Making Healthcare About Human Care - Taylor Justice, Co-Founder and President, Unite Us

SHIV GAGLANI: Hi, I'm Shiv Gaglani. Today on Raise the Line, I'm happy to be joined by Taylor Justice. Taylor is the Co-founder and President of Unite Us, a technology company that facilitates coordination of care for patients with multiple barriers to health. He is passionate about social issues and implementing technology and collaboration within the health, human and social service sectors.  Taylor, thanks for taking the time to be with us today.

TAYLOR JUSTICE: Thanks for having me.

SHIV GAGLANI: Can you start by telling our audience a bit more about your background and some of the key points in your career?

TAYLOR JUSTICE: My background comes from the U.S. military. I was a U.S. Army Infantry Officer, graduated from West Point and commissioned in 2006. Unfortunately, I was medically discharged and through that experience of dealing with the VA, finding a new job and finding a place to live, just noticed the inefficiency of military veterans transitioning into the quote-unquote civilian sector. Fortunately, I didn’t struggle. I landed in Philadelphia and quickly got involved with veteran nonprofit organizations as a volunteer and realized that people would have their needs across multiple sectors and that really was the spark for starting Unite Us and really filling a void that we noticed in the market.

SHIV GAGLANI: That's great. First of all, we just celebrated Veteran's day, so thank you for your service as well. We've had several Raise the Line guests who have connections to the VA, including David Shulkin, who I'm sure you've come across. He was the secretary of the VA, and our Chief of Staff Max used to work for Tammy Duckworth, who I know is very passionate, as a U.S. Senator from Illinois, for VA initiatives and issues. Can you tell us a bit more about what Unite Us does besides the cursory introduction I gave at the beginning?

TAYLOR JUSTICE: Yes. Unite Us is a community-wide care coordination platform and that word “community” is really important. Often in healthcare, we are trying to solve people's needs within the four walls of a clinical setting, but research done by Robert Wood Johnson Foundation and other academics is that 80% of someone's overall health and wellbeing happens in the community where they live -- what they eat, their families, their communities, everything. Unite Us really saw a void in the market as we started to move from this fee-for-service healthcare model to include human and social service agencies as part of that holistic care. 

Unite Us is a technology p latform that connects health, human, and social service organizations across public, private, and nonprofit entities to securely exchange data around a shared patient, member, client -- however they're defined -- to ensure no one falls through the cracks. Our technology platform extends the traditional clinical care coordination network by including those human and social service agencies.

SHIV GAGLANI: Can you give us a bit of a sense of how many lives you reach at this point through Unite Us, and then what secret sauce is really behind the tech-enabled approach that you've taken to helping with care coordination within the community.

TAYLOR JUSTICE: Unite Us was founded in 2013, again, initially just focused on the veteran and military population. My fellow co-founder and I both had a military background, and we started to build these networks of health, human, social services agencies, and realized that the challenges the veteran and military community face are they just happened to be this perfect petri dish of American society when you look at age, race, or socioeconomic status, and the majority of organizations participating in these networks weren't just for veterans only. 

They were state and local government, healthcare entities, education entities that obviously serve the larger population, but the commonality between all of them was they had a veteran military program. So we saw that our platform, regardless of population or regardless of the organization and the services that they provided, could connect people to these needed services and prove that they received them. So we expanded in 2015-16 timeframe to focus on being population agnostic and service provider agnostic. We now represent appropriate public health infrastructure in 42+ states across the country.

The ultimate goal is that anybody that needs to connect into human, social, or healthcare services will engage with Unite Us in some shape or fashion. We're building appropriate public health infrastructure nationally and focusing our platform on the individual in need, whereas historically technology solutions or government solutions are there more to support a program or an initiative where we focus on the individual that no matter what door they walk into to be a public, private or nonprofit, they have access to this larger network and can prove that they received the services that they were seeking.

SHIV GAGLANI: Yes. One thing I love about your approach is, again, just understanding that people are unique, but also that they live within these communities and oftentimes need a lot more support than just that one visit with a primary care doctor every year or the regular visits with a psychiatrist. There are so many social determinants of health, which is a concept that I learned about in medical school, but we didn't really learn much about how to coordinate care between the different players on a care team. I think that's obviously been changing. Is there any evidence that addressing social determinants of health and coordination of care actually helps improve outcomes or reduces costs in the healthcare system?

TAYLOR JUSTICE: Yes. There are a lot of academic studies -- real-world, evidence-based studies -- that have been done. You can see them for singular service categories… so think of food, think of connecting people to transportation, where 25% of individuals are missing appointments because they don't have a way to get there. You also see groupings around particular populations…so think of maternal health, opioid addiction, food insecurity, frail elderly. Each of those population groups has an evidence-based solution that, if you can address the social determinants, it has a financial impact on the cost of healthcare but also improving their health. That's really what the focus area is. What there hasn't been in the market is proof of scale. 

That's really where Unite Us has come in. We saw an opportunity where we have a number of different product lines that we deploy. Most people know us for our flagship product, which is called "Unite Us Platform," a community-wide care coordination platform. It's better known as a kind of mesh between systems of record. We're not going to replace an electronic health record. We're not going to replace the care management platform that a health plan might have. 

We're not going to replace a government's benefits and enrollments with technology, but we need to integrate with them, so this mesh between systems of record allows these bigger institutions to better coordinate care around that share of an individual in need. When you have that infrastructure, think of it as a supply chain. Now you can do a lot of really cool things on top of it. There are tons of data analytics companies out there that take publicly available data from LexisNexis or somewhere else and create a social risk score or create population health data sets that allow us to look at heat maps within a particular community. 

No one's really looking at what's tactically happening on the ground, so Unite Us can take that publicly available data, marry it with what's happening within a community to have a very, very tight group of what are the needs for this individual within the community in which they live and the supply that's available based on food, housing, employment, education…what we know as the social determinants. And the scale portion of that really rolls into what we're building with Unite Us Payments, which creates an economic relationship between healthcare and social care. We're moving from a fee for service model to value-based healthcare because there is an ROI for health systems and health plans to participate and engage with these community-based organizations. We're providing the mechanism with not only the connections to these organizations but the financial incentive as well. If I can remove moldy carpet from someone's home in an efficient and cost-effective way, I might have a better chance of treating asthma. I might have a better chance of ensuring that this person stays in that home if they have an employable wage. 

I make sure that someone with diabetes can adhere to a healthy food plan if they have a home to go into and a refrigerator that they can store produce and other materials. Again, we think about holistic care. Human and social services are operating on pen and paper, Excel sheets, the dreaded wall full of brochures, if you've ever gone into your primary care doctor. That's our referral mechanism across the country. It's not sufficient, so bringing those human and social service agencies into the 21st century with a technology solution that is seamless, easy to use, and connects them into the behemoth that is healthcare allows us to have the infrastructure to provide that scale and provide these intervention models that allow us to again, improve health while reducing the cost of healthcare care. 

Our view of the marketplace is that to truly incentivize healthcare to care about social care, it needs to impact their bottom line. That's really what we're trying to focus on, and how we can put human and social service agencies at the same priority level as healthcare and facilitate an economic relationship.

SHIV GAGLANI: That is fascinating. I love those examples that you provided. One of our other guests that we've had on the podcast is Dr. Sachin Jain, who, when he ran CareMore Health, initiated this collaboration with Lyft to help improve the reduced number of missed appointments because of transportation issues. I know you know DaVita has a similar thing with Uber, I believe. 

Everyone's heard of companies like Handy or Thumbtack and these massive networks of people who can do the social services that you mentioned, like removing mold from the house of someone who may have asthma. Are those the kinds of companies you would eventually integrate with and provide a scalable way for someone to get their home fixed up if they had that need?

TAYLOR JUSTICE: Yes. The short answer is yes. When we talk about “community-wide,” we truly mean it. It could be an organization like Handy. It could be a community church. It could be a barbershop. What we're building is infrastructure, and we're meeting the community wherever they congregate. In certain communities in North Carolina, we have barbershops that are access points to a greater network. You want people to feel comfortable. In certain settings, like a barbershop, people are willing to open up or say, “Hey, I might need assistance with X, Y, and Z.” Now that barbershop isn't necessarily going to provide food or housing or transportation, but they can connect that individual to a provider in the community. Provider here is defined as health, human, and social. It's not just healthcare.  So they become a conduit. 

We want to have an infrastructure where regardless of the door you walk in, regardless of the organization and the services that they provide, there is a solution or an opportunity for those organizations to participate within this greater network because it needs to involve all sectors. Again, healthcare is almost 20% of our GDP in the country. What we are looking to do is reallocate some of that spending to these human and social services so we can take care of people holistically. That requires multiple sectors coming together and coordinating around that individual in need.

SHIV GAGLANI: In that specific example of a barbershop, what's the incentive of the barbershop? Obviously, they care about their customers, and there's a conduit there, but would they be paid for referrals? How do you get them on board with the system?

TAYLOR JUSTICE: It's not necessarily them being paid for referrals. I think it starts with what you started with -- if they care about their customers. They're already talking about things that are going on in the community. It could be just general gossip. It could be about a sports game, or it could be like, "Hey, I need assistance with X, Y, and Z," just as they would say, "Hey, go to the local church,” or “Have you tried this other organization?" What we're doing is we're operationalizing that manual process or that conversation where now that barbershop can be an access point and can easily say, "Hey, you need assistance. Because I care about you, let me connect you to an organization that might be able to help."

It really empowers that organization to address needs as they uncover them. I think in the future, there could be potential for a barbershop to be financially incentivized. You see health plans today that are paying health systems to do social determinants of health screeners, but what if you did that in the community and provided these other organizations, that have more touch points, spend more time with these individuals, and you incentivize them to ask a couple of questions, "Hey, do you have enough food to eat? Do you have an employable wage? Do you have a place to sleep tonight?" Those are access points that will drive success, not only for healthcare but government, and what we're trying to do is extend that support network not just to be clinical support, but holistically.

SHIV GAGLANI: That's fascinating. Shifting gears a bit, we launched this podcast because of COVID. The concept of “raising the line” is how we strengthen the healthcare system so that, regardless of this pandemic or a future shock to the healthcare system, we have enough healthcare workers, we have enough social support, and you're clearly helping provide care beyond the walls of a hospital or health system or clinic, which is a great approach. How has COVID affected your operations at Unite Us? What do you think some of the long-term changes are going to be to Unite Us and to the healthcare system as a result of COVID?

TAYLOR JUSTICE: There are second and third-order effects of the pandemic. While the death rate is relatively low, you have the effects of people going into the hospital or hospitals being at capacity, no more beds, or being able to treat other different service categories. There are also second and third-order effects in the community. What we've seen from the pandemic is people at unprecedented levels are accessing human and social services. Sometimes, for the very first time. Meaning they lost their job, or they don't have access to childcare anymore so they might not be able to go back to work, or you see a large number of families having to make the hard decision of one parent continuing with full-time employment and the other one's staying home to take care of the children. 

That creates an economic burden on that family. If they have to access human and social services for food then, for housing, for income assistance, our systems in the states aren't set up to support that influx. So the second and third-order effects of the pandemic are the spotlight that states are now starting to see on their lack of appropriate public health infrastructure. For Unite Us, over the past seven to eight months, we've had a number of states that have selected Unite Us to build the infrastructure. We've had 15 new statewide contracts that we're building out to connect health, human, social service organizations into this common infrastructure. 

For us, it's unfortunate what the country has had to go through, but fortunately, our team was there ready to scale and could build out this infrastructure to address the need in real-time and build what we're calling “rapid response networks,” really focusing on these emergency basic need providers. As a venture-funded technology company that raised our last financing around 18 to 20 months ago, our team has grown 7x since then, and a majority of that has happened in the past eight months. Just because the need is so great. Governments, to better govern, need to have the data of what's happening tactically on the ground so that they can make better decisions and we can allocate resources to where they need to go.

Just as we saw the shortage of PPE and ventilators and all of the different clinical tools that were needed to address the clinical response to COVID, states are also having to do that around food and access to care and making sure that people are remaining in quarantine if they need to. Our team has been there to kind of answer that call in these 15 states, and I only see that increasing. I think moving forward in 2021 and 2022, the focus on appropriate public health infrastructure should be priority number one because it's impossible to address all of these needs by handing somebody a phone book and saying, “Hey, try these resources.” You need to not only know that they showed up, but that they actually received that care, and if they didn't, why? Is it because there is no capacity in that community? Is it because eligibility requirements are too stringent? 

Maybe we need to change some policy, but it's also how do we allocate government dollars, philanthropic dollars, community benefit dollars. There are a lot of components that need to be addressed if we're actually going to help states move to a place of recovery. It's hard to do that if you don't have the infrastructure, and we're starting to see, like I said, a number of states across the country that are like, “Okay, we need to address this, and we need to address it now.”

SHIV GAGLANI: It's wonderful that you guys have been in a position ready to scale to help support more and more states dealing with these issues that, I totally agree with you, are going to last for many years to come given how much unemployment there's been and psychological distress there's been in communities. Evictions obviously are at an all-time high. 

We are an education company. We do a lot of training for health professionals, and we've seen a dramatic increase in the demand for, even before COVID, but now, especially because of COVID, in training up other types of care providers like nursing assistants, home health aides, obviously a lot of need for psychology and psychological health providers. Is that something that you all are seeing as well? How do you plug those caregivers into the infrastructure? Everything from, maybe the COVID contact tracers, which has been a big deal over the past few months, to MDs who are mainly on telehealth now as opposed to in-person visits.

TAYLOR JUSTICE: Honestly, you can replace the service that's being provided. Primary care, health system, health plan, behavioral healthcare, food, transportation -- everybody is facing very similar issues. People that come in have these dynamic needs and often see people come in with more than two needs that need to be addressed at a given time. Often, those organizations don't provide those multiple needs, so the need to coordinate care is super important. It's across the board, and there are phases to care as well. It's not just episodic. "Okay. I send somebody to a food pantry, and the food problems are solved." 

No, there's probably an economic issue there. There could be a behavioral health issue there. If someone's coming out of the justice system, they might not be able to leverage government assistance. They have to be dependent upon that nonprofit network in the community that has the ability to provide services to them. So when you get into specific populations, there are specific needs that they might have but ultimately, regardless of the title of the population or regardless of the service provider, they need to connect with complementary services in their communities, so that you provide these wraparound services. We can't do it with onesies and twosies and, or just line of sight type of services anymore. It has to be holistic, and we have to operate and collaborate across sectors. 

I think that's one of the big learnings that we've seen from the pandemic, it is that no one can do this alone. If we're not collaborating collectively, we're missing the mark. I think in healthcare generally, we've been so focused on creating these siloed and competitive networks where that needs to change up a little bit, especially around social determinants of health. We shouldn't have health plans, health systems, and government competing on connections to community-based organizations. They should be competing on the services that they're providing their patients, their members, their clients. 

These broad networks where everybody's operating within a common ecosystem, I think, is the way of the future, and you will start to see clinical behavioral health in these social services as the standard moving forward. Whereas right now, it's a one-off type of relationship in a community, now it's going to be across the broad service categories and thousands of organizations in a community or across the state.

SHIV GAGLANI: That's definitely a vision I think we can get behind, too. I know we're coming up on time, so my last question for you is what advice would you give to our audience, which mostly comprises current and future healthcare providers and professionals about meeting the challenges of COVID and beyond?

TAYLOR JUSTICE: That's a very loaded question. I will do my best. I think as healthcare professionals, if we're truly gonna provide services or an environment that improves health, it can't happen within just our four walls anymore. You have to reach out and connect with your communities. You have to connect to these human and social service agencies. You need to think of them as your peers, not just another support system in the community. The market itself is going to change where we are going to start to reallocate healthcare to these human and social services. It will become the standard within a three to five-year period. That is my prediction. 

Within that, we are going to start to look at holistic care and prescribing food, prescribing access to maybe a government benefit or access to a covered benefit that health plans started to pick up. They do it a little bit here and there with the NMA population and some of the Medicaid population, but I think that will become a standard. I think as you practice, think about how I pull in these human and social services into my care plan for an individual, or into my prescriptions for an individual, and then how I get them to adhere to that and how I make it easy for them to access those services. I really think how I can incorporate these human social services to be at the top of mind of the folks that are listening to your podcast of how I actually improve someone's overall health and wellbeing.

SHIV GAGLANI: That's an exciting vision. I hope our audience takes that to heart. I definitely know when I was in med school, I could have benefited from learning more about social determinants of health and how to access and coordinate care across the community. With that, Taylor, thanks so much for taking the time to be with us today. 

TAYLOR JUSTICE: Thanks for having me. I really appreciate it.

SHIV GAGLANI: I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to flatten the curve and raise the line since we're all in this together.