Jacob Luria, CEO at Algorex Health

Data-Driven Approaches to Social Determinants with Jacob Luria, CEO at Algorex Health transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
Welcome back to the Outcomes Rocket. Saul Marquez is here and today I have the privilege of hosting Jacob Luria. He is the CEO for Algorex Health. Jacob’s background and population health and technology provide a unique lens to use modern consumer marketing tools to drive scale in the supporting services that support vulnerable populations with deep experience of Medicaid program design and financing. He regularly utilizes objective data from all available sources to drive performance gains and has experience with Medicaid plans in 22 states. We’re going to be diving into how they’re adding value to the health care ecosystem and more importantly, how they’re thinking laterally with some marketing skills to help drive results for the populations that need it most. Jacob, so glad that you’re able to join us today, and I’m excited for our discussion.

Jacob Luria:
Absolutely. Thank you so much for having me.

Saul Marquez:
Yeah. So, you know, you guys are doing some really neat things and definitely want to dive into those. But before we do, I want to take a minute to just figure out what inspires your work in health care.

Jacob Luria:
Absolutely. Saul, before jumping into that, let me give a little bit of my background, because over the past 15 years, I’ve had the luck of being within a number of practices. So the first job that I got coming out of undergrad was with Arcadia’s solutions. And that job originally had me spend about two and a half years working with federally qualified health centers to pull data out of their electronic health records to create the uniform data services, UBS reports, to maximize their federal reimbursement activities. And through this activity, probably before I had a real management job and was still really an entry level analyst, I had been in over 200 ambulatory practices and got to see what was going on at the actual sort of patient and counter level. What was going on in the waiting rooms of FQHCs from there sort of road that E.H.R implementation wave had a good handle on technology, but always had this view of what was the data that was underlying all of these activities? What data was available and what data was actually being used to make point of care, check in discharge care planning decisions. After that, I went to ECD management consultants and built accountable care organizations nationally. So again, got to have this really good purview from the bottom, working with hands on clinicians, utilizing technology in their encounters to then working with very large organizations, trying to put together networks. Got to about twenty two thousand providers under participation agreements, within accountable care and value based contracts. So from that purview of having this incredibly wide lens by luck of career Right. not not from any scale on these activities, but to be able to see this wide purview. The thing that got me most excited was these organizations do absolutely great work and much of the great work is really, really difficult to scale. And if we’re able to scale those activities and I’m talking about programs where people are delivering food, where the front desk staff is bringing in sort of their own canned food drive to help give food to different individuals where people are helping call their friends to give rides around. And in some cases, you see this scaled up for paying rent for individuals and looking at the provisioning of housing. But from my purview, I saw all of these programs happen just without significant scale. And that’s really the sort of driving force behind some of the work we’ve done with Algorex is how do we take some of these really great things that are happening and provide opportunities, frameworks, methodology, and I’m sure we’ll talk more about it. But the data to make these decisions and scale some of these activities.

Saul Marquez:
Yeah, and that’s that’s great. And your experience there, like, you know, I didn’t intend to do it that way, but just because of how things laid out that’s been setup to create something that to help scale and grow and help make more efficient the work that a lot of people are doing in healthcare. So tell us about that. Tell us a little bit more, Jacob, about what you guys are doing exactly in the health care ecosystem.

Jacob Luria:
Absolutely. And I think your comment on intentionality is absolutely correct. I graduated college with a Latin American studies degree, but had been an intern in my local FQHC. So I ended up taking that experience and growing from there. But there was not a view of let’s go get this wide lens of all of the different healthcare providers and build on top of it. So what are what are we doing at Algorex and how are we trying to support that? So if I take that thesis on the problem, statement around great things happening in small scale and how do we expand upon those most of these activities that are being done and the sort of population health one on one infrastructure is driven by enrollment files. It’s driven by claims data sets, and it’s driven by the quality reporting dashboards. None of those things are going to be able to. If a member doesn’t have a place to sleep, none of those things are going to say, do they have a car? And so when we started Algorex, we really came together and said, is there a organization, a community, an industry that we could look at to say, yeah, they actually know enough to help guide and help scale some of these programs. And ultimately, the answer is yes, there is. And it’s consumer marketing. It’s how we’re marketed toothpaste. It’s how they know how big consumer marketing firms know that. I, as sort of a former consultant living that travel life as well as running Algorex health. They know to send me travel credit card up cell offers all the time. Now, that’s a double edged sword because my tablet at home absolutely loves the pictures and the little sticky things that keep them together. But it’s also a lot of mail that comes through our front door. But the industry that does that targeting knows more about us than we would probably ever give them credit for. And so if we think about how can we harness that power and much of it comes through in external data acquiring data that exists outside of the four walls of a hospital, outside of the four walls of a community health center. And how do we put that data to work in value based care? You can start to do some good. And so that’s really the driving force around the data asset that we’ve built that helps us then point that asset into how can we help use consumer marketing principles to identify optimal investments in value based care. And that’s led us to the majority of our work in social determinants that I’m happy to go into more detail on.

Saul Marquez:
Yeah, that’s really neat. And I think you’re right. You know, we don’t leverage those principles in consumer marketing that they do so well. Right. there’s a reason you buy certain things that you didn’t even know. You need it.

Jacob Luria:
The dirty secret is that marketing works. Right? Much as I would love to say no, I’ve definitely never been convinced by some marketing activity. I absolutely have. I have a wallet that I got from I’m one of those targeted ads from a company called Delroy and their marketing was fantastic. The wallet’s fine, but these type of marketing activities actually work.

Saul Marquez:
Yeah. And and it’s about what they know about you that makes them work. And so we tend to be in the dark about what we know about consumers of health care, especially as providers and employers. So what are we doing to know more? And so tell us how your service works and some examples of what you guys are doing.

Jacob Luria:
Absolutely. So the first thing we do and this has been a two year journey that we will never finish is go acquire as much data as we possibly can. And this is not from the social media companies that we’ve seen some sort of not great activity from like the Cambridge Analytica stuff, which I’m sure we’ll get into. But this is from companies that have sterling reputations around use agreements that are sharing data under very, very strict privacy controls are sharing data under direct marketing guidelines. Companies, LexisNexis, V12 data and some non-traditional sources. One of my absolute favorite data sources is a consortium of solar panel installers. I mean, you might be saying, well, where is the connection in that? But this is a survey that a consortium put together to figure out, OK, where should we send our field sales staff? And when we think about installing solar panels on roofs, it’s a Dornoch sale. It’s someone making a connection, is knocking on a door and saying, OK, you have Great Southern facing roof exposure. That survey also calculated distance from mailbox to door. They calculated a level of difficulty. It would be to put a ladder up next to someone’s home. And so when you’re thinking about functional mobility, Right. or social isolation or someone who might be lonely. Understanding these data sources and understanding, it’s really difficult for them to get out of their driveway, especially in winter. Right., it’s really difficult for them if they’ve just had a surgical procedure to get out the front door and into a car become really, really important. And so when we think about the work that we’re doing, we’ve invested all this time to build a data asset. And then on top of that data asset, we’ve built a set of targeting predictive models that are built and trained against someone’s propensity to have a social determinant. And we don’t look at that generally to talk about, oh, they have socio economic challenges. Therefore, they’re going to be at more risk. Therefore, generally, they’re going to cost more. We think that that generalization actually doesn’t follow the principles of consumer marketing, which is be as targeted as you possibly can. And so our services are built to be much more specific. So we think about how can we have a model that sits on top of that data asset to predict food insecurity built up from access and affordability. Can we look at housing instability? Can we look at the likelihood that someone is going to have to change their residence in the next 30 days? Can we look at the likely. That a member has a car or that they have a household member that has a car so they can get from point A to point B reliably. And so we built those type of models. Now, 18 months ago, we were probably just doing the data services to say, here’s the models. Right. So are deliverable to our client, were highly qualified, highly targeted lists to say here’s your 4200 members that are likely to move in the next 30 days. You should really make sure that their addresses are up to date within Medicaid state databases. And what we found is that actually, for some organizations, was great and they would take action. They had the infrastructure to do that. But the other part of consumer marketing is actually launching these campaigns is not only surfacing a list, but then doing something about it. Right. And so we now have built on sort of the campaign services where we look like a campaign automation shop internally with how can we align those members to an appropriate intervention and then help our clients manage those with their own communication resources, with their own community based organizations, or help them onboard specific partners where it’s helpful may pause there and say, where? Where can I help make sure that I’m providing clarity. Obviously, this is the work that we do all day, every day. I want to make sure that it’s understandable to the broader group.

Saul Marquez:
Yeah. No, this is great, Jacob. And thanks for walking us through the data assets, the algorithms to figure out, you know, risk. And so now it’s all about. OK, great. You know, I have a list. So how do we power you up with with process? A campaign that’s specialized to action on that. And those insights. And so I think what would be helpful here is maybe some examples, you know, of what types of campaigns have been launched and what types of outcomes you guys have seen thus far.

Jacob Luria:
Absolutely. One of the areas that we spend a ton of time with is in the provisioning of nutrition and food services. And there’s a really important reason for that. One is that the unit costs on a food delivery is actually quite low. And so if you think about the clinician reimbursement for any type of evaluation and management visit called a 99213 can be between eighty five and one hundred thirty five dollars per visit based on site a service, that’s actually a lot of money. When you think about providing either delivered type of gift card, a debit card or sort of different shopping market opportunities to provide food. So the example that I like to speak about here was working with a Medicaid plan in the Northeast. They had about one hundred and ninety five thousand attributed members to their land and from their internal health risk assessment data. They thought that about less than one percent of their Medicaid members had a challenge with food access and affordability based on self reported activities through their health risk assessment. Now, anyone who’s done work in Medicaid know that that percentage is comically low. That’s just not accurate. That’s a lack of data coverage, not the accuracy of what’s going on in their communities. So we engage with them. And from our modeling, we found that was more like seven to eight and a half percent of their population had these challenges. And that led to a set of campaigning activities where quarterly we were reaching out to and delivering food to about forty eight hundred of their members. And the thing that excites me about that program and I think is really important, is we went from a retroactive process with that health plan where there only one who needs help was through a health risk assessment, which is really a way of a health plan, saying to someone that they might have a relationship with or not. But it’s hey, can you please tell me your deep, darkest secrets about where you struggle day to day and then maybe I can help you Right., which if we take a step back, that’s a ludicrous way to try to create a relationship with someone. It’s a really challenging conversation to have. And it’s really hard for someone to admit to the fact that, yeah, I might need help in this situation through our modeling activities. What we were able to do is from that predictive model of our food access and affordability model, we’re able to reach out to that same group that we identified and say we have a food program. Do you want to participate? Right. To that member. Right. Right. It looks like, oh, this is just me that my health plans offering. Yeah. That’s an easy thing for me to say behind the scenes. We knew we were targeting individuals based on were they in a food desert? Do they own a car? What’s their income? What’s their change in income? What’s their household side? Do they have kids at home? All of these different factors that are helping us create that list. And that sounds like a small shift just in terms of the conversationality, but it’s actually huge in terms of response rates. So we started doing this with an unengaged population that we had defined as no outpatient visits in the prior 24 months. And out of the members that we contacted, which was about 72 percent, about 80 percent of them saw an outpatient provider within 90 days. So we went from this population that was not attached, did not believe their health plan was there to help them, went through a modern targeting program with a message of help. First, then get them to attach later to my clinical assets. And we had this tremendous result of reaching about seventy two percent of people and getting about 82 percent of those individuals into an outpatient setting of care. Now, for anyone who knows risk adjusted Medicaid, that program paid for itself about six times over on risk adjusted revenue alone. We’re starting to see a medical expense tale in the data. But this is a good way to use non-clinical programming. It’s a low unit cost to earn engagement with really hard to reach members.

Saul Marquez:
That’s pretty neat. You know, just thinking through the engagement point where you say, hey, you need food vs. hey, this is a program that we offer to a highly targeted, identified group. I can definitely see how that’s powerful and drives results. Is there any particular setback that you guys have seen or any key learning that you want to share with us today?

Jacob Luria:
I think the biggest one that we’ve learned and this happened because we had to present in front of a pediatrics subcommittee of one of our clients, board of directors, the day after the Cambridge Analytica scandal came up. The biggest learning was that as ubiquitous as consumer marketing is, it’s still not understood. And so much of it is educate, educate, educate that, yes, we might be able to learn the vehicle ownership of your members. But at the same time, we’re never going to disclose that. We’re going to reach out and say we have a food program not pay. We’re calling you because we know you don’t have a car and you need a ride. And so it’s so much around the education because this is an entirely new way of engaging a membership. And yes, we will fully admit that it’s a little big brother. Right. to know all of this data. But so I think that early on we’ve made the assumption that the common knowledge of what consumer marketers do day in and day out was both well understood and individuals were looking to apply those things. That wasn’t true. And so we’ve had to do much more education around how do we learn about what is allowed, what isn’t allowed, what’s available, what’s not available so that we can create programs that everyone is comfortable with.

Saul Marquez:
Yeah, that’s a that’s a good call out. And what’s your typical response to that? Like, you know, how is the data collected and how can you assure people that it’s that it’s done the right way?

Jacob Luria:
Yeah. So much of it is through a set of guidelines and binding restrictions from the Association of Direct Marketers. This is really sort of the gold standard that we abide to. One of the things that’s interesting is within our client base, we make them actually sign a data use agreement, which is something that you do not often see organizations come forward with as vendors provide data back to their clients. But if you’re a client of ours, you have to sign up for restrictions that are more significant than those guidelines around how you can disclose the information, how you can use it. And then we also provide a lot of education about what to do for call center staff or frontline staff who are asked about this. But it’s really about education and coming up with a really significant amount of information on what we can collect and what we cannot collect.

Saul Marquez:
It makes sense. Makes sense. So talk to me about what you’re most excited about today.

Jacob Luria:
So the thing that I’m most excited about is two to three years ago, organizations were dabbling in the social determinants space and housing programs were seen as white. New food programs were seen as quite new. And so organizations were struggling to invest a hundred thousand dollars in social determinants activity. And so the growth that that we’ve seen in organizations looking to be leaders in building their community is in building social determinant responses and putting money behind those activities. Not just referring to those as mission statements has created an ecosystem. That, to me is incredibly empowering for how health systems and health plans can be leaders in their community, not just the sort of brick and mortar anchor in their communities, but also the convener of all of these services, not necessarily the sort of owner of all of these services, because the medicalisation is something that we could probably spend another sixty four hours on. But to be as a convener and an investor in the targeted needs of specific populations. And so I think that those are the conversations that are more fun to think about. How do we have significant impacts with our clients versus how do we launch a pilot program? And I think we’re past the stage of people trying to dabble in the social determinants space versus trying to make significant investments in their community health.

Saul Marquez:
And it’s definitely changed. And it is an exciting time to be in the space, you know, when social determinants are now considered a main stream. Part of the conversation. So awesome that you guys have a name to stay in the game to this point where now it’s actually a focus area.

Jacob Luria:
Yeah. And I think that what we’ve realized and maybe this is my background as a reform consultant, but don’t take short the risk adjusted revenue gains that can come from social determinant programs. There is this opportunity to get in a virtuous cycle of investing where programs earn engagement and attachment of members, that increases revenue, that allows programs to get bigger than the medical expense tale start to come in. And you really can start to see these programs where on specific cycle you’re seeing a two X return on risk adjusted revenue in nine months. You’re seeing a five X return on engagement quality scores and starting to see a medical expense activity in 18 to 24 months. And on thirty six months or starting to see a seven to eight X, largely driven by medical expense. And so when you get these virtuous cycles, it’s pretty remarkable what you can do. Now I say that and this is obviously sort of what we’re passionate about, and we still haven’t encountered an organization who’s got the funds to pay rent for all of their members or provide them rides everywhere they want to go. So being really targeted about these investments is the way to enter that virtuous cycle. But you can do it and you can do it in some of the products like Medicaid and highly subsidized exchange, where it was previously probably thought to be much more challenging.

Saul Marquez:
What I love about what you guys do, Jacob, is is that you’re really at this midway point between, I mean, really being technologically advanced and higher, garnering these insights as well as you have that health care perspective that in center understanding, in addition to that consumer methodology, it puts you guys in a really unique position.

Jacob Luria:
No, I’d agree, Saul and I looked to sort of my chief technology officer, Dan Ecklund, who did not come from health care, and I’m so happy that he did not bring the type of knowledge because the insiders in health care haven’t been spending the tens of years required to build some of the consumer marketing data platforms and know that environment. It’s a different world out there. It really is.

Saul Marquez:
Yeah. Now, good call up. Good call out. So great stuff here, Jacob. Folks, if you’re curious about how to learn more about Algorex, visit their Web site. It’s AlgorexHealth.com. And you can also go to OutcomesRocket.health type in Algorex in the search bar. And you’ll find my conversation here with Jacob. The full transcript, short notes and links to all the wonderful things that he has described here today. Jacob, you know, books are something that we enjoy sharing on the Outcomes Rocket. Do you have any for us?

Jacob Luria:
Oh, absolutely. So I try not to read health care specific books just to get a world away in terms of some of the relaxation at night. And the biggest sort of set of books that I’ve been rereading have been the series by Anthony Bourdain, just finished Medium Raw. And I cannot recommend those books enough in terms of going deep into a totally different world of sort of restaurant cooking. What an incredible storyteller. And I cannot recommend anything that he has written enough.

Saul Marquez:
Wow, that’s cool. That’s cool. Appreciate that recommendation. So as we write the interview down here, Jacob, you know, why don’t you go ahead and leave us with the closing thought? And then the best place for the listeners could continue the conversation with you or somebody on your team.

Jacob Luria:
Absolutely. Probably the best place to follow up with us is just through our website info@algorexhealth.com and more route that through appropriately put the closing thought. And I think that when we’re asked you’ve been in social determinants for a number of years, sort of what’s the biggest learning you’ve had? The thing that we know is that being targeted and specific is better than being general. Think about your screening questions. Are you asking people how are you doing at home versus we have service X? Do you want to participate? Ask very, very targeted questions that you can actually provide a service behind and you will earn attachment, trust, engagement and the right to ask for your members and patients to follow through with some of the things that you want them to do. So I think that that’s probably the biggest lesson we’ve learned and it’s directly taken from some of the consumer marketing activities. Be incredibly targeted.

Saul Marquez:
Man. Powerfully said, my friend. I appreciate you leaving us with that very, very specific learning. Be targeted and be specific. It’s better than being general. Earn that trust and the results will follow. Such a great opportunity to connect with you, Jacob. Thank you so much for sharing all that you guys have learned and the services you provide. Definite. Looking forward to staying in touch.

Jacob Luria:
Absolutely. Thank you very much for having me and hope to come back on next year and we’ll give me an update on where things are up.

Saul Marquez:
That’ll be great.

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