Inspiration

Wellth CEO Matt Loper came up with the idea for the company while working on Wall Street in the healthcare sector during the exciting time when the Affordable Care Act (ACA) was being hotly debated and ultimately passed. The ACA was a great catalyst for the expansion of Value Based Care (VBC), which better aligned the interests of health insurers and hospitals. This alignment is absolutely necessary to achieve better patient health outcomes. But Loper questioned, how can we better align the incentives of the patients themselves? Through the adoption of VBC, hospitals are now financially on the hook for what happens to patients even after they leave the hospital. So, their payment now depends on patients taking their medications and following their care plan at home. But providers have very little control over patient behavior at home, and many patients do not always follow their doctor's orders. Wellth was created to become the crucial stakeholder that can follow patients home and motivate them to do better by rewarding them for taking their medications and following other aspects of their care plans. This is extremely important for chronic diseases where patients feel little difference day-to-day whether they adhere to their care plan or not, but it has a huge health and financial impact -- both of which are realized in as little as a few months. While other companies attempt to solve this problem by pushing more technology, coaching, and education onto patients, we believe this fails to address the core issue: lack of patient motivation. We believe that changing patient motivation is the crucial ingredient to actually effect real patient behavior change, and behavioral economics is the field of research that tell us how to do it. Wellth applies proven principles from behavioral economics at scale using a comprehensive technology platform involving patient smartphones to help payers and providers improve the health of its highest risk members during the 99% of the time they spend outside the "four walls" of the healthcare system.

What it does

The Wellth platform achieves high-value behavior changes in patients with chronic illnesses - e.g., better medication adherence - through mobile technology and behavioral economics. Our key customers include health insurers and providers.

When a customer decides to use Wellth, we analyze their population and business model to identify the key chronic disease population(s) as well as specific patients that will benefit most. We then perform all customer reach-out, enrollment/on-boarding, monitoring and support -- which optionally includes patient care coordination using our own care managers. For customers who choose to integrate our programs into their own care management efforts (typically the model that applies to health insurers), we supply them with access to high level analyses of real-time patient adherence data and actionable alerts when, for example, a patient with heart failure displays a sudden jump in weight. In all cases, Wellth's business model is milestone-based, so that we only succeed when we help our customers achieve positive patient engagement and outcomes. Typical target outcomes include reduced hospital 30- and 90-day readmissions, which providers are financially penalized for under Value Based Care.

From a patient perspective, in most cases they learn about our programs and enroll while they are inside the hospital after an admission for heart failure, heart attack, or other similar condition. Let's take Joe, a heart failure patient, as an example. In a typical program, before Joe is discharged, he is offered a financial incentive of $150 ($50/month for 90 days) to fully adhere to their care plan for 90-days starting from his first day at home. One of our nurse enrollers helps him download our app onto his smartphone and learn to use it, and gives him a connected scale to take home. Then, each day he receives reminders that help him to take his medications and step on his scale each morning. He checks in his medications by snapping a photo of the pills in his hand just before taking them. His weight is automatically recorded by the scale. Each day he fails to check in his medication and step on his scale, he loses $2 from the amount to be paid out.

How we built it

We studied the patient engagement solutions in the market, and realized that we wanted to create a platform that could drive better adherence to clinically-relevant patient tasks like taking medication and post-acute condition management. We developed a product roadmap based upon the needs of this specific patient user base, and then set to work creating prototypes on Android and iOS simultaneously. With those prototypes to validate some of our assumptions, we then launched into a full-fledged build-out process on both mobile platforms, in concert with the development of our scalable backend API and our internal web dashboard for care monitoring and management.

We used primarily open-source tools and libraries, like React, GraphQL, and a host of networking and UI libraries for the mobile platforms. We managed our workflow with an agile development process, working in weekly sprints and planning collaboratively with an eye toward group accountability and focus on our higher-level goals. Ultimately, our mission is to drive patient adherence to therapies that may save their lives and significantly improve their outcomes, so we made sure to keep our focus on the features that could drive that great user experience and that strong impact.

We are HIPAA-compliant and secure by design. Wellth encrypts all data in transit and at rest, and we protect user data in the cloud by ensuring that all databases are encrypted and all connections are secure, along with compliance with all other physical, technical, and administrative elements of HIPAA. We currently use a HIPAA-compliant Platform-as-a-Service vendor to host our backend infrastructure securely.

Challenges we ran into

As we built and tested our prototypes with the market, we ran into a number of instances where we had over-planned our feature set, making too many assumptions about what was needed by our user base. By iterating quickly, we were able to quickly throw away parts of our feature set that we realized were unnecessary to build or to support, thus focusing on just the components that were necessary and drove value creation for our users and customers.

Accomplishments that we're proud of

Right from the beginning, our product and idea generated a lot of interest, and we quickly gained and executed small projects and pilot opportunities. We were also very lucky and are proud to have had the chance to participate in some valuable accelerators such as Healthbox, New York Digital Health Accelerator, Tigerlabs, and Dreamit Health Accelerator. From the traction we gained through these amazing opportunities, we were able to successfully raise over $2 million in seed funding, led by AXA Strategic Ventures, and assemble an amazing advisory board with thought leaders from industry and academia including Dr. Mark Fendrick (creator of Value-Based Insurance Design), Larry Hausner (former head of the American Diabetes Association), Jeffrey Sachs (Sachs Policy Group), and Michael Laskoff (founder of AbilTo and Annum Health).

One of the most important milestones for us came last year when we secured a pilot with a large national insurer where we implemented the Wellth platform in 114 users with Type 2 Diabetes population. The pilot showed a 78% improvement in adherence for users who were financially incentivized versus a control group who was not.

Currently, we are proud to be launching our platform at two university hospital systems in patients with congestive heart failure and heart attacks. Additionally, we are implementing a program in type 2 diabetes with members at a managed long-term care organization in New York City.

Lastly, we were recently named the winners of the American Heart Association’s HealthTech competition, which has given us more partnership opportunities and valuable exposure. This is the second major challenge we won, after the Super-Utilizer Devpost Challenge sponsored by the Center for Healthcare Strategies to help individuals who have complex physical, behavioral, and social needs that are not well met through the current fragmented U.S. health care system. We were also chosen as semifinalists for the Cisco Innovation Grand challenge.

What we learned

Over the past two years, partnering with thought leaders in healthcare to secure customers and funding, design and execute research studies, and participate in four leading startup accelerators, we have identified our core principles and validated our internal hypotheses and approach. In particular, we identify our core principles as 1) Change patient behavior so they get better, 2) Improve care management efficiency to make way for more effective, higher touch care, and 3) Mitigate risk for health plans and provider organizations so they can reduce costs. We learned that the way to accomplish these goals are by truly understanding the workflow, cultures, perspectives, and pain points of our customers. In addition, we have evolved our business model to focus on narrow solvable problems and take on more financial risk ourselves by setting up milestone payment structures so that it is easier for our customers to say yes up front and know that we are committed in the long run.

What's next for Wellth

Our top priorities are to completely satisfy existing customer relationships and complete ongoing clinical studies to gather additional hard evidence that validates our approach in multiple disease states and business areas of focus and raise Series A funding in the next six months.

Secondly, we need to start rolling out in our upcoming implementations some of the new high-tech features of our product, which include a wide range of artificial intelligence (AI) and machine learning (ML) capabilities we have in development. For example, we have internal development projects ongoing to analyze the pill photos we receive from patients to use computer vision and AI to automatically determine whether patients are taking the right pills at the right times. We have other similar features in beta-testing that involve analyzing photos and datasets from glucometers, blood pressure cuffs, meals, and activity trackers to create deeper, more personalized intervention programs in a wider range of disease states.

Finally, in the long term we are building a repeatable, scalable sales process that includes identifying customers based on their risk contracts and specific patient populations, and choosing customers that align with our own strategic goals. We have already become proficient at designing custom tailored intervention programs for each customer, and now we are seeking to progressively roll them out over the next few quarters to cover heart failure, heart attack, diabetes, asthma, COPD, and specialty pharmaceuticals where costs due to nonadherence are high and there is already a strong evidence base for our approach to change patient behaviors using incentives and technology.

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