We're here today with Sue Bajaj of Uvo Health. Sue is the CTO.

Sue, thank you for joining us today.

Thanks, Jordan. I appreciate you having me on.

Sure. So.

But the conversation.

For our listeners, you vote is a health tech startup based in New

York City, providing value based contracting and administrative

support to community health centers, including federally

qualified health centers, which for the rest of this episode

will be referring to as FQHC's. Sue. I'd like to kick off the

conversation by discussing.

You know the the intersection Yuvo was at the intersection of

HealthEquity and technology. I think many of our listeners are

interested in health disparities, diversity, equity

and inclusion, and the topic of HealthEquity more generally,

would you be able to give us an overview of what yuvo is doing

in this area of the healthcare sector?

Sure, sure it be. Be happy to. So YUVO was founded a couple of

years ago in 21 and more recently in 22 had had

contracted with some FQHC's in downstate New York.

Umm. And you know our our mantra, our goal at at Yuvo

halls is really to be inclusive where a bipod founded

organization and in that many of the founders you know grew up

using FQHC's. And so this really means a lot for folks to be able

to enable FQHC's in the HealthEquity space, but also

just really enable FQHC's to take on value based care. That's

really what you vote does.

A part of that, of course, is HealthEquity. And looking at

what we can do from a technology standpoint to be able to enable

FQHC's to do more with this Medicaid population. So largely

there's a more more prevalent Medicaid population in FQHC's

and for our listeners, FQHC's can be essentially where there's

not a lot of other available options for patients to go to a

clinic.

Whether it's really rural, deeply urban just, you know, in

different areas and that's where FQHC's fill the void, there's

about 1400 of them nationally. So there's quite a large

footprint.

Umm Yuvo is looking at this from the standpoint of, you know,

over the last few years there's been many adapted technologies

adopted technologies because of COVID. But even prior to COVID

some interesting stats that you know, Deloitte had done a survey

back in 2018 showing that Medicaid, the Medicaid

population was at about 86% adoption with smartphones. And I

remember when I saw that back in 2018-2019 and I thought wow,

that's really untapped potential.

Umm, in terms of, you know what we can do to enable the Medicaid

population and then COVID happened, right?

Umm. And we were all focused on how do we do outreach to various

populations through telemedicine using smartphones using tablets

and other other modalities. And I think the way that you was

looking at this from a product standpoint is how do we use the

86% population in and grow that so that we can leverage other

modalities of care along with the FQHC. So enable the FQHC's.

With telehealth remote patient monitoring, some of these other

other capabilities and that's really what we're looking to do,

we're startup. We just started all these things. We're kind of

excited to get going on them, but but that's the direction

that we're headed in.

Because, Sue, I, I'd like to take a step back here, so I

Around this. Yeah, go ahead.

asked about technology and intersection of HealthEquity. We

spoke a bit about the Medicaid population and and where they

potentially are, but I'd like to ask you to define areas of

health disparities. What what is, what does HealthEquity mean?

What is not equitable that?

What? Where? What are the hot topic issues in within the

context of HealthEquity in America today?

Yeah, man, I think there's there's a few. One would be, you

know, access to care, access to seeing a clinician when it's

needed and you know, being able to get to a clinician. So for

example, not having a car and having an urgent emergent

situation. So it might be after hours and you're in a place

where you can't go see a primary care doc or there's not urgent

cares. You know, I live in a suburb, there's an urgent care

at every corner.

That's not the case for a lot of our FQHC patients. And so they

end up in the Ed or the ER, which is not the right place

for, you know, this, this kind of this kind of care. It's

really needs to be redirected to primary care. So that's an area

of of health inequity, right. Another area would be when

you're looking at what are the drivers of high utilization,

it's for a large part of the population in terms of health

inequity.

It's really things like consistent food, homelessness,

you know those, those those drive quite a bit of the health

and equity. You know if I don't have a place to to hang my hat,

I'm certainly not worried about taking my medicines on time. I

may not have a place for them. I may not be able to pick them up

even though in Medicaid, you know they it's from the

standpoint of you can go to a pharmacy and edit without

payment. However, if I've inconsistent housing that ends

up becoming a problem. So really the definition here is.

We have folks that don't have the same access that the rest of

us do in terms of.

Umm.

I'm a a home food.

Access to care and necessarily to be able to manage. And so if

they have chronic conditions or even if they don't have chronic

conditions and they just have other issues going on, it

exacerbates the situation.

Where you know they're they're not able to manage, manage

themselves and end up in the ER and Ed, et cetera.

So when I think of health disparities, I I heard you say

basically food and homelessness, I'd categorize under

socioeconomic status. SES you said access, beneath which there

Right.

was urgent care, transportation, timely access, that's all under

the umbrella of access.

Interestingly, I did not, and that all seems basically to to

seem to be financial indicators, but I did not hear you mention

race or age, which are often considered to be areas where

health disparities are measured. Care to comment?

Yeah, absolutely. And that that's like, you know, something

that absolutely you see the skew for you know, other races, non

Caucasian races, that there is a greater disparity in access to

care in in some of these other other items I've mentioned. So

what ends up happening is an outcomes really. So when you

look at infant mortality, we all have heard that black mothers

have much higher infant mortality.

And much higher rate of something happening to them when

they're delivering a child or postmortem post postpartum.

Excuse me, then you know others. So absolutely. Age and race

play.

You know a a role in this as well and I think FQHC's are are

very much there and the localities to help address those

as well. And that's where I think again technology.

You know, I I come from a tech background. I'm the CTO here at

Yuvo. I do think of tech in a lot of ways as a great equalizer

in allowing us to do outreach and allowing us to do some

things that create access that create knowledge about what's

going on with somebody that we otherwise wouldn't be able to

know. It's not perfect. Of course. There's inherent biases

right in technology because of who designs technology, right?

By and large, technology is not driven and designed by women.

By you know non, non, non Caucasian folks. It's it's

actually driven mostly predominantly by white males.

And that does create bias and technology. Yuvo is looking at

things differently again and wants to focus on how do we use

technology enable technology to with FQS with patients to sort

of close the gaps in in that in those.

In those access issues, yeah.

Yeah.

Sue, let's dive a bit deeper right here. I'd like to ask what

specifically is being done to reduce disparities and enhance

equity using technology as a platform.

Yeah. I think one of one of the key things that's being done is

you know driving patient care to.

Telehealth and and telemedicine and I think there was a great

uptick, you know about 17% of Medicaid patients during COVID

were using telehealth and telemedicine.

In various ways, and there was, you know, greater utilization

just because centers were closed and or if they were open limited

hours, limited clinicians available, et cetera. So there

was a greater drive towards that at the time. And then of course,

once you know, we all opened our doors, full-fledged everyone

sort of gone back to even though they have smartphones, even

though they have access have gone back to wanting to see

folks in person, there's a preference there.

Umm.

But I think again, when you're looking at managing chronic

conditions and you're looking at managing non acute conditions,

telehealth is a fantastic way in order for us to do outreach to

patients and to schedule patients that otherwise might be

turned to a more acute, higher acute center, right, that isn't

necessarily gonna solve their problems because in the end,

they do need to come back to their primary care doc. In the

end, they do need to come back to their specialist.

In the end, they do need to see somebody who's going to help

manage their conditions and the the LED visit where the urgent

care visit is is more avoidable.

UM, then we think by leveraging these these technologies and so

that's an area that we're looking at because we see that

this keeps growing and how do we partner with FQ to enable them

to do telehealth and expand telehealth hours along with, of

course, you know there's there's health plans in the mix here who

offer some of this in the third leg of the stool here is patient

knowledge, right. So patients may not know. OK, I did this

during COVID.

But they may not realize that, hey, this is still a capability

that I have and rather than me walking down to the ER, I can. I

can actually just, you know, log into an app and see somebody for

my flu or for me to manage my condition. That's one way.

It.

Sorry, go ahead.

It sounds like a lot of what you just discussed in terms of

actions that can be concretely taken using tech to reduce

disparities include providing lower acuity care in the form of

telehealth or telemedicine in order to address chronic

conditions and reduce readmissions and therefore

increase shared savings with value based payment plans. Is

that an accurate representation?

Yeah, you nailed it. Exactly. Exactly. That's one of the ways.

Perfect I.

Yeah. Yeah.

I heard you differentiate between telehealth and

telemedicine. Would you mind elaborating for a moment on a

difference between the two?

Yeah. I think folks do use that interchangeably and I do as well

use it. You know it. It means different things to different

folks. But I think that there's an aspect of the quick I've got

the flu, right. And and I've done this, I've done this with

my my children where you know they've got something and it's

not. It's not very cute, but I would like them to see somebody

and it's after hours and you know, I don't. I don't wanna

take them to urgent care or to the ER.

It's not necessary, and so you make a decision from, you know,

a telehealth. You download a telehealth app, pick one right

and and whatever is in network with your health plan and you

and you go for it and it works great. Whereas you know the

other telemedicine, this is more of a.

And again, I do this as well with one of my clinicians who's

in the city. I can't get to her very often. She's managing a

condition with me and I every other visit instead of going in.

It's way more convenient for her and me. We talk 15 minutes. We

have a chat. See how things are going and that's another Ave.

right for really managing chronic conditions. And I think

the differentiator in my mind may not be true for everybody.

Is this sort of low acute? I've got the flu.

Got you know some, some minor cold type of thing, but I do

wanna be seen and and maybe get get some help around it.

And be triage, because maybe that along with chronic

conditions could be something right worse. But the other side

of this is if I'm trying to manage a chronic condition on a

regular basis, and my practitioner does not have the

bandwidth to, you know, have me come in and vice versa, I don't

have access to go in, I don't have a car, I don't have access

to go in. This enables the patient then to feel confident

Right.

that hey, once a month or once every two months, I'm gonna have

this call.

And it's a face to face that get to see my clinician, we get to

talk about what's going on and how managing my care, yeah.

2.

Would it be fair to say that telehealth is ad hoc and

telemedicine is more regular?

Yeah, I I would say that I hope, I hope it's just not my

Perfect.

definition, but I've I've heard it a few times, but I yeah.

Great.

I we still have a lot of some ground to cover before the end

of this episode and few different issues I'd like to

cover. One thing that occurred to me is I'd like to ask, in

your opinion, in your experience, what does diversity

look like within the Medicaid population? Again, this is

getting back to financial, race, age, and sex, but also I'm

wondering with the recession and periodic unemployment, I'm

wondering if maybe white collar professionals who find

themselves.

How to work for seven months and up in that time going from

employer sponsored health insurance coverage down into

uninsured and and and and and then Medicaid and then go back

into normal white collar professional jobs. And I'm

wondering what the impact is on that like cyclical or kind of

one time temporary?

A unemployment or or professional? Yeah, a gaps in

care gaps in coverage I'd say.

Yeah. And and I think we saw some of that right with COVID

where COVID expanded Medicaid by about 10 million folks

organically where we didn't have redeterminations. And you've,

you've probably heard that there's gonna be roll offs of

you know, since the PBE is officially declared as over and

you are looking at, you know, losing this this 10 million and

a lot of those folks are looking to.

Health plans are being allowed to help them enroll either re

enroll in Medicaid or help them enroll in ACA plans, or just

kind of unheard of, right? This is a new thing, and I think

Umm.

that's great. And you make a great point because there is a

socioeconomic factor here, right? Is it skewed to words,

you know, certain certain sections of the population? Yes,

absolutely. But there's a lot of folks that are. This ends up

being a socioeconomic problem as well. Just just as it was in

COVID, where there was a layoffs.

Umm and folks, you know, lost jobs didn't have insurance

coverage and we, you know, accepted them into Medicaid with

no redeterminations like we normally do annual

redeterminations that's been going on for almost three years.

So I think we've seen that. I think that it worked really

well, but it definitely overwhelmed systems that were

already overwhelmed and add in COVID which which was

overwhelming systems.

Again, that's where I think having, you know telehealth,

telemedicine come into play and other you know we we haven't

talked yet about some of these other technologies that we're

looking at but.

I I think that can be a game changer for a lot of folks who

are trying to manage conditions and have, you know, have lost

insurance and don't know can I don't know what to do and there

are gonna come into they are gonna come into Medicaid that

Yeah.

have the right income to come into Medicaid and or into

subsidized ACA programs.

What are some of those other tech solutions that you just

referenced?

Yeah. So some of these other ones that I think you know that

I think we just started to see especially you've you've heard a

lot of these like digital health startups, right, that we're

managing weight or managing a variety of different things like

autoimmune disease or other chronic conditions. But I think

we just are at the tipping point, not even just just

starting maybe at the tipping point there around these M

health apps that sort of give people a community, right. So

now many of them need to be vetted, right for us and who we

partner with, but.

Looking at for example, you know telehealth or telemedicine for

specialty care where we have an opportunity for folks who need

specialists, could they use? Could they use some of these M

health apps to improve medication adherence, manage

chronic conditions and again be more preventative because they

need specialists that maybe aren't readily available. And

the FQS, they're most definitely not, but they have to go

outside. It's hard to get. It's hard to get appointments,

etcetera.

And and the other part of it is, it gives them a community,

right? I don't know if you've ever used any of these M health

apps, but you know, I have and it gives you a community of

folks who have similar chronic conditions and gives you an

opportunity to discuss, even talk about nutrition, talk about

a variety of things to help you manage your conditions. So I

think, again, the third leg of the stool is always education.

And how do we get patients to adopt? How do we incentivize

them to use these and then measure?

Right, so was this useful? Did this help us?

To really manage this patient, how did the patient work? You

know, how did the patient use this? Now? Some of these health

apps, they're they're measuring things like clicks and

interaction, which isn't the best. You know, I've I've, I've

used some of these, which isn't the best way to say, OK,

somebody's sticking to something. It it doesn't

necessarily mean that. I think it ends up being kind of a false

positive. We need to really look at outcomes for these for these

apps and outcomes with these patients. But I think, again,

that's a very underutilized ecosystem.

That has really been, at this point more direct to consumer

and it hasn't been brought into the Medicaid population at

large. I'm not saying we're using it yet, but it's something

that we're definitely considering as well.

So Sue, I've been enjoying this conversation. However, we are

approaching the end of this podcast episode. As such, I'd

like to pose a final question to you and invite you to elaborate

where you see most, where you have the most interest. My

question is, given that our audience is mostly large health

systems, CIOs, how can large health systems best partner with

FQHC's and serve this Medicaid or perhaps dual eligible,

meaning Medicaid and Medicare population?

Yeah, I think I think at the end of the day, there's a few ways.

I think there's this data that's really important for us to help

manage these patients. So I think as you know, their

admitted and I think we we see them being admitted or even pre

admission where there's a planned admission, right,

there's some some instances where there is a planned

admission, especially with we have a large population of

pregnant women.

And I think in the Medicaid population again, there's real

opportunity to partner with health systems with this

population and.

Uh, you know postpartum care in, in the actual, you know, birth

and and exchange of data between us and them and that hey, we

have all this information about this patient that's walking

through your door. Right and partnering with you so that you

understand what their primary care has been working with them

on what are the conditions they may have etcetera. And then even

in postpartum. So in follow up of postpartum care for us.

And with the health system, where they may be coming back in

to see their OB, et cetera. And I think there's a real

opportunity even if we start there with.

You know women, women who are delivering kind of well in

advance of delivery so that we are giving the health system the

opportunity to see our curated data which which we work on to

say, OK, these are the conditions, this is this, these

are some of the social determinants of health for this

patient that we have readily available. So as they walk into

the door and they're delivering at your system, you're you're

more well versed, your clinicians are more well versed

and what's actually happening. So I think I think data is the

core of it and there's a real opportunity to.

To to work together around it.

Well, I love ending on that note. Sue would like to remind

our listeners this has been sue Bajaj, the CTO of Yuvo health

tech startup in New York City. Sue, thank you very much for

joining us today.

OK, great. Thank you.