Mobile app is ‘the most optimized for the Medicaid population of any that I am aware of,’ says Healthfirst CIO G.T. Sweeney
Author – David Raths
New York City-based Healthfirst was planning to launch a new mobile app this July. But when COVID hit New York hard, the nonprofit health insurer moved up the launch date to April 15 and re-sequenced the features to meet the needs in the market driven by COVID.
Healthfirst describes six key features the new app offers members:
• Search for in-network care providers by specialty, location, gender, and language.
• Access Teladoc to speak with U.S. board-certified doctors 24/7 by phone and video.
• Find essential services nearby—food, housing, education, employment, financial and legal assistance, and more.
• Pull up their digital member ID and save, email, text, or AirDrop it.
• Use the Healthfirst Virtual Community Office to search for a local sales rep by borough, office location, language, and gender.
• See benefits and coverage information specific to their plan.
In a recent interview, G.T. Sweeney, Healthfirst’s chief information officer, described the mobile app’s features in depth and explained why they have offered help during the pandemic.
Healthfirst was established in 1993 by 15 New York hospitals. It serves 1.5 million members in New York City and on Long Island, as well as in Westchester, Orange, and Sullivan counties. Over 1 million members are in the Medicaid program, a population severely impacted by the pandemic. “Our hospitals were the heroes on the front line,” Sweeney said. “Our partnership with them has proven valuable in so many ways.”
He noted that the hospitals have been progressive in the last few years, being increasingly focused on the Medicaid space with the DSRIP program, whose purpose is to restructure the healthcare delivery system by reinvesting in the Medicaid program. But when COVID hit, they reverted to being 100 percent focused on the acute care of COVID, he said. “Our job was to keep people out of the hospital. That was very explicit and intentional. We wanted to keep people healthy, minimize their exposure to the disease as much as we could, and get them the care they need at home.”
That involved three main steps. The first was to get members access to telemedicine, primarily to help them triage any COVID-like symptoms without having to go to the emergency room. The new app has a direct integration with Teladoc. Another aspect involved pharmacy and medications. “CVS Caremark is our pharmacy benefit manager, and CVS is in our network, but most of our members get their prescriptions filled at community pharmacies,” he explained. “Many of those were shut down or substantially impacted by COVID. We had to come up with creative ways to get members their meds.”
The third was food resources. “We saw a spike in unemployment rate from 3 to 15 percent in four weeks, a spike in enrollment and a spike in the need for food,” Sweeney said. “We have been increasingly focused on social determinants. As we were refreshing our annual strategy last year, the two leading factors were digital and social determinants.”
Healthfirst has built a strong relationship with NowPow, the Chicago-based company whose tech platform supports participants by building and managing community resource networks.
“Every member of our customer-facing teams has access to the NowPow catalog of social determinant resources,” Sweeney said. “We accelerated the integration of that into our mobile app in a seamless way. This is a mobile app that is the most optimized for the Medicaid population of any that I am aware of,” he added. The social determinant catalog is ever present at the bottom of our app, with a flexible and modern search capability built in.”
In partnership with PwC, Healthfirst also did some analytics around emergent food deserts in the community in areas where food resources were shut down. “We added over 450 food resources to the NowPow catalog that were optimized for where our members live and where these food deserts were,” Sweeney explained. “We took it a step further and partnered with City Harvest and stood up some pop-up food distribution sites in the remaining food deserts and then added those to the catalog.”
Healthfirst worked with a human-centered design company called Solstice on the app, and asked members to help test it as it was being built.
Sweeney stressed that his team’s agile approach to software design made the changes possible when COVID hit. “When we needed to re-sequence the work, we had the features already defined. We were intentionally sequencing them in a different way before COVID, but we re-sequenced them and added other resources.”
The initial roll-out was an iOS version, with an Android version to be released this fall, as well as Spanish and Mandarin Chinese language options coming as well.
Sweeney said the number of downloads so far is a four-digit number, but it is too early to tell about deployment because they have only begun a widescale marketing effort. “We feel that the features are really strong. Virtually all of our members will find a feature that they will use the next time they seek healthcare. You can show your digital ID card, and if you change primary care provider, it is instantly reflected in a new ID card. We have care navigation features and the catalog of community-based resources. We build a personalization engine in as well that allows us to do more targeted outreach for members who have gaps in care or who need to be reminded to fil a prescription.”
I asked Sweeney if he thought healthcare has fallen behind other industries in this type of mobile app development. “I think they have lagged substantially,” he said. “I think healthcare has yet to be truly disrupted by consumer digital. If you think about the consumer experience, it feels disjointed. If the way the delivery system collaborates is with faxes and files and phone calls, there is no way to knit that into a cohesive consumer experience. We are working to curate a modernization of the provider collaboration to improve the experience for the consumer.”
Sweeping regulatory changes
I also asked Sweeney how else his job as Healthfirst CIO has been affected by the pandemic. “Every element of our business was impacted,” he said. “We have 12 different agile programs to deliver all our changes. Every one of them was impacted by a huge amount of regulatory change.” For instance, certain plans have modest premiums due of $10 or $20. But historically if the members don’t pay, Healthfirst isn’t allowed to keep the state portion of the premium. “All of that was rather abruptly waived,” he said. “Those rules were shut off. All recertifications were halted. We no longer had to pursue them. Utilization review regulations were changed. Reimbursement rates were changed, with a 20 percent premium put on all COVID treatment. We had to turn that around very quickly. In addition to accelerating all the digital app work, we were able to absorb all those other changes, while everyone was working from home. I think agile business is increasingly important.”
And things continue to change. The focus on telehealth is one example. The mobile app has a tight integration with Teladoc, and all members have access to it now.
In March and April, the hospitals were totally focused on treating the patients in their hospitals. They wanted Healthfirst to use Teladoc to triage patients and keep people out of the emergency room unless they really needed to be there. They also were not eager for Healthfirst to send patients to their health system telemedicine offerings. But then things started to change.
“May was the most challenging month financially in the history of almost every hospital in New York City because they no longer had COVID patients at the scale they had previously, but the return of elective procedures had not yet begun either,” Sweeney said. “So they wanted us to get members seeking care that had been deferred during the crisis to connect to their telemedicine offering, and each one has its own.” Now in June and July, hospitals are capable and confident about seeing patients in their office settings again, so now they have pivoted and are focused more on getting people into those settings, where appropriate. “I describe telemedicine as an order of magnitude more important than it was six months ago but an order of magnitude less important that it was two months ago,” Sweeney said. “Hospitals now want us to use Teladoc as urgent care for off hours.”
Healthfirst has integrated information about telemedicine capabilities of physicians into its directory. “You can search it for physicians who support telemedicine and then for some of the better organized hospital systems, we can do a little more. For instance, Bronxcare has a single phone number you can call to get access to any telemedicine or office appointment for anybody in the whole system. For members with a Bronxcare primary care physician, we are personalizing the app to show a card every time they open the app that says you can get access to anybody at Bronxcare by calling a certain number. We can use personalization to do that. We built our mobile app really featuring the relationship between the member and the primary care doc. On that card, you can see whether your doc has telemedicine and how to get it.”