Deboleena Dutta started her career in finance in New York City.
But when she came to Philadelphia to get an MBA in entrepreneurship from Wharton, her life changed course.
She became aware of a church on campus that gave out meals and performed health screenings for the needy. That experience made her step out of the bubble of academia. She began to learn about the health disparities for people who lived in North and West Philadelphia. There were barriers to getting primary medical care, nutritious food, and transportation to health services, even given the close proximity of top research hospitals such as Penn, Jefferson and Temple.
Soon after, Dutta lost a family member due to poor diabetes management during a period of social isolation. It made her realize that “people who face barriers to health need more personalized support at home in order to be successful with their health.”
So Dutta founded Viora Health, a start-up that uses technology to try to reduce the barriers. Viora Health works with community-based organizations, health centers, and health plans to better engage their members at home.
Recently, Viora was one of four North Philadelphia organizations — all led by people of color and/or women — to receive funding from the American Heart Association’s Bernard J. Tyson Impact Fund, which aims to address health equity in underserved Philadelphia neighborhoods.
Dutta, an immigrant from India, recently spoke with us about her company and its mission.
What health-care problem are you trying to solve?
Today, there are lots of remote monitoring devices. There is digital care delivery, all aimed at making health care more accessible. However, what’s missing is that they do not acknowledge health literacy gaps or technology gaps. They do not acknowledge social barriers and behaviors that prevent people from following through. As a result, engagement is poor.
As an example, I’ll use the story of someone we’ll call Sheila. She is diagnosed with diabetes and hypertension. Her doctor gives her a treatment. He tells her to eat healthy and to exercise. Then he sends her home.
Even though Sheila has health insurance, she doesn’t have the tools to follow through on her treatment. She doesn’t have a good understanding of diabetes or hypertension. She is working long hours. She has an elderly mother and three young children to take care of. She doesn’t have the resources or time to visit a nutritionist. She lives in a food desert, so even though the doctor says to eat healthy, she doesn’t know what that is or how to achieve it. She perhaps doesn’t understand how the medication works. So she stops taking it.
Ultimately, Sheila shows up in the emergency room. That’s the first time she’s on the radar of her health insurance provider as having a problem. But Sheila’s decline in health was avoidable.
How can you help?
Instead, if Sheila had also been referred to the Viora Health app, we would have taken account of her goals and identified what is keeping her from following through on her treatment.
Then we would have helped her address those barriers much earlier. We focus on the social determinants of health – things like food insecurity, lack of transportation, social isolation, access to care, and health literacy.
We empower Sheila to be a more engaged consumer in her own health care by creating a program with tools, strategies and support needed for her to be successful.
How do you accomplish that?
First, we do an assessment to determine eligibility. We assess Sheila’s goals — diabetes and hypertension management — and, based on her barriers, create a program for her.
If she were eligible, we would enroll her in a program for a period of three to 12 months. A typical program involves health-related content and resources, which are automatically texted out on a weekly basis.
Our program takes a holistic approach to health. Some of the content — healthy eating and exercise — is applicable to everyone to improve general health and wellness. Other content is specific to Sheila to help her manage her diabetes and hypertension.
In addition, the program shares resources in her community — a food bank, for example, or a rideshare service via text. Our app reinforces goals, tracks progress, and keeps Sheila engaged with five to seven touch points every week.
I want to clarify that we are not providing, say, a ridesharing service or some other service. Rather, we are taking a long-term, program-based approach to close barriers and educate, while supporting people at home.
Sheila is supported by a case facilitator, typically a community health worker, who is well-trained to offer culturally competent advocacy. So, once our software determines the plan for Sheila, the facilitator helps Sheila access health care in her own community. Sheila also is placed in a group of peers that are able to interact with and help each other.
Over time, Sheila is helped in reducing her gaps to health care and empowered to become more confident in taking care of her own health.
What results are you seeing?
Across this industry, the drop-off rate for minorities in long-term evidence-based treatments or programs — higher than that for Caucasians — is 70%. So just 30% stick with such programs. In our program, targeting diabetics and pre-diabetics, more than 80% stayed and completed a one-year program.
Participants in our program also lowered their blood glucose. They lost weight and improved their sleep and stress levels.
Ultimately, what we care about is, “Have we gone beyond just closing gaps? Have we improved Sheila’s confidence in taking care of her own health?” That’s not a metric that is currently being measured. But it’s so important if we are to stop the cycle of repeated failure, to improve outcomes, and reduce costs associated with hospital readmissions. And we think we are helping with that.
Why do you think your program is so successful?
Basically, it has to do with three primary things. First, are barriers removed? Social factors and health behaviors drive 80% of outcomes, while clinical factors drive only 10%. So, we focus on first closing barriers.
Secondly, is the tech simple? Our technology is sophisticated in the back end (powered by data-driven insights and behavioral science). But it is basic text in the front end and requires no download.
No. 3 is the trust factor. Trust and empathy-based relationships between participants, facilitator and peers form the basis for all of our engagement and communication. I would say that the best testament to our program’s success is that participants went from believing, “My entire family has diabetes, so I’m bound to have it, too,” to understanding that diabetes is preventable, manageable, and reversible with small consistent steps, and that they can make this change.