Q&A: How Soda Well being plans to vary ‘patchwork’ supplemental advantages

Even with a background in social work, Soda Well being CEO and cofounder Robby Knight mentioned it was a wrestle to assist his father arrange supplemental advantages when he turned eligible for Medicare.

“What actually hit me exhausting there was that regardless of what we do to make our lives higher and actually have an effect on well being extra broadly within the U.S., the problem is we nonetheless have lots of people which can be experiencing very foundational challenges of their lives daily,” he mentioned.

Final yr, Soda launched with the purpose of creating it simpler to entry advantages for wholesome meals, over-the-counter drugs and transportation. The startup just lately raised $25 million in a Collection A funding spherical. 

Knight sat down with MobiHealthNews to debate how Soda’s mannequin works, why beneficiaries typically cannot entry these packages, and the way the corporate plans to make use of its Collection A funds.

MobiHealthNews: What are a few of the issues you are seeing with accessing supplemental advantages as a Medicare Benefit or Medicaid member?

Robby Knight: It relies upon. It is a patchwork of providers. So you might have something from an over-the-counter catalog, the place well being plans ship it within the mail to members every year. And as part of that course of, members establish what they need, fill out a kind and mail it again. Utilization of that’s abysmal, proper? It is not an amazing member expertise. All the way in which from that, to name heart base success, to retail base success. It is actually complicated on which retailers to make use of, and even what objects are eligible. 

So what occurs is, for Medicare Benefit for OTC particularly, solely 30% is getting used. The opposite challenge is that in some unspecified time in the future, you do not want extra Tylenol. You do not give a ravenous particular person a blanket, you give them meals.

It is a one-size-fits-all method the place persons are simply getting OTC and utilization is actually low and engagement is low, as a result of it would not truly handle the quick wants individuals have in entrance of them.

MHN: Are you able to inform me slightly bit about how Soda Well being works, from each a affected person perspective and a well being plan perspective?

Knight: Well being plans have subpopulations of members they need to present these advantages to. We work with them to establish what advantages they need to offer most effectively from their perspective and to verify members have probably the most {dollars} that they want. 

As part of that course of, now we have what we name a flex card. So we ship out member communication with that card — via our well being plan companions — after which members obtain that card and a welcome package within the mail. Each bodily mail they usually additionally obtain different notifications as nicely. The member then prompts it and goes on to our member portal to establish what further sources they’re eligible for after which see how they’ll use their present advantages in a much more straightforward and consumer-oriented approach. 

MHN: Whenever you’re working with well being plans to determine what advantages they need to offer, how do you identify that? 

Knight: One of many attention-grabbing issues about the way in which this course of at the moment works is it is too typically the gross sales pitch. And what we see on this area is, OTC is vital. It’s factually right to say that in the event you’d have an OTC profit or any profit versus not having a profit, you are in all probability going to be more healthy. The query is, what is the actuarial worth? And what is the ROI [return on investment] related to making sure trade-offs {that a} well being plan has to make to handle their P&L [profit and loss statement] and assist their members to enhance their well being outcomes?

And so we are saying, hey, well being plan, primarily based available on the market in your area, and primarily based on the varieties of members you might have and their wants that we see right here, these are the varieties of advantages packages that we are available in on the entrance aspect and advocate to you. Here is how the mathematics works. And this is how we are able to optimize all the things else downstream to verify, from a price profile, what you are doing is sustainable, it is aggressive available in the market, and that it permits for extra funds that we unlock later, as soon as we establish members’ wants that exist.

So we may be actually versatile serving to members after they have a housing challenge or after they have a transportation challenge. They don’t seem to be going to their annual wellness go to, as a result of they can not truly get to the physician, as a result of there is not any transportation. For us, it is how we are able to establish what these factors are, and be sure that the well being plan most effectively spends these sources to assist that human being on an individualized foundation.

MHN: You used to work at Walmart. How did that have an effect on the event of Soda? 

Knight: So I might say two experiences got here into the attitude that I’ve at the moment. Primary, my expertise as a social employee understanding actually intimately the wants on a regular basis individuals have, and that I skilled as nicely rising up. 

In my time at Walmart, it was actually useful as a result of it allowed me to grasp scale and the way totally different markets transfer. Walmart offered a very compelling understanding of the nuances of various enterprise fashions, and the way scale works in a approach that nobody else actually can due to the purview that they’ve available in the market. 

MHN: So that you simply introduced your $25 million Collection A elevate a couple of yr after you launched. How do you intend to make use of that funding?

Knight: What we’re doing for our Collection A is constant to develop the organizations and retailers that we join with, so that folks can have locations to make use of these playing cards, to entry these sources and to establish new sources that they are eligible for.