Pear Suite, a digital well being firm empowering neighborhood well being employees (CHWs) to handle the social determinants of well being, is constructing a rising supplier community in partnership with well being plans.
Over the previous ten months, Pear Suite has partnered with seven well being plans to recruit and onboard greater than 1,000 CHW suppliers from over 200 community-based organizations, increasing capability to serve greater than 11 million Medicaid lives throughout three states. Concurrently, Pear Suite has contracted with eight extra Medicaid and Twin Eligible Particular Wants Plan (D-SNP) plans to deploy CHW suppliers in communities the place they’re wanted most.
Pear Suite says its AI-powered platform continues to evolve, offering considerably better worth to CHWs, doulas, and different frontline well being employees, a lot of whom are transitioning from paper assessments and spreadsheets. Pear Suite at the moment helps organizations throughout 25 states, with speedy enlargement deliberate for 2025.
In a 2024 interview with Healthcare Innovation, Colby Takeda, co-founder and CEO of Pear Suite, mentioned his group helps CHWs, promotores, well being representatives, doulas and others assess and deal with social drivers of well being. In California and different states with Medicaid-sponsored CHW advantages in place, Pear Suite has additionally supported CBOs in billing managed care organizations for qualifying CHW companies.
Because the software program resolution was being created, state companies had been beginning to roll out CHW reimbursement for Medicaid. “That was good timing for us, as a result of the Medicaid reimbursement itself had data-tracking necessities and had compliance and audit necessities,” Takeda mentioned. “You’ve to have the ability to submit claims that primarily based on Z codes. So we really constructed assist for all these instruments, and now assist community-based organizations of their billing,” he added. “For a lot of of those teams, going from nothing to now getting paid for his or her work has been big.”
Pear Suite is seeking to assist CBOs with different data-sharing use circumstances. Initially the well being plans are those which might be the managers and facilitators of the CHW profit, Takeda defined. After all, they wish to tie this profit to their care hole closures of their inhabitants well being initiatives. “We’re now doing a little sharing of that type of knowledge between well being plans and community-based organizations,” he mentioned. “The following step after that’s to get knowledge from the well being system in order that we all know who will get discharged from a hospital or an ER or has particular sorts of therapies they must get linked to.”
One Hawaii-based nonprofit group that has change into a Pear Suite consumer is Na Hoaloha on the island of Maui, whose work connecting individuals to native assets grew to become much more essential after the devastating August 2023 Lahaina hearth.
“We have been concerned with Pear Suite for about 4 years now. Proper after the pandemic started, they had been very instrumental in gathering all of the healthcare suppliers and nonprofits in Hawaii to deal with meals insecurity,” mentioned King Van Nostrand, the group’s govt director. “We dwell on a valley island and a ravishing place that has a number of farmers and plenty of crops, and we would have liked to get these crops to the individuals. They actually targeted on offering safety for meals in the course of the pandemic, and we have simply been rising with them ever since.”
Na Hoaloha’s work change into much more difficult after the Lahaina hearth. “Our work grew to become dramatically dysfunctional after the fireplace,” Van Nostrand mentioned. “We nonetheless took care of over 137 members who had been within the hearth zone who needed to be relocated. They needed to readjust with completely nothing of their fingers or pockets.”
“Our individuals are very way more remoted,” mentioned Kathleen Kenney, Na Hoaloha’s navigator, who helps join individuals with the care they want. “They’ve misplaced their pure assist system and their pals. I had one individual inform me he would not know the place any of his pals are. It has been over a 12 months, so these issues are actually heartbreaking and actually impacting individuals’s psychological well being and simply their well being basically.”
As a substitute of getting a folder with a stack of papers on her desk, Kenney now has a system to trace each assembly and referral about every consumer. “Anybody that I meet with, I do a baseline survey, and all of that will get documented into Pear Suite, after which there is a two-week follow-up, a quarterly evaluation and a six-month evaluation,” she mentioned. “All of that then generates knowledge, which reveals, hopefully, the optimistic influence {that a} navigator or neighborhood well being employee has on bettering the lives of individuals residing independently, and that helps show the necessity for the place and future funding, after all.”
“Kathleen has made an enormous distinction in our enterprise,” Van Nostrand mentioned, “as a result of we’re current. We’re not simply behind a wall or behind a door or a cellphone. We’re on the market in the neighborhood and discovering out precisely what we have to know to assist attempt to remedy somebody’s issues. Our enterprise is altering on a weekly foundation, and we have to have assist and instruments which might be simply adjustable, which might be fluid, and that may develop with the instances. And we discover that by working with Colby and the Pear Suite neighborhood, we’ve that flexibility.”
The corporate mentioned that members of the Pear Cares Supplier Community additionally profit from medical, operational, and administrative assist, together with care plan critiques, claims administration, coverage coaching, and compliance help—key areas that always current vital challenges for community-based organizations.
Well being plans are additionally benefiting from the Pear Suite software program, as they’re desperate to simplify the credentialing, contracting, compliance, and reporting course of for CHWs, whereas elevating their expertise and experiences, the corporate mentioned. The community additionally gives complete instructional assets, common coaching alternatives, and a sturdy neighborhood to share finest practices and collaborate.
“The final word purpose of the Pear Cares Supplier Community is to extend utilization of preventative CHW companies whereas breaking down legacy boundaries which have restricted CHWs from partnering with well being plans,” added Takeda in a press release. “By doing so, people with unmet well being and social wants can actually profit from the data, expertise, and lived expertise of CHWs, an underutilized workforce that has confirmed to be distinctive at closing care gaps in a culturally delicate, person-centered approach.”
As one among Pear Suite’s earliest companions, California’s Well being Internet, a Medi-Cal managed care group and a Centene subsidiary, has partnered with Pear Suite to recruit and onboard over 300 CHWs to assist their statewide membership of 1.6 million.
“Group well being employees play a significant position in bridging the hole between healthcare methods and our members, serving to guarantee they obtain companies associated to perinatal care, preventive care, transportation, oral well being, growing old and way more,” mentioned Dorothy Seleski, senior vp for Medi-Cal at Well being Internet, in a press release. “Via our partnerships, we’re in a position to empower members to take cost of their well being, in the end resulting in improved well being outcomes and lowered disparities.”
Because the Pear Cares Supplier Community expands, Pear Suite mentioned it could proceed forging new partnerships with a various vary of well being plans throughout all enterprise traces, together with Medicaid, Medicare, and industrial insurance coverage.