinking innovators I know, and you
(01:28):
will be sure to learn a lot from what she
shares today. So without further ado, I'll turn it over
to Minnie to share more with you about her health
focused approach at Factor Health. Many I like to start
with why could you tell our listeners why you founded
Factor Health and your vision for what it will accomplish?
Mini (01:44):
Thanks. Ann Summers I'd love to. So I've been immersed
in health system transformation work for more than a decade
and have been able to see what's possible, the improvements
we're making from within the system. But in the meanwhile,
as more attention has been focused on the broader drivers
of health, I saw an opportunity to really re-envision where
(02:06):
we begin in addressing health issues. So even as I
saw folks in the clinical enterprise embrace some of the
social and non-medical drivers of health, it were still starting
from where they were comfortable, which was within the clinic,
starting at a hospital, beginning to screen as necessary, referring
(02:27):
people to services. But as I thought about the possibility,
I thought we might be missing the biggest area of
opportunity by starting in the clinic. And so we began
by saying, What happens if you start in people's lives?
What happens if you start sort of in the rhythm
of the life of a mother and her child and
(02:47):
ask in that rhythm of life, how best to support
the mother in driving health for her child or how
best to support the child, or how best to support
someone who is homebound and has a lot of medical
risk factors as well as social risk factors? Do we
wait for them to show up at the hospital or
can we meet them where they are and sort of
(03:08):
design around that first and then as necessary, refer back
to the clinic so that they are then able to
get the expert professional help they need when they need it.
Ann (03:20):
I love how you talk about re-envisioning, where you begin
and really grounding the opportunity in people's lives. Think you
said the rhythm of people's lives and really designing around
where people are first and then going back to the
clinic if that's necessary. So I love how you've really
flipped the health care frame from starting with the traditional
(03:41):
supply side. What health care is providing starting in the
clinic to really grounding your offering in demand? Now you've
built a unique business model with factor health, which you
and your team built from scratch. What is it about
your structure that separates you from other non-clinical health organizations
in the market?
Mini (04:01):
The first thing just for us to come to grips with,
of course, is that we're talking about a business model
within a market that's really not been created yet. So
whatever we're doing has to embrace the fact that the
value propositions aren't clear, that the payer, the customer in
some level is not clear about what they're actually going
(04:21):
to get, let alone the mechanisms to purchase. Consumers, on
the other hand, definitely know what they want, but they're
not used to a health system actually giving them what
they want necessarily just telling them what to do and
then then waiting for things to get worse. So as
we designed our business model, we took those two things
into consideration. And so in our business model, we focus
(04:44):
both on the customer, on the on the pair, which
is primarily health care insurance. And and we actually start
with them not because they're the most important the person
we're serving is, but recognizing that the market was still
to be developed. We wanted to be really clear about the.
A major pain points that health care bears have so
that knowing that they would have to go through considerable
(05:07):
hurdles to pay for a novel kind of solution, we
would begin by solving some of their hardest problems so
that they would be more motivated than not to actually
pay in the future. So we start with a pair.
We make sure we understand their interests in terms of populations,
conditions and timelines, which is a really big deal. So
(05:28):
how fast do they need results? Then we go back
to the opportunity space and we look at the science
and the literature and the evidence, and we take a
really pragmatic lens around what we think is actually doable,
what are the areas of opportunity? And we sort of
go back and forth. And then once we come to
a an understanding of an area, a condition and a
(05:48):
population for which the healthcare payer is really feeling strapped.
So they would actually do more than they normally do
to put effort into paying for a solution. Then we
think about the people that are affected by that condition
and then we actually stop thinking about the pair or
the customer in a sense, and we think about the
(06:09):
consumer and then we really design around the consumer's interest
And what that means in the world of drivers of
health is that we don't come to a problem saying
we're a food solution for a person or we're an
alternate workforce, a community health worker solution, or we are
a physical activity or behavioral incentives or financial incentives solution. Instead,
(06:31):
we think about all the pieces that are necessary to
meet the person where they're at, and then we stitch
all of those together, getting some of the parts of
the solution from existing providers where that's available and other
parts of the solution, designing them ourselves. If that is
in fact what's necessary.
Ann (06:46):
I love the multifaceted approach in how you are grounding
your value proposition, both in what the customers need, like
you said, predominantly the payers in the situation and what
the consumers need. And in health care, unlike other industries,
it's so critical to design around both and so few
business models do. So it's fascinating how you've how you've
(07:08):
done that. And actually, as you were talking, I was thinking, wow,
if I still worked in industry, I'd want to go
work for many just in how you really you really
do align the business model, just as the theory says
you should, to have an effective value proposition. And I
loved what you said about you design around the consumer's interest.
It's not about coming at the problem with here's a
(07:31):
solution around food or here's a solution around community health workers,
but really doing the deep work to understand what's the
progress those people are seeking to make. And then how
can you craft a solution that addresses their needs as
well as the payers main pain point? Another thing I'd
love to hear you talk more about is some of
(07:53):
the health outcomes that you're most proud of that have
resulted from this model. Now for listeners, awareness Factor Health
is fairly new. You have not been around for tens
of years and you're a relatively new model that launched
right amidst the pandemic. So could you talk about some
of the outcomes that you've achieved in a fairly short
(08:15):
amount of time?
Mini (08:16):
I'd love to. What a great invitation to talk about
some of the results that we're most proud of. So
let me start with some of the best work is
done comes about serendipitously. And in fact, we were beginning
a meals program in in spring of 2020 and in
March of 2020, actually, and just as we were supposed
to begin a meals program for people with diabetes, which
(08:38):
we are now doing in a different format, the pandemic
struck and the very people we wanted to serve became
even more isolated than before. And these were clients of
our local Meals on Wheels of Central Texas, a great
partner organization of ours. And they had to huddle and
start creating new ways to support the people they were supporting.
And we had an opportunity. We had to pause the
(09:00):
meals program, but we had an opportunity to sit back
and think about the needs of the people we were serving.
Realizing now conditions like loneliness and isolation might be even
more of a problem to sort of tackle than before.
And we had been thinking previously about the role of
human connection and empathy in a world where we were
(09:20):
reaching people outside the clinic and we then took some
of those ideas and very rapidly through April, designed a
totally novel program. I'm really proud, actually, about the timeline
of doing this kind of sort of program design implementation,
clinical trial results. So we started in April and the
results I'm going to talk to you about were published
(09:40):
in February of the following year. And that if anyone
who knows who does clinical trials knows, it's kind of
crazy talk. And they were published in JAMA Psychiatry. So
really well, you know, really well recognized, peer reviewed publication.
I'm really proud of the science. Here's what happened. We
went in and. We took the person's viewpoint, right? Just
(10:01):
as I said, the consumer's viewpoint. We thought about how
to serve them with connection and empathy. We use the
telephone because we were not going to be entering their
homes to set up video terminals. Turned out it was
the best thing we could have done. Most of the
work that we compare ourselves to still does video tele
engagements and ours is just using the telephone. And we
(10:22):
found people that were passionate. In this case, they were
mostly students, 17 to 20, 23 year olds that were
passionate about giving back, concerned about people in their community.
And we ended up with about 15 to 16 of
these wonderful volunteers. We paid them as hype and eventually
for their time. And they took on each a panel
of about 6 to 9 people. And we put a
(10:44):
telephone call based, empathy focused program in place where, again,
thinking about the person at the end defined every part
of the program. So, for example, if we're going to
be reaching out to people, we wanted people, the people
we were reaching out to decide what they wanted to
talk about, how long they wanted to talk, when they
wanted to be called. Even things like the frequency of calls,
(11:07):
which usually when you design a trial, you want to
you think that the dosage is, you know, the number
of telephone calls. And instead, after the first week, we
let people decide if they wanted five telephone calls a
week or if they wanted 2 or 3. And we
believe that that giving people that agency is also a
big part of the solution. So we implemented a randomized
controlled trial where we compared what happened with those that
(11:30):
received our program versus those that didn't. And we found
a definitely effects on loneliness, on some standard scales of loneliness,
as we expected, within four weeks. But what really surprised
us was the degree of effect we had on some
clinical measures of symptoms of depression and anxiety. And those
were really important because those are measures that our customer,
(11:55):
our health care payers do respond to. And so those
large influences on depression and anxiety really caught the attention
of a lot of folks when the paper eventually came
out in 2021. And we are now building on that
in the midst of what I think is going to
be really exciting results from a trial where we kind
(12:15):
of doubled down on the mental health effects, but asked
can we increase the value proposition further by using mental
health as an entry into supporting people with chronic conditions.
In our case, it's unmanaged diabetes. So that's one example
of results that we sort of stumbled into in some ways.
But our focus on the customer and consumer kept the
(12:37):
discipline going and which is why I think we were
able to get the results that we saw.
Ann (12:41):
That's so impressive. And I know one thing that listeners
are probably wondering after how do I replicate this is
how did you pay for this effort? So in thinking
about the business model, you talked about the value proposition
of focusing on both the consumer and the customer. When
you talked about how you executed it, you covered the
(13:02):
resources that you leverage. So the phone was critical as
opposed to the virtual video that many others are using.
The passionate students were another critical resource. And then I
believe we have talked about before how some training was
done for those callers so that they were well versed
in listening and empathetic conversations. And so as I think
(13:24):
about the four components of the business model, I'm wondering
about the profit formula. So could you talk a little
bit about how the study was paid for?
Mini (13:33):
The study was paid for through.
Our so one of the reasons we're able to do
this work is we have an amazing partnership with a
foundation in Texas called the Episcopal Health Foundation, whose own
strategic plan focuses on health, not just health care. And so,
I mean, it is a match made in heaven. And
I am tremendously grateful for their bet on me on
Factor Health, the team. So they helped to de-risk this
(13:57):
work by supporting the program definition and also most importantly,
allowing us to be flexible. Can you imagine if we
had had an NIH grant, we would not have been
able to pivot in the way we did from March
to April and deliver the results that we did. And
so the the addition of foundations are another funder that
we have for our youth program is the Michael and
(14:19):
Susan Dell Foundation. These foundations really end up providing the
risk buffer for testing these out. Now we're looking at
who pays for it. And I'll tell you what the
models look like and what conditions look like. So just
for mental health and one area of great interest is
for maternal health, where not only are there challenging issues
(14:40):
and postpartum depression, but turns out not many have really
looked at the impact of and resolution of mental health
issues during pregnancy itself. So even before giving birth and
then how that if you can improve mental health before
giving birth, how does that impact postpartum depression? And so
that's an area of. It interests where we have ACOs
(15:01):
and some Medicaid plans that are very interested in deploying
this kind of talented layperson approach to manage the mental
health in this case for maternal and infant outcomes. So
that's one. The other place, another sort of model for
implementing it is through FCS or other clinic systems. Now,
as long as their payment mechanism incentivizes results rather than
(15:25):
the number of visits per se. And so that's another
line of interest where they are already talking to to
see how we can implement this at scale. We added
the diabetes focus, which is the trial we're currently in,
that I'm really excited about because if we're able to
demonstrate amplified impact not only on mental health but on
(15:47):
managing people's unmanaged diabetes, then the value proposition just is
blown out of the water and we're excited about where
that takes us. And even more doors would open.
Ann (15:57):
I think a key takeaway there for listeners is the
power of the alignment between what you as a founder
are trying to do and your funders goals. When you
talked about the role of the foundation and how they
really provided a risk buffer and allowed you to be
flexible because you both had the same goal of improved
(16:17):
health as the output. And now because of that and
the foundation you were able to create with the Sunshine
Calls program, you have all this interest from other payers.
So it really goes to show the role that philanthropy
can play in bridging a business model from its early
days to a more sustainable long term trajectory. So thanks
(16:39):
for explaining that. And as I've said, you've built such
a unique business model that's grounded in what both consumers
and customers really desire. And you've shown in a very
short amount of time that your interventions improve health and
it's cost effective. So I'm sure many listeners are wondering
what can they learn as they go to replicate your approach?
(17:03):
So my question for you is what would you advise
other innovators who are looking to impact drivers of health
through new business models?
Mini (17:13):
Thanks. Ann Summers The first piece is really the piece
you emphasized when we began, which is in order to
solve a problem, start with a problem which sounds so obvious,
but I think we just don't do that enough. In addition,
in this space, you've got to solve the problem based
on specific perspectives and then kind of do a dance
(17:33):
around those to settle on something that that serves multiple
different I mean, actually multiple different customers. You have the
paying customer may be an insurance insurer. You have people,
the consumers who are also paying customers because they pay
with their health, in effect, and then because these are
emerging areas. So some of the work we're doing, for example,
(17:53):
is an early kidney disease. When we look at the
effect of produce on albuminuria there, the science is still
is still developing, for example. And so I think actually
one of our major customers is the scientific field in general.
So they need evidence in a certain way so that
others can then build on the research and continue to
to push these sort of scientific ideas out. So really
(18:18):
it's important to think about all of the people that
have problems to be solved that all come together in
the service of improving health. So that's the first thing
I would say is think of everyone involved in the
problem and don't try to average those out, but put
yourself in the shoes of the people whose problems you're solving.
(18:38):
Another group, by the way, are the potential deliverers of
the future providers of the future. They have problems to
solve as well. So that's the first thing I would say.
And then the second is definitely look at the science.
Take a pragmatic lens on how to review evidence. Convince
yourself that something can actually work in the time frames
of interest. A lot of things that we believe in
(19:00):
are true generally speaking, but when you apply them to
the time frames of the settings of interest, you might
question it a little bit more, which doesn't mean that
they may not be true in the future, but it
exposes you to the questions that remain to be answered.
So that's another one. And then thirdly, we are ourselves
always open to people reaching out and on our work
(19:21):
share as much as we can about the elements of
our work that we believe made made our work successful.
We have projects. One of the other pieces of results
that we didn't talk about was around influencing child diet
by supporting caregivers and parents. We have a lot of
food based work as well, all of which we'd love
to share information about with like minded folks.
Ann (19:44):
Awesome. To that end, what is the best way for
our listeners to learn more about your work at Factor
Health that you didn't cover today or to connect with you?
If they are working in similar spaces and have learnings to.
Mini (19:57):
Share, I think one of.
The best ways to get in touch. Such is just
search for many on at Dell Medical School on Google
you'll find me. My email address is public, but it's
at Austin texas.edu. You can look for me on LinkedIn
or on Twitter at McAllen and get in touch.
Ann (20:19):
Thank you so much, Minnie. Thank you for coming to
share the story of Factor Health, your incredible business model
that you've built in the outcomes that you've achieved. A
couple of the things that you said really stood out
to me, and I'll recap those for our listeners. Now
to solve a problem, start with the problem. It's not
something we do enough of and make sure that you're
(20:39):
involving everyone in the problem, not averaging them out, but
really putting yourself in the shoes of those who you
are seeking to serve. You mentioned the importance of starting
with the science and identifying the gaps and the questions
to be answered, and I'll leave listeners with your comment
around the importance of connecting and collaborating with others to
(21:00):
make progress. So many of you truly practice what you
preach and thank you so much not only for sharing
the great work of Factor health, but for launching it
and growing it and for the impact that you are making.
Mini (21:14):
Thank you. Ann Summers. That was a great summary. I
need to record it for myself.
Ann (21:19):
Well, luckily you'll have it on this podcast. So there
you go. Thank you so much, Minnie. Really, really appreciate
your time. Thank you for listening to life centered healthcare.
If you like what you heard, please leave a review
on Apple, Spotify or wherever you're listening. And for more
of the latest in healthcare, check out our website, Christensen Institute. Org.
You can sign up for our newsletter and read our
(21:40):
latest industry insights. Until next time, have a wonderful day, everyone.
A lot of leaders and innovators talk about disrupting health care,
but what does that really mean and how does one
actually do it on life centered health care? We dive
into these questions and more talking to innovators who are
leveraging Clay Christensen's theories to transform our health care ecosystem.
I'm Ann Summers Hogg, senior research fellow of health care
at the Clayton Christensen Institute. And I hope these stories
(00:23):
help inspire you along your journey to transform health and care.
Hello listeners. Welcome back to another episode of Life centered
Health Care. Today we'll talk about the drivers of health
and the fact that while they play a significant role
in health outcomes, most existing health care business models aren't
(00:44):
equipped to address them. Now, this will be a two
part episode. And today we'll talk to an innovator who
has built a new model to address the drivers of health.
And then in part two, we'll speak to an incumbent
transforming their business to better address drivers of health. Wherever
you are and your drivers of health. Journey, you can
learn from both of these perspectives and am thrilled to
welcome Mini Callan to the show today. She is a
(01:07):
founding vice dean of Dell Medical School, the founder and
director of Factor Health and an associate professor in the
Department of Population Health. Many has her PhD in neuroscience,
was previously the CIO at UCSF'S Clinical and Translational Science
Institute and is an award winning technology leader. She is
among the most forward thinking innovators I know, and you
(01:28):
will be sure to learn a lot from what she
shares today. So without further ado, I'll turn it over
to Minnie to share more with you about her health
focused approach at Factor Health. Many I like to start
with why could you tell our listeners why you founded
Factor Health and your vision for what it will accomplish?
Mini (01:44):
Thanks. Ann Summers I'd love to. So I've been immersed
in health system transformation work for more than a decade
and have been able to see what's possible, the improvements
we're making from within the system. But in the meanwhile,
as more attention has been focused on the broader drivers
of health, I saw an opportunity to really re-envision where
(02:06):
we begin in addressing health issues. So even as I
saw folks in the clinical enterprise embrace some of the
social and non-medical drivers of health, it were still starting
from where they were comfortable, which was within the clinic,
starting at a hospital, beginning to screen as necessary, referring
(02:27):
people to services. But as I thought about the possibility,
I thought we might be missing the biggest area of
opportunity by starting in the clinic. And so we began
by saying, What happens if you start in people's lives?
What happens if you start sort of in the rhythm
of the life of a mother and her child and
(02:47):
ask in that rhythm of life, how best to support
the mother in driving health for her child or how
best to support the child, or how best to support
someone who is homebound and has a lot of medical
risk factors as well as social risk factors? Do we
wait for them to show up at the hospital or
can we meet them where they are and sort of
(03:08):
design around that first and then as necessary, refer back
to the clinic so that they are then able to
get the expert professional help they need when they need it.
Ann (03:20):
I love how you talk about re-envisioning, where you begin
and really grounding the opportunity in people's lives. Think you
said the rhythm of people's lives and really designing around
where people are first and then going back to the
clinic if that's necessary. So I love how you've really
flipped the health care frame from starting with the traditional
(03:41):
supply side. What health care is providing starting in the
clinic to really grounding your offering in demand? Now you've
built a unique business model with factor health, which you
and your team built from scratch. What is it about
your structure that separates you from other non-clinical health organizations
in the market?
Mini (04:01):
The first thing just for us to come to grips with,
of course, is that we're talking about a business model
within a market that's really not been created yet. So
whatever we're doing has to embrace the fact that the
value propositions aren't clear, that the payer, the customer in
some level is not clear about what they're actually going
(04:21):
to get, let alone the mechanisms to purchase. Consumers, on
the other hand, definitely know what they want, but they're
not used to a health system actually giving them what
they want necessarily just telling them what to do and
then then waiting for things to get worse. So as
we designed our business model, we took those two things
into consideration. And so in our business model, we focus
(04:44):
both on the customer, on the on the pair, which
is primarily health care insurance. And and we actually start
with them not because they're the most important the person
we're serving is, but recognizing that the market was still
to be developed. We wanted to be really clear about the.
A major pain points that health care bears have so
that knowing that they would have to go through considerable
(05:07):
hurdles to pay for a novel kind of solution, we
would begin by solving some of their hardest problems so
that they would be more motivated than not to actually
pay in the future. So we start with a pair.
We make sure we understand their interests in terms of populations,
conditions and timelines, which is a really big deal. So
(05:28):
how fast do they need results? Then we go back
to the opportunity space and we look at the science
and the literature and the evidence, and we take a
really pragmatic lens around what we think is actually doable,
what are the areas of opportunity? And we sort of
go back and forth. And then once we come to
a an understanding of an area, a condition and a
(05:48):
population for which the healthcare payer is really feeling strapped.
So they would actually do more than they normally do
to put effort into paying for a solution. Then we
think about the people that are affected by that condition
and then we actually stop thinking about the pair or
the customer in a sense, and we think about the
(06:09):
consumer and then we really design around the consumer's interest
And what that means in the world of drivers of
health is that we don't come to a problem saying
we're a food solution for a person or we're an
alternate workforce, a community health worker solution, or we are
a physical activity or behavioral incentives or financial incentives solution. Instead,
(06:31):
we think about all the pieces that are necessary to
meet the person where they're at, and then we stitch
all of those together, getting some of the parts of
the solution from existing providers where that's available and other
parts of the solution, designing them ourselves. If that is
in fact what's necessary.
Ann (06:46):
I love the multifaceted approach in how you are grounding
your value proposition, both in what the customers need, like
you said, predominantly the payers in the situation and what
the consumers need. And in health care, unlike other industries,
it's so critical to design around both and so few
business models do. So it's fascinating how you've how you've
(07:08):
done that. And actually, as you were talking, I was thinking, wow,
if I still worked in industry, I'd want to go
work for many just in how you really you really
do align the business model, just as the theory says
you should, to have an effective value proposition. And I
loved what you said about you design around the consumer's interest.
It's not about coming at the problem with here's a
(07:31):
solution around food or here's a solution around community health workers,
but really doing the deep work to understand what's the
progress those people are seeking to make. And then how
can you craft a solution that addresses their needs as
well as the payers main pain point? Another thing I'd
love to hear you talk more about is some of
(07:53):
the health outcomes that you're most proud of that have
resulted from this model. Now for listeners, awareness Factor Health
is fairly new. You have not been around for tens
of years and you're a relatively new model that launched
right amidst the pandemic. So could you talk about some
of the outcomes that you've achieved in a fairly short
(08:15):
amount of time?
Mini (08:16):
I'd love to. What a great invitation to talk about
some of the results that we're most proud of. So
let me start with some of the best work is
done comes about serendipitously. And in fact, we were beginning
a meals program in in spring of 2020 and in
March of 2020, actually, and just as we were supposed
to begin a meals program for people with diabetes, which
(08:38):
we are now doing in a different format, the pandemic
struck and the very people we wanted to serve became
even more isolated than before. And these were clients of
our local Meals on Wheels of Central Texas, a great
partner organization of ours. And they had to huddle and
start creating new ways to support the people they were supporting.
And we had an opportunity. We had to pause the
(09:00):
meals program, but we had an opportunity to sit back
and think about the needs of the people we were serving.
Realizing now conditions like loneliness and isolation might be even
more of a problem to sort of tackle than before.
And we had been thinking previously about the role of
human connection and empathy in a world where we were
(09:20):
reaching people outside the clinic and we then took some
of those ideas and very rapidly through April, designed a
totally novel program. I'm really proud, actually, about the timeline
of doing this kind of sort of program design implementation,
clinical trial results. So we started in April and the
results I'm going to talk to you about were published
(09:40):
in February of the following year. And that if anyone
who knows who does clinical trials knows, it's kind of
crazy talk. And they were published in JAMA Psychiatry. So
really well, you know, really well recognized, peer reviewed publication.
I'm really proud of the science. Here's what happened. We
went in and. We took the person's viewpoint, right? Just
(10:01):
as I said, the consumer's viewpoint. We thought about how
to serve them with connection and empathy. We use the
telephone because we were not going to be entering their
homes to set up video terminals. Turned out it was
the best thing we could have done. Most of the
work that we compare ourselves to still does video tele
engagements and ours is just using the telephone. And we
(10:22):
found people that were passionate. In this case, they were
mostly students, 17 to 20, 23 year olds that were
passionate about giving back, concerned about people in their community.
And we ended up with about 15 to 16 of
these wonderful volunteers. We paid them as hype and eventually
for their time. And they took on each a panel
of about 6 to 9 people. And we put a
(10:44):
telephone call based, empathy focused program in place where, again,
thinking about the person at the end defined every part
of the program. So, for example, if we're going to
be reaching out to people, we wanted people, the people
we were reaching out to decide what they wanted to
talk about, how long they wanted to talk, when they
wanted to be called. Even things like the frequency of calls,
(11:07):
which usually when you design a trial, you want to
you think that the dosage is, you know, the number
of telephone calls. And instead, after the first week, we
let people decide if they wanted five telephone calls a
week or if they wanted 2 or 3. And we
believe that that giving people that agency is also a
big part of the solution. So we implemented a randomized
controlled trial where we compared what happened with those that
(11:30):
received our program versus those that didn't. And we found
a definitely effects on loneliness, on some standard scales of loneliness,
as we expected, within four weeks. But what really surprised
us was the degree of effect we had on some
clinical measures of symptoms of depression and anxiety. And those
were really important because those are measures that our customer,
(11:55):
our health care payers do respond to. And so those
large influences on depression and anxiety really caught the attention
of a lot of folks when the paper eventually came
out in 2021. And we are now building on that
in the midst of what I think is going to
be really exciting results from a trial where we kind
(12:15):
of doubled down on the mental health effects, but asked
can we increase the value proposition further by using mental
health as an entry into supporting people with chronic conditions.
In our case, it's unmanaged diabetes. So that's one example
of results that we sort of stumbled into in some ways.
But our focus on the customer and consumer kept the
(12:37):
discipline going and which is why I think we were
able to get the results that we saw.
Ann (12:41):
That's so impressive. And I know one thing that listeners
are probably wondering after how do I replicate this is
how did you pay for this effort? So in thinking
about the business model, you talked about the value proposition
of focusing on both the consumer and the customer. When
you talked about how you executed it, you covered the
(13:02):
resources that you leverage. So the phone was critical as
opposed to the virtual video that many others are using.
The passionate students were another critical resource. And then I
believe we have talked about before how some training was
done for those callers so that they were well versed
in listening and empathetic conversations. And so as I think
(13:24):
about the four components of the business model, I'm wondering
about the profit formula. So could you talk a little
bit about how the study was paid for?
Mini (13:33):
The study was paid for through.
Our so one of the reasons we're able to do
this work is we have an amazing partnership with a
foundation in Texas called the Episcopal Health Foundation, whose own
strategic plan focuses on health, not just health care. And so,
I mean, it is a match made in heaven. And
I am tremendously grateful for their bet on me on
Factor Health, the team. So they helped to de-risk this
(13:57):
work by supporting the program definition and also most importantly,
allowing us to be flexible. Can you imagine if we
had had an NIH grant, we would not have been
able to pivot in the way we did from March
to April and deliver the results that we did. And
so the the addition of foundations are another funder that
we have for our youth program is the Michael and
(14:19):
Susan Dell Foundation. These foundations really end up providing the
risk buffer for testing these out. Now we're looking at
who pays for it. And I'll tell you what the
models look like and what conditions look like. So just
for mental health and one area of great interest is
for maternal health, where not only are there challenging issues
(14:40):
and postpartum depression, but turns out not many have really
looked at the impact of and resolution of mental health
issues during pregnancy itself. So even before giving birth and
then how that if you can improve mental health before
giving birth, how does that impact postpartum depression? And so
that's an area of. It interests where we have ACOs
(15:01):
and some Medicaid plans that are very interested in deploying
this kind of talented layperson approach to manage the mental
health in this case for maternal and infant outcomes. So
that's one. The other place, another sort of model for
implementing it is through FCS or other clinic systems. Now,
as long as their payment mechanism incentivizes results rather than
(15:25):
the number of visits per se. And so that's another
line of interest where they are already talking to to
see how we can implement this at scale. We added
the diabetes focus, which is the trial we're currently in,
that I'm really excited about because if we're able to
demonstrate amplified impact not only on mental health but on
(15:47):
managing people's unmanaged diabetes, then the value proposition just is
blown out of the water and we're excited about where
that takes us. And even more doors would open.
Ann (15:57):
I think a key takeaway there for listeners is the
power of the alignment between what you as a founder
are trying to do and your funders goals. When you
talked about the role of the foundation and how they
really provided a risk buffer and allowed you to be
flexible because you both had the same goal of improved
(16:17):
health as the output. And now because of that and
the foundation you were able to create with the Sunshine
Calls program, you have all this interest from other payers.
So it really goes to show the role that philanthropy
can play in bridging a business model from its early
days to a more sustainable long term trajectory. So thanks
(16:39):
for explaining that. And as I've said, you've built such
a unique business model that's grounded in what both consumers
and customers really desire. And you've shown in a very
short amount of time that your interventions improve health and
it's cost effective. So I'm sure many listeners are wondering
what can they learn as they go to replicate your approach?
(17:03):
So my question for you is what would you advise
other innovators who are looking to impact drivers of health
through new business models?
Mini (17:13):
Thanks. Ann Summers The first piece is really the piece
you emphasized when we began, which is in order to
solve a problem, start with a problem which sounds so obvious,
but I think we just don't do that enough. In addition,
in this space, you've got to solve the problem based
on specific perspectives and then kind of do a dance
(17:33):
around those to settle on something that that serves multiple
different I mean, actually multiple different customers. You have the
paying customer may be an insurance insurer. You have people,
the consumers who are also paying customers because they pay
with their health, in effect, and then because these are
emerging areas. So some of the work we're doing, for example,
(17:53):
is an early kidney disease. When we look at the
effect of produce on albuminuria there, the science is still
is still developing, for example. And so I think actually
one of our major customers is the scientific field in general.
So they need evidence in a certain way so that
others can then build on the research and continue to
to push these sort of scientific ideas out. So really
(18:18):
it's important to think about all of the people that
have problems to be solved that all come together in
the service of improving health. So that's the first thing
I would say is think of everyone involved in the
problem and don't try to average those out, but put
yourself in the shoes of the people whose problems you're solving.
(18:38):
Another group, by the way, are the potential deliverers of
the future providers of the future. They have problems to
solve as well. So that's the first thing I would say.
And then the second is definitely look at the science.
Take a pragmatic lens on how to review evidence. Convince
yourself that something can actually work in the time frames
of interest. A lot of things that we believe in
(19:00):
are true generally speaking, but when you apply them to
the time frames of the settings of interest, you might
question it a little bit more, which doesn't mean that
they may not be true in the future, but it
exposes you to the questions that remain to be answered.
So that's another one. And then thirdly, we are ourselves
always open to people reaching out and on our work
(19:21):
share as much as we can about the elements of
our work that we believe made made our work successful.
We have projects. One of the other pieces of results
that we didn't talk about was around influencing child diet
by supporting caregivers and parents. We have a lot of
food based work as well, all of which we'd love
to share information about with like minded folks.
Ann (19:44):
Awesome. To that end, what is the best way for
our listeners to learn more about your work at Factor
Health that you didn't cover today or to connect with you?
If they are working in similar spaces and have learnings to.
Mini (19:57):
Share, I think one of.
The best ways to get in touch. Such is just
search for many on at Dell Medical School on Google
you'll find me. My email address is public, but it's
at Austin texas.edu. You can look for me on LinkedIn
or on Twitter at McAllen and get in touch.
Ann (20:19):
Thank you so much, Minnie. Thank you for coming to
share the story of Factor Health, your incredible business model
that you've built in the outcomes that you've achieved. A
couple of the things that you said really stood out
to me, and I'll recap those for our listeners. Now
to solve a problem, start with the problem. It's not
something we do enough of and make sure that you're
(20:39):
involving everyone in the problem, not averaging them out, but
really putting yourself in the shoes of those who you
are seeking to serve. You mentioned the importance of starting
with the science and identifying the gaps and the questions
to be answered, and I'll leave listeners with your comment
around the importance of connecting and collaborating with others to
(21:00):
make progress. So many of you truly practice what you
preach and thank you so much not only for sharing
the great work of Factor health, but for launching it
and growing it and for the impact that you are making.
Mini (21:14):
Thank you. Ann Summers. That was a great summary. I
need to record it for myself.
Ann (21:19):
Well, luckily you'll have it on this podcast. So there
you go. Thank you so much, Minnie. Really, really appreciate
your time. Thank you for listening to life centered healthcare.
If you like what you heard, please leave a review
on Apple, Spotify or wherever you're listening. And for more
of the latest in healthcare, check out our website, Christensen Institute. Org.
You can sign up for our newsletter and read our
(21:40):
latest industry insights. Until next time, have a wonderful day, everyone.
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