bosWell: Caring for the Most Vulnerable

Aristotle Mannan wants to put high-tech at the service of high-touch. His digital health startup, bosWell, seeks to connect vulnerable populations to healthcare. “Our mission is to reach Medicaid’s unreachables and build bridges back to care,” he says. “There are a lot of people who access services at homeless shelters, food pantries, churches, mobile clinics, needle exchanges, and other neighborhood touchpoints. They are not going to show up in a primary care setting, so why not find ways to meet them where they are?”

For Ari, founding a social enterprise was a swerve from his original career plan. With an undergrad degree in molecular biology and early work experience as a cancer researcher at the Broad Institute in Boston, he expected to follow the path his parents had taken into biotech. When he stepped off that path in 2014 and became a community health worker, a whole new world opened up. One of the first things that struck him was that so much information gathered about vulnerable populations was still being recorded with pen and paper.

“That was beyond me,” Ari says, “the fact that there was no technical infrastructure there, and the staff had to do after-hours transcribing to a database.” With help from his next-door neighbor who was a software engineer, he reached out to community-based organizations he had developed relationships with and started a project to get them off pen and paper and streamline information intake, workflow, and data reporting.

“These organizations are serving a lot of the folks who slip through the cracks in the healthcare system,” he says. “At-risk people show up at these neighborhood touchpoints because they need help, but because there are so many information gaps, there are missed opportunities to provide care.”

Missed opportunities happen most often with people who are at the very edge of risk. Ari recalls meeting a homeless man named Huey who was sitting on a bench, drinking Listerine and wearing a green hospital gown because he was in and out of Boston Medical Center nearly every day. He also recalls a young woman who appeared at a mobile clinic with a stab wound and needed treatment. She returned later with an infection that required the mobile clinic to drive her to the emergency room.

“At the Broad Institute, we were working on a multiplex drug screening platform to identify novel targeted therapies for cancer,” Ari says. “That felt like a pretty complicated problem. But then I’m out in East Boston and see a guy drinking Listerine and going to the emergency room all the time, and I think, this shouldn’t be so complicated. It doesn’t make a lot of sense. How is it that you can go to the Brigham and get a face transplant but we can’t keep a girl on Boston Common from having a wound get infected? It’s something I think about a lot.”

“This is not just a Rhode Island problem or a Massachusetts problem, it’s an American problem. It’s a healthcare delivery issue and also a disenfranchised population that doesn’t get a lot of breaks for anything.”

Over the next few years, Ari continued to develop bosWell technology so community-based organizations could use it to keep track of the vulnerable populations they served. He also began to thoroughly explore the healthcare system. He shadowed hospital emergency rooms, where people with socioeconomic risk factors such as unchecked chronic illness, sleeping out in the cold, and mental health and substance abuse issues were regularly showing up. He went to health insurers to understand the system of Medicaid claims. He traveled to Colorado Springs to cultivate relationships with an entirely new group of local safety-net organizations and saw the same pattern of information gaps and missed opportunities happening there. Along the way he met an investor who staked him with enough funding to work on the problem full time. People were interested in what Ari wanted to do with bosWell. But everyone wanted proof that his technology would offer a solution. He needed to get a pilot going, but no one wanted to be first.

Then, in 2017, he went to Philadelphia and had a breakthrough. A health insurer he was pitching as a client for his software was candid about their needs. They simply could not find a large percentage of their members. The state had given them a list of individuals with Medicaid coverage who were assigned to their plan, and they could not locate 40 percent of them. They had tried automated texts and phone calls, but the phone numbers changed all the time. They hired teams of people to knock on doors, but the addresses changed all the time.

“I guess they always talk about startups going through pivots,” Ari says. “That was our aha moment. Invariably what happens is the check engine lights in the population are those unreachable people – Medicaid’s MIA. Quantitatively we were trying to figure out who those rising-risk individuals were, by looking at people that show up at food pantries or syringe service programs more often. But qualitatively if you’re already vulnerable, on Medicaid, it’s hard to get ahold of you, and you’re unengaged with care, you’re probably a check engine light in a different way.”

From then on, bosWell’s mission would be to find Medicaid’s MIA and connect them back to care. Around that same time, Meg Wirth, director of health and wellness programming at SEG, reached out and invited Ari to consider Rhode Island as a good ecosystem to try things out in.

The SEG Connection

As a result of conversations with Meg, Ari applied to SEG’s 2018 Health & Wellness Accelerator. He had already brought bosWell through a couple of similar programs, including MassChallenge Boston and Village Capital, but now he was looking for introductions in an environment that was easier to navigate.

“In the SEG Accelerator, there’s an emphasis on tell us your story, tell us what you’re doing, tell us the steps you need to take to get there, and make it concise.”

“We immediately got connections in Rhode Island,” says Ari. “The degrees of separation to connect here are a lot fewer than in Boston. We were able to quickly foster relationships with health insurance plans and providers and start building relationships with community-based organizations. Jim Berson, who was our mentor, was really helpful. He opened a lot of doors and made a lot of introductions. Rhode Island is closeknit and hyperlocal. We may have finally have found an ecosystem to build our use case and potentially pave a path to market.”

The experience also pushed him to refine his messaging. “In the SEG Accelerator, there’s an emphasis on tell us your story, tell us what you’re doing, tell us the steps you need to take to get there, and make it concise,” he says. “It was helpful to go through that exercise, especially with people who were not familiar with our domain.”

The best advice he received in the SEG Accelerator is the same advice he would give to any new entrepreneur: Get out there and talk to people. “It’s a contact sport,” he says. “There’s this Japanese term, genchi genbutsu – go and see for yourself. It’s an approach Toyota used to reengineer a minivan that didn’t sell. They actually hired engineers to live with families and go on road trips across America. It comes back to doing your diligence. You have to know your domain and focus on the problem before focusing on the product. And document all the information you are capturing. I still have that little database of every discussion I’ve engaged in since May of 2014.”

“Now the vision is to prevent people from slipping through the cracks and find people who are invisible to the system and bring them back into care.”

Funding for bosWell has increased since Ari’s participation in the SEG accelerator. In 2019, the company received an SBIR grant from the National Science Foundation and a $50K investment from the American Heart Association’s Social Impact Fund. After bootstrapping his technology for years with his own money and the help of part-time programmers, Ari has been able to hire his first full-time CTO, and he’s taken on two interns from Brown University. He’s focused on hitting his milestones.

“We want to get the blueprint right here and then see where else we can go,” he says. “We know how long it’s going to take, and we know that it’s relationship driven, and relationships take time. We still talk to our contacts in Colorado, D.C., Newark, Philadelphia, Wilmington, and Baltimore. This is not just a Rhode Island problem or a Massachusetts problem, it’s an American problem. It’s a healthcare delivery issue and also a disenfranchised population that doesn’t get a lot of breaks for anything.”

The more Ari discovers, the more his vision for bosWell evolves. “Our north star is to enable people to better access the healthcare system and reduce missed opportunities,” he says. “We’ve learned there’s already a lot of good that’s happening in neighborhoods but with very few resources and a lack of infrastructure to make it happen efficiently. Now the vision is to prevent people from slipping through the cracks and find people who are invisible to the system and bring them back into care. But I think moving forward it might actually be to leverage the information we are collecting at the macro level to guide policy changes and potentially correct some of the issues upstream of what we’re seeing.”

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