Lessons from Taylor Justice, Co-founder and President of Unite Us, on enhancing care coordination with closed loop referrals
This episode is part of Pear VC's series on Medicaid, covering the basics that founders need to know to build innovations that support communities in need.
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and diving into building a digital health business from 0 to 1.
This series aims to demystify Medicaid, starting with insights from federal and state agencies, FQHCs, and managed care organizations, before exploring successful founders' strategies. Read our primers on the key players and innovations here, and stay tuned for upcoming posts featuring interviews with key opinion leaders, purchasers, and startup founders.
Today, we're delighted to introduce Taylor Justice, the driving force behind Unite Us, a company that uses advanced technology solutions to coordinate community-focused social care and integrate social drivers of health into the healthcare continuum and regulatory landscape. Â
Unite Us developed the first closed-loop referral (CLR) platform that links social care service delivery with detailed outcomes to understand a person’s total health journey. The platform streamlines collaboration among healthcare professionals, community organizations, health plans, and government agencies to provide real-time visibility into the community impact and actionable insights. Through active engagement and accountability, this model increases the efficiency of social care and improves the experience by removing the onus from the patient to navigate eligibility requirements for local services. Â
Founded in 2013, Unite Us has grown to more than 600 employees serving communities across the US. The company's investors include ICONIQ, Oak HC/FT, and more who are helping advance the company's mission to connect people to the care they need to improve their lives.
Taylor started his career in the US Army. After serving in the infantry, he transitioned into an Account Executive role at CCS Medical. From there he became a sales engineer for JDSU which offers products and solutions for communications. After that, Taylor started his entrepreneurial journey co-founding the consulting firm, HigherEchelon, which helped organizations meet their performance goals. In 2013, he co-founded Unite Us and serves as President to this day.
Taylor holds a BS in Latin American Studies and Environmental Engineering from West Point Academy and an MBA from Columbia Business School.
In this episode, we explore Taylor’s founding journey and how Unite Us's closed-loop referral process is improving care outcomes. We also discuss what it's like to be at the forefront of using social determinants of health data in Medicaid.
We encourage you to listen to our podcast recording where we dive deep into all of the following sections.
Taylor's Background and Career Journey
How did you end up starting Unite Us?
Taylor took an unconventional path to entrepreneurship, attending West Point and serving in the U.S. Army as an infantry officer. After leaving the military, Taylor started in sales at a medical device company and then a technology company, where he learned traditional sales techniques.
During this time, Taylor got involved with a nonprofit called Team Red, White and Blue, which helped transitioning service members connect with their communities. Through his volunteer work, Taylor saw that veterans had needs beyond just finding a job or navigating benefits—they needed help accessing a wide range of social services. Taylor personally made these calls to community-based organizations and learned the workflow challenges through that process.
This inspired Taylor to co-found Unite Us, aiming to build a platform to connect individuals and communities to the resources they need.
What lessons did you take from your time in the Army that impact how you run your company?
Adaptability and dealing with ambiguity:
Taylor says in the military, you have to be able to adapt when things don't go according to plan. No decision is always the wrong decision - you have to be willing to make a call and then pivot if needed. This ability to navigate ambiguity and be flexible has been critical in building a startup, where the path is rarely straightforward.
Teamwork and shared decision-making:
Taylor notes that the military is not a dictatorship - everyone has a voice and opinion that needs to be considered. This experience of working collaboratively as a team has shaped how Taylor approaches leadership at Unite Us, where he values input from all participants.
Understanding people and motivation:
Taylor says his time in the Army was a "true education in leadership of humans" - learning how to understand people's motivations and how they respond to information and feedback. This people-centric approach has been vital in building relationships with the community organizations Unite Us works with, who are often understaffed and overworked.
Preparation and standards:
The military emphasis on being thoroughly prepared before a mission or meeting has carried over to how Taylor and his team operate at Unite Us. Maintaining high standards and attention to detail has been crucial in coordinating the complex network of healthcare, government, and community partners.
What made you realize you wanted to be co-founders with Dan?
Taylor and Dan randomly connected through a mutual contact at Columbia Business School, where they had never met before. This chance encounter led to a strong co-founder partnership, which felt serendipitous to them.
Both were passionate about solving the problem of helping transitioning service members and veterans access needed resources. This shared commitment to the mission drove them together as co-founders.
They recognized that they were "two different humans" with different skills and communication styles. They saw this as a strength, as they could complement each other and work well together despite their differences.
Unite Us
How would you describe Unite Us and the problem it's trying to solve?
At a high level, Unite Us is a technology platform that aims to connect individuals and communities to the resources they need to live healthier lives. The key problem it is trying to solve is the fragmentation and inefficiency in the human and social services landscape.
Historically, the human and social services sector (things like food, housing, transportation, childcare, etc.) has been highly fragmented, with many different nonprofit organizations and government agencies providing various resources.
This fragmentation makes it very difficult for individuals in need to navigate and access the right services. They often have to go through a painful process of trying to figure out eligibility, availability, and how to connect with the appropriate services.
On the services side, these community-based organizations are often understaffed, underfunded, and relying on outdated technology like Excel sheets or pen-and-paper. This makes it hard for them to efficiently coordinate and share information.
The Unite Us platform aims to solve this by acting as the connective tissue between individuals, healthcare providers, government agencies, and community organizations. It allows them to securely share data and make electronic referrals to ensure people get connected to the right services.
The goal is to create a more streamlined, coordinated system that improves health outcomes by addressing the social drivers of health - the non-medical factors like housing, food, and transportation that heavily influence overall wellbeing.
How did you choose your initial market?
Pain Point and NeedÂ
They started focusing on improving transitions for veterans based on Taylor's personal experience. There were around 45,000 nonprofit organizations designated as supporting veterans and military families, providing a concentrated market to focus on initially.
Why now?Â
A contemporaneous research study suggested the need for transitioning service members was not any specific service category, but rather the ability to navigate the "sea of goodwill" - the overwhelming number of nonprofit organizations and resources available (rather than a lack of resources altogether).
How did you decide on your initial product?
The founders initially thought that simply identifying and mapping out all available resources for veterans would allow veterans to find and access those services on their own. So they built a comprehensive directory of various nonprofit organizations and resources.Â
However, Taylor and his co-founder realized that just providing a list of resources wasn't enough. There were still major challenges around eligibility, capacity, and actually connecting individuals to the right services.
Eligibility Requirements: Many social services and community resources have specific eligibility requirements based on factors like income, age, location, veteran status, etc. If individuals don't know upfront if they qualify for a particular service, they can waste time and effort trying to access something they ultimately aren't eligible for.
Capacity Constraints: Community-based organizations often have limited capacity. They may only have a certain number of spots in a program or a waitlist for housing assistance. Without visibility into the current capacity of different providers, individuals may be directed to services that are already full.
Coordination Issues: Historically, these community organizations have operated in silos, with little coordination or data-sharing between them. This makes it extremely difficult for individuals to navigate the full landscape of available options and find the right fit.
By building the infrastructure to track eligibility requirements and real-time capacity across their network, Unite Us is able to make much more informed and effective referrals.
"The details really matter because if you don't go that last mile to the community-based organization, you might get a closed loop, but you have no idea what the capacity is at those organizations."
How do users use Unite Us?
Community-based organizations (CBOs)
Organizations like food banks, housing providers, and other nonprofits use Unite Us to manage referrals and coordinate services.
They can input their available programs, eligibility criteria, and real-time capacity into the system.
When an individual comes to them in need, the CBO can then make an electronic referral to the most appropriate service provider.
Healthcare providers
Hospitals, health plans, and other healthcare entities integrate Unite Us into their existing workflows and electronic health record systems.
This allows clinicians and social workers to identify social needs, make referrals, and track outcomes, all within their normal care coordination processes.
Government agencies:
State Medicaid programs, human services departments, and other government bodies use Unite Us to manage public benefits and social services.
They can leverage the platform to connect individuals to the right resources and monitor the delivery of those services and reimburse CBOs for those services.
Individuals in need:
While individuals don't directly use the Unite Us platform, they benefit from the coordinated network that it enables.
When they engage with a CBO, healthcare provider, or government agency using Unite Us, they are more efficiently connected to the services and support they require.
How do you characterize and segment underserved populations?
Unite Us acquired Carrot Health for data analytics to identify risk factors and insights at a population and individual level. They combine this with their unique on-the-ground data set from service usage to understand needs in each community.
One of the key ways Unite Us uses data is to identify the 5% of Medicaid beneficiaries whose needs account for over 50% of the costs.
Growth and Business Model
What was your first sale experience like?
In the first 5 years, Unite Us was primarily focused on serving the veteran and military community, which was their initial target market. During this early period, Unite Us was largely funded through philanthropic grants and donations, as they worked to build out their platform and network.
Around 2018, Unite Us started to see a shift as the healthcare industry began to recognize the importance of addressing social drivers of health and entities being willing to pay for SDOH data.Â
This led to Unite Us closing their first commercial deal, working with a Performing Provider System in New York state. Shortly after, Unite Us became the statewide infrastructure for social determinants of health initiatives in North Carolina, through a program called NCCARE360.
What was it like building product market fit?
Rather than just building a technology platform, Unite Us made a concerted effort to deeply engage with community-based organizations (CBOs) on the ground. They tailored the platform to solve specific pain points and operational needs. Taylor emphasizes that community organizations are often protective of the populations they serve and wary of new technology companies.
Unite Us invested significant time into building trust and relationships with CBOs, demonstrating how the platform can benefit them. Instead of just selling the technology, Unite Us focused on solving operational challenges like improving efficiency, increasing referral response rates, and providing better data and reporting.
Recognizing that CBO participation is crucial for effectiveness, Unite Us emphasized change management, training, and ongoing support to drive adoption and engagement.
Unite Us brought together healthcare, government, and community organizations into a single coordinated platform. Addressing the technological and operational challenges of integrating these entities was key to achieving product-market fit.
How does Unite Us differentiate itself technologically?
Unite Us has an enterprise master person index which reflects longitudinal patient data, workflow automation, and analytics. This enterprise-level technology is critical for scaling across large healthcare systems, government agencies, and multi-site community organizations that are motivated by compliance with various regulations.
"If you're just working off of a list [of social services], you're shooting in the dark. And so the ability to have an accountable network of organizations that will respond, provide services, and give you that outcome feedback is critically important."
Unite Us has built a comprehensive network of community-based organizations, healthcare providers, and government agencies that are actively participating and sharing data. This allows them to have a deep, real-time understanding of service availability, eligibility, and capacity across their network.
Unite Us is not just about making referrals, but about tracking and measuring the actual outcomes and impact of the services provided. This outcomes-focused approach is essential for demonstrating ROI and securing government/Medicaid contracts.
"You've got to be able to prove that the CBO provided a service. You can't just take the word of someone else. You've got to have receipts because there's actual dollars in funding flowing through that."
How does Unite Us expect to incorporate AI into its product?
With the insights Unite Us has on service providers, eligibility, and capacity, AI can help automate and optimize the process of matching individuals to the right resources. This could include things like automatically suggesting the best-fit referrals or streamlining the referral workflow.
AI and machine learning could also be applied to longitudinal data for service utilization and outcomes to enable more sophisticated predictive analytics, allowing them to better anticipate people's needs and intervene proactively.
Similar to the CBO support, AI could provide personalized guidance and navigation for individuals seeking services, almost like a "turbo tax for poverty" as Taylor describes it. This could help people understand their options and avoid potential benefit cliffs.
What lessons have you learned selling into Medicaid?
Taylor emphasizes that selling into Medicaid moves at a much slower pace than other commercial markets. He says you have to "double or triple" the amount of time you think it will take.
Medicaid health plans often have very tight margins, with the majority of their budget going towards clinical services. This makes it challenging to get them to allocate funding towards the kind of social care infrastructure that Unite Us provides.
Medicaid is a highly politicized program, with differing views on the role of public benefits and social services. Navigating these political dynamics is critical when trying to sell Medicaid programs on new approaches.
"Historically these community-based organizations that are participating are all fighting for the same dollars and their government grants and philanthropic funding. They're just fighting to survive."
Taylor emphasizes that when selling into Medicaid, you have to deeply understand and adapt to the needs of the community-based organizations that are the boots on the ground. It’s also a competitive environment where multiple organizations are competing for the same dollars. Earning the trust of these CBOs is just as important as selling to the government agencies.
Given the budget constraints, Medicaid programs require Unite Us to rigorously demonstrate the return on investment and cost savings their platform can deliver. Capturing robust outcomes data is essential for making this business case.
Industry Insights
What are the biggest obstacles and opportunities you see in Medicaid?
There is growing awareness that addressing social needs (housing, food, transportation, etc.) is critical for improving health outcomes and reducing costs.
States are experimenting with new Medicaid funding models that allow for reimbursement of social services and infrastructure. In 2018, NC announced a $550M initiative to improve social determinants of health. More states are expected to follow NC's lead in getting CMS approval for billions in social care reimbursement, especially because Medicaid is often their largest budget item.
Integrating AI and modern technology into outdated government systems offers an opportunity to streamline and improve Medicaid service delivery.
Interested in UniteUs? Learn more on their website and their Linkedin.
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