This week I am talking to Steve Wigginton, CEO, Icario (@icariohealth) who are creating truly personalized and incremental ways to help the world a healthier place, one person at a time.
Steve has a long career in healthcare and prior to iCario came from Sutter Health/Aetna where he was responsible for launching an innovative health insurance business, delivering best-in-class clinical care, and driving breakthrough consumer and member experiences.
iCario pulled their name and inspiration from the Blue Zones and the work by Dan Buettner to deliver that level of wellness and longevity to everyone, or as Steve puts it – every human being. We discuss the use of labels and the impact that has on healthcare and the people in the system – both those delivering and receiving care or services. As Steve points out we may not consider ourselves a patient, or member and being labelled as such likely impacts any interactions that take place and ultimately the success of making people healthier and importantly how not all decisions can be made as ‘Consumers’ with all options or choices available. This is the ‘Label Gap’ – the space between healthcare and life that needs to be fixed to deliver a holistic health and wellness wraparound or perhaps cocoon.
Their approach is incremental in nature tailoring each and every interaction to the individual and importantly crafting messages that will resonate with their audience very much in line with Matt Waellert’s concepts: Making it Easier to do the Right Thing.
Listen in to hear the incremental things that have worked to move the needle in wellness – incentives do work but they have to be culturally attenuated to be heard by the populations we are trying to reach and serve
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Raw Transcript
Nick van Terheyden
Today, I’m delighted to be joined by Steve Wigginton. He is the CEO of iCario. Steve, thanks for joining me today.
Steve Wigginton
Thanks for having me.
Nick van Terheyden
So, help our listeners understand a little bit about your career and how you arrived at e carrio. And actually, I think it’d be worth sharing a little bit about the name because it plays into the organization.
Steve Wigginton
Yeah, well, I’m happy to do so it is, I guess I’m blessed to say a long career, hopefully, with some runway left to go. But yeah, I’ve been in healthcare now for about 25 of my 30 year career, all in and around helping to improve the health and well being of populations here in the United States. I’ve spent time working with hospitals to improve the efficiency of how they purchase the supplies that they use, and ultimately help support their mission at a very local level. I spent time in and around behavioral health and high risk chronic care management, so of populations with two or three or four chronic conditions and, and very often accompanied by mental health issues, which of course, today is very much a frontline topic and behavioral mental health and the shortage of, of capacity there. But earlier in my career was was a part of helping to improve those those modalities. And then over the last 10 ish years of was more involved in population health and helping payers and providers provide more comprehensive care and well being for individuals beyond just when they crossed the threshold of a doctor’s office or a hospital. And in that journey, spent a lot of time with very sophisticated clinical interventions. You know, we had nurses and physicians and specialists designing care pathways and care coordination programs and different programs and capabilities that improve the health of individuals that were most at risk. And always in all of those experiences. One of the most challenging things we had to overcome was helping individual human beings take advantage of the goodness that these health plans and these health systems and these physicians were trying to provide. And that engagement that consumer engagement in health care was always a challenge. In all of those experiences across my career. In the middle of 2020, I had the opportunity to join a company called Nobu health that specializes in getting individual human beings to connect to the goodness of healthcare. And over the last 18 months, we were fortunate enough to combine Novo with two other businesses and rebrand all three of those companies under the carrio brand that you mentioned earlier. A carrio To your point was was really a derivative of a name that we saw as we looked across the market. There was an island in the GNC called a Korea spelled differently with a K and an a instead of a C and no. But was one of the the five blue zones in the original Dan Buettner work around. The idea of a Blue Zone was people were healthier, live longer lives, and studying what was what was underneath that in different geographies around the world. And this idea of connectedness, movement, taking care of one another, really resonated with our team as we rebranded into a choreo. So that’s a little bit of the history since the middle of 2020. As we merge these three businesses together, we’ve grown extremely rapidly, we work with almost every major health plan in the country, in support of their mission, to make people help people live healthier lives. And our role in that is to connect individual human beings to the goodness that these healthcare enterprises are so committed to delivering.
Nick van Terheyden
Fantastic. It’s interesting that the Blue Zones are really an extraordinary sort of data point that even to this day, as I reread and, you know, continue to see still don’t provide it and I think everybody looked at and said, Oh, right, we must do X but there is no single point in that data that says this is the way that you generate that longevity, you know, it’s the contribution of all of those elements. And, you know, you talk about one of the things that for me, I think is I know understood, but relatively poorly implemented, which is the connectivity and you sort of touched on it with the patient engagement, which, you know, back some years ago. Eric Topol and Leonard Kish described as the, you know, the blockbuster drug of the century. Have we managed? Or are we managing to actually connect with patients to get that value?
Steve Wigginton
Well, it’s interesting, you use the term patients, because it’s, I think, each of us as individual human beings, we carry a lot of labels in the healthcare system. Our insurance company calls us a member. Our doctor calls us a patient, even when we’re not sick, is the patient in the waiting room for their annual wellness visit. And so it’s some level one of the fundamental challenges that healthcare has in its attempt to deliver value is that it depending which part of the system you are in, you carry a different label. And yet, when I wake up in the morning, I don’t think of myself as a member, maybe of my country club, I don’t think of myself as a patient unless I’m sick. And yet, when I think about my long term health and well being I think of myself as a human being, I’m a father, I’m a husband, I’m a member of my community, an employee of my company. So all these labels are interesting, and in some ways, barriers and part of a Kyrios mission is to break those down and connect with individuals as human beings and then bridge that back to whatever goodness the healthcare system is trying to deliver. So when you talk about this idea of a blockbuster drug, I think a carrio is approaching it in a more incremental way. Which, which probably will resonate with you given given the title of your podcast. In fact, there are specific use cases where human beings would benefit from a discrete interaction with the healthcare system that is good for them. Case in point, you’re a senior who signed up for a Medicare Advantage, program or plan, you are entitled to an annual wellness visit, unfortunately, and then your health plan would actually really like you to do that, because we will spot things preventatively that are better for you to treat earlier, that are better for the plan to understand the risks that you’re managing. And yet many healthcare, many seniors don’t take advantage of that. And so Carl’s role there as Hey, Steve, get your annual wellness visit, you’re entitled to it. By the way, here’s a little nudge, would you like to get a gift card? Or how do you how would you, you know, maybe we appeal to your behavioral biases, you you have grandkids, would you like to be around for those grandkids? Let’s put messaging in front of you that says, this is actually for them, not for you. And so this interface between the healthcare system and human beings is the place that we are focused. There are, there are science, there’s science, there’s data, there’s artificial intelligence, and machine learning, and a bunch of fancy buzzwords that we can apply against that, you know, but at the core, healthcare doesn’t wake up in the morning, the same way we do. They think of us as a member or a patient, we think of ourselves as a human being as a father as a husband. And so that that interface is where we’re most focused, to try to unlock the value that already exists in healthcare.
Nick van Terheyden
You know, I, I love that sort of approach and thinking around labels. You’re right. I mean, I come at this as a clinician, I default to that patient. Monica, you know, struggle a little bit with the consumer branding that’s pushed out. And it’s interesting. I was doing two recent interviews, both with physicians, and both pushed back on the consumer, Monica into hundreds of each other. So I think you’re right, we do sort of unintentionally label, but it does sort of carry through and I think that’s important.
Steve Wigginton
Well, I’ll give you I’ll give you an example. Right from inside my own home. My wife is a physician. She’s an OB GYN, I would argue, you know, one of the best in the market that she works. And she pushes back on this idea that, you know, she has a responsibility as the physician, which sometimes includes saying no to your consumer request. Hey, I’d like some more opioids, you know, would be the extreme example, and having to, you know, insert the clinical data discipline and, and responsibility oversight responsibility that she has. So it is it’s an interesting even in our around our own kitchen table we have some of these debates. But I think across the broader population, certainly in the instance of AI as a physician interacting with you as a quote unquote, patient, there are responsibilities there. But across the broader population to create holistic wellness, and certainly as you think about health plans, we’re taking on overall cost and quality responsibility, I do need to speak to you as a consumer, because that’s how I move you more so than as a patient and, and many of the interactions that healthcare offers, actually don’t come through the clinician or through the physician. And so that’s a little bit of our trick. And a little bit of our science is trying to figure out how to fit in that in that label gap, which I don’t think I’ve ever used that term before, but maybe well, again.
Nick van Terheyden
You know, I wonder if your wife will resonate with this, and you bring up the sort of obstetric piece of this, my wife, practicing midwife delivered many, many babies in the United Kingdom 1500, by the time she’d finished her practice, and she would push back on the patient label as well, that’s a perfectly normal activity. So, you know, point well taken. I think it’s, you know, an important focus. You mentioned something else that I think is really integral to this, and it’s part of the messaging. It’s getting the right message, because you can say the same thing, different ways. And you talked about, you know, do you want to be around for your grandkids? I recall this from a previous guest who talked about this, when you’re trying to encourage flu vaccination to elderly folks, they don’t always say, Well, I don’t care if I die. I’m not saying that’s true. But you know, you tend not to sort of think of it whereas I do want to be around. How are you approaching that in terms of the messaging component?
Steve Wigginton
Yeah, it’s a critical part, we believe, of how we can assist our clients, most often our clients our health plans, is to segment the messaging to be as focused and as tailored as possible, we have a goal as a company, to personalize our communications at what we would say the N equal one level, meaning, the communication to you and the communication to me are ideally perfectly tailored to what we believe will motivate you. Part of the way we do that is you have to understand your audience, right. And if you can segment that audience down to deciles to Again, our goal is n equal one, I would understand uniquely what motivated Steve Wigington. And I would be able to speak to those motivations based on data based on understanding my beliefs as a consumer looking at data that we can acquire models that we can build digital twins, a lot of fancy buzzwords, but being able to do that is important understand that audience The second piece is then say, based on that understanding what what data has what have we seen works from a messaging standpoint, and then also doing really primary research. So we were just talking about babies and midwives and obese and so on, you know, in the managed Medicaid population, where we do a lot of work today, you have a lot of young mothers, very often single moms, you know, taking on at a very young age, a lot of responsibility for Medicaid Managed Care health plans that we work with being able to communicate to those women in a way that motivates them, not only to take care of themselves prenatally, but to take care of their newborns, and tailoring the messaging and the incentives in some cases, you know, a $50 gift card to acquire diapers may motivate a pre post natal visit that is really valuable, both to the health plan and to the mother. So there’s a lot of primary research that we do. And it it is understanding the motivations, understanding how folks will respond to rewards or incentives that that motivate healthy behaviors, being able to make those communications culturally attenuated. So what works in Houston may not work at all in LA, or certainly not as well. And so a lot of those nuances in bringing the customization of the content is is a part of what drives the incremental value and uptick and ultimately how these women you know, in the case of an example I just gave have a healthier pathway, mom and baby pathway.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick incrementalist. today. I’m talking to Steve Wigington. He is the CEO of e carrio. We were just talking about that motivation, the customization that, you know, is based on the individual they’re sort of circumstance, which brings up one of the sort of compelling issues particularly around that population you were just talking about, which is great. So I’m, I’m in this Medicaid population. I’m a single mother. Huge inequities, huge lack of access to technology to conductivity. How are you dealing with that? I mean, I it’s just the the numbers are stunningly large.
Steve Wigginton
Yeah, well, what’s interesting about so first off, I agree 100%, I mean, the the inequities in terms of availability of health care, and the broader social determinants of health, which, of course, SDOH has now its own category of budget. And, and it’s got its own set of buzzwords. But but if you peel that back in, you mentioned, you know, your experience in the UK, I have my family is from, you know, when when you think about the way the council thinks about a population or a community, it’s not exclusively healthcare, is their housing available? Do they have access to food and vegetables? Do they, you know, those things, you know, we understand scientifically that they are all interrelated, that if you have mental health issues, and you’re homeless, you will show up in the emergency room, and you will be an expensive managed Medicaid patient. But the driver of those expenses is very often not an underlying medical condition, their social conditions, and the interrelatedness of those things is significant. You mentioned, you know, sort of access to digital, the digital divide is the is that I think the term of the day, all of those things contribute to your overall health and well being and where they tend to show up from an expense standpoint in those populations is as health care expenses. What we’re seeing now with health equity and social determinants of health is health plans. And states and government sponsors of healthcare are recognizing that providing benefits that may not traditionally have been viewed as health benefits, in fact, improve the overall health outcomes of those individuals and lower the costs of ER visits and other things that are, you know, radically inefficient that like No, no debate. And so as those benefits now are being legislated, is probably not the right term, but but they’re being incorporated. And there is a recognition that those benefits have a value. There’s an opportunity that at a Korea, we have really stepped in to help our clients capitalize upon if I provide a food benefit. But the members of the health plan, don’t take advantage of it, I might as well not have done it. And so as with a bunch of other things in health care, this goodness is offered but very often not taken advantage of and it is in that quote unquote, sale, that Accardo steps in and says how do I educate? And then if someone has a food insecurity that I’ve identified, how do I motivate them to take advantage of this offer, that we have to deliver groceries or give them a discount? And so those are, those are the places where we’re playing? We’re seeing it, you mentioned the digital divide, we see, Major, there’s legislation in place now that subsidizes digital access. We’re seeing folks like Comcast step up through their foundations and try to help bridge that gap. And so we’re stepping in and saying, Okay, if we have this opportunity for you, how do we get you to take advantage of it. And you would be surprised. Making these benefits available is only half about the other half is then getting these individuals to take advantage of them. And then once you create those connections, you unlock a ton of potential value from a health outcome standpoint.
Nick van Terheyden
So I recognize this as a very difficult question to answer. But you keep talking about the N of one which I think is exactly right. But I’m going to ask you to generalize and see if there were some elements within your experiences that you found success in moving populations or groups. Were there elements and things that you go, Gosh, that was something that really helped in terms of moving a population or a group towards healthier, more appropriate choices.
Steve Wigginton
Yeah, I mean, two things immediately come to mind one, speaking to, and we talked about consumers, and a little bit of the tension around that term in the healthcare space. But But consumer motivations definitely work. When an individual is offered an incentive, or a reward, or a time based opportunity that they must complete in exchange for something, we find that works extremely well, you must be cognizant of the regulatory framework around those opportunities, and you must deliver those in a way that that recognize risks of fraud and other things. But generally speaking, they work They work extremely well. And particularly with, you know, historically noncompliant, you know, there are, there’s a group of us that will always take advantage of an opportunity to improve our health. And then there’s a more recalcitrant group that you really have to work at. And with that group, we found that ladder group particularly rewards incentives, those things are incredibly effective. And then the other thing we found is tailoring the message culturally, is another incredibly effective tool. So being not only from a language perspective, but really going a level deeper around culture, region, ality geography, the tailoring, there has a significant impact on uptake and uptake drives, drives health outcomes.
Nick van Terheyden
You know, it’s interesting, you talk about the incentives. And, you know, there’s a part of me that surprised part of me not, I’m sort of ambivalent around that, because sometimes I’ve seen it work. Sometimes it hasn’t. And I think part of that might be tied up with the messaging. But the cultural piece I haven’t heard previously, and I’m curious, the element of that, you know, you see the multi lingual, but that’s not it, clearly, there’s something more to it. As you think about those elements, where does that fall, what pieces in there that you think about and go, that really made the difference to push people across the line?
Steve Wigginton
Well, it cultural attenuation really meant then opens up a receptivity to the message you’re trying to deliver. So if I’m a single mom, I’m in Houston. Spanish is my first language, simply translating your content into Spanish doesn’t get you there, recognizing the market that you’re in, and being able to customize your communications, whether they’re verbal, or email or print or whatever channel you’re using, to resonate with that individual, this makes sense to me, this is applicable to me, it’s harder than you think it requires, you have to understand the audience, you have to segment that audience and then you have to be able to dynamically generate content that speaks to that audience. But as you do that, you will see a receptivity increase, that’s really a it’s twofold threefold increase in uptake and impact. And that’s a big part of if you think about health care in the United States, it is highly local. And recognizing that as a component of our work has been a really impactful driver for our success.
Nick van Terheyden
No, I and I think, critical points in that if you were to sort of put that into a package, it would be the, you know, to the example that you gave that Spanish as a first language, Houston native, actually delivering the message, which you can’t scale. But you do that with technology. This is not about putting the content into Google Translate, translating it into Spanish at all, that customization down to the individual, I think makes a huge difference to the way that they receive it plus all of those other nudges that you, you know, talked about earlier. Unfortunately, as usual, we’ve run out of time and you know, extraordinarily interesting to hear effective change that’s delivered to the widest population possible. I think that’s the thing that’s been most troubling to me throughout the pandemic. And you know, even prior to that, and here’s real solutions down to the individual that are actually moving the needle. Very grateful for the conversation. Just remains for me to thank you for joining me on the show.
Steve Wigginton
Well, thanks for having me. It’s always a pleasure to represent the great work that our teams are doing and look forward to chatting again soon.
