How COVID Inspired SDOH Food Support Program Expansions as a Tool for Chronic Disease Management with Moshe Pinto, CEO at WiderCircle: Audio automatically transcribed by Sonix

How COVID Inspired SDOH Food Support Program Expansions as a Tool for Chronic Disease Management with Moshe Pinto, CEO at WiderCircle: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

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Saul Marquez:
Welcome back everyone, to the Outcomes Rocket. Saul Marquez here and today I have the privilege of having Moshe Pinto on the show. He is the CEO at WiderCircle. When he launched the company, they set out to really on a mission to find a better way to help Americans thrive at any age. Over the course of his journey, his team has learned that the most effective approach to enabling better health and independence is to integrate support and services at the community level, making it easier for neighbors to take the best care of each other. They’re working on some incredible things, with health plans nationally to connect members with family members to inform, support, and motivate our most vulnerable populations. We’re going to have a great discussion with him today. His background has been in health care with various companies developing solutions for chronic care conditions. And so with that, I want to welcome Moshe to the podcast. Thanks so much for joining us.

Moshe Pinto:
Thanks for having me, Saul. So it’s a great pleasure to be here with you today.

Saul Marquez:
Yeah, absolutely Moshe. And so you’ve got a really community-based way of making things happen for care coordination, for population health. And so I love to learn more about you and what inspires your work in health care.

Moshe Pinto:
Yeah. So you know, what inspired my work in health care is several things. It starts with the fundamental belief that health is a foundation for a satisfying and fulfilling life. And when your health is taken away from you, your life can never be good. And as I thought of where I would want to apply my talents, I thought that focusing on an area that is as important for quality of life was more important than that, ensuring that a commercial service works better or reaches more people. So that’s first and the second is a personal experience. I’m originally from Israel and in Israel, we have a draft and serving in the Israeli army taught me that healing is much, much harder than hurting and that operations or the rate at which we do things in the real world move at the pace of trust and the combination of those beliefs. And meeting some folks serendipitously at Stanford University during my time there led me to be in health care.

Saul Marquez:
I love it. Yeah. And I love that what you said. Operations move at the speed of trust. And that’s so true. And we’re faced with some continued challenges right now. On the topic of the COVID-19 vaccine, you guys are doing a lot there. So I’m looking forward to hearing some of your takes around that. But, you know, I would also say that maybe some of the apprehension is lack of trust and lack of information. So back to your point. And so talk to us about what a WiderCircle is doing in general and then maybe take us to the efforts that you guys are doing with the COVID-19 vaccine.

Moshe Pinto:
Absolutely glad to do so. So at WiderCircle, our mission is to connect neighbors for better health. And underneath that is really a new community care model in which able neighbors are the pinnacle of supporting their less able neighbors. And together they form these trusted delivery networks that enable health care information to flow better and health care information to translate into action. And really, our strategy to achieve our mission is three-pronged. It starts with being in the last mile of health care to build trust and relationships. And that’s not a trivial dictum. Health care has been going through a process of becoming more transactional. I’ve been a member of the same health plan for the past 15 years. I’ve never spoken with anyone from the plan, nor have I met them. And the few times that I do need to interact with them, I try to do it via an app that’s transactional health care at its best. Relationship-based health care, which is really essentially disenfranchised American and vulnerable populations where health care is a more consistent need. It’s not as if exotic and sick and the barriers of trust and disempowerment are such where you need to build a more consistent relationship. I think getting closer to members and what I mean by being closer to being there in the last mile of health care in every neighborhood and knocking on every door, talking to people inside their homes on their balconies is essential for you to build meaningful relationships that translate to actions.

Moshe Pinto:
And I’ve just told you about myself that I’ve never met or seen anyone from the plan. WiderCircle sees its members in person between 10 and 20 times every year. In many ways, these hand-on-hand interactions being there is what leads to this creation of trust that enables us to basically translate it into real action. And it really the second pinnacle of that is galvanizing able plan members to volunteer with us as community ambassadors that extend and scale our reach in the community. The inspiration for this was my own mom. When I went to visit her for that, I had a fancy job at a private equity group. I was shaken to my core by the thought of aging on my own. Mom was my hero and when I ask her What’s up? My mom, in her blunt, direct way, says irrelevant skills. I want to feel needed. I want to be useful. I need to have a good reason to get out of bed every morning. And that made me think about seniors and baby boomer organizing moms is this wonderful, awesome resource, knowledgeable resource that we could basically further their own health.

Moshe Pinto:
And by giving them a good reason to get out of bed every morning, we could be culturally competent in every community. One of the most humbling experiences in WiderCircle is nobody cares about the kids from Stanford saying, can you really? If you want to build trust, you need to be hyper-culturally competent, very local. We deliver connect for life in five different languages ranging from Kami, Cantonese, English, Spanish and Vietnamese. Because in every community people trust and tend to be influenced by people who are like them or like people they aspire to be. And that’s a key principle that guides a wider circle, the like principal that is also enabled by engaging this wonderful resource, which is the community ambassadors. That’s how we get a unique vantage point that no other actor in the health care system has happens when Maria speaks with their neighbor Lincoln every week over the years. And that’s how we learn that that may be Lincoln’s bad past and he might take into depression. Didn’t feel like getting out of bed. A typical health plan would know about it. When Lincoln would show up in the E.R., we would know about very early. Organize the neighbors, go to the animal shelter, bring a pet and prevent a very costly adverse health event and more importantly, improve Lincoln’s life.

Moshe Pinto:
And the third element of this is really having physical support. The other element is that it has to be a group intervention. When we thought about this, the challenges of growing old, the challenges of disenfranchisement, and there have been at its base this fundamental loneliness and isolation, it starts with not being needed, with not having a good reason to get out of bed every morning. California might lose your driving license, would be hard to get around, even go grocery shopping, and then you might lose your spouse or a husband and be isolated. And on top of lacking the sense of purpose, we find many of these issues affecting disenfranchised poor Americans as well. They lack this communal support. And we think that until you address people’s motivation to live, provide them a good reason to get out of bed every morning, all health care efforts, all case management, care management, motivational efforts would fall short of their true potential. Health plan execs always ask me, you know, we offer seniors five hundred dollars a year to just do the right thing. Go get your checkup at your age. I want to see tested people living off of Social Security annuity. And still, fewer than 20 percent of seniors act on this. And we explain to them that it’s not about pecuniary rewards.

Moshe Pinto:
Pecuniary rewards matter when you have motivation to live, when you want to participate when you want to be around. And you cannot assume that with disenfranchised populations. And so in many ways, WiderCircle is bucking the trend where health care is becoming a technology process efficiency. We say people first, technology enables these people-to-people interaction. In many ways, it’s bringing care back to health care because that’s how we win trust. We show people we care. We do motivational interviewing at scale. Think about the seventy-five thousand lonely and anxious seniors that we support throughout COVID via the buddy program. That’s a lot about helping them withstand the throes of social distancing, but also about finding motivation to take better care, to engage with health care and make that happen. So I just commented on how WiderCircle starts and cherishes being there in being hand on hand in every community.

Moshe Pinto:
The pandemic is obviously challenged our ability to do so. I’ll tell you how we responded in a second. I just want to share one member story and it epitomizes what WiderCircle is talking about. And so when member Lincoln Straton, that’s one of our members here in California learned that his neighbor, Maria Teresa Juarez, and needed emergency food support, he wanted to help. He actually used the 50 dollars remaining on his card Fresh Guard. He is part of a Medicaid support program. He went to the grocery store and picked up dialysis-friendly food because Maria was on dialysis. Maria can safely eat until our next second harvest box arrived. Lincoln is 80 and uses a walker, but he never lets that stop him from helping fellow WiderCircle neighbors. He represents to me everything we stand for and strive to achieve. A sustainable community full of members who help one another and able to thrive without our help. It’s something that when it happens to me personally, it gives me the motivation to carry on. And thankfully, the stories abound even with the young and disenfranchised. So we’re always humbled and surprised to see what our real heroes and our facilitators and ambassadors who have been knocking on doors, meeting people in person, delivering food throughout the pandemic are really frontline workers that by and large volunteer because they love their neighbors and love what we do. And to me, that’s an ever-growing fountain of hope. I’ll tell you one last story before I discussed COVID and that pertains to our efforts in Michigan.

Moshe Pinto:
In many ways, in and around greater Detroit. We are dealing with many of, I think, the open fissures in our society. You know, massive inequality blended with some racism, the existence of a food desert basically in downtown Detroit. It’s taking 20 minutes to find an apple and pockets of minority communities that haven’t really made the effort or were integrated into our society. And so we work there with the Medicaid plan that’s really innovative and forward-looking and believes that operations move at the pace of trust. And throughout the pandemic, we are knocking on members door. And when we knocked on Calvin’s door, he was surprised to see us. Calvin hasn’t seen a doctor or had his teeth looked at in about nine years, and he’s never met anyone from the plan he was in. He’s in his early thirties, chronically employed. On his porch, he told us that he often worries about food, can’t find a job, and he worries about not having enough to eat. And we visited his home once more before he started attending our events despite the pandemic. The first thing we ensured that he had enough food and contacted our partners at the local food bank so that Calvin receives a community food box twice a month and with support from his friends and WiderCcircle, he now has a checkup. He visited a dentist and he will soon be getting glasses, which is why he lost his his previous job. He just wasn’t seen well and thought he couldn’t afford glasses, didn’t even know that he has a free vision benefit.

Moshe Pinto:
To me, these two stories, young and old, black and white on the West Coast, in the Midwest, demonstrate that we all need somebody to lean on and that operations move at the pace of trust. And that’s really what a WiderCircle does. I commented on being there and delivering a hand-on-hand engagement at the last mile to build trust is at the core. Pandemic has challenged our ability to do so. I think in the process it made us better. And we launched we responded by launching a suite of tools and services that first addressed immediate safety and access to care needs and they offered distance socializing services to members sheltering in place.

Moshe Pinto:
One of our key concerns was that social distancing is going to translate into a pandemic of depression. Our health plans customers have been sharing with us that their customer service lines have been flooded with calls from anxious and lonely and isolated members. And so we start by doing welfare checks. We’ve reached about one hundred and twenty thousand seniors to assess their well-being. We first ask do you have any COVID symptoms? Then we wanted to see whether they are able to access care. We serve, I think, more than ten thousand seniors who are illiterate in any language. Sometimes they tell us kind of amazing stories of working in the field from being five year old and they and how they’ve never gone into school and never received any formal education. So they can’t read or write. And they tell us that even before they told their own children. I keep wondering how you could go through fifty years of life in America without being able to read and raise a family and send your kids to college, and so with folks like that and with all of our members were focused on can you access health care if you’re not feeling well after verifying that you’re feeling well, if you don’t feel well, you know what you need to do. It embarked on a massive telehealth education campaign for those members that had challenges with digital literacy.

Moshe Pinto:
We placed them on an emergency phone tree and that a neighbor that proactively reaches out to them once a day, each time there’s a state alert in L.A. County, reaches out to them, make sure that they know what’s going on, even if they didn’t get the texting or how to sign up for the texting services. Then we assess their ability to access food or medication. We’ve often seen couples of seniors that were just stranded. Usually one is caregiving for the other and we’re sheltering in place and challenges with public transport for folks who can drive. Folks who had means became food insecure, like, look, we’ve got resources.

Moshe Pinto:
We just can can’t leave the house, can’t leave them alone. There’s no way I could go to a supermarket. There’s no public transport. So we assess those needs around food insecurity. The other one was maintainance medication. Close to 70 percent of all of our members in all the states we serve have multiple chronic conditions, more than two. That means maintenance medication that needs to be there and enrolling folks in mail-order delivery of drugs. But after assessing the needs, our engagement specialist really focused on addressing those needs. What what does that mean? It means that our partnership development team forms partnership with the likes of over to deliver food albritton and local food banks to source food and LinkedIn and helping hands to source volunteers. And we’ve had LinkedIn employees who wanted to do well for the pandemic, that we’re supporting seniors and helping hand volunteers that came from all over the Silicon Valley, that search for ways to engage. And we became these connective tissues that enabled all this magic to happen. And as I said in the beginning, with more than a thousand committed seniors, volunteer ambassadors, engaging their neighbors, these are the most important partner of all. And they’ve demonstrated that repeatedly through the pandemic and that’s how we deliver food throughout today.

Moshe Pinto:
I will comment just on one primary effort and also to ensure that I’m not construed as a technology hater because I’m actually a geek in nature and in previous lives, real diabetes technology and an artificial kidney. I believe in technology. I also believe that we need somebody, not a Tamagotchi. And so we have in terms of how you enable this all to operate it at scale, our partners have challenges to do so. Optum care has approached us and said how could we quickly, efficiently scan tens of thousands of people and assess their needs? We love the fact that your volunteers call and reach out, but it just doesn’t happen fast enough to meet the scale of the pandemic and the scale of the need. And so our technology team right here in the heart of the Silicon Valley has developed a chat bot that enabled us to scan seventy thousand members at a very low cost in a span of days and more than quadruple food delivery pace to about thirty thousand meals per week really through an effort that scan needs automatically. When folks expressed any, they got to speak with the person that’s scheduled and fed the need to an automatic backend and coordinated it with our partners, with our delivery partners in Ubers, or with the facilitators that deliver the food in case we did so. And with our food partners at the local food banks, we have built a system that is so flexible that we could deploy service and support members in need in Pennsylvania within eight days of being asked to do so.

Moshe Pinto:
We were already delivering food on the ground in a state in which we had no operations heretofore. And I would say that beyond addressing food, addressing basically inconsistency with access to medication or care, we stay true to our core of connecting people to better health. And it also means that the service development team quickly adapted in-person services to in-home in drive-throughs. We’re doing throughout the states in which we operate drive-through events in which we people are in their cars. And we do Flu shot vaccination campaigns that are combined with flu kits and general education about vaccination, and often we will involve caregivers in the actual event so that we could complete it there. And then we conduct close to, I think, fifteen hundred. We’ve conducted more than fifteen hundred virtual events in which more than between 10 and 30 participants in each call that are done in a specific platform that had to be developed as part of this effort that enables senior or older adult adapted calling and video conferencing platform. And on those we really focus on health education and health promotion be related to the pandemic or in general, what’s in it for me with the checkup, why should I have a checkup? What what is an individual care plan? How would it help me and how would it enable me to be at my granddaughter’s graduation when she graduates college? So with that, I hope that I have shared a bit about what a WiderCircle does and about how we responded to the pandemic.

Saul Marquez:
And I appreciate that. And certainly, the work that you guys are doing is critical to communities higher, getting in touch with the toughest needs, the food insecurity, making sure that people have all of the basics, really what we were calling our social determinants of health. It’s critical to driving results. And so I’m thankful that you and your community is focused in that effort, doing a very human-centric approach to really help drive healthier lifestyles and healthier lives for many people that deserve it. So if you had to leave us with the closing thought share, what would the closing thought be? And then tell us where the listeners could get in touch with you or somebody on your team to continue the discussion.

Moshe Pinto:
Yeah, thanks for that. I think the closing thought pertains to the social determinants of health in general. So for many years, it’s been something which everyone likes to talk about. And the aggregators in health care, the big plans and providers that aggregate all the resources of the federal government and dispense them have started committing more and more resources to it. To me, as someone that, you know, had to spend at one point forty million dollars on securing a national coverage decision for a new device, it was never clear that health plans should pay –, that because when everything else falters, you show up in the emergency department and the health plan picks up a tab that they should engage in an effort to connect you and engage you and prevent or ameliorate address these determinants in your life that have contributed to this situation.

Moshe Pinto:
What excites me is that I think that this skepticism and skepticism I mean, when you walk by, by just assessing the amount of resources dedicated to the effort starts to dissipate. What is really key, I think, for everyone who’s trying to bring about change is actually to think like a health plan. And what I mean by that is to think carefully through the attribution and verification of the impact of what you do in quality of care and acute care resource metrics that are important to a health plan. I fundamentally believe in that, not just because it’s important to a health plan because I fundamentally believe that primary care is air traffic control of wellness in the third age. And if you don’t have a family doctor that you like, that you enjoy engaging with, it’s very hard to take better care. And so measuring engagement with preventative care than being true to the effort so that you could ensure continued resourcing of your endeavor. WiderCircle hasn’t lost a single customer the past five years and some of our customers have increased the spend with US 50x, they’re all good people. But I think our discipline in demonstrating the bang for the buck is really what powers these unique and vitally important as you suggested, a social mission that we have. WiderCircle has consistently demonstrated that across Medicare and Medicaid it returns four dollars per member per month for every dollar invested through keeping people out of the hospital, giving them back healthy days for closing specific gaps in care, getting people to get the breast cancer screening, colorectal cancer screening, rheumatoid arthritis, cancer and diabetes screening that keeps them healthy and add years to their life. I think that it’s really important that many of the folks that are out there trying to bring about change will be disciplined in thinking through how it scales. I think it scales through the resources of the big aggregators and I think that thinking like an aggregator would yield to a more robust impact on members and a more impactful change in the world, which is what I assume folks are trying to do.

Moshe Pinto:
In terms of contacting me, there are many, many ways to contact me. Folks are more than welcome to contact me at moshe@widercircle.com or try to contact us through our website www.widercircle.com. Saul thanks for having me. It’s been a pleasure to share some of the WiderCircle story.

Saul Marquez:
Yeah, no, it’s been our pleasure, Maché, and we appreciate your insights. And ultimately this idea of connecting thinking like an aggregator the payers to ultimately make an impact. That’s what leads to a healthier world, a focus on health care, not sick care. And you’re doing amazing things Moshe, just keep up the awesome work. And we’re really grateful that you came here to the Outcomes Rocket to share it.

Moshe Pinto:
Thank you so much for having me. And thanks for giving a stage to folks that are trying to bring about a change. It’s a wonderful thing.

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