Even with a background in social work, Health Soda CEO and co-founder Robby Knight said it was a struggle to help his father settle down Additional services when he became eligible for Medicare.
“What really struck me there was that despite what we’re doing to improve our lives and really affect health more broadly in the United States, the challenge is that we still have a lot of people who face very fundamental challenges in their lives every day,” he said.
Last year, Soda launched with the goal of facilitating access to benefits for healthy foods, over-the-counter medications, and transportation. The startup recently raised $25 million in a Series A funding round.
Knight sat down with MobiHealthNews to discuss how Soda’s model works, why recipients often can’t access these programs, and how the company plans to use its Series A funds.
MobiHealthNews: What are some of the issues you face accessing additional benefits as a Medicare Advantage or Medicaid member?
Robbie Knight: It depends. It is a mosaic of services. So you have anything in an over-the-counter catalog, where health plans mail it out to members every year. And as part of that process, members identify what they want, fill out a form, and mail it back. Using this is catastrophic, isn’t it? Not a great member experience. From that, to running the call center base, to running the retail base. It’s really confusing which retailers to use, and even which items are eligible.
So what happens, for Medicare Advantage for OTC in particular, only 30% is used. The other problem is that at some point you no longer need Tylenol. You don’t give a starving person a blanket, you give them food.
This is a one-size-fits-all approach where people only get OTC and usage is very low and engagement is low because it doesn’t really meet people’s immediate needs.
MNH: Can you tell me a bit about how Soda Health works, both from a patient perspective and a health plan perspective?
Knight: Health plans have subpopulations of members to whom they wish to provide these benefits. We work with them to identify which benefits they should deliver most effectively from their perspective and to ensure members have the most money they need.
As part of that process, we have what we call a flexible map. So we send a communication to members with this card – through our health plan partners – and then members receive this card and a welcome package in the mail. Physical mail and they also receive other notifications. The member then activates it and goes to our member portal to identify the additional resources they are entitled to and then see how they can use their existing benefits in a much simpler and consumer-focused way.
MNH: When working with health plans to determine what benefits they should offer, how do you determine that?
Knight: One of the cool things about how this process works now is that it’s too often a sales pitch. And what we see in this space is that the OTC matters. It is factually correct to say that if you have an over-the-counter benefit or any other benefit versus no benefit, you will likely be healthier. The question is, what is the actuarial value? And what is the return on investment [return on investment] associated with certain trade-offs that a health plan must make to manage its P&L [profit and loss statement] and help their members improve their health outcomes?
And so we say, hey, health plan, based on the market in your area, and based on the types of members you have and their needs that we see here are the types of benefit packages that we offer on the front and recommend you. Here’s how the math works. And here’s how we can optimize everything else downstream to make sure, from a cost profile, that what you’re doing is sustainable, competitive in the market, and allows for additional funds that we’ll unlock later, once we have identified the member needs that exist.
So we can be very flexible in helping members when they have a housing problem or when they have a transportation problem. They don’t go to their annual wellness visit because they can’t get to the doctor because there’s no transportation. For us, it’s how we can identify those points and ensure that the health plan is most effectively spending those resources to help that human being on an individual basis.
MNH: You worked at Walmart. How did this affect the development of Soda?
Knight: So I would say that two experiences went into the perspective that I have today. First, my experience as a social worker understanding very intimately the needs of ordinary people, which I also had growing up.
When I was at Walmart it was very helpful to me as it gave me an understanding of the scale and evolution of different markets. Walmart has provided a really compelling understanding of the nuances of different business models and how scale works in a way no one else really can due to the reach they have in the marketplace.
MNH: So you just announced your $25 million Series A raise about a year after you launched. How do you plan to use this investment?
Knight: What we’re doing for our Series A continues to expand the organizations and retailers we connect with, so people can have places to redeem those cards, access those resources, and identify new resources they’re eligible for.