OnlineMedEd: Why We Invested

By Ander Iruretagoyena and Priya Parrish

Medical doctors and other healthcare professionals play a vital role in society, as COVID-19 has reminded us all. While the United States is a leader in educating doctors, there is a global need for well-trained physicians and healthcare infrastructure to deliver high-quality care. At the same time, the medical field offers prospects of high quality, well paid, and stable jobs for those who can break into the competitive job market through rigorous academic training. However, due to the systemic limitations of the current medical education model, there is a significant lack of diversity among medical professionals. In the U.S., for example, 6% of active physicians are Latino, 5% are Black, and 36% are Female. Specifically, the lack of diversity among faculty (predominantly White (63.9%) and Male (58.6%)) and unequal resources across schools to support students with rigorous coursework, disadvantages students of diverse socio-economic backgrounds. Compounded with the detrimental effects of implicit bias in delivering care to racial and gender minorities, there is a meaningful opportunity to help narrow the disparities in health outcomes.

Solution

OnlineMedEd (OME) is a global digital healthcare learning platform for aspiring and practicing healthcare professionals. Currently, more than 86% of medical students in the United States use OME to supplement knowledge needed to pass their board exams, as well as in their clinical practice. 250,000 monthly active users learn from the platform, while an average of 50,000 are global users in 191 countries. 

Growth among international users has grown 50% as OnlineMedEd has proven its ability to create effective supplementary curriculum beyond medical school walls. Over the past year, OME launched its Crash Course suite of free online video tutorials to more than 30,000 redeployed health care providers helping during the pandemic. The company has also transitioned medical school faculty online, and is a natural partner to support institutions in the transition towards active digital-enabled learning. 

Built by founders with medical education experience, the platform is centered around the PACE (Prime, Acquire, Challenge, Enforce) pedagogical method. For each lesson, students have access to: 

• Prime: Lesson overviews, companion notes, diagrams and key takeaways

• Acquire: Peer-reviewed video lectures comprehensively covering the topic and contextualizing within the broader curriculum 

• Challenge: Board-style questions or quizzes; additional video-based explanations for Q&A 

• Enforce: Digital Flashcards for review, automatically set to a study calendar based on memory science

Why We Invested

OnlineMedEd’s platform has attained a leading market share, strong user engagement, and favorable brand preference in the traditional medical school market for supplementary education. With its freemium business model, the company is already democratizing access to medical careers by helping students graduate from rigorous programs and succeed as practicing physicians.

The Company originally served 3rd and 4th year medical students, but in the past two years, OnlineMedEd has invested to expand content to address 1st and 2nd year students, creating a full digital medical curriculum. This foundational success positions OME well to expand into a multi billion-dollar addressable market across adjacent verticals (e.g. Nurse Practitioners, PAs, and Dental), geographies, and the complete student lifecycle.

We also see an opportunity for OnlineMedEd to support the development of the next generation of healthcare providers that more fully represent the populations they serve. To do this, OME is partnering with medical schools and other educational institutions to provide its premium content to all students. With effective supplementary content, students from all backgrounds and in schools across tiers and geographies will enter the job market to serve rural and urban communities globally.

Impact

Given its reach, Impact Engine believes OnlineMedEd has an immense opportunity to help increase representation in the medical field in order to actively combat widening health outcome disparities. In addition to its intentionally accessible product, OME is also ensuring diverse representation in patient and practitioner case studies to create more inclusivity within medical schools. Impact Engine’s involvement will focus on strengthening these efforts and exploring new drivers of impact, such as implicit bias training curriculum and programs to increase the diversity of students enrolling in medical school.

A Recap: Session #3, Investing in Health Equity

By Chris Wu

The third and final session of Impact Engine’s 9th annual Chicago Impact Investing Showcase wrapped up our series with a great discussion on health equity in Chicago, moderated by Elizabeth McCluskey. In reference to our 5P Framework, this session focused on Product-based impact where the product or service a company is providing will directly create impact and connect growth and revenues with positive social and environmental impact. Joining Elizabeth for the event were panelists Justine Mitchell (SVP of AtHome at Array Behavioral Care), Nate Pelzer (the CEO and Co-Founder of Clinify Health), and Will Boeglin (the CEO and Co-Founder of TimeDoc Health). 

To frame the day’s discussion, Elizabeth referenced a study on life expectancy published by the NYU School of Medicine. According to their findings, Chicagoans who live in Streeterville have a life expectancy of 90 years, while 9 miles to the south in Englewood the average life expectancy plummets to just 60 years. The researchers studied life expectancy in America's 500 largest cities, and that 30 year gap represented the nation’s largest disparity. Clearly there are acute problems around both health care delivery and health equity when people only a train ride away are living 30 fewer years. More recently, the Black and Latinx populations in Chicago were disproportionately affected by COVID-19. During the fall, majority Latinx zip codes in Chicago were experiencing the highest rates of infection and Black residents were experiencing death rates 2x that of White residents. Here are some highlights from the discussion:

Q: What is driving disparities in health and why is values-based care so important for serving underserved for providers to facilitate their care?

Nate Pelzer: The simple answer is it’s historically systemic racism at its core. Over the last few centuries through things like redlining, busing, Jim Crow, you have had disinvestment in certain geographic areas in the country. And as these areas have had less investment in health care and fewer employment opportunities, the result is that people have less access to primary and preventive care. Over time, those things that were once just social factors begin to impact their health outcomes. Moving to values-based care is important in Medicaid because it shifts the focus from patients coming in when they need something acute in nature to instead putting the onus on physicians to be more aware of what the population health needs of their patients are in general. 

Q: What are you seeing in terms of disparities in conditions that patients are suffering from and ways you’re finding to intervene?

Will Boeglin: We see a high incidence of both chronic medical conditions and behavioral health conditions in the dual eligible population (people that qualify for both Medicare and Medicaid). But even more so than clinical intervention, often what is needed is social work to address social determinants of health. In this patient population, 40% don’t have a smartphone and 25% don’t have access to WiFi. When you think about the transition to telemedicine that the pandemic has necessitated, that creates some really serious barriers to receiving care. A significant percentage of the dual eligible population don’t have a caregiver at home, they live alone. That means no one is advocating for them, encouraging them to stay on track, reminding them to pick up their prescriptions, or helping them get scheduled for vaccines. In one instance, one of our care managers was speaking with a patient that was homeless and currently living in their car. They didn’t have the paperwork or authorizations from the health center to get admitted to a local shelter. So the care manager worked with the health center to make sure they completed all the correct forms, shared that with the patient and the shelter, and was able to get the patient admitted. There are lots of examples like that of our care manager engaging to help ensure positive interventions, whether it’s connecting someone to Meals on Wheels, trying to find discounts on medication to make their meds more affordable, or referring patients to resources the local community centers on aging. 

Q: What have you seen in terms of mental health throughout the pandemic? What populations have seen an increase in need?

Justine Mitchell: It’s well documented that there is a widespread increase in need for mental health services because of COVID. Social isolation, anxiety, lack of control, job loss, disruption in the home and grieving over loss of loved ones have really driven people to need and utilize behavioral health services more. From a forced adoption point of view, at CMS (Centers for Medicare & Medicaid Services) a lot of federal regulations have been relaxed this year around telehealth and licensure across state lines. Also, hospitals and health systems who may have had some utilization of telehealth, and comfort with it, have been forced to move to telehealth and accept it as a standard of care. We’ve been seeing an increase across multiple business lines. On the direct-to-consumer (D2C) side, utilization has grown month-over-month sometimes as much as 18%. It reflects an increase in need for behavioral health services which is a negative, but on the other hand it’s good that people have access to the behavioral care they need via telehealth – it’s broken down some of the old barriers. In behavioral health there is a supply/demand problem, there simply aren’t enough licensed clinicians to meet the needs of the patient population. Given that, telehealth and video bridges that gap and increases access to care for patients in underserved areas, both urban and rural, even in their home in a more effective way. Combining a D2C product plus more access in clinical settings has been the way to take a bite out of behavioral health deserts.

The entire Impact Engine team is grateful to Justine, Nate, and Will for taking the time to share their perspectives on these important issues that affect all of us. We’re glad that the talented teams at Array Behavioral Care, Clinify Health, and TimeDoc Health are all so passionate about health equity and working hard to develop solutions that address these disparities in health. We’d also like to thank the MacArthur Foundation for their continued support of this annual Chicago showcase event. See you next year!

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Missed this session or want to revisit the full discussion? Visit here for a full recording.

A Recap: Session #2, Any Company Can Be an Impact Company

By Roger Liew

This session was moderated by Jessica Droste Yagan, Impact Engine’s CEO, and the intention was to demonstrate how any company, through being intentional and positive in their business practices, can be impactful. Jessica’s own career has focused on the overlaps between making money and social good, and she used this experience to explore how three different organizations of very different scales apply process-based impact. The discussion illustrated that no matter the product or service of the organization, processes can be modified to produce benefits for society or the planet. 

The basic question posed was “how do you find the win-wins where what’s better for the planet or better for society can be better for the bottom line?”. Our goal was to inspire, educate, and offer ideas anyone can apply in their workplace.

The three panelists were: 

Steven Dyme, Co-Founder & CEO, Flowers for Dreams

The company, based in Chicago, offers floral bouquets where a portion of proceeds are donated. Thus far, $750k has been donated to 130 causes in the communities that they serve. An additional positive impact is introducing Flowers for Dreams customers to the beneficiaries, ultimately growing the following of their non-profit beneficiaries by 1.5x.

Jenny Farver, Co-CEO, 8th Light

8th Light is a consultancy which helps companies build software. Known for high quality work, the way they’ve built their workforce is by hiring primarily through an apprenticeship program. This hiring technique has produced a much more diverse workforce than is typical in the technology industry.

Jenny McColloch, Corporate Vice President of Sustainability, McDonald's Corporation

McDonald’s operates 40k restaurants across 140 countries, with a focus on feeding and fostering communities while maintaining both local and global perspectives. The sustainable sourcing team is most proud of their climate work, as McDonald’s is one of the first companies that set science-based targets to reduce greenhouse gas emissions. Their global scale has created a focus on the resiliency and strength of the global food supply chain.

Some key impact examples from our panelists included:

• A focus on carbon management for grazing cattle has yielded improvements in the efficiency of raising beef.

• Climate thinking is inherently long term, which has prepared the company to manage supply chain disruption.

• Lower cost per hire via apprenticeship programs.

• Diverse teams build better software because the users of software are diverse.

• Differentiating between a “buy to give” model that’s tacked on versus integrating the giving program into the core product offering.

Other questions addressed included:

• How do you deal with tensions between a social or environmental pressure and financial returns?

• How do you engage your employees in the process of evaluating the company’s performance towards their impact goals?

• How do you communicate your impact to customers?

• How do you address the tensions between types of social impact, such as paying your employees more or lowering your prices?

The session closed by addressing the question of “can you be an impact company if your product or service is not solving a societal problem?,” which included concrete suggestions from the panelists:

• Be authentic.

• Iterate work in progress. 

• Be intentional and prioritize; don’t spread yourself thin.

Lastly, two book recommendations surfaced during this session:

Small Giants by Bo Burlingham, which is about companies that choose to be great by staying small. 

Six New Rules of Business by Judy Samuelson, which includes ways to think about business holistically.

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Missed this session or want to revisit the full discussion? Visit here for a full recording.

A Recap: Session #1, Investing in People and Place to Close the Racial Wealth Gap in Chicago

By Ander Iruretagoyena

On Wednesday, February 10th, Priya Parrish kicked off Impact Engine’s 9th annual Chicago Impact Investing Showcase. In this session, we explored the various forms of racial wealth disparity in Chicago and how different types of investment capital and approaches are intentionally creating more equity. Specifically, the session focused on the People and Place P’s of our 5P Framework. Through opening remarks by Debra Schwartz (MacArthur Foundation) and a moderated conversation with Dr. Helene Gayle (The Chicago Community Trust) and local business leaders Jim Casselberry (4S Bay Partners), Julian Posada (LiftUp Enterprises), and Don Thompson (Cleveland Avenue), participants listened in on how businesses with underrepresented founders and operations that create opportunity for people historically underserved lead to powerful and lasting change for individuals and their communities. The speakers are real life examples of businesses that purposely base their operations/investments in areas with little upward mobility and who inspire each of us to act. Impact can be optimized by focusing on the root cause of so many of the problems (lack of access to high quality education, health disparities, violence, etc.) that plague this country. We cannot expect the country to move forward when we are holding close to ⅔ (the Latinx and Black communities) of it back. In spite of its virtual format, the session maintained the high energy spirit and rallying call to action that has come to be expected at Impact Engine’s showcase events.

Notwithstanding all of the increased attention, closing the racial wealth gap is not a new issue. Institutions like the MacArthur Foundation have been working to close the racial wealth gap and make financial systems more inclusive for over 35 years. Chicago has been a key battlefield in this war, with innovations like Community Development Financial Institutions (CDFIs), programs like Benefit Chicago ($100M in capital to support impact enterprises throughout the Chicago region looking to enhance job readiness, create jobs, or build wealth) and studies like Next Street’s (for Black and Latinx entrepreneurs in Chicago, 80% of their equity capital needs go unmet and that there is a gap of at least $146M between the supply and demand for equity capital for these communities). It's a case study for the power of combining traditional grants, donations, and public-private partnerships, with impact investing across all the P’s. 

During the session, we heard from Cleveland Avenue and their efforts to bridge the gap for underrepresented entrepreneurs in the food and beverage space by giving them the support to overcome perceptions attached to them. Key to these efforts is utilizing structures that are aligned with the interests of those founders. Creative structures like convertible debt or bridge loans help avoid unnecessary dilution. Equity should only be used when there is a reason for it and to create alignment for long term success; it should not be the de facto structure. 

LiftUp Enterprises explained how implementing best-in-class diversity and inclusion practices can be a source of competitive advantage. Furthermore, they shared some of their recent operational improvements like establishing weekly payroll and setting up a company sponsored emergency funding lender so workers do not have to go to payday lenders. These practices are not only solving liquidity issues for workers but become the foundation for paradigm-based impact by ensuring the creation of wealth at all worker levels (senior, middle, and entry). 

Lastly, we heard from 4S Bay Partners, which strives to eliminate prejudice and inequities by helping create useful, wholesome economic opportunities for marginalized communities and amplifying their stories through private capital investments. As a single family office, 4S has the flexibility to engage in multiple different funding strategies like opportunity zones or setting up vehicles like Chi-Town Impact to drive wealth creation, which in their view is not a zero sum game. 

The summer of 2020 was a rollercoaster for the city of Chicago, and not exactly the fun kind. Amidst a pandemic, election uncertainty, and racial equity marches, the city fluctuated from desolate streets to packed ones to desolate again in a matter of days. As a fellow Chicagoan, it was shocking to see empty streets due to numerous store and small business closings, packed streets filled with peaceful protesters, and again empty ones with the exception of National Guard patrols demanding to see identification. No amount of snow will make us forget the events that transpired this past summer in Chicago. Now more than ever, we know that systemic racism is unrelenting in our country. The events of the past months have crystallized how frustrated, saddened, and angry we all are. Despite some progress, we know that the stories of George Floyd, Ahmaud Arbery, Christian Cooper, and Breonna Taylor won’t be the last. With spring just a couple of days away, it is time to come out of hibernation, join Chicago’s vibrant impact community, and support efforts aimed at closing the racial wealth gap. Be loud, be bold, think outside the box, be impactful, listen to those who you are trying to impact, take the time to collect feedback, and above all: 

“Just open your eyes, your paradigms, your perspectives, and increase the possibility to folks that are black, brown and women in this field...don’t make us overprove ourselves.” 

— Don Thompson, CEO & Founder, Cleveland Avenue

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Missed this session or want to revisit the full discussion? Visit here for a full recording.

Market Wagon: Why We Invested

By Elizabeth Coston McCluskey and Tasha Seitz

Consumers today are more aware than ever of where their food comes from, and they are concerned about food safety, transparency, and access to local supply. Sales of locally produced foods in the US grew from $5 billion in 2008 to $12 billion in 2014 and was expected to reach $20 billion in 2019. However, the current grocery system in the US was built to serve 20th century needs. In a pre-digital era, stores focused on consolidation and centralization in order to maximize efficiency. Today, that means that mainstream retailers carry a limited amount of local food. Prominent retailers like Walmart only carry 11% local-sourced produce, and even progressive stores like Whole Foods may only have 20% local offerings. Local food producers are looking for new ways to sell to consumers who are increasingly interested in connecting directly with their food sources.

Solution

Market Wagon is an online farmer’s market that shortens the food supply chain by sourcing and distributing local food directly to consumers. Their platform enables farmers to connect directly with end consumers, creating a direct supply chain. The direct interactions between consumers and producers allows them to develop relationships and to build trust. Farmers have profiles on the site that promote brand content, list product information such as pricing and availability, and facilitate direct interaction via Q&A. Consumers are able to search by category across multiple suppliers and combine selections into a single online order, creating a true alternative supply chain to grocery retailers. The company requires vendors to fulfill customer orders at central distribution facilities, and uses a distributed labor pool to complete last mile deliveries. This enables the logistics model to remain capital-light and scalable. 

Why We Invested

The co-founders have extremely relevant and complementary backgrounds. Nick Carter, the CEO, grew up on a farm in Indiana before becoming a tech founder. Daniel Brunner, the COO, has deep experience with grocery operations and supply chains from his time as VP of Grocery Solutions at Kiva Systems (acquired by Amazon). Market Wagon has demonstrated very strong momentum and growth. Prior to COVID they achieved 200% growth Y/Y. Since COVID, they have been able to capitalize on disruptions to food supply chains and consumer preferences to expand even faster. The company has taken a thoughtful approach to launching in new markets thus far. In February of this year they had 6 locations, all in Ohio and Indiana. That number more than tripled to 20 locations in 8 states across the Midwest since then. This funding round will be used in part to fuel their next phase of geographic expansion.

Impact

Local food sold directly to consumers more than doubled from $1.3 billion in revenue in 2007 up to $2.8 billion in 2017. According to the USDA over 163,000 farms in the US market their foods locally. Of these farms, 70% reported that direct-to-consumer (DTC) was their only sales channel. Small farms (less than $50,000 in gross annual sales) account for 81% of all farms reporting local food sales in 2008. DTC is a crucial marketing channel for these small businesses, traditionally in the form of farmers markets and community supported agriculture (CSA) agreements. Many local food producers have been forced to adapt as both in-person farmers markets and restaurants have been greatly impacted by the COVID-19 pandemic. Market Wagon gives local food producers a new and potentially more efficient channel by offering an online marketplace to sell directly to consumers. 

In addition to the economic benefits for local food producers, local foods have been linked to a variety of other benefits such as enhancing the rural economy, increasing access to healthy and nutritious food, as well as improving the environment. 

Borrowell: Why We Invested

By Ander Iruretagoyena and Priya Parrish

COVID-19 has exacerbated economic inequalities globally and the need for consumers to have healthy credit profiles in order to achieve economic stability and mobility. While some consumers have been able to build stronger balance sheets amidst lessened spending opportunities, that has certainly not been the case for all, especially for those underserved by the financial ecosystem. Many impact investors are aware of the need for financial inclusion strategies in emerging economies, but the size of the under/unbanked in developed economies is also notable. Take Canada, for example, where approximately 9M Canadians (close to 1/3 of adults) have non-prime credit scores (credit scores under 660). Consumers in this cohort face constraints accessing affordable credit, which can put additional pressure on already tight budgets. 53% of Canadians live paycheck-to-paycheck and 27% still don’t have enough money to meet their needs. Outside of predatory lenders, there are few options for this group of financially insecure consumers.

Solution

Borrowell Inc. is a leading Canadian online lending platform designed to offer personal loans and free credit scores. The company's platform utilizes free credit scores and monitoring services to make AI-powered product recommendations, including money management solutions, bill alerts, and predictive cash advances. Users benefit from access to low-interest loans and financial education tools while financial partners benefit from high intent pre-qualified leads. Borrowell aims to be the go-to platform for anyone looking to see their credit reports, gain financial education, and have access to budgeting and capital products aimed at improving financial stability and mobility. This should make a difference for the more than 25% of Canadians who feel overwhelmed by debt.

Why We Invested

Borrowell’s acquisition of Refresh Financial (a fintech company enabling credit rehabilitation through its credit builder loan and secured credit card products) represents a compelling opportunity for the company. With the funding in place to finance this acquisition, Borrowell will be able to expand its product line and build out a multi-product strategy that can produce stronger financial stability for their target customer while increasing their lifetime value. Upon close, the company will immediately realize gains through cross-selling opportunities, improved unit economics related to decreased loan origination costs, and significant synergies. Having a strong first-mover advantage, Borrowell is the clear leader in the large but relatively uncompetitive (when compared to the United States) Canadian financial origination market. The Impact Engine team has conviction in Borrowell’s management team and their systematic and comprehensive plan for integration that includes continued focus on driving measurable improvements to their customer’s financial health.

ImpacT

The combined entity will target the underserved subprime credit population. 53% of Borrowell users have credit scores of less than 659 and the average starting credit score of a Refresh Financial client is 500. However, through engagement with the Borrowell platform, users are able to improve their credit score by a demonstrated 171+ points in 24 months. Borrowell has already demonstrated its ability to establish financial prosperity for its user base through raising the credit scores of its users, lowering their cost of borrowing, making budgeting more manageable, and increasing their savings. This acquisition and round of funding will amplify that impact by enabling the company to serve more non-prime credit seekers and to provide a broader suite of products and services that meet the diverse needs of each user.

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Clinify Health: Why We Invested

By Tasha Seitz and Elizabeth Coston McCluskey

Healthcare represents 18-20% of GDP in the US, and $1 out of every $6 spent on healthcare is through Medicaid programs that serve 75 million individuals in low-income households (almost $600 billion in fiscal 2018). Regulations and the Centers for Medicare and Medicaid Services are shifting the system towards value-based care, and providers will have to adapt or drop out of the system. 

The transition from fee-based to value-based care has not taken place in underserved communities where many patients are covered by Medicaid and Medicare. Value-based contracts still only represent 20-30% of the market, and adoption has come primarily from large physician groups that have the capital to invest in technology, quality experts, and customized interoperable technology platforms. 57% of the market opportunity lies outside of these large provider groups.

Physicians are time-strapped and likely to treat patients for acute symptoms and thus overlook other underlying common chronic conditions and prioritize preventive services at a population health level. Physician practices managing multiple value-based plans can find it challenging to determine which plans prioritize which cost and quality measures for which patient, and when there are more than two recommended measures per patient, compliance drops to 20%. In addition to the challenges of effectively managing patient encounters, the process to get reimbursed under value-based care programs is cumbersome, and it can take up to six months  for providers to be paid for their services.

Solution

Clinify Health supports providers and practices in underserved communities to transition from fee-for-service to value-based care by automatically risk stratifying a practice’s patient population, guiding medical staff as to which patients they should be proactively reaching out to, and providing recommendations to physicians on what actions to take during their patient engagements based on the cost/value of services in addition to clinical utility. Clinify is embedded in clinical workflows through the electronic health record; it pulls clinical data and compares it to value-based contracts to see what services to provide to the patient as part of a complete check-up based on that patient’s needs. In the future, Clinify will enable immediate verification of contract milestones and improve the cash flow cycle for providers serving Medicaid patients.

Why We Invested

Physician practices have been hit hard both emotionally and financially during the COVID19 pandemic, which has had a disproportionate impact on underserved populations. Keeping providers in business and serving their local communities is critical, and Clinify is aimed at supporting these practices to deliver high-quality care, in a cost-effective manner. With the drop in fee-for-service revenues due to the pandemic, there is a near-term opportunity to aid provider groups in shifting to value-based care contracts. Clinify’s recommendations are based on state-by-state guidelines and can give guidance on a contract-by-contract basis across multiple payers, and the company’s business model aligns values and incentives across key stakeholders.

The founding team at Clinify reflects the community the company aims to serve and has deep experience in healthcare, including primary care, value-based care and Medicaid populations. The team also has strong connections to payers, who are interested in accelerating the shift to value-based care but have struggled to get providers on board.

Impact

By enabling physicians serving Medicaid patients to transition to value-based care, we believe that Clinify will improve outcomes for patients while reducing overall healthcare costs and improving the financial viability of physician practices in underserved communities. Access to quality care is an important dimension of health equity, and Clinify will assist physicians in identifying high risk patients and proactively reaching out to those individuals to ensure they are receiving the appropriate care. The company will track quality metrics that are foundational to longitudinal care (for example, BMI and A1C for diabetic and pre-diabetic patients). In the longer term, we expect Clinify to reduce emergency visits, increase post-discharge follow-ups, and lower the overall cost of care. 

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