The Reverse Mullet Healthcare Podcast
Ellen Brown, Justin Politi, and Dave Pavlik bring their 90 collective years of healthcare experience to BP2 Health where they're on a mission to effect real change in the industry. Connect with BP2 Health Here: https://bp2health.com/contact/
The Reverse Mullet Healthcare Podcast
Andrew Toy – Educating & Empowering Instead of Enforcing
What's the secret to making technology feel more human in healthcare? Join us for a fascinating conversation with Andrew Toy, CEO of Clover Health, as he shares the refreshing approach his organization has taken by offering AI insights to physicians to transform the Medicare Advantage experience for seniors. As a computer scientist turned healthcare innovator, Andrew offers a fresh perspective on empowering primary care physicians with advanced data access. We explore his unique approach to managed care, focusing on creating a collaborative environment where technology enhances clinical decisions without dictating them. Discover how Clover Health is reshaping the way healthcare providers align with best practices, making them feel more like partners rather than followers.
We hear in one word how Andrew thinks we could effect REAL change in healthcare - education. And with special co-host Erin Martin at the mic, we enter the world of Food Is Health and discuss how Health Savings Accounts could revolutionize your access to healthy food and exercise. We tackle this intriguing idea, discussing the complexities and potential benefits of such a proposal. Our conversation dives into the role of AI in bridging the gap in nutritional education for healthcare providers, enabling them to guide patients more confidently on nutrition matters. By empowering physicians and facilitating connections with nutritionists, AI holds the promise of transforming healthcare advice into actionable lifestyle changes. Celebrate Clover Health's recent successes with us and get inspired by Andrew's visionary insights into the future of healthcare.
Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health. Today we are at health and I'm with my co-host, ellen Brown.
Speaker 2:And I'm with my co-host, justin. Blaine, we're going to introduce each other today and we have a guest co-host, Erin Martin, with FreshRx, Because you know we might like food a little bit and think food is part of health.
Speaker 1:But yeah, we're inserting it here, aren't we?
Speaker 2:Super excited for our guest today, Andrew Toy. Yes, and we happen to be big fans of what Andrew's doing and we were lucky enough to grab 15 minutes for a Live at Health edition. So, Andrew, tell us about yourself.
Speaker 3:Sure, yeah, my name's Andrew the Toy. I'm the CEO of Clover Health. We're a Medicare Advantage plan mainly based out of New Jersey. We only serve Medicare Advantage, so that's the seniors and disabled folks and we're very, very focused on the early detection and management of chronic disease, a major passion of mine.
Speaker 2:Okay, so I don't even think that Justin was with me. So we had lunch with I won't lose any names here, but we had lunch with you actually really like what I have to say. So we were having lunch with a virtual primary care organization and one of their founders I still don't think I'm going to give them away and we were talking about platforms and we were talking about Medicare Advantage plans and he brought up that their physicians that they employ love working. They love running into the Clover platform because of the information that it brings them. Oh, that's fantastic.
Speaker 2:And I was like, oh my gosh, this is so great Because we think it's such an interesting spin on just Medicare Advantage in general. So to hear it from the clinical side, the virtual guys.
Speaker 1:The virtual guys, yeah, they love it he was like it's such a great tool.
Speaker 3:I thought you would love to hear that, I love that and I didn't intentionally plan that. I did not plan that either.
Speaker 1:Yeah, exactly, this is the first time I'm hearing about it and I'm absolutely delighted that's what we're going for, Like I think the idea is to actually I wish it wasn't so unusual but to be a managed care company who wants to help clinicians manage care. Wow, what an idea. Yeah, like I'm like.
Speaker 3:That seems like I was like isn't, isn't that the job?
Speaker 2:I thought that's what we were going to do. Yeah, so I'm delighted. Thanks for sharing that. That's awesome. I thought you would enjoy that. So talk for a minute about your AI assistant and just what you've built. Tell us more.
Speaker 3:Yeah, absolutely so. Our whole goal is to serve seniors by empowering their physicians, and so the idea is, instead of having, like, a managed care it's in vogue right now. You know you have a lot of care management teams and things like that inside the plan.
Speaker 3:You guys all know about that. We don't employ like any of those really kind of people. We do have some of our own physicians, but what we do is we build software so that the physicians who are already out there the primary care physicians can get access to more data and practice medicine the way they want, and by doing that they'll do a better job Really. It's as simple as that.
Speaker 2:And then you deploy AI as well.
Speaker 3:Yeah, so that's behind the scenes, so we don't brand it across there. But I think that my thesis, speaking as a technologist, is AI just makes technology more human. That's its entire job, right, and so, behind the scenes, what the AI is doing is sort of anticipating what would be interesting and important for a primary care physician to see.
Speaker 2:So this person actually said that that's what their clinicians experience.
Speaker 3:I'm even more pleased.
Speaker 2:Like described it. Just like that.
Speaker 3:That's what we're going for. Like once you know, I was talking to a payer and they were like, oh yeah, but you know how are you going to make physicians do what you want? And they were like, oh yeah, but you know how are you going to make physicians do what you want? And I was like I think the phrasing of your question is just inherently the wrong thing to say Like I mean.
Speaker 1:I think if you're going to try, and make them do it.
Speaker 3:They're going to not want to do it, I mean.
Speaker 1:I already don't want to do what you want.
Speaker 3:So what the AI is doing is positioning. I always say like it should feel to a physician like they were doing something that felt really natural, that they were already going to do, even though in our data we clearly see that they might not have done it. That's where the AI really comes in to smooth over that data, to frame it in a way that is really effective.
Speaker 2:I mean, I know with my 15-year-old that the power of suggestion is a lot better than authority. You just made me think of that analogy. I was like you know this applies to me as a parent.
Speaker 1:Natural behavior. It sounds so intuitive, but things are done so differently within managed care plans than that. How did you think of this? How did you come up with this?
Speaker 3:So I think about that a lot. I actually don't know the root. It was fairly intuitive to me and that's not trying to mean saying that I'm smarter than everyone else, but I think about that a lot. I actually don't know the root. It was fairly intuitive to me and that's not trying to mean saying that I'm smarter than everyone else, but I think what probably informs this is I was giving a version of this talk once. I talked about the assistant and I talked about our approach and then someone came up at the end. They're like okay, they're talking to me and they're like because you're a doctor, right, right. I was like no, I'm not a doctor, I'm a computer scientist. And he's like oh no, you must be a doctor. Like, no one would talk like this.
Speaker 3:And then I mentioned and you probably might have seen like, but I told I'm public that I have a condition called marfan syndrome. It's a congenital condition, it's a connective tissue disorder. Um, it's genetic. So I've had it since I was born. I've been very well managed, but I'm a very high touch. I touch the healthcare system every year. I go in for like scans and things like that. And then when I explained that, I think that this person was like. No, that's what it is.
Speaker 3:You're not a doctor, but because you're so engaged with the healthcare system you see what the problems are. That's right, like he was, literally he was like like this is not intuitive to most people because most people just don't aren't accessing the way they are by the time they do.
Speaker 2:They're on medicare and I'm looking after them. Yeah, well, and the other thing that I I I figured out is true in our conversations preparing for this is you are, in fact, an engineer. I am an engineer yes, and as we have as we have, as we have really jumped into this quest of finding the unicorns in healthcare of people that are really truly doing things differently. What I am blown away with is I think it's probably what Justin like nine out of ten people are engineers by training that fall into the unit.
Speaker 1:I'm not joking.
Speaker 2:It would be an interesting study that, when you really look at who is not just doing what you're supposed to do, how you've always done it, but maybe slightly better Sure, it's the people that are design and systems thinkers, that process.
Speaker 1:Yeah, you're trained to solve problems. We started to purposefully stop asking about people's background until we hear a little bit more, and then we're like, oh, this is really interesting.
Speaker 2:And then it's like what do you do, Engineer? I was an engineer, I'm an engineer, it's amazing. So, all right, I'm going to ask you the big question that we ask everybody. So what do you think can affect real all caps change in health care?
Speaker 3:So many things, so many points of pressure, yeah, and you'll have like four minutes, right, yeah, yeah, yeah. So I'll keep the room.
Speaker 2:Only one word actually. No, I can do it in one word, oh wow.
Speaker 3:Impressive so my word is education, but it's probably not the kind of education you might think it's going to be. It's not clinical education. I can take care of that. I think AI will help a lot with that. The kind of education is when I think about know what an eob is and I deliberately say eob for the listeners who are like what?
Speaker 1:is an eob. I'm like you can check I can guarantee you have one, yeah. What is it? What is an eob?
Speaker 3:um, and you're all laughing because you know exactly what I meant by that but I was the kind of person where I was like, okay, eob, and at the top it says this is not a bill and I'm like, then why did you send it to me? I don't understand what this is what do you want me to do with this? And then I would just give it to my wife.
Speaker 3:I'm like, here you go you just get this and you can do what you like with it, right? Um, I didn't understand co-pays. I certainly didn't understand co-insurance, right, I did like, like, like pre-auth like all those things all those things.
Speaker 3:And so, if you think about it, what do we normally do when someone doesn't understand really important things? We teach them those important things. Right, like that's education. But how, where did you go to learn these things? Like how many of your friends, I'm sure you guys have these conversations where, like they're like, oh, I don't understand it. I'm like, okay, I gotta take you through this.
Speaker 1:This is how this is gonna work.
Speaker 3:And then their eyes glaze over very quickly but then you're like but this is so important like it's so important yeah you need to be looking at those. Yeah, you need to be looking at those or if they, you need to be looking at those. Or if they call and they're like oh, my insurance won't pay for it, and I'm like no, no, no, no, no, no, no.
Speaker 2:That's right. The conversation does not end there.
Speaker 1:Right.
Speaker 3:Exactly Like like how, where do you even learn that Right? Like who's teaching you those things? So to me learning to navigate the healthcare system care system. Now, knowing what I know right, I'm like okay, chat, gpt is going to write a protest letter you know something like we'll take care of this, um, but, and so I think that's a really important thing that we could do that's really interesting.
Speaker 2:Okay, so you guys have any more questions? We have three extra. We have three additional minutes. Aaron, your eyes just got big, you have a question? Yeah, I had one and then it just escaped me. Come on, it'll come back, Okay, so yes, so Casey and Kelly Means are on Joe Rogan's podcast and they were talking about writing the that doctors should be writing a medically a medical necessity letter for people to have medical for food, for food.
Speaker 2:Oh, for food, for food and exercise and for exercise, and that way their HSAs could pay for that. And I was just interested to see what do you think about that? Is that something that you've seen happen, or do you think that's something they could be asking their primary?
Speaker 3:care doctors for See. This is why we have the guest co-host, because she comes up with questions that Justin and I would never ask. Yeah, so a couple of different dimensions there. Like I don't necessarily think this is a procedural answer, I don't as an insurance person I'm not a hundred percent sure that just because your doctor would write an order for it, that I would necessarily cover it out of an.
Speaker 3:HSA, but I would have to read the statute and the rules around that. I think spiritually it makes sense. I think the issue that I see when you actually go in there and we have done a lot of stuff, like, if you looked at like, food is medicine and all these kinds of things is that the dimension of this and this is an innate part of healthcare is that what people actually and I'm sure you run into this all the time what people want to do is not remotely correlated to what is good for them.
Speaker 1:Oh sure, sure, sure sure.
Speaker 3:And so just, and so my first, where my mind first goes to, is the kind of person who already wants to use their HSA to dollars to buy food that is good for them.
Speaker 1:It's a different person. It's different.
Speaker 3:Right Now. Could you find someone who wants to use their HSA?
Speaker 1:to buy Doritos. Oh sure can you find someone who would want to use it. No, we're not doing that.
Speaker 3:But you see what I'm saying there, right yeah?
Speaker 2:But if you're like, oh, you know, you have to be a pretty educated consumer to be asking your doctor for that, that's right, absolutely that's right, and there's not a massive selection bias around those people who would have that conversation in the first place, and so I'm all for it.
Speaker 3:I I think it's a good idea, but I'm not sure it cracks the nut on that problem.
Speaker 2:I just got an idea that I will leave my idea and it'll be like a mic drop walk. How do you incorporate food education for providers into an AI tool? So like I see nine codes are informing it, medical history is informing it, right, but then it's like can you, is there, it's, it's not just food, it gets to. Does that ai get to a point where it actually helps educate providers on the knowledge gap?
Speaker 3:yes, so I have a very specific view here, but this is a podcast I'm going to give. Like, this is not my official work view, but I'm gonna give like a podcast view. So I I have personal view that one of the reasons why physicians have a difficult time on food as education is, at the end of the day, physicians are people too, and I think that there's a certain layer of it where I don't think most physicians necessarily follow all the same rules.
Speaker 1:In fact, I'm pretty sure that they are.
Speaker 3:I'm being very generous in that statement, and so it's difficult for them to do it, because it's hard to talk to somebody about give them advice.
Speaker 2:Yeah, when you're a human.
Speaker 1:When you don't follow it yourself, or even know it.
Speaker 3:Or know it.
Speaker 1:So my answer is, and they're not trained in it.
Speaker 3:So my answer is basically here is that the physician? We can actually just have the AI have the conversation on behalf of the physician. Yes, and even if we train them, take them out of that awkward position.
Speaker 2:Yes, sure, I like that.
Speaker 3:And then they can be like look, I think you should have a chat with this nutrition.
Speaker 1:Yes, and then?
Speaker 3:they'll have the nice chat.
Speaker 2:I'll do all those things and the physician doesn't have to do that anymore. I love it. This is such a great. I always like talking to you.
Speaker 1:Thank you, I was really looking forward to having you Just a very unique point of view and like it is refreshing, that's the word. It's refreshing.
Speaker 2:Well, we wish all the success to Clover Health.
Speaker 1:We really do.
Speaker 3:We're excited to see what all you do and we're excited to see the success that you're realizing it's well, very good timing.
Speaker 2:People like it well. Thanks, andrew. Thanks so much, andrew. Thank you, thank you you.