122: AI in Play: More Social Work. Less Paperwork.
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See You Now is a podcast highlighting the innovative and human-centered solutions that nurses are coming up with to solve for today's most challenging healthcare problems. Created in collaboration with Johnson & Johnson and the American Nurses Association and hosted by nurse economist and health tech specialist, Shawna Butler. Typically, you think about administrative burden for the healthcare provider. But what we don't talk about enough is the administrative burden for the family.

So many of the patients that we serve did not need more health care. They needed to be able to afford the medications that were already prescribed to them. They needed to access the healthy food and have stable housing. It was disheartening because there were programs that would help them. If they were able to do the paperwork and were able to navigate the systems.

The thing that every community organization struggled with that was the exact same feedback from health systems is being able to actually get someone into the program. People are more comfortable with artificial intelligence when it is a tool.

When patients step into the healthcare ecosystem, our goal is for every one of them to have the ability to sign up for food, housing, transportation, healthcare resources, all in one snapshot. And that's really the core of our mission. Welcome to See You Now. I'm Shawna Butler. Administrative burden. Yep.

That's a term and a feeling, and not a great one, common to so many who are aware of and eligible for many existing, funded, well-designed, evidence-based assistance programs for everything from food, housing, transportation, job training, health insurance, utility payments, and more.

And yet, in the U.S. alone, billions of dollars in resources for low-income households go unclaimed every year because families face barriers in completing the paperwork or online applications. Factors like internet access, reading and comprehension, and stigma contribute to this problem. But too often, it's the confusing paperwork

and the enrollment process that are the barrier and seem designed more to keep you out rather than in. Have you ever wished you could enroll in a social benefit program with a phone conversation instead of a confusing paper chase? Wish granted.

In this episode of our AI in Place series, we meet an emergency care nurse, health innovator, and entrepreneur using an AI-based technology to unlock enrollment into essential resources, services, and programs, one phone call at a time, and giving busy families, healthcare providers, and health systems some much-needed help, a mountain of enrollment paperwork. Ready to chat? ♪

Hi, my name is Kwame Liddell and I'm an emergency department nurse and the founder and CEO of ThriveLink.

At ThriveLink, we build telephonic, artificially intelligent enrollment agents that talk to families over a phone call and help them enroll into social programs like food stamps, utility assistance, health insurance, and even care management programs. This is important because just last year, 4 million children lost their Medicaid coverage simply because their parents were not able to understand the paperwork.

Six million moms currently are not enrolled into women, infants and children's programs. And over 12 million people right now are behind on their utilities, but are not enrolled into the federal utility assistance program because they are not able to complete the paperwork. And we're proud to say we've completed over a million dollars in program applications for families across the country.

Wow, Komain, that's a lot of people not getting the services they need, particularly at moments when we're thinking about it or asking about it.

Do people have a roof over their head? Do they have food on their table? Do they have a place to sleep? These are some of the questions that you had on a daily basis for the people that you were taking care of through the emergency department that has then led to a much bigger realization of a gap in care and the solution that you've beautifully crafted and commercialized, you know, gotten out into the world called ThriveLink.

I was at a stroke center and we were thinking about the next requirement to be certified and get the next American Heart Association designation. You had to think about social determinants of health.

We were the community hospital. So you had everything from heart attacks and strokes to falls. Lots of seniors in the community used our hospital. And actually, we had a skilled nursing facility associated with us. So we even have patients from there who have really critical needs. Medication management and Oakland is one of the largest unhoused populations in America.

So many times we were everything from the emergency department to the social resource and the primary care all under one roof.

And so many of the patients that we serve did not need more health care. They needed to be able to afford the medications that were already prescribed to them. They needed to access the healthy food that they actually understood what low sodium was and how to control their glucose. They just couldn't afford the food and have stable housing. Some of the patients with wounds that were leaving the hospital and going to sleep in places where they didn't have running water.

And it was disheartening because there were programs that would help them if they were able to do the paperwork and were able to navigate the systems and newest questions to ask and how to answer the questions. Those things could be solved in some cases, temporary, in some cases over long periods of time.

The very first thing we did, there was a food bank just a couple miles away from the hospital. It was the Alameda Food Bank in Oakland, California. It's a small food bank, so it wasn't always open, but they deliver food to families in the community. And I remember I was driving by and someone had walked out or walked in. I pull over and I'm just running down the street. It's hot. I'm like sweaty. And I catch up to her.

And I'm asking her, hey, I work in the emergency department. We have all these patients that need help. How do we get them into your program? And I really loved it that she understood what we were trying to do. So I just described the patients that we served in the community. And they were very gracious. And we got all the appropriate permissions from leadership to try it. They helped us adjust the intake form so that we just created a Google sheet that

that we could fill out or patients could fill out and they would be on their list for people who receive food. And even with that sheet, we learned so much. Not a lot of patients used it, but we learned so much from those who did and from nurses to really understand what is it that you need to be able to easily support people. And from there, we began to volunteer to fill out applications for people.

Because we quickly learned that the patients themselves actually did know where food banks were and the patients actually did access food banks and resources. So we think about, hey, give them more resources. But the thing that they really needed and began to ask for was those more complicated programs like the Supplemental Nutrition Assistance Program. Can you help us do that? Women, Infants and Children's Program.

They'll say, you know, hey, I filled out the paperwork, but they want these additional attachments. I want me to take off work to come to this place. How do we help them navigate this so that they can actually get into those long term programs? Using women, infants and children as an example. People don't realize that children are eligible for the food benefits and various benefits until they're five years old.

So this is not a short term program. Just getting through that barrier is incredibly impactful for families. We became a nonprofit. We called it Nutribull. And there were two things that happened when we began to think about it.

We learned that medically tailored meals had become covered in California. Now every Medicaid plan that I'm aware of covers medically tailored meals. So we reached out to a few health plans in the area, Medicaid plans, and we asked to become medically tailored meal vendors. At the same time, we reached out to Instacart. They were just releasing Instacart Health.

and asked how we can deliver food through Instacart. And Johnson & Johnson had an innovation challenge, and we signed up for it and just told our story. And we were lucky that the Contra Costa County Health Plan allowed us to become a medically tailored meal vendor. And...

We won Johnson & Johnson's Innovation Challenge that year, which gave us the funding that we needed to formally create a team and become a medically tailored meal company. And we now serve hundreds of patients every month and deliver medically tailored meals directly to them.

I think another really important progression in that is so many of the technology-based companies, they are looking at healthcare. When you mentioned Instacart, that was such an important tipping point. It was, especially because even when I think back now,

The capacity that it would take to deliver food to hundreds of people across the country, especially the volume that we do now, it would be incredibly difficult to operationalize. So I think platforms like them and DoorDash that delivers groceries now will continue to make a big impact. We even work with hospitals now that don't have a huge budget to hospitalize.

hire a team to deliver groceries and do a lot of this work. But because those programs exist, we deliver food as soon as they're discharged. There's a big piece in operationalizing SDOH needs.

There are some incredible forces happening in health care payer systems that are making it more feasible. So Medicare covers S.C.O.A. screenings and navigation. Many Medicaid plans do. I think all of them do in California and it's beginning to happen in other states. And technology platforms are really making those things possible.

People are aware of these programs, namely SNAP, Supplemental Nutrition Assistance, WIC Women, Infants and Children, Medicaid, and most of the health insurance medication discount programs. In fact, we won a CDC grant in partnership with the Integrated Health Network and Washington University and various community organizations in St. Louis.

And one of the asks in the grant was to evaluate awareness of food related programs, especially SNAPWIC and supplemental programs, which are grocery deliveries for people over 65. And we did not encounter any community organization that did not already know about these programs. Not one.

The thing that every community organization struggled with that was the exact same feedback from health systems is being able to actually get someone into the programs, complete the paperwork. That is the thing that no one has resources or the bandwidth to do. And when our company was named Nutribull, what we quickly learned was that

That piece is the piece that the ecosystem really needs most. We just really deeply study what is the patient's experience and what are the payers and providers experiences. And we actually changed our company's name. We moved from being the nutrition focused organization to being a resource access organization. So we don't even see ourselves as a health care company anymore. We are an accessibility company.

We create products now that make it easier for that mom who has limited time and is doing all these things to be able to sign up for women, infants and children's assistance and sign up for the LEAP program, which is the low income home energy program to get utility assistance and sign up for care management programs all at once while talking.

Typically, you think about administrative burden for the health care provider. But what we don't talk about enough is the administrative burden for the family. And I think people get it, especially the sandwich generation when we began to take care of our parents. Then we began to see, oh, there's a lot of paperwork. So we don't realize we can have a conversation with the person, give them this packet of paper and assume that they're able to read it as well. But 54 percent of all adults are not. And that's that's one hundred and thirty million adults.

Is it really that high? Low literacy in the U.S. is really at 54%. Yes, that's correct. Gosh, that's just, yeah, that's a problem hiding in plain sight.

Yeah. And so handing them a form to register, to vote, to get signed up for Medicaid, to have their their child enrolled in school, any special needs kids who need to have an evaluation. I mean, yeah. And our programs don't always make sense if you don't know that there are. So I'll give you an example. The Medicare Extra Help program is the Medicare medication discount program.

It should be called the Medicare medication discount program. But but you if you have to look at what Medicare extra help means to know that that's where you go if you can't afford your medication. At Thriving, we build bots that talk to families and enroll them directly into social programs like food stamps, utility assistance, health insurance and even care management programs.

It works in 75 languages. There is no additional work for care management teams or any clinical teams that offer this to their patients. And our utilization rate is twice that. And we've done it in multiple studies. We have twice the engagement of any other published studies ever.

to date, at least as of 2023. The reason that it works for the population that we serve is because you don't need the internet. You don't need a smartphone. You can use any working phone and be able to dial the number and actively enroll into any of those programs. We have this picture where patients at Atrium Health

have called from the hospital phone, the big bulky phone that's connected to the wall. They have called from that phone and had their utilities turned on because in North Carolina, being sick in those settings, you qualify for crisis utility assistance. So they came in the hospitals with their utilities turned off, but left with them turned on because that program is just so much more accessible to them. And that's really the core of our mission.

You listed a couple of awards that you've received. There's another really important one that you received from the American Nurses Association. Those awards are seeking out those nurses who are transforming care delivery. And you're really transforming how communities and people are accessing social services that already exist and taking these very complex, complex

paper forms and transforming that into a conversation with a technology that is readily available, a phone call and answering a set of questions. So maybe you want to mention that particular award and what that's meant for ThriveLink. It's been transformative for me personally and for our organization. I think both are important.

So just the mentorship that I've gotten around, you know, building an organization and commercializing and marketing and storytelling have been just vastly transformative for me and for Thriveling as we've been able to adopt some of those things we've learned. We've improved our website and our marketing materials. And even I think this is probably the most important one, how we've been able to

collect feedback from patients and doctors and all the different stakeholders that do this work. And I'll give you an example. We were trying to figure out how do we describe this thing that talks to people and does this paperwork? And we described it as automated community health worker or automated social worker.

And we asked community health workers and social workers, what do you think about this? If we hadn't gotten this feedback, we would have been offending so many people that we really want to partner with and support because community health workers and social workers do so many things. And the last thing we want to do is offend them. And they actually developed the name Telephonic Social Program Enrollment. It helped us learn that

people are more comfortable with artificial intelligence when it is a tool. People thought, and even we thought, well, you know, some communities might not feel comfortable talking to a bot. But one of the reasons we started describing it as a bot is because we associate our platform with a calculator or a computer and not as something that

may confuse people into thinking that you're talking to a real person. Yeah. Chat bots are a regular part of our life. Before we started chatting, I was making plane reservations. So get on the phone with the airlines and it's like, are you calling about a current reservation? Have you been impacted by the recent hurricane? Are you looking for award redemption? So it was asking me this set of questions to route me to the right place.

People are doing that with their banks. They're doing that with ordering out food. I mean, this is a technology and a way we conduct our lives that people have familiarity with and trust in. So it's creating chatbots that are tailored to solving problems that become they're quite cumbersome when people.

100% of it needs to be done by a human agent, you know, or a community health worker. I mean, how many people...

need access to signing up for health insurance, for food assistance, for utility assistance, for housing assistance, for transportation system. You know, it's millions of people, hundreds of millions of people. So what barriers are you removing so that people can get to the services that they need? And I want you to think about that in terms of the human resources

work hours, paperwork. I think back to like the transition of ATMs and travel agents and boarding agents and all these different things that we have been able to use a telephonic response system to frequently better deliver, but definitely much lower cost. You know, we can reach more people. Yeah. We are removing so many barriers. When we work with healthcare organizations,

they typically see a need for this work. And one of the things that shine light on the need for this is the Joint Commission earlier this year required every hospital and health system to screen for social determinants of health. And the Joint Commission added, you need to do something and support them. And it could be as simple as just giving them a flyer to actually helping them. And what we're seeing is, and what healthcare providers are seeing is that

What we talked about earlier, you just you told them about a program that they already knew about, but you didn't actually help them enroll into that program. And what health systems are doing now is saying we need to find a way and expand the capacity of their current staff. We say providers about 30 minutes per patient that uses our platform.

And when you think about large organizations that have 50,000 or more emergency department visits, that's significant in terms of the paperwork that their staff would have been doing without ThriveLink. And I'll give you a quick story that's thinking about a family in North Carolina where this patient had very serious clinical needs. She needed to go to a specialist but couldn't take off work. But when ThriveLink paid her utility bill,

We learned that that's why she wasn't able to take off work because she needed money to pay her utility. She'd been going to the doctor, that same doctor for years, but the trust that she had when her doctor heard her needs and gave her something that truly changed it was just transformative. And even as a nurse, I had never seen that kind of reaction and trust from this, from, from a patient in that way. And for patients, it's,

We work with organizations in so many different places, but one that stands out as a patient in Boston Medical Center. She was in her 70s and had never had her own home, just had never had her own place to live. And working with ThriveLane, she signed up for the Boston Housing Lottery and won. Someone who had just not been able to access this resource and really the paperwork was the barrier. That was it.

It's just been really transformative for patients and our partners and ourselves, just our team internally. Yeah, I'm just letting that wash over me. For people to go hungry or to be cold or to be unhoused because we don't have an application process that works for just millions of people, that's terrible. Yeah.

And you are, you're fixing that. I mean, that's just, that's just a very sobering thought. Yeah. But, but that's where ThriveLink comes in, right? It does. It does. So you've got a lot of key partners in all of this. So partners like health payment plans, state health departments, you know,

health systems, industry partners? Who are some of the partners so that this scales much more rapidly? How's that working? Yeah, we have two key partners. Our goal is to be in every emergency department and safety net health system in America and partner with health plans. We have the ability to support families where the rubber meets the road.

And that's while you're in care. You just had that social determinant of the health screening. You just told someone that you need housing. That moment when they need to do something, ThriveLink is available and works in those settings really well. So really the...

The place that you see a disconnect currently in the ecosystem is that a health plan will sponsor this program, but none of the members will use it because that disconnect from program available to actually getting a person made aware of it and enrolled into it. And the other side of the disconnect is what we've been talking about is I'm a nurse. I know that this program exists, but I don't have the resources to actually get you there.

So we really focus on high-value places, emergency departments, safety net health systems, and primary care practices in those areas, especially if they're interconnected. Because when those screenings happen and those vulnerable patients step into the healthcare ecosystem, our goal is for every one of them to have the ability to sign up for food, housing, transportation, healthcare resources, all in one snapshot.

So you started out thinking about people are hungry, you know, their food banks, medically tailored meals. Now you've recognized there are all sorts of programs that we need to connect people to. Let's remove the barrier so that they can get to them. You're branching out into clothing, all sorts of other things. In your biggest, broadest vision and aspiration, what else do you think ThriveLink can do? Where else do you think nurses need to be

playing and solving the problems that are contributing to people's poor health and poor health experiences and poor outcomes. We need to make the work that it takes to go to specialists and get medications and all those things. We need to make that work more simple.

at a minimum, make understanding it more simple. We think about discharge records and those, the big packet of paper you get when you leave a doctor or a hospital. I think that is the next area that needs to be solved and we're going to embark on. I'm glad to hear that you're thinking big because the problems and the challenges out there need really big thinkers because they're not small by any stretch of the imagination.

Special thanks to nurse, innovator, and entrepreneur Kwamein Liddell and the team at ThriveLink, where they're leveraging AI to face a barrier hiding in plain sight. Evident in Kwamein's practice, nurses are closest to the gaps in care, closest to the suffering, and as Kwamein shares, have the ability to support families where the rubber meets the road, and that's while someone's in care.

Healthcare encounters, whether in hallways, exam rooms, or registration or discharge, offer key moments to identify where and how people slip through the cracks in enrolling for vital social services and support. There are also ideal opportunities to fill those cracks in new and novel ways.

The power, flexibility, and capacity of specialized AI applications to manage complexity, personalization, and volume are becoming increasingly common and more useful, particularly when used as tools to support the uniquely human and nursing superpowers of observation, advocacy, and system design.

As we race towards this AI-powered future, being aware, being involved, intentional, and transparent about the design and deployment of AI will build trust, allay fear and suspicion, avert harm in ways we might not predict or intend, and enable humans to flourish.

If you haven't done so yet, subscribe to See You Now wherever you listen to podcasts to make sure to catch every episode as we dive into the thrilling possibilities and daunting challenges of AI. For See You Now, I'm Shawna Butler. Thanks for listening.

Nurses are transforming healthcare through innovation, compassion, and leadership. And Johnson & Johnson is proud to continue its 125-year commitment to champion nurses through recognition, skill building, leadership development, and more. The American Nurses Association is dedicated to building a culture of innovation.

Nurses improve the lives of patients and communities through innovative thinking, empathetic connection, scientific rigor, and sheer determination. ANA is proud to support and advocate for our nation's most valuable healthcare resource, our nurses. For more information on See You Now and to listen to any of the earlier episodes in our library, visit seeyounowpodcast.com.