Poster Presenters - Community Based Organization Category

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Q1 Please provide your contact information below.

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Q2 Please describe your company or organizations overall goals and mission.

NowPow is a women–owned and led technology company that powers communities with the knowledge people need to get well, care for others, and manage with disease. NowPow´s multi–sided self–care referral platform seamlessly supports all participants in the referral process by building and managing community resource networks. NowPow is built on the scientific research of founder Dr. Stacy Lindau, who pioneered the idea of e–prescribing "community", connecting health care to self–care. The platform achieves this mission by generating high quality, personalized referrals driven by comprehensive filters and condition–based algorithms. In addition to delivering targeted self–care interventions, NowPow also supports highly automated universal interventions which drive resource awareness across a large population. Through our community resource network management strategy, we readily support ecosystem data aggregation to capture insights at a macro–level. Key community stakeholders can use this aggregated data to understand the supply and demand of SDOH resources across NYC. Through insights into the resource landscape (including areas of service gaps and saturation) as well as aggregate data on overall population needs, NowPow data informs long–term strategic initiatives designed to shift population health outcomes.

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Q4 Innovation Executive Summary. Please describe the innovation, and how it addresses the social determinants of health. Please identify how the innovation addresses the 6 innovation criteria (i.e. ROI, scalability, feasibility, evidence–based support for innovation, relevance to the Medicaid population and speed to market).

NowPow, a play on knowledge is power, is a multi–sided self–care referral platform with an array of tools that drive community level collaborations across the entire care continuum. With a focus on referrals to address basic needs and manage with chronic disease, NowPow partners with health systems, health plans, and community–based organizations to conduct SDOH–related screenings, identify self care needs, facilitate closed loop referrals, support bi–directional patient engagement, and document referral outcomes. NowPow was born from an evidence–based research project called CommunityRx led by founder Dr. Stacy Lindau at the University of Chicago. The research was funded by a $5.8MM Center for Medicare & Medicaid Innovation (CMMI) Award and provided personalized community resource e–prescriptions, or HealtheRxs, to over 113,000 patients in Chicago. After the grant ended in June 2015, the technology was licensed out of the University and NowPow, a for profit LLC, was born. Over the past three years NowPow has partnered with major health systems across seven markets, developed an ROI model, proved scalability and feasibility, gained significant experience serving Medicaid populations, and has a proven speed to market track record.

ROI: NowPow is the only self–care referral software whose impact and data have been reviewed by a third–party evaluator. The results of Dr. Stacy Lindau´s CMMI award have been reviewed extensively by RTI International. The large–scale results showed a significant increase in providers´ ability to meet patients´ unmet social needs, a reduction in Medicare inpatient stays, a reduction in Medicare unplanned readmissions, and a decrease in Medicaid ED visits. Informed by the original CommunityRx outcomes, NowPow has created a logic model and ROI calculator that are provided to all customers. Prior to each customer implementation, NowPow collaborates to identify the specific outcome objectives that the customer wants to achieve, and the metrics needed to measure progress. We support all internal evaluations undertaken by customers and provide standard and custom reports as needed to assist these initiatives.

Scalability: NowPow has scaled to seven markets across the United States and has developed a strong community network in New York City. In NYC, NowPow partners with three Performing Provider Systems (Community Care of Brooklyn PPS, Mount Sinai PPS, and New–York Presbyterian PPS), the NYC Department of Health and Mental Hygiene, Montefiore Hospital, and nearly 250 community– based organizations. The health system comes together each month to collaborate on the city–wide rollout which includes the onboarding of referral–receiving community–based organizations (CBOs) in overlapping provider networks, reviewing network–wide analytics, and sharing best practices. An important aspect of NowPow´s scalability includes building and maintaining a comprehensive community resource directory in each market. In NYC, this initiative is supported by a bi–directional data–sharing partnership with the Greater New York Hospital Association (GNYHA) HITE site.

Feasibility: NowPow´s products are in use by nearly 10,000 care professionals across health systems, health centers, and a wide array of community–based organizations. NowPow has demonstrated feasibility through active partnerships with hundreds of organizations and continued expansion.

Evidence–based support for innovation: NowPow is uniquely built on the evidence–based research project CommunityRx. At the heart of CommunityRx, was the concept that providing patients with tailored self–care referrals at the point of care can move the needle on health outcomes. The evaluation led by RTI International showed exactly that: a significant reduction in Medicare inpatient stays, a reduction in Medicare unplanned readmissions, and a decrease in Medicaid ED visits. NowPow continues to build functionality that improves the patient and provider experience when it comes to providing highly matched referrals, coordinating care, and reporting on SDOH–related outcomes.

Relevance to the Medicaid population: While NowPow can provide support to patients across all payer types, health systems can drive the largest ROI from focusing NowPow interventions on Medicaid, Medicare, and uninsured patients. Examples of these interventions include the Accountable Communities for Health (AHC), Pathways HUB, and DSRIP models. NowPow partners with four health systems who have been awarded AHC grants from CMMI: Allina Health, Presbyterian Health Services, NewYork–Presbyterian, and Yale New Haven Health System. NowPow supports all technical aspects of the Track 2 and 3 projects including the resource directory build and maintenance, the health–related social needs (HRSN) screening, needs identification, navigation, referral tracking, and reporting requirements. We partner with the Health Coalition of Passaic County, led by St. Joseph´s Health, to identify and address patients´ social determinants of health through the Pathways HUB model. The DSRIP projects most directly impacted by NowPow include 2.a.i – Create Integrated Delivery Systems that are focused on Evidence–Based Medicine and Population Health and 2.c.i – Development of community– based health navigation services.

Speed to Market: NowPow at three years old has launched a fully functional multi–sided technology platform and implemented at healthcare organizations in seven states. NowPow follows an Agile methodology and iterates its technology every two weeks. We listen carefully to feedback to align our roadmap with functionality important to their specific interventions. A recent example of rapid–cycle iteration includes the development of patient–facing screenings that improve workflows across our Accountable Health Communities partners. Another is the development of Community Resource Finder, a patient–facing product that was designed and tested in partnership with the NYC DOHMH. NowPow is constantly releasing new features and functionalities that support our partners´ interventions.

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