Designing for Health: Interview with Memora Health’s Omar Nagji [Podcast]

Access to care and continuity of experience continue to be major issues for many patients. Though COVID-19 accelerated the implementation of virtual care solutions at many organizations, a lack of technological capability or other digital determinants of health (DDoH) continues to impact patients. As healthcare organizations look for solutions that meet the needs of their patient population, the emphasis needs to be on designing in ways that help patients overcome DDoH and improve outcomes.

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Show notes:

[00:00] Intros

[01:33] Omar’s background, including his time at Lyft

[07:45] How and why Omar made his way to Memora

[09:56] How patients interact with Memora

[10:50] Memora’s intentional design and how it improves the care delivery process

[13:56] Using social determinants of health to design workflows that lead to better care

[16:40] Designing for a team-based care approach

[19:30] How to get people engaged with their health and its value

[23:23] The inherent inequalities with using an app

[26:15] The secret sauce that achieves the scale that’s needed to move the needle on healthcare’s bigger problems

[29:09] Things that are so well designed they bring Omar joy

Transcript:

Dr. Jerome Pagani: Hi, everyone. We're here today with Omar Nagji, the chief commercial officer for Memora Health. Omar, thanks so much for joining us.

Omar Nagji: Yeah, Jerome, Craig. Great to be here. Thanks for having me.

Dr. Craig Joseph: I'd like to start by getting some of your background and where you work now and where you've worked before. And looking over your rather impressive resume, something that kind of pops out at me is that you were involved with healthcare at Lyft. And I think that the vast majority of humans are not aware of how healthcare and Lyft intersect. So, it would be great if you could kind of tell us a little bit about that and how did your background lead you to Lyft and then we'll start talking about what you're doing now.

Omar Nagji: Yeah, absolutely. I'll definitely go into that, but the idea of Lyft in healthcare was definitely foreign to me, too, at the time. I actually laughed it off when I was first having those conversations. My background is all healthcare. So, I studied at the School of Public Health at UNC in Chapel Hill, actually wanted to be a dentist or an eye banker. None of which really had to do with like traditional healthcare. I found myself going to the School of Public Health and just fell in love with it, health policy administration, learning how to be an administrator of a hospital. Went into consulting, really working with case managers, with nurses, physicians on this crazy concept in the early 2000’s called patient throughput. So, really working on reducing length of stay for those inpatient visits. Loved it. learned a ton about the gaps in communication across care teams and then wanted to challenge myself a little more. Consulting was great, but you know, I think there was a lot more out there and that, probably, we’ll get into, the thread of what led me to Lyft and ultimately what led me to Memora as well. But it was really trying to find like how can we, like, disrupt even more in a positive way? How can we impact positively more patients? How can we make it easier for people within the hospital world to operate efficiently as possible? And so, I went into the revenue cycle, which obviously was not sexy at all, going in and looking at denials and numbers and, you know, accounts receivables and discharge, not final bill, but I loved it. It was amazing to see kind of the inner workings of how our healthcare ecosystems work. Did that for about ten years. Learned a ton about so many different things from a building of startups aspect, from how important relationships are, how to do damage control with things. And then after about a decade, very similar to after consulting, I was kind of getting a little bored and tapped into the network, and a good friend of mine named Amit Patel, he was like number five at Lyft. You know, we were on the same kickball team together in San Francisco. We were out for drinks one night, and he said, “Hey, dude like, talk to me about, like, healthcare and like, you know, we're thinking about starting this at Lyft.” And I was like, “Dude, you're crazy. What are you talking about, Lyft and healthcare.” Anyway, we proceeded to have more drinks. And, you know, that night, I was kind of sitting back and I was thinking myself like, “Holy crap, actually, like this, this may work.” And so, like, I started feverishly typing, I think I typed like three pages and sent it in an email, which, you know, shockingly, he read, and he connected me with a gentleman by the name of Gyre Renwick who was running up heading up the government, education, and healthcare team at Lyft. And we had a conversation, and next thing you know, we're building out a pretty impactful vertical within Lyft, which helped Medicare Advantage, Medicaid patients primarily, and obviously hospitals as well, but really helped those patients get to and from their appointments, their points of care, and at the time, it wasn't the buzzword like it is now, but, you know, as we started to really dive into what we were doing is, ultimately we were breaking down the transportation barrier that's very prevalent in what we now know is, you know, social determinants of health. So, it was a pretty fun experience. When I joined Lyft, I was like employee number 200, excuse me, 189. We were in 27 cities. Within like three months, I signed Ascension, which was in 23 states. Imagine having that conversation when they said, “Hey, can we roll this out nationwide?” And I was like, “Well, kind of need some drivers.” And so it was, you know, no pun intended, it was quite the ride. And just to see the impact we had on the millions of patients and the lives that we were helping was pretty, phenomenal. And so, as we built that to a pretty substantial portion of Lyft's business, you know, went on to the next challenge, and I made my way over to Memora, which, you know, very similar to me on the Lyft side. You know, we're doing something that, you know, the market really needs when you think about care plans and when you think about digitizing and automating the experience and creating an opportunity to not only connect with patients and increase their adherence to care plans, but then ultimately have the infrastructure to reduce the administrative burden that a lot of care team members have when they're trying to connect with those patients and ultimately seamlessly integrating all of that into an already complicated workflow that a lot of these health systems and health plans have.

Dr. Craig Joseph: Yeah, so, I think the take home from that is kickball is the beginning of everything good in the Silicon Valley area. So, that was my take home.

Omar Nagji: That's it. Kickball, that’s exactly right.

Dr. Craig Joseph: So, it's very interesting that, when you began this quest, almost an equity play, really, that's what's seemingly kind of gone through your history.

Omar Nagji: Yeah. Unbeknownst to me, it was definitely an equity play. And now that we've got some very smart marketers that have, you know, experience in creating buzzwords, it's made a lot more sense that health inequalities has been a driving factor in a lot of the moves I've made. It's a very rewarding part of the business where you actually get to see some of the some of the insights from patients, some of the testimonials, and things. And that's, you know, again, if you're really in it for the right reasons, that's the fun part. That's the exciting part where you get to see it day in and day out.

Dr. Craig Joseph: So, Omar, tell us a little bit more about what's going on at Memora Health and how that seems like a natural transition from healthcare at Lyft.

Omar Nagji: Yeah. So, there were a couple of similarities. So, you know, as I was looking at kind of a new role, I was really looking for the intersection of where is there a need? So does the product solve a critical need that, regardless of what's happening in the industry, is this basically recession-proof? Again, unbeknownst to me, here we are, right, potentially in a recession slash, we are in a recession, and is the product able to weather that because it's, again, truly solving a critical need? And so that was the first lever I was looking for. The second lever was the people. The people make everything within a company. And that was a huge piece that I learned at Lyft. The culture, the people, the buy-in to the mission made everyone feel like Lyft was their own. And I saw that, and I'm still seeing that here at Memora. That was a huge driving factor in why I chose Memora over several companies that I was talking to at that time as well. And then kind of the third and the fourth to me go hand-in-hand, the executive leadership team and the backing from the venture companies, they had to be aligned, and they had to be top notch. Lyft had Andreessen as a pretty significant backer, and I saw the power that that team had when it came to connections within the industry and insights into where the market was going. And with Memora having that same backing with the Andreessen team, in addition to several significant other ones, Frist Cressey, Martin Ventures, Transformation Capital, etc., the level of knowledge and the impact that that brain trust has on kind of understanding where we could fit in and how we can help was massive. And so that kind of perfect combination across product, people, product fit, and essentially the guidance that that brain trust provides was kind of the recipe for success for me to join Memora.

Dr. Craig Joseph: So, if I'm a patient, how do I interact with Memora?

Omar Nagji: Primarily through text message. We talked about health inequalities, text message allows for a significant amount of engagement without the need for a smartphone, without the need for an app. And so, what Memora does is we take a care plan, not only digitize it, but then we whittle it down into these bite-sized chunks and deliver it to patients through text. Patients can then text back, it's very conversational, it's dynamic. It's not a simple multiple-choice or a yes, no-question. We're using NLP and AI, and it really kind of gets to the core of what those patients are asking for, requesting, talking about, so that we can then incorporate that into the workflows of those care teams.

Dr. Jerome Pagani: Omar, one of the things we're focused on is ways in which the healthcare system hasn't been intentionally designed. And it sounds like Memora is really thinking about designing clinical workflows, in particular on both the delivery side and the patient side, with the people giving and receiving care in mind. Can you give us an example of, you know, how it used to work and one of the ways that Memora is using that intentional design to improve the healthcare delivery process?

Omar Nagji: Yeah, you know, I think women's health and maternal care is a great example and specifically within, like, kind of the postpartum journey. And so, you know, even now you have examples like OB-GYN nurses in the labor delivery, like, you know, been there for several years, and the connections that they're building with these new moms, right, are very meaningful and impactful. And so, you know, there's times where, right, they're giving out a lot of times they’re giving out their personal number so that these new moms have an ability to connect with them. And so, what that does is, you know, for these OB-GYN nurses, it's creating continued touch points, however, at the expense of the nurse's personal life. Right? And so, what's happening is you're creating more of that burnout. And for the new mom, you know, you're kind of bypassing a lot of the needs when it comes to looking at screenings, looking at some of the processes and protocols that that health systems have in place. And so, with Memora, we still allow for that text communication. But throughout that journey, we're able to take a lot of that burden off of that nurse, off of that care team member, and for example, send mental health screenings, PHQ-9 or GAD-7s, out to those new moms. And if and when there's a flag for potential mental health, we're able to, at that point, bring the nurse or the care team in, still able to make the connection, allowing for both the care team member and the new mom to feel like they still have that connection. But ultimately, taking a lot of that burden off while creating more of that adoption engagement, we talked about sustained engagement, and again creating that connection so that the mom feels comfortable responding to some of those questions. So, we're actually able to tease out even more if and when, for example, postpartum depression, is in a high risk.

Dr. Jerome Pagani: And I love that idea of not only designing a better process but figuring out how to intervene before an end state.

Omar Nagji: That's right. That's exactly right. And so, you know, Memora does this across multiple different care programs, disease states, service lines. So, whether it's cardiology, oncology, you know, we talked about one care program or one example within the maternal health space. And so, we've kind of built this out across about 28 to 30 care programs, again, across multiple different service lines and disease states.

Dr. Jerome Pagani: You mentioned social determinants of health a little earlier, and I think we're all pretty familiar with the effort to begin to incorporate some of those data into existing clinical records to be able to understand disease states a little better. But I think one of the things that that you've always been interested in, and that I think Memora is doing, is figuring out how to use that information to design healthcare processes better for patients. So, can you pull on that a little bit and tell me a little bit about how you think about social determinants of health and how that both closes some of those equities and gaps, and the equity in care and how you think about designing the experience for people on the receiving end of care.

Omar Nagji: Yeah, absolutely. So, from a social determinants aspect, right, you can think about transportation barriers, food inequalities. There's a number of different kind of social determinants of health. And then, you know, you've kind of touched on that, Jerome, from a, on the other end, like, care gap closures, looking at transitions of care, and so like more of like the population health world, and so where Memora kind of plays in that intersection is on the patient side, we're able to kind of tease out some of those social determinants. Right? We're able to ask, “Hey, can you make your appointment? Do you have transportation?” “Do you need additional assistance for X, Y, and Z?” And then based on what those responses are, and this is where that conversational text comes in, based on what those responses are, we're triggering different workflows that ultimately help to either bring in or notify different care team members. So, it's not just a manual intervention where it's like, okay, we've got someone right at the front desk hearing on a phone call, which, you know, 20% of the time will connect, right, talking to someone, and at that point, right, we're uncovering some of the social determinants or some of these barriers and then trying to manually route those in. What we're doing is we're kind of incorporating all of that in an automated fashion so that as soon as we're hearing that, it's almost instantaneous whether the patient has access to helping to reduce or break down some of those barriers while also again on the care team side, bringing in the right person, not just any person, which ultimately then frees up the time for those care team members to be working top of license, right, to be spending their extra time with patients or even with family members. So, we're reducing that burnout and ultimately helping that overall ecosystem around how patients are receiving and continue to maintain their care plans.

Dr. Craig Joseph: So, from the clinician standpoint, when you say working top of license, I'm hearing team-based care. How have you designed your system to kind of take advantage of everyone's particular expertise? Working top of license simply means, for those of us who are maybe not experts in healthcare, that folks are doing everything that they possibly could, not being limited by policies that might have made sense in a former time, but maybe not so much so now. So, have you designed with team-based care in mind? And if so, are there any examples of that?

Omar Nagji: Team-based care is exactly right. And ultimately, we have clinicians, so, you know, we have an SVP of Care Delivery, Jamie Colbert, he’s a practicing physician. You know he comes from the payer world and the health plan side. We've got I think about a dozen active clinicians on staff as well, everything from physician assistants to nurse practitioners, to PA, to PTs, etc., and as they're building out these different care programs, are what we call them, they're thinking about the team-based model with kind of how to incorporate that team structure in mind. It's not just the physician or just the PA who's providing the care, it's to your point, Craig, there's an entire team approach. And when we're building out this care program and building out the decision trees underneath that to figure out who do we bring in, the platform and Memora has the flexibility to not only bring multiple people in depending on what the flag alert or escalation looks like, so, depending on how the patient is responding. For example, if it's a pain level of four, we'll bring this person in. If they say they've got a rash, we're going to bring this person in. If they say they've got, you know, X, Y, and Z, we'll bring other people in. So, we've built all of those channels, and into the actual workflow itself. But in addition, we've added a layer of customization where you can inform those care team members depending on the time of day and the method or modality that they actually like to be communicated on. So, is it an InBasket notification? Is it a text message? If it's within the hours of 8 p.m. to midnight, it has to go to a centralized location versus from midnight to 3 a.m., this care team member actually likes to be texted. So, all of that kind of customization depending on the preference of the team model and that care team is built on the back end with that idea of the kind of the team-based approach in mind.

Dr. Jerome Pagani: Omar, one of the problems that come with the traditional methods of healthcare delivery is that clinicians really get to interact with their patients in narrow slices of time, usually when they're not at their best, you know when they're sick. And there are these big gaps in the record that occur when folks are just going about living their everyday lives, you know, quote-unquote, healthy. Can you say a little more about how to keep people engaged with their health over an extended period of time and what the value of that is?

Omar Nagji: Yeah, I'll kind of take this in two different paths. So, you know, there's sustained engagement when a patient has a question, and then there's sustained engagement across the lifecycle of their care plan and even beyond, to your point, Jerome. So, if you think about the first one, sustained engagement when a patient asks questions, it's very difficult to just get engagement overall. And so, plenty of statistics out there, like MyChart has about a 30 to 40% engagement rate. Email is not, you know, not the best, there’s inequalities with that. But when you think about text message, right, like texts, as you look at your phone right now, you probably see a bunch of red dots except for your text message you have. The statistic is 98% of text messages are read, 90% within the first three minutes. And so that immediately just creates the opportunity for a very quick point of engagement. But what happens with, take like MyChart as an example, if you if you message into MyChart, right, there's usually an expectation that you'll receive a response depending on the facility within anywhere between one to three days, at least in my experience having used MyChart here. And so, like, if I have a question for my care team member and I ask them on MyChart, and I get a response in one to three days, I mean, I just signed up for Target, and I can get something delivered in two hours, anything I want. Right? Let alone what Amazon offers. And so, why would I wait one to three days for any response on a pretty critical piece of my health? Right> I'm going to go and research everything and probably get the wrong piece and then go to the E.R. and here we go. I've just caused another strain on the financials of our healthcare world. The conversational text that Memora has allows for, you know, the curiosity of patients to be very confined and to truly what is happening with kind of the specifics of their care. Right? Giving that insight real time to those patients to create that sustained engagement within that point of time. Ultimately, that helps to then drive the sustained engagement across the care program. So, some care programs are two weeks in duration. Some care programs are six months, one year in duration. Right? Think about oncology patients. Think about a number of different things. And so, when you have that ability to kind of create the infrastructure of that sustained engagement when a patient is engaged with you, you then create this trust factor that, as patients have something that come up in their head throughout their care plan, their journey, you're able to then increase that overall sustained engagement, because patients can trust that that feedback and that notification, that communication is not only real-time but is accurate, and it's reliable. And that becomes the driving factor behind Memora’s having, you know, 74, 75% sustained engagement rates over two, three, four plus months.

Dr. Jerome Pagani: Yeah. Human attention is only so long, and the speed of those interactions becomes key.

Omar Nagji: Exactly. Exactly.

Dr. Craig Joseph: So, Omar, one thing that seems to be one of the secret ingredients of the success of Memora health is the fact that you're texting. I would presume many of your competitors are out there with an app. And that's something that you've avoided. Why is that? Why can't I just download an app, and it can be free from the app store, and that will work just as well, wouldn't it?

Omar Nagji: Yeah, it's a great question. So, you know, if you think about the idea or the concept of an app, there's a lot of inequalities built into the use of an app. So, one, you need a smartphone to have an app. Two, you need a credit card to put onto an Apple ID. Three, you need an email address. Four, then you need to have a data plan, unless you're using wi-fi, which then means, five, you need to be in a place that you can have wi-fi, you need to have transportation, six, to said place with wi-fi. So, assuming you can get all six of those, I'm sure I'm missing a ton, then Craig, to your point, you can use an app. Now you kind of go into this realm of, now you’ve got, what, 800 apps on your phone, and so now you're having to battle with other apps. Then when you're actually in the app, how do you navigate within that app to the specific point of reference to the specific response? Now you're having a whole other slew of challenges when you actually open said app. Meanwhile, if you're texting bite-sized chunks, you have an immediate response, and there's also nudges or automation built in. We're sending out proactive pieces of information, knowing that, day three of your chemo regimen, you're going to have potentially a rash on a specific side. “Hey, just as a heads up, this is day three. You're going to probably experience these symptoms that are completely okay. If you have any other questions or if you feel like you need to talk, just, you know, respond here.” All of a sudden, you're waking up to more love, to more understanding of what you're about to go into, as opposed to freaking out, trying to remember what app you had, trying to, you know, go and look at WebMD, I don't even know if that's still in existence, shows you my age. But right, you're going in, and instead of kind of left to your own devices, you're getting that proactive notification, and you have that very real-time touchpoint with the care team that took care of you, which is massive.

Dr. Craig Joseph: And I think that that's hard to underestimate that lessons that you just said. You know, this is the care team that took care of you. So, it's not just an anonymous bot or even a human who doesn't really know you, per se. But to have that kind of personal relationship, that information seems much more real all of a sudden. I think that does make a lot of sense and resonates with me.

Omar Nagji: Awesome.

Dr. Jerome Pagani: You mentioned that when you were at Lyft healthcare, you had this very sudden scale problem. You were in 23 cities, and you signed a client, it was in 23 states, and their first question was, “How do we roll this out everywhere we are?” Healthcare has a lot of problems going from pilot to scale. And so there, you end up with pilot fatigue. What’s some of the secret sauce that you think helps achieve the scale that's really required to move the needle on some of the bigger problems in healthcare?

Omar Nagji: Execution, communication, and curiosity, probably hinge on those three. So, we'll start with curiosity. Every location in that health system is going to have some nuance. And so, communicating what those nuances are with your clients, with understanding where are some of the differences? How do we make sure that we're adjusting where needed? But while also making sure that we're not deviating so far from a standard care plan, in this example, because there are benefits from a standard care plan, and if you get into a hyper-customized approach, you're going into kind of the disaster world of 12-month implementations, etc. I'd like to keep that right at the 6- to 8- to 12-week mark, which is the sweet spot of implementations, you're having to be very communicative and understanding and curious on where and why with some of these changes need to happen. And then, ultimately, it's all about execution. So, building it right, having the appropriate product, having the appropriate approach to then be able to execute and show value going back to them, communication, communicating that value back to the stakeholders, to the clinical and business stakeholders alike. But then going back then to the third piece, which is curiosity, teasing that curiosity even more to say, what else could we be doing together to then go back to the communication, back to the execution, back to the communication, back to the curiosity. So, if you kind of follow that mindset, just hopping from one to another, it really helps to make sure that you are thinking about this at scale, because without execution, without curiosity, without communication, you're kind of doing things in a vacuum and that doesn't help anyone.

Dr. Jerome Pagani: So I like that. I think that resonates with a couple of ways that Craig and I think about this, one of which is to get the right stakeholders at the table from the beginning so you know who you're designing for, that piece that you mentioned around really having an intentional design, right? You're not just sort of cobbling things together. What you have is a vision for the complete workflow or the complete plan and what the end state should look like for everybody who's involved. And then, really, that last thing you mentioned sounds a lot like continuous improvement to me, right? So, you've designed, you've executed, you’re there, and then you see what needs to be adjusted, and then you come back around, and that becomes an iterative process and it’s just kind of baked in.

Omar Nagji: Yeah, that's exactly right.

Dr. Jerome Pagani: Omar, we like to end the podcast asking folks about their experiences with design and what are three things that you have interacted with over time that are so well designed that they just bring you joy when you experience them?

Omar Nagji: Yeah. Great, great question. So, I mean, the first thing that comes to mind is, you know, hands down, Delta. I'm an avid Delta flier. Manav, my CEO, gets mad at me because I only fly Delta, which means that I'm always connecting because here in Austin there are not many Delta direct flights, but I still love it. I think the customer service wrapper that they put around kind of your frequent fliers, the experience that they've included, whether it's checking into a flight, what their app looks like, they now text as well, into like the lounge experience, into the actual in-flight experience is pretty great. I also really love flying, and so, I really enjoy knowing that I have a flight coming up. So, Delta, Delta is one of those for me, for sure. Second, I think, and this is because I'm a brand-new parent, so seven months old. There's this app called Nanit. It's a video that kind of hangs over Raya, who's my seven-month-old daughter. And so, like, wherever I am, whether it's in my house or if I'm at my brother's place or if I'm, you know, across the country, across the globe, I can open up the app. Not only can I see Raya, but I can also talk to her through that. The app also lets me know if Raya's room is too hot, too cold based off the parameters I've set. Right? It gives me kind of insight into when Raya is moving around, when she's a little too active, when she's yapping away, and she should be sleeping. It kind of gives me the comfort and the confidence that she's safe, and it just gives me kind of real-time access to see her. So, I never thought this would be the case, but like, even when she's napping, like crazy amounts of like, I miss her all the time. And so, like, I just like, pop open the screen and look at her, and it's weird, like, I can basically get rid of every other app on my phone, but if I had only had that one and my Delta app, I would be I'd be set.

Dr. Jerome Pagani: That's perfect. Omar, thanks so much for joining me and Craig today. It was a pleasure speaking with you.

Omar Nagji: This was fun. Thank you both.