Community organizations as access points for healthcare

HealthOpX is addressing two points of the MIT Solve challenge

• Enable informed interventions, and decision-making by governments, local health systems, and aid groups by providing social determinants of health data and service history from our community organization partners

• The partnerships we create between the community organizations and healthcare organizations are in low-income underserved communities, and our electronic referral platform improves accessibility and quality of health services for those communities.    

In addition, as a diverse company that is co-founded and owned by a 2nd generation Asian American, 2nd generation Latinx American, and black-American, we currently work with refugee organizations, food banks, diaper banks, churches, and other organizations across the U.S. that impact similar communities that our families grew up in.

HealthOpX has built an in-house nonprofit CRM called HelpOpX that digitizes processes and member data for community organizations such as diaper banks, food banks, religious organizations, and ethnic organizations. This new and flexible technology specializes on low-tech nonprofits that have large amounts of data and service underserved communities that are uninsured or on Medicaid/Medicare.

Our nonprofit CRM has a custom plug-in that we built that allows community organizations to send electronic referrals to federally qualified health centers, case workers, and other relevant groups. This referral can send over survey data, social determinants of health data, notes on what the person needs, and nonprofit services the community member has received in the past so that healthcare professionals can accurately assess the needs of the patient. Community members can also scan a questionnaire QR code at the nonprofit site, or have it scanned for them if they do not have a smart phone and be automatically referred to different organizations on our network based on their needs. This could be for transportation needs, medical needs, housing needs, enrolling in food assistance programs, etc. This transforms the community organizations into a familiar access point of care for community members.

Blending in individualized social determinants of health data and healthcare data as a healthcare organization or government organization allows them to make more informed decisions with interventions. It is also more useful than population health level data because outreach can be conducted at the individual level.

Bridging the technology gap for community organizations enables a natural partnership between community organizations, government organizations, and healthcare organizations to better serve their overlapping underserved communities and removes barriers to access care for those communities.

The population we work with are people in the U.S. on Medicaid/Medicare, uninsured, or living below or around the ALICE threshold. The ALICE threshold is the minimum income level necessary for survival for a threshold. Specifically, the people that receive services or attend food banks, diaper banks, religious organizations, ethnic organizations, and community outreach organizations. One of the organizations we work with gives an example of the health needs of this population: the Community Food Bank of Central Alabama stated that 70% of those surveyed had high blood pressure which leads to stroke and heart disease. 37% of those surveyed have diabetes.

There are rampant, correlative health issues related to poverty and social determinants of health. On average, a person will go to the food bank 7 times a year. We see that as 7 times that we could work with healthcare organizations to identify and address healthcare issues, create individualized treatment plans, or deliver preventative care resources catered to that individual. By providing these services, we are able to overcome barriers to transportation, access to care, and knowledge gaps for community members.

The easiest way to engage the population we are targeting is to show up at places where they are already asking for help and work with entities that they trust. By providing newly digitized data from community organizations to government and healthcare organizations, not only will there be the opportunity for positive healthcare outcomes, there will be opportunities for structural and policy change from the government.

Wesley Ma (Co-Founder/CEO) is a 2nd generation American had to help his parents navigate the healthcare system. He and his family faced numerous barriers to access care and received support and comfort from their local community-based organization. To deliver a sustainable system that would ensure proper care for families like his, he knew that he had to support community organizations and partner them with healthcare organizations. Wesley surveyed 50 nonprofits similar to the ones that helped him growing up to build the beginning functionality for HealthOpX.

Dr. Jose Hernandez’s (Co-Founder/Head of Data & AI/ML) parents were farmers that immigrated from Mexico to California. With his family facing the challenges of poverty and citizenship, Jose was the first in his family to go to college. He experienced first-hand the barriers that underserved communities had to go through. He still never missed a chance to volunteer at nonprofits and give back to the community through mentorship. His passion for the community and personal experiences pushed him towards co-founding HealthOpX. His knowledge of data and AI/ML makes him a valuable team member when working with healthcare and government organizations.  

Kyle Harris (Co-Founder/CTO) is a black-American who’s family is originally from Detroit. He has witnessed the negative impact of health inequity on his family and community. When him and his family were able to move to the suburbs, they took in their cousin who’s immediate family was not able to do the same. He was able to see all of the opportunities afforded to him that were not afforded to his extended family and the opportunities mutually excluded due to being black. Kyle utilizes his years of software development experience and personalize experiences to create a product with the community members experience always in mind.

We currently work in Michigan and Alabama.

In Alabama we work with a community outreach organization that services ~4,000 individuals every year and a Diaper Bank that collectively services around ~30,000 individuals every year. We are currently onboarding the Community Food Bank of Central Alabama that has 330 food pantries and collectively serves around ~40,000 people a year. We have an upcoming paid pilot with the University of Alabama-Birmingham Health System, which is the in the top 10 largest health systems in the U.S., and Cooper Green (federally qualified health center) to improve access to care for individuals in Birmingham, Alabama.

In Michigan we work with a food pantry that see's ~2,000 unique individuals a year and the largest Burmese nonprofit in the Midwest with ties to Burmese refugee organizations across the U.S. which services ~1,000 individuals every year. We have not set up healthcare relationships in Michigan yet.

Of our already onboarded organizations, we currently have 37,000 community members in our database that we are looking to serve. With our target population of 34,000+ in Birmingham, Alabama, it is our goal to provide healthcare and social services to these individuals. 

Our goal is to scale our solution to underserved communities across the United States. We are excited to connect with other ambitious and resilient social impact entrepreneurs, mentors, and organizations that genuinely care about the populations we serve.  

To provide some background on some of the barriers we face, Alabama is a very conservative state, and is not a Medicaid expansion state. Meaning, even though we seek to benefit the uninsured population there few monetary incentives outside of working with health systems and Medicaid/Medicare payers (health insurers). Although we were able to secure a paid pilot with a health system, the payers are very risk averse. Even if we can prove that we can get people to primary care physicians, case workers, and social assistance organizations, the payers need data that ties our services into outcomes, which typically takes a year or longer. This is a barrier we will run into in many states. 

The reason why we are applying to Solve is to receive the monitoring and evaluation support to build an impact measurement practice at our pilot sites and help with business model development. We currently have a plan to expand into underserved communities in other states, and would benefit from the media and conferences from Solve. The combination of network and services from Solve would undoubtedly help the growth of our company and help us impact more underserved communities in the U.S.

Our technology is able to bring low-tech community organizations into the digital age. These organizations are often the largest holders of up to date contact information, service information, and social determinants of health data for underserved communities. This newly digitized and structured data is extremely valuable for healthcare organizations, government organizations, and innovators to address needs and complete data sets at an individual level. Making it so that community organizations can easily work with these broader organizations without needing to be tech experts opens the door for collaboration that would positively impact underserved communities. Making community organization collaboration more accessible from a process, data, and security standpoint would break down barriers and catalyze more ideas and solutions targeting underserved communities. For example, we are able to leverage our community organization network, healthcare network, and government network to help those dis-enrolled from Medicaid re-determination.  

In the past, electronic referral networks were made solely from a healthcare provider standpoint. These complex and hard to use systems made it nearly impossible for low-tech community organizations to participate. In fact, many community organizations still use paper, excel, and google forms. Which makes it hard for them to collaborate with other organizations in a structured and secure manner.  

Our solution is focused on the community organization point of view, not only improving access to care for community members they serve, but also helping them organize their member data, service data, and subsequently grant reporting. We provide a solution that works for the community organizations as well as healthcare and government organizations.

Our measurable impact goals for this year utilizing our community organization and healthcare network are:

Health Education

1. Improved Health Literacy in understanding insurance, navigating low-cost options, and seeing the right healthcare specialists

Care Coordination

2. Increased access to primary care services

3. Increased access to case workers

4. Increased utilization of nonprofit services that benefit social determinants of health

5. Total number of people screened for social determinants of health on our platform

Community Health

6. Total number of people re-enrolled onto Medicaid after Medicaid Re-determination

Five Years

1. Reduction in minority health disparities in communities we serve

2. Estimated amount of ER and urgent care visits reduced

3. Estimated number of lives saved by early preventative screening and care interventions

4. Reduction in deaths by cardiovascular disease correlated to high blood pressure

5. Number of collaborations between newly digital community organizations, healthcare organizations, and government organizations

Next year measurements for Good Health and Well-being

For our health education goals in improving health literacy, we are counting education materials handed out and using our nonprofit service tracker tool. When a nonprofit teaches a class on health education we are able to grab the member list and display it in our dashboard.

For our care coordination goals of increasing access to primary care services and access to case workers we can see the list of completed referrals to different entities on our platform. To see if there is increased utilization of nonprofit services that benefit social determinants of health we are able to utilize our nonprofit service tracker tool. To see the total number of people screened for social determinants of health on our platform we are able to track this across all organizations using our in-house survey analytics/reporting tool.

On our platform we can track completed referrals to case workers and county governments when trying to determine how many people we were able to get re-enrolled onto Medicaid after Medicaid Re-Determination. Since people are not always accepted onto Medicaid after applying, we will have to check every quarter to reassess the referral to enrolled ratio.

Five Year measurements for Good Health and Well-Being

Measuring progress towards estimated amount of ER and urgent care visits reduced we will work with our healthcare partners and cross-reference our nonprofit service data with their electronic medical records. Leveraging the medical records from the healthcare partner and matching who received services from nonprofits we work with, we can see if the interventions and improved access to care we are creating through partnerships is influencing ER and urgent care visits in the zip codes we serve.

Estimating the number of lives saved by early preventative screening and care interventions and reductions in death by cardiovascular disease correlated to high blood pressure is utilizing a mix of historical data and predictive modeling. Working with the healthcare and government partners we will see if our services have had an impact in the communities we are in vs. a control group of an nearly identical population.

Estimating the number of new collaborations that address needs for underserved communities between newly digital community organizations, healthcare organizations, and government organizations will be continuously internally tracked within a master dashboard on our systems.

Five year measurements for Reduced Inequalities

To measure reduction in minority health disparities we will grab government and healthcare data through our partnerships to do a historical trend analysis and can point to the communities that our platform is in. We will be looking specifically at communities where we were able to create community organization, healthcare, and/or government relationships with.

Goal:

Health Equity

Objectives

Create efficient partnerships between community organizations, healthcare, and government organizations.

Causal Link

By creating partnerships between community organizations, healthcare organizations, and government organizations we can coordinate better health outcomes for at-risk communities the organizations mutually serve.

Outcome

Improve health outcomes for at-risk communities that community organizations, healthcare organizations, and government organizations mutually serve.

Causal Link

“Healthcare organization and CBO respondents alike identified ways in which participating in a partnership has built or expanded organizational capacities. Over half of respondents indicated that their organization’s capacity expanded in network-building, improving processes and programs, program development, and generating new funding as result of partnership. On average, partnerships that were established earlier tended to report more expanded capacities. In addition to health outcomes and cost savings, partnership has contributed toward an expanded set of skills for both healthcare organizations and Community-Based-Organizations, skills that can strengthen individual organizations beyond the context of partnership.”

https://www.chcs.org/media/Wor...

Outputs

Product: HelpOpX – A nonprofit CRM system that specializes in digitizing data and processes for low-tech community organizations such as food banks, diaper banks, religious organizations, ethnic organizations, and community outreach organizations.

Product: HealthOpX – an electronic referral plug-in that allows referrals to be sent to community organizations, healthcare organizations, and government organizations.

Causal Link 

“Data is a critical component of partnerships, and is required to understand and articulate the effort’s value in improving health or reducing costs. In many cases, data is also required to get paid. As outcomes-based funding becomes more prevalent, the ability to collect quality data is an essential component of partnership. Private funders, too, are increasingly incorporating outcomes data in determining how to achieve greater impact with their money. Beyond funding, data also plays an ever-important role in prudent partnership management – to understand growth opportunities, to course-correct, and to continually improve programs and processes.” https://www.chcs.org/media/Wor...

“Coordinating care for adults and children has become one of the fastest growing and most complicated challenges facing communities today...The ease of securing necessary supports for persons with complex health needs is paramount to patient
well-being. Using technology, real-time confirmation of services availability reduces frustrating ‘dead ends’ for both clients and providers, and ensures a feedback loop that makes follow-up on referral outcomes possible so clients are less likely to ‘slip through
the cracks.’ ” - Respondent from partnership based in Washington

https://www.chcs.org/media/Working-Together-Toward-Better-Health-Outcomes.pdf

Activities

Bring low-tech community organizations technologically forward so that they can efficiently partner and collaborate with other nonprofits, healthcare, and government organizations.

Provide care coordination to vulnerable populations through partnerships between community organizations, healthcare organizations, and government organizations to improve health outcomes in the communities they live.

Goal:

Health Equity

Objectives:

By creating an easy to use and flexible nonprofit CRM, we can bring low-tech nonprofits technologically forward to effectively partner with healthcare and government organizations.

Causal Link

By building tools that break down barriers for nonprofits, healthcare, and government organizations to collaborate, these organizations can effectively coordinate care and services for at-risk communities that they mutually serve.

Outcome:

Increase coordinates services for at-risk individuals in underserved communities.

Causal Link

By accessing individualized data from nonprofit, healthcare, and government organizations they can collaboratively create individualized treatment plans and track outcomes for those individuals.

Outputs

Increase health outcomes for at-risk individuals in underserved communities.

Causal Link

By receiving up-to-date individualized social and medical data on an individual, it is easier to stage interventions and provide preventative care for them before it is too late. Catered services for this individual can be coordinated with newfound data.

• Transportation services if they have identified themselves as having transportation needs
• Access to a primary care physician if they do not currently have one
• Referral to a case manager to identify next best steps and offer guidance in receiving government assistance if they qualify
• Schedule treatment, resources, and planning for medical issues common in low-income communities such as high blood pressure and diabetes
• Referral to wide variety of services in their community that nonprofits such as churches, ethnic organizations, and community development organizations provide to address social determinants of health

Diversity is extremely important to what we are building at HealthOpX. HealthOpX founders are 2nd generation, Asian, Black-American, and Hispanic. All our current full-time team members are BIPOC. We plan to hire a diverse group of engineers and community network builders that understand the importance of serving diverse communities with an equity mindset.

Most communities we work with are immigrant or black and brown communities. Being from a similar community is extremely important to us when it comes to motivation and understanding the importance of our mission.  

Our major clients are health insurers such as Managed Care Organizations that bid on Medicaid/Medicare contracts such as BlueCross BlueShield. We charge $3-$5 per member per month for our services with a $4-$8 performance bonus, with a flexible implementation fee of $100,000. We provide care coordination, engagement, interventions, and referrals for their members that go to community organizations on our network.

For Health systems we charge $2K-$5K per month depending on the size of the health system. We provide referrals, interventions, and additional access points for health systems such as federally qualified health centers to engage Medicaid/Medicare or uninsured patients.

We charge community organizations a sliding scale fee of $50-$500 per month and provide a discounted rate for foundation sales looking to buy bulk licenses. We provide a flexible CRM tool that tracks their services, establishes a member database, survey builder tools, reporting tools, and more to help with grant funding and external partnerships. Foundations and food banks are increasingly looking to track the impact of their donations with their low-tech community partners or grantors.  

• Nonprofit revenue – Projected $200,000 FY 2023. We have a couple of major foundation deals we are looking to close.
• Healthcare revenue – We currently have a paid healthcare system pilot for Q3 2023 and planning on expanding our pilot to include Medicaid payers. In Q4 Through our diaper bank customer we plan to work on a maternal health initiative with another major health system in Alabama that works with a large Medicaid population.
• Government – We are currently going after SBIR-NIH Funding around minority health disparities and exploring additional revenue opportunities with the state and county governments around Medicaid redetermination.

Revenue:

University of Alabama-Birmingham 2022 Pilot - $2.5K

University of Alabama-Birmingham 2023 New Pilot - Projected $10K

Nonprofit Foundation Projected $100K

Nonprofit Foundation #2 Projected $100K

Federally Qualified Health Center Pilot - Projected $80K

Investments:

Jumpstart Foundry: $150K

Angel Investors: $70K

Redhawk Advisory: $100K

Camelback Ventures: $40K

Gener8tor: $60K

Grants:

Halcyon Incubator: $10K

Michigan Business Accelerator Fund: $5K