{"id":16625,"date":"2026-11-10T06:24:00","date_gmt":"2026-11-10T06:24:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=16625"},"modified":"2026-11-10T06:24:00","modified_gmt":"2026-11-10T06:24:00","slug":"amy-bucher-lirio-health","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=16625","title":{"rendered":"Amy Bucher, Lirio Health"},"content":{"rendered":"<p class=\"wp-block-paragraph\"><em>Lirio Health is an interesting under-the-radar company, which works with plans, providers and others to try to influence the behavior of their members and patients. Of course, everybody wants to change the behavior of human beings, and it\u2019s been proven over the years to be very hard. Lirio probably has more PhDs per square foot than any other company in this sector. I spoke with one of them, the Chief Behavior Officer, Amy Bucher, and she showed me a wide variety of case studies in which they are using a wording approach and psychographics to nudge people to better behaviors. A great discussion on how and whether we can use psychology to improve health.\u2013<strong>Matthew Holt<\/strong><\/em><\/p>\n<div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Amy Bucher, Lirio Health\" width=\"640\" height=\"360\" src=\"https:\/\/www.youtube.com\/embed\/BU_Qy2RJySM?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div>\n<p class=\"wp-block-paragraph\">The transcript (made by Youtube and Claude so blame AI for any mistakes!)<\/p>\n<p><span><\/span><\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Matthew Holt, with another THCB Spotlight. I have with me Amy Bucher. Amy is the Chief Behavioral Officer, scientist, and intellectual powerhouse, I think, behind Lirio. Lirio is a company in the behavior change space, so you\u2019re absolutely in the right place. Amy has a long history of hanging out in the world of healthcare design and healthcare media, with stints at what was Health Media before it was J&amp;J, and after it was J&amp;J, and then Mad*Pow, a company I knew well, because Mad*Pow was run by your fellow Amy, Amy Cueva, who I think went on to become chief design officer at UnitedHealthcare at one point, and is now doing something else. I know she just harassed me recently.<\/p>\n<p class=\"wp-block-paragraph\">But Amy, welcome, and tell me a little bit about what the basic idea is that Lirio is helping with. We hear about behavior change, and we don\u2019t know if it\u2019s possible. Tell me what Lirio is trying to do. What\u2019s the objective?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yeah, and thanks for having me. Lirio is really premised on the idea that personalizing how we talk to people, and giving them what they need to overcome their barriers to action, is what will engage patients and actually get them to do the things that are recommended for their health. We know that in healthcare, adherence and patients taking action has been a consistent problem. I\u2019ve been working in this space for over 20 years, and while we\u2019ve solved some challenges, there are still so many that remain.<\/p>\n<p class=\"wp-block-paragraph\">But now we have the technology, especially with artificial intelligence, where we can look at a huge amount of contextual data and really figure out the right way to talk to each person, at a specific moment in time, about different behaviors. We\u2019ve had approaches in healthcare like segmentation, which are so much better than generic, one-size-fits-all messaging, but which still miss the mark. As much as you might be a certain type of person when it comes to \u2014 we were talking earlier about mammograms \u2014 mammogram programs, at least for me, that doesn\u2019t mean I\u2019m that same type of person when it comes to my vaccines. Or if I\u2019m actually diagnosed with a serious health condition, that segment won\u2019t necessarily carry through. We haven\u2019t had a mechanism to accommodate that kind of segmentation drift: how do we understand how people are shifting in the moment and changing over time? So what Lirio really does is take in, and in fact create, a large amount of data and figure out the optimal way to communicate with this individual at this point in time.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Broadly speaking, we\u2019ve got quite good outside of healthcare at moving people around, in areas like e-commerce and retail, combining advertising with information. We seem to be getting very good at it \u2014 perhaps too good at it in terms of politics, voting, campaigns, misinformation, and God knows what else. But what is the state of the science behind this? Where did you originally come from, in terms of the state of the science of behavior change? How much more effective are we now than we were when it was basic? Go back 100 years, really basic, general generic advertising, then more segmentation and targeting, obviously turbocharged by the internet, and now AI and tons of data. We had the big data era, and now we have AI. How much better have we got? And then we\u2019ll talk about healthcare.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">It\u2019s an interesting question, because it\u2019s sort of how much better could we be, and how much better are we actually? There\u2019s what we could do with the science, and then there\u2019s what we actually do when we get into the messy real world and have to negotiate with legacy technologies and business rules and so on. I do believe, and have seen lots of evidence, that behavioral science makes a difference in how we can activate people around their health. I wouldn\u2019t have devoted my career to this otherwise.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Before we get into health, let me ask you how much better we\u2019ve got outside of health, in these other areas like retail.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Oh, a lot. And I say this as sometimes a victim of the behavioral science, because being educated in it doesn\u2019t help you. Lord knows how many hours I\u2019ve lost to TikTok, or even Netflix. One of the things those technologies specifically do \u2014 or even Facebook, a product which I quit years ago, to the benefit of my mental health, because it\u2019s so good at this stuff \u2014 is pick up on situational signals: not just what am I interacting with, but when, and for how long. They use those sources of data too, which are really powerful in getting people to \u2014 in their case \u2014 spend more time with their product. What we\u2019re trying to do is get them to spend more time actually with their health care. But it\u2019s all that context that I think makes a huge difference. It\u2019s not just what I would call traditional behavioral science, of what are you doing.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">If I like putting things on scales of one to ten: generic advertising was a one or a two, and market segmentation, sort of pre-internet, was a three or four. Outside of healthcare, are we now an eight? A ten?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">My instinct is to say an eight.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Okay. So it\u2019s pretty good. The fact that ads follow me around the internet because I expressed an interest in plumbing or something \u2014 it\u2019s gotten pretty good at inference. Now let\u2019s go to healthcare, because in the case of other behavioral mechanisms, it\u2019s trying to get us to buy something, vote for somebody, send money somewhere. There\u2019s a transaction involved. Healthcare is a real pain in the rear, because you\u2019re trying to do transactions, but you\u2019re also trying to get people to change how they\u2019re thinking and how they\u2019re behaving, and these changes tend to have the unpleasant artifact of cost or activity being required up front, and the benefit usually coming a long time down the road. We know that\u2019s hard for people in general, and it seems to be getting harder \u2014 judging by my analysis of society, which is observational only.<\/p>\n<p class=\"wp-block-paragraph\">So where\u2019s the state of play in behavior change in healthcare? You\u2019ve been doing this for a long time. How are we doing with people who have chronic diseases, where we\u2019re trying to change diet, we\u2019re trying exercise? We\u2019ve got some drugs that seem to be working on the diet side. But broadly, going back to my scale, where was healthcare, and where is healthcare?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Oh boy. Were we negative before?<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\">I mean, healthcare certainly wasn\u2019t good. I\u2019m going back about 20 years when I think about this. I would say maybe a two or a three, and I think maybe now we\u2019re at a four or a five. We have some good reasons for that, and some maybe not so good. The good reasons are that we care more about data privacy in healthcare than we do in consumer interactions. The things that I do with my doctor are not available as data as readily as the things that I do on my internet browser, which is sort of for sale to the highest bidder \u2014 or honestly, anyone who\u2019s willing to pay anything, probably. So we protect healthcare data more than other sorts of data, and that limits the way we can use it to personalize and engage people. I think that\u2019s probably a good thing overall, but we also sometimes take it too far.<\/p>\n<p class=\"wp-block-paragraph\">One of the things I see a lot in my research is that patients get frustrated with healthcare because we know we\u2019re sharing our most private, personal data with our doctors, with our pharmacies, with our insurance companies, and then we have an interaction with one of these organizations and they\u2019re asking us all the same questions again. It\u2019s like they don\u2019t talk to each other, and they don\u2019t even seem to remember the things we say to them. For all that people find some of the consumer advertising creepy, we actually expect our healthcare organizations to know things about us, and then feel surprised when they don\u2019t. So I think we have a lot of latitude to use the data that we do have a little bit more assertively. Yes, data privacy matters a lot, and we need to be really thoughtful about how we protect that data, but even the organizations that already have it are not using it the way they could be. So that\u2019s one part of the problem: can we get the data?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Speaking as somebody who\u2019s been involved in a lot of surgery and a lot of healthcare visits lately: my name and my birth date, I know very well. I\u2019ll say them six times in one visit. That\u2019s just for identification, so they know they\u2019ve got the right person. They have to be careful, and obviously there\u2019s lots of checking going on. But yes, there\u2019s a lot that clearly could be done better by those organizations, because of data limits.<\/p>\n<p class=\"wp-block-paragraph\">But there\u2019s the other side of the equation, which is that you\u2019re asking people to do hard things, right? Change their behavior, eat better, take their medications, get their vaccine, whatever it happens to be. Life gets in the way, or, hey, that chocolate bar is really good. There are these other forces, the people who make high fructose corn syrup and whatever else, who are counteracting what would be good for me. And we know the numbers. I was judging an event yesterday where there was a company doing remote heart monitoring that had gotten hypertension control up to, I think, 85%. That\u2019s great, because the California statewide average for people with hypertension, I think, is 50% at goal, out of people who have it \u2014 let alone the people who have it and don\u2019t even know they have it. So is five okay, and maybe we get to a six or a seven, but we\u2019re never going to get to an eight or nine? How hard is this problem?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Again, it\u2019s a hard problem that is actually kind of easy in some ways. We have some of the tools we need to be better at this. Some of the work we\u2019re doing at Lirio, I\u2019ve been blown away by. You just mentioned hypertension control: we\u2019re working with Cone Health in North Carolina on hypertension control. They have a series of nine clinics for high-risk hypertension patients, and they\u2019ve been doing this whole big effort, for which they\u2019ve gotten a national award from The Joint Commission, around how they get, in particular, their Black patients to hypertension control. The goal is to have 70% of them reach control. They\u2019ve done well in the past with their overall patient population, but if you break it down by race, it tends to be the white patients who are doing well. So they\u2019ve really focused on the health equity piece of this, received their national award, and Lirio is part of their work.<\/p>\n<p class=\"wp-block-paragraph\">What we\u2019re basically doing is trying to nudge the people who don\u2019t engage after they\u2019ve gotten the patient portal messages. They\u2019re overdue for their doctor\u2019s appointments. Part of what Cone is trying to do is have the doctor talk to you at the appointment about making the next appointment, but if you never go to the appointment, obviously the doctor isn\u2019t having that conversation with you. We\u2019ve been able to get upwards of 60% of these patients to show up for at least one doctor\u2019s visit. So we\u2019re using some data that we have about them, and we\u2019re using behavioral science to speak to them and hopefully address the actual reasons why they haven\u2019t been showing up to the clinic. Otherwise, these might have been patients who were left behind. That\u2019s not 100%, that\u2019s not getting us to ten out of ten, but I think having these sorts of things to address the pockets of the population that haven\u2019t responded in the past can get us a lot further along the way. I don\u2019t want to say it\u2019s easy, but we know how to do it.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Go a layer deeper into how you do it. What kind of data is Lirio collecting? What\u2019s the secret sauce behind the algorithms, the wizardry? What are you collecting, what\u2019s going on internally? And then I\u2019d like to see what it looks like on the other end. But first, explain what is new about what Lirio is doing in behavioral science.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Sure. When we start, we can work with whatever type of data our client organization has available to give us. At a minimum, we need to know who we\u2019re communicating with, we need to have consent to communicate with them on the channels, and then we need to know who\u2019s eligible for what, which is typically some degree of health background. With the hypertension example, we know who has a diagnosis of hypertension, when they last visited their doctor, and when they were supposed to come in, so that we can say: yes, this is a patient who\u2019s overdue for that visit. Some organizations will give us a lot of data on the population we\u2019re nudging, which we can definitely use to make more informed first outreaches, and some will give us the absolute minimum. It doesn\u2019t really matter, though, ultimately, because our secret sauce is that we\u2019re creating new data every time we nudge somebody.<\/p>\n<p class=\"wp-block-paragraph\">My team builds a logic model for every set of nudges. Basically: what are the barriers that prevent somebody from taking this action, and what are the behavioral science techniques we\u2019re going to use to overcome those barriers? We write all the content that uses those techniques. Then when we send a nudge and somebody responds or doesn\u2019t respond to it, we\u2019re learning whether this is a technique that\u2019s effective for this person, for this behavior. That includes the context of, hey, we text messaged on Wednesday at 2 in the afternoon about a mammogram, and Amy opened that text, clicked the link in the text message or didn\u2019t, scheduled the mammogram or didn\u2019t, and then ultimately, did she show up for that mammogram? So we\u2019re tying together the behavioral science outreach to the individual\u2019s behavioral response, and that\u2019s what\u2019s really allowing us to develop this picture of what a person responds to in terms of outreach.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">How much does it matter that you know a lot? You get a lot from what you\u2019re doing. Do you get pretty quickly to where you\u2019re pretty smart about what to do next from just your own data, or does it help if you know a decent amount more about people and their health status, and is that information easily available?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">It depends on the behavioral space, and it\u2019s also because we bring trained AI models to our implementations. If it\u2019s a space where we\u2019ve done a lot of work \u2014 vaccinations is a place where we have nudged millions of people over four years \u2014 we can nudge a new population with minimal data and be pretty effective very quickly. If it\u2019s a new behavioral space for us \u2014 I\u2019m trying to think of something we don\u2019t do \u2014 oh boy \u2014 actually, cancer treatment. We do a lot of cancer prevention and screening, but we don\u2019t do anything yet in the space of cancer treatment. So let\u2019s say we were doing that. It would probably take us longer to be effective.<\/p>\n<p class=\"wp-block-paragraph\">We do typically see a sort of hockey stick in our behavioral conversion data, where to start, we do fine. We\u2019ve actually done tests where it\u2019s just the behavioral science, no AI, no personalization \u2014 let\u2019s just use our behavioral science messaging against a standard of care \u2014 and we outperform that. As you would know, behavioral science messaging does well compared to just flat health messaging. But the AI takes a little bit of time to learn, and I guess that curve gets pushed out a little bit if we\u2019re in a new space with less data.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">When Lirio gets engaged by a health plan, hospital, pharmacy \u2014 a big healthcare organization trying to reach consumers \u2014 are you generally regarded as messaging outreach that is online, text, phone, whatever? Or is there a change that has to happen when the doctor and the patient, or the person in the call center, are reaching the patient as well? Is this a bolt-on, or are you a fundamental change in how ABC Health System is trying to figure out how to deal with people?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Our aspiration is to be the latter. We really see ourselves as an intelligence capability, and part of what we\u2019re doing with the behavioral science is not just putting content into the product. When we implement, we go through a process we call behavioral discovery and design. Actually, you mentioned that I used to be part of Mad*Pow; it\u2019s very similar to the work we would do at Mad*Pow. We want to map the patient action paths, we want to understand what we\u2019re asking people to do, and offer feedback to help make that a smoother process for people. And then there are parts of our product that we can also use to support people, like a call center rep or a provider, but it depends on how the client wants to use us.<\/p>\n<p class=\"wp-block-paragraph\">We have some clients who say, \u201cWe want you to just take over our mammography outreach, because we\u2019re really struggling there.\u201d In that case, it does feel a little bit more like a bolt-on, perhaps. But we work with a national retail pharmacy chain, and we\u2019re doing all of their healthcare communications. In that case, it\u2019s really an integral part of how they interact with their pharmacy customers, and what we\u2019re seeing is that, because of that, the learning system is superpowered. Just from when we first went online with prescription refills, we were able to raise the percentage of people refilling their meds from their existing customer base by several raw percentage points. Out of the box, that\u2019s pretty incredible. And we\u2019ve had experience nudging their pharmacy patients about vaccines for years now. So that\u2019s really where the power of what we do gets unlocked, at that sort of full integration.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">So why don\u2019t we take a look at what this looks like in actual reality. I think you have a couple of examples of things that you\u2019ve been doing.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Absolutely. One of the things I\u2019ll emphasize is that we work really closely with our clients to make sure we\u2019re embedded in their existing patient experiences. We white label the product. Patients have not heard of Lirio. We want to leverage that trusted brand and create a consistent experience across their touchpoints. So what I\u2019m going to show you could look different depending on who we work with. This is the generic demo.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">I get it. Other people will look at this too, so I want to make sure they get it. Who is this health system we\u2019re discussing here?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">It\u2019s our ABC Health, or whatever it is.<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Okay, great.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">So this is precision nudging for mammography, which I mentioned. It\u2019s actually our OG precision nudging intervention, which we first launched in 2019. It\u2019s geared toward getting women who are overdue for their screening mammograms to come in and do that. What you see here on the left is what a patient would get, and this is an email. On the right is a visualization of the behavioral intelligence behind the scenes. It shows what barrier is being addressed and which behavior change technique we\u2019ve chosen to use to address it. The \u201cBCTTv1\u201d thing refers to the COM-B model and the Behaviour Change Wheel, which is the framework behind the scenes that we use to structure all of this.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Is that well known in behavior change, or is this a behavior change technique that you\u2019re adopting?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">It\u2019s well utilized. It\u2019s all made publicly available, and one of the reasons we like it is that it\u2019s just an organizing framework. It still leaves you a lot of space under the top level to do your art, but it creates this replicable, evidence-based approach.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yeah, it\u2019s good.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">So here\u2019s the email. It\u2019s personalized: you can see here, it\u2019s been over a year since your last screening. One thing you don\u2019t see in this particular image is that we can demographically tailor the images, which I know from all the way back in my health media days helps to engage people \u2014 seeing folks similar to yourself in the images. The call to action is really to book the mammogram. Like I mentioned, that\u2019s going to be the key piece of data that we train on: whether the person actually did that or not. We could also do this in SMS if that was indicated as better for this person, or if that was the only thing they had consented to. Or we could do something like an app push notification. What you see here is that across all three channels, the behavioral science methods remain consistent. We build our content in a way where we can flex to the form factor instead of changing the message entirely.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">So the message is slightly different, but all related, and basically the same technique.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Right, exactly. There are things you need to change about it. For example, we also do MyChart messaging, and even though that looks like an email, it doesn\u2019t have a subject line, so what they do instead is make the subject line the first part of the message. We structure the messages differently for different form factors. But I\u2019m going to say \u201cnot scheduled\u201d here, because I want you to see what happens: she\u2019ll get another nudge. Typically when we nudge somebody, the frequency is something we can use the AI to determine, or sometimes our clients will say, we want to message people once a week until they schedule. But if somebody doesn\u2019t respond, the next message they get will be different. It will be selected by the AI, knowing that whatever we sent last time wasn\u2019t the thing, or at least not the thing at that time. So here you see a different barrier being addressed, a different behavior change technique, and again it could be in any of these form factors. It could also be in different languages. We work across cultures and across languages; I just spent the last week in Europe doing some work over there.<\/p>\n<p class=\"wp-block-paragraph\">This time I\u2019m going to have her schedule. She\u2019d book the mammogram, and it would deep link her into a scheduling page, or potentially inside MyChart. Sometimes our clients use phone numbers here. We\u2019ll have her confirm this appointment, and she receives a commitment message. I\u2019m just going to happy-path this and have her say she\u2019ll be there, and then she attends. Basically her precision nudging for mammography journey has ended for now, and you can see a recap of what she \u2014 I say she, it\u2019s my name \u2014 received and completed.<\/p>\n<p class=\"wp-block-paragraph\">One of the things we actually measure: people often become eligible for precision nudging when they\u2019re overdue for something. Not always, but a lot of our clients have basically said, \u201cWe want you to work with the people who are not doing what they\u2019re supposed to do.\u201d If someone gets nudged by us and goes and has the mammogram, for example, and then they don\u2019t become eligible next year because they\u2019ve proactively scheduled and don\u2019t go overdue, that\u2019s a big win, even though they don\u2019t show up in our outreach anymore.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">I think that\u2019s great, and that seems fairly obvious, right? I get a lot of text messages. Most of the text messages I get are saying, \u201cPlease donate to some political campaign,\u201d because of the time of year we\u2019re in at the moment, coming up to the midterms. They\u2019re obviously trying lots of different things, trying, \u201cplease just give a dollar.\u201d It\u2019s a standardized behavioral change technique that\u2019s been around for a long time, but there\u2019s a lot going on behind the scenes here, right? Obviously you\u2019re changing the message based on this. For something that\u2019s relatively simple, like booking an appointment for something you should have once a year, what\u2019s the level of complexity going on, and how much did AI, and what we\u2019ve learned in the last few years, add to this?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">The level of complexity, I think of that, first of all, in terms of the logic model that my team is building. In general, for most of these behaviors, we\u2019re identifying 15 to 25 barriers that are broadly applicable. We\u2019re looking at the literature, we\u2019re doing some of our own research, but basically, if you look at a population of people, what\u2019s the majority of reasons why they might not be doing this? Then we build out message assets, at least one message asset per each one of those barriers. So you\u2019re looking at libraries that have potentially, I don\u2019t know, five, six, 700 combinations just from those base pieces.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Even for what is a relatively, quote-unquote, basic transactional thing, like, can I get you to sign up for a moment? There\u2019s a lot going on behind the scenes.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Well, maybe not transactional so much, because we do sometimes nudge things like enrolling in the patient portal. Those don\u2019t tend to have as many or as serious barriers as something like prostate cancer screening.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">But it\u2019s a one-time thing. And I know you have some other examples which are longer journeys.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Well, and again, because it\u2019s AI, it\u2019s a learning technology, and the more data that\u2019s available, the easier it is to learn. So we are best suited to behaviors that recur more often. That\u2019s kind of why our capabilities are best with that whole intelligence-layer implementation instead of a bolt-on. Even if each behavior only happens once a year \u2014 colonoscopies once every ten years, if you\u2019re lucky \u2014 if we\u2019re nudging you about a couple of different things, we can learn more about you anyway.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Okay, I see. So perhaps you can show me one that\u2019s a little bit different, where you\u2019re talking more about a patient journey.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yeah, for sure. I\u2019m going to show something we\u2019ve built for the life sciences space, so it\u2019s really focused on medication adherence. You\u2019ll see that it appears there\u2019s much more going on, but that\u2019s because the intelligence view on the right is built out in much greater detail, showing some of the system inputs.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Who am I, looking at this? I\u2019m probably somebody in a call center who\u2019s helping do adherence management or something like that.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Well, there\u2019s a piece of it where yes, you would be that person. This is for a fictional specialty pharmaceutical product, and as you know, these are incredibly expensive medications with high consequence to non-adherence, so these organizations do have telephone support representatives for their patients. Part of what we built here is something that they can look at when they\u2019re on the phone with the patient.<\/p>\n<p class=\"wp-block-paragraph\">I went through Maria\u2019s demo a little bit just so that I could populate this. What it\u2019s doing is recapping what Maria has actually done in the system. She\u2019s received her medication, she\u2019s done one refill, but she hasn\u2019t completed her labs, which is a risk for non-adherence. And it\u2019s creating a non-adherence risk score for her. It\u2019s using data that we were perhaps able to pull in, like her physician enrolled her in this program and provided information about her insurance and her health history. Then there\u2019s third-party data available that we could use around things like social determinants of health. We derive data all the time from things like her zip code: we can tell income level, and how far she is from the nearest pharmacy, and things like that. All of that goes into the non-adherence risk score. The engagement score is based on her interactions with the digital product.<\/p>\n<p class=\"wp-block-paragraph\">The phone rep could be looking at this and saying, \u201cHey, Maria\u2019s at really high non-adherence risk and she\u2019s only so-so engaging with digital. This is somebody who it\u2019s worth outreaching to by phone, or trying to get involved in something that\u2019s a little more high-touch.\u201d So it tells the life sciences company where they might want to invest the patient support money they have. And on the left, it has some feedback that the patient support rep could be using on the phone with the person. A self-efficacy phrase that resonates with Maria might be, \u201cIt takes effort some days.\u201d She\u2019s told us in her interactions with the system that this isn\u2019t easy, which we know, of course, but now we know that this language is going to resonate back with her. We want to make the intelligence our system is gathering human-readable for the people who are supporting the patients in the real world.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">So these data and these scorings \u2014 there\u2019s a combination of AI-based inference from data you\u2019ve got and data surrounding the person, and then some direct connections back and forth, some notes taken, kind of like a medical record, from the conversation. And what\u2019s the messaging look like? Can we go back to the message she received?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yeah, absolutely. Again, this is for life sciences, so you would be seeing this inside an authenticated experience, and we want to really limit the self-report here, because adverse event reporting is a concern in this area. Here it\u2019s letting her know she has to have a blood test in about two weeks, and it\u2019s asking her to let us know: did you schedule this or not yet? She can say \u201cnot yet.\u201d It also has celebratory sorts of things: your first month on Clarenza is almost done, that\u2019s a real milestone. And we give her the opportunity to ask to connect with the pharmacy if she wants, so she can schedule a callback. I\u2019m not going to click that, because it works.<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\">Down here, this is just for operating-the-demo purposes, to say whether she received the refill or not. In the real world, we\u2019d be receiving this data from a database that we connect to. As much as possible, we want to be getting that sort of objective, real-world data. There are cases where we do ask people to self-report, because how motivated are you feeling is not something you can really get from anything except self-report. Here it\u2019s asking an adherence question: how many days out of the last seven were you able to take it as prescribed? I\u2019m going to have her say \u201cmost days.\u201d It gives her a little bit of feedback, but now this is something the phone rep can use as well, to say, \u201cHey, I\u2019ve noticed you said you\u2019re not doing this every single day. Can we work on that? Can we talk about that?\u201d<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">So in general, you\u2019re essentially combining vast amounts of data from different places: some inference, some direct, some self-reported, some from, did a refill get issued, that kind of stuff. And obviously there have been a lot of complications about getting this data right, but there\u2019s much more of this data around now than there ever was before. Then you\u2019re essentially giving informational support to a phone rep or somebody who\u2019s working directly with the patient, and obviously motivational support to the patient.<\/p>\n<p class=\"wp-block-paragraph\">What\u2019s the most important part of this? What moves the needle on patient behavior the most? We hear that some people like human contact, some people prefer getting texts or messages. If you\u2019ve got something that\u2019s complex \u2014 we hear these terrible numbers that 50% of people on chemotherapy don\u2019t finish their courses, even though it doesn\u2019t work if they don\u2019t, and it costs the pharma company a fortune in lost revenue \u2014 what is working here? What\u2019s moving the needle?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">I think part of it is actually addressing the barriers that people experience in a direct way. You don\u2019t see that a lot in healthcare communications. When you do see healthcare communications that try to address barriers, they don\u2019t select what might be most applicable to an individual. I have some provider organizations that I\u2019ve received care at, and I get these emails from them that are literally two, three pages long. I have a high need for information and I\u2019m willing to process things, and even I\u2019m like, ugh, I can\u2019t do it. Your average person is not going to read through all of that. But we\u2019re sending very short messages that directly address something we believe is relevant to that person, and I do think that makes a difference, that it doesn\u2019t feel generic.<\/p>\n<p class=\"wp-block-paragraph\">We do a lot of user testing, and we consistently hear that people feel like, \u201cThis cares about me. This seems to think about me as a person.\u201d So it\u2019s giving them something a little different from what they\u2019re used to getting from healthcare organizations. I think that cuts through the noise and helps it stand out. And I do think that\u2019s probably one of the most important things, because if you don\u2019t get people\u2019s attention, it doesn\u2019t really matter what else you put into the message. It\u2019s not going to do anything.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">For a program like that, where you\u2019re going to an ABC pharma company and helping them with a high-cost drug that obviously has to be taken to work, what are the kind of numbers you\u2019re seeing? Where were they, and where do they end up after the program?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Well, we just submitted a paper about one program that we\u2019re doing with a health system. They were sending out an email to people around their birthdays that was, welcome to your new year, here\u2019s the preventive healthcare you\u2019re going to need in the next year. We took that on starting January 1st and added our personalization and behavioral science to what they were doing, and only nine months in, we are at 2.5 times the number of preventive care appointments and screenings that people have had compared to last year. So it\u2019s our nine months over their twelve months, and it\u2019s 2.5x.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Has this gone from 30% to 70%, or has it gone from three to six?<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">More like the former. Part of it, too, is that these are not necessarily people who weren\u2019t getting the preventive care, because the way we\u2019re measuring it is that we have to have sent them the message, and then they have to have scheduled within a time window. I think we looked at 30 days after the message. So we\u2019re not looking at the full year, like, did they ever come in and get their thing. But it wasn\u2019t a super sad-sack case. With vaccinations, we\u2019re not going from zero to two.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">No, this is more like 30 to 60 type of deal. So what you\u2019re saying is that this behavioral science-based approach, plus AI, plus what you guys are doing, is not only moving the needle but moving it on a large swath of people, which is the point, right?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yeah. And the one I\u2019m really excited about \u2014 I keep coming back to vaccinations and our pharmacy partner, because we\u2019ve been working with them now for four years \u2014 when you look at the year-over-year, that\u2019s where you really see the effect. We\u2019re nudging all their vaccines, and every year up until this year, we\u2019ve done a treatment versus control, where we use their old standard messaging on a subset of the patients and measure. In the fall season \u2014 flu, COVID, vaccination season \u2014 we doubled their control messaging. Then starting January 1st, we released everybody back into Lirio messaging, and we were able to convert 30% of those folks who hadn\u2019t gotten vaccinated yet in an average of 1.1 messages. The year following, I think it was 40% of the people who got vaccinated did so within the first two messages we sent. Our personalization is getting really, really good, because we\u2019re just so knowledgeable about the population.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">I\u2019m not sure if Walgreens has managed to convince me to get the RSV vaccine yet.<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\">But it works on the COVID and the flu shot. So I think you have one more demo to show me, which is around a wider preventive journey.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yeah, I can quickly show you this as well. This showcases some of our conversational AI capabilities, which you haven\u2019t seen in the others as much. Conversational AI is increasingly the way people interact with these tools, and it\u2019s something we have in our toolset. When I say conversational AI, that\u2019s both chatbot and voice. We\u2019re doing all the automated voice communications as well for our pharmacy partner \u2014 I can\u2019t say who they are, but if you ever call them, hopefully \u2014 I\u2019m sure there\u2019s a pharmacy chain in America somewhere that people have heard of; this is the one.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yes. It could be one that\u2019s down the street from you. If you see one with really good communications, that\u2019s the one.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">If you like the communications, it\u2019s the one that we designed. Great. This one\u2019s designed for the health insurance space. Health insurance companies don\u2019t always know a lot about their members. They want to keep people healthy, and they compete every year, since people usually re-enroll in their insurance plans, so health insurance companies want to differentiate themselves in terms of offering good service and being the one that people choose. This is an onboarding experience we\u2019ve built to help with that.<\/p>\n<p class=\"wp-block-paragraph\">I\u2019m going to start here with Sarah, who is a brand-new member. Again, on the right, you\u2019re going to see the visualization of the intelligence behind the scenes, and the left is the patient experience. Sarah is getting a text message from her brand-new health plan, letting her know she has something called the Health Empowerment Index available to her. We\u2019ve built this to be bite-sized interactions with the system that give us some information that allows for future personalization and for recommending preventive care activities, which, of course, people like. It\u2019s a value that your health plan can add for you. The health plan likes it because if people can stay healthier, they\u2019re lower-cost members over time. If Sarah were to click on this, it\u2019s an email letting her know about this new experience. If she gets started, it will populate her in here. It\u2019s a very short, conversational experience, I think three questions. It\u2019s using some behavioral science and asking her to self-report some things that we would not otherwise know about her, which will then let her health plan communicate with her in a more personalized and meaningful way.<\/p>\n<p class=\"wp-block-paragraph\">It starts with stages of change: what feels most true about your health right now? She\u2019s going to say that she\u2019s working on some changes right now. Over here, her behavioral profile is starting to populate based on what she says. And then in terms of the insights, I like this bit: she\u2019s already motivated, so we don\u2019t need to educate her about why change is important or try to put a carrot in front of her. We just need to help her do what she\u2019s already decided to do. So those are the implications for further messaging. She gets a little congrats for that, so we can point her toward the right resources, and she gets a few suggestions: members like you ask. One thing I mentioned before is that we receive data from our clients, and part of what we can use that for is to see who people are like, sort of like Amazon does.<\/p>\n<p class=\"wp-block-paragraph\">Here she\u2019s going to say, \u201cI want to lose weight.\u201d She\u2019s going to type in something different, and it will ask her, hey, that\u2019s great, but there are two different pillars of lifestyle medicine that connect to that. Do you want to work on eating better or moving more? I\u2019ll have her start with eating better. Behind the scenes, there\u2019s a database we\u2019ve built of the different benefits the health plan offers, and it\u2019s going to curate suggestions for her. It will only offer two choices. Behind the scenes, I think there are seven or eight per pillar of lifestyle medicine, and they vary in terms of intensity, the commitment level required, whether they\u2019re virtual or in person, all that good stuff. Here she\u2019s offered either MyFitnessPal or a telehealth visit. She can select one of those, and it\u2019s going to urge her to sign up for the app, which, let\u2019s pretend she did that. Then it will drop her into this Health Empowerment Index experience.<\/p>\n<p class=\"wp-block-paragraph\">The intention is that the health plan can use this to reach out over time. Most health plans don\u2019t really have a good, meaningful reason to reach out to their members and interact with them beyond an explanation of benefits or, you know, we\u2019re denying your care. So this is something that\u2019s hopefully a little more upbeat than that, and lets people reach out and have a productive conversation. If for some reason Sarah wanted to self-report her way through the other pillars of lifestyle medicine, she could do that here. We\u2019re not going to hold somebody back if they want more recommendations, and she can also see all of the different activities available to her. So again, it\u2019s a way to collect some of that behavioral information that might not otherwise be available, connect people with preventive care resources, and hopefully get them healthier and differentiate the health plan from their competition.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">In this case, are you actually taking over almost all of the health plan communications? How much of the website and the app are you in, in these cases?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">We don\u2019t typically run the website or the app ourselves. This usually comes from working with the client to advise on changes they\u2019re making to those properties. We can also use our intelligence layer inside of those types of assets, but typically they would own the presentation layer of that, and of course they\u2019re also the ones offering the engagement endpoints. We\u2019re not doing, like, the MyFitnessPal app; they need to have that available. I sometimes say Lirio\u2019s like connective tissue. Those pieces need to be there, but if they\u2019re there, we can do all the amazing routing in between and get people to the right destination.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">There are obviously a number of companies doing patient engagement websites in general for those companies, and obviously a ton of apps they\u2019re buying. I was chatting with a friend the other day about what Cigna was currently offering me, which I\u2019ve now remembered: I think seven, eight, or nine different mental health companies, and six or seven different substance use disorder companies. That\u2019s presumably very personalized to me, I would assume, because that\u2019s what they think I need.<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\">But there\u2019s a lot going on there, and it\u2019s tended to be a very messy experience for people, because they\u2019ve Frankensteined these websites and applications over the years. Helping just get people to the right place and pointing people around is probably a very valuable service, for you to be the connective tissue doing that.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yeah. Just in talking with some health plans, they\u2019ll talk in terms of offers: \u201cWe have these offers for our members,\u201d and they\u2019ll say we have 150 offers for any given member, and it\u2019s almost like internal politics which three or four get highlighted on each person\u2019s dashboard. There\u2019s a better way. I understand that every part of the business wants their initiative highlighted, and we all think all these things are important, but at the same time, it\u2019s about the patient or member, and what they need, and what they\u2019re going to do. We\u2019ll be more effective as a system if we\u2019re getting people to that point.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">What you\u2019re saying is that companies like Lirio, and the science you represent, are over time helping figure out the mess of applications, data, and stuff that has been launched at health plans, providers, and everyone else in the business system: how do you sort through the mess and make it more impactful, and get us higher up the scale of helping people? Are there particular types of people for whom it\u2019s easier? We talked about the persona of the woman out for drinks with her besties in the video \u2014 this is the early part of the night, before it gets to the substance use disorder later \u2014 but you also mentioned Black populations in the South dealing with hypertension. We\u2019ve heard a lot about selection bias in the early days of a lot of these tools. We had a lot about that at Health 2.0: that\u2019s great, you\u2019ve convinced the person who was already the triathlete, eating well, to go on your program, but the person who was pre-diabetic, sitting around watching video games, eating chips, you couldn\u2019t reach. Is there a population that\u2019s harder to reach, easier to reach? And are there things we can do for those harder-to-reach populations, who are the ones at risk of getting the chronic disease or who already have it?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Well, by accident, we sort of specialize in the harder to reach, because we\u2019re a newer company, and a lot of our early clients were like, we\u2019ll give you a try, but we\u2019re going to give you this population.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">This horrible thing to do.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Yes. One of our very early case studies was a population of about 6,000 people with diabetes who had not been seen by the health system in three years. These were value-based contracts, so big deal. We got 60% of them, over 18 months, to come in for at least one provider visit. We do breakdowns of the populations that we nudge around things like what type of insurance they have, and some of our populations are 80% Medicare and Medicaid: older, lower income, higher disability. We look at similar things in terms of race and education level, and pretty consistently, the populations that we\u2019re messaging in these sorts of scenarios are the more disadvantaged ones.<\/p>\n<p class=\"wp-block-paragraph\">We do better when we can message an entire population that includes your triathletes and your A students, who are going to do it anyway. But we do really well with those populations who struggle, and again, I think a lot of it is that we\u2019re approaching them differently. We\u2019re really trying to put empathy in the middle of the way we communicate. We\u2019re trying to be personal. We\u2019re really trying to say, hey, we know this is hard for you. We\u2019re not assuming that you should just do this thing; you have a real reason why you haven\u2019t taken action, and we want to help you with that reason.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">It strikes me that what you\u2019re trying to do is something we\u2019ve failed miserably at in healthcare. My favorite one-liner in healthcare ever was from an expert workshop I ran in the 1990s, when I was at the Institute for the Future. A guy called John Mattison, one of the smartest guys I ever met, who was the CMIO of Kaiser Southern California for years, said: the problem with healthcare is that we know what to do. We don\u2019t know how to do it.<\/p>\n<p class=\"wp-block-paragraph\">When I think about the examples you mentioned \u2014 hypertension, hard-to-reach Medicaid populations and so on \u2014 I love the example of a guy called Bob Matthews, who talks about the medical group he\u2019s associated with, which is PriMed Physicians in Dayton, Ohio. Whenever I talk about this, I say to my audience: this is a medical group in a city you\u2019ve never heard of, in a state you\u2019ve never been to. I\u2019m always talking to the Silicon Valley or New York crowd or whatever. They\u2019ve got hypertension control rates in their Black population \u2014 majority-Black population clinics in Dayton, Ohio \u2014 above 90, control at over 95%. They\u2019ve done it. They\u2019ve figured out how to do it. Can we replicate that in the rest of the country? Apparently not.<\/p>\n<p class=\"wp-block-paragraph\">So what you\u2019re doing is sort of taking that and promoting it at scale, saying we\u2019ve got all these organizations that have got access to people, whether it\u2019s the pharmacy or the health plan or whatever, who\u2019ve really not used it for good. There are a couple of health plans I could introduce you to that still need to figure out how they\u2019re communicating with their population.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Listen, I am currently covered by one of them.<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\">There\u2019s a lot of, can we get the average up a little bit. But there is great stuff going on out there. We have these amazing programs and amazing organizations that have figured it out, and we somehow haven\u2019t used the ability to scale that.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">I think that\u2019s clearly where you are. So let\u2019s end with hearing a bit more about Lirio, the company. How big are you? You raised some money a while back. How long have you been around? Give me a sense of the state of play: how many people are there, how many clients are you working with, where is Lirio?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">We call ourselves about a seven-year-old organization. If you look on Crunchbase or something, you\u2019ll see Lirio extending back further, but we dedicated ourselves to healthcare, and most of the current leadership team started five to seven years ago. That\u2019s the modern Lirio. We\u2019re about 80 people full-time, and we also work with contractors and extended teams, especially as we do more international business. For example, I will always have at least one behavioral science contractor who\u2019s on the ground in the client location, who works directly with my team to make sure we\u2019re acculturating. But 80 full-time folks, based in Tennessee, with a hybrid workforce. I live in Boston, a lot of folks live remotely, and we travel and see each other either in the office or on client sites.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Give me a sense of how many clients and what the structure is. You mentioned pharma companies, pharmacies, hospitals, and health plans. Is it spread across the board?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Health systems were our first clients, so I think we still have the most clients in that category, and they\u2019re our longest-tenured clients as well, since we\u2019re still working with some of our very first clients. But it\u2019s increasingly becoming the life sciences companies and health plans, and then also international. We\u2019re working in Japan, we\u2019re working in Costa Rica, and I just got back from the UK, where we\u2019re doing some work. Those organizations maybe don\u2019t fit as neatly into the US categories, but they\u2019re becoming a bigger part of our business.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">And then finally, we\u2019ve mentioned AI a lot, but we haven\u2019t mentioned the big AI companies, who seem to be very much in the behavior change space in some ways. People are using ChatGPT as a therapist, people are getting Claude to design their life for them. It\u2019s certainly happening in my household: my daughter\u2019s running both her school projects and, when she wants to fix something in the garden, she runs it through these things. What is the role of behavior change from healthcare organizations using someone like Lirio to message, when you\u2019ve got these brand-new but heavily used consumer tools, which are all kinds of other influencing and informational supply, and now the Google search has become the Gemini answer? As a behavioral scientist, what do you think is going on there, and how are these two things potentially being integrated?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Well, we can work on directly integrating them. When we do conversational AI, for example, we don\u2019t have an LLM at Lirio. We sometimes call our intelligence a large behavior model, but we can integrate with the sorts of things our clients are using. But I think the question you\u2019re asking is really: when you have a patient who\u2019s using these tools, what is the role of the healthcare organization? I think there still is one. We are consistently finding in our research with patients that \u2014 maybe not so much the organization, especially in the US; we\u2019re seeing things like trust in the CDC really fall. We used to be able to say, \u201cThe CDC recommends,\u201d and we\u2019ve moved completely away from that in the last two years. But people do still trust their doctors, they still trust their pharmacists, and I think they\u2019re probably trying to cross-reference what they\u2019re learning from a Claude or a ChatGPT with what they\u2019re hearing from these individuals, or the organizations that employ them.<\/p>\n<p class=\"wp-block-paragraph\">So there\u2019s something about us making the personal outreach and saying, \u201cHey, that thing you\u2019re talking to Claude about is relevant to you when it comes to your pharmacy, and we\u2019re here to provide that service.\u201d It\u2019s that final mile of what you\u2019re talking to the AI about: we\u2019re here to do that.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Do you think, as scientists, that the direct connection to the big LLMs is helpful in general, or is it more misleading?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">When I say we\u2019re doing that, I\u2019m talking about, for example, if we\u2019re working with a client that has a chatbot that\u2019s powered by ChatGPT, we can be behind the scenes in that instance, basically providing structure to the responses that happen. I hope it\u2019s helpful. We\u2019re doing it because we think it\u2019s helpful. In that case, that chatbot, although it\u2019s using the general LLM, is designed for a specific purpose that is aligned with what we do, so it\u2019s trying to get people to take some sort of action. This is something we\u2019re doing in Costa Rica, where their health insurance system is extremely different from ours. We\u2019re trying to get people connected with the right wellness benefits for them in the system they\u2019re in, and the chatbot is designed to understand what they care about in terms of their health, what their health status is, and based on that, where they\u2019re going to get the most value for their money and the best care. The guardrails keep it to that sort of conversation. The person isn\u2019t going to be able to ask about, \u201cI feel like I\u2019m having a heart attack.\u201d And I think that helps, too.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">And then finally, going back to where I started: we\u2019ve been really bad at doing behavior change in healthcare, we have all these not-great outcomes, and we haven\u2019t moved the needle on much of this stuff. How optimistic are you? Take off your Lirio hat for a second and put on your behavioral scientist hat. How optimistic are you that things are going to get better in terms of the big issues, chronic disease, lifestyle choices, diet, exercise, all that stuff? You look at America and go, it can\u2019t be fixed in many different aspects. In that one, do you think this is fixable using the new tools and the clinics we have?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">I think the right ingredients are there. I think the system we\u2019re in right now doesn\u2019t have the right incentives in place for things to get better. I think we need to see some major structural change. I don\u2019t know how into politics I want to get, but I am really optimistic about things like GLP-1s. We haven\u2019t even seen the long-term health effects of those, but from the early results, it seems like they might contribute to longevity \u2014 healthier, not just living longer, but living longer at quality. That\u2019s incredible. But right now, the economics of GLP-1s isn\u2019t there for most people, and there\u2019s a lot that would have to change in the system for that to change. So I\u2019m optimistic that if we can kind of blow things up and rebuild, we could do better. But can we blow things up and rebuild? I don\u2019t know.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">You\u2019re joining me on the barricade. Knock it all down and have concierge care for all. That\u2019s my spiel. That\u2019s a separate podcast I\u2019m about to launch, which is not so much about companies, more about techniques in primary care. I think you know a lot, and there\u2019s some interesting stuff being uncovered in some of the interviews I\u2019ve been having: for instance, people now with AI managing patient populations, the doctor with the AI raising issues, the doctor coming in and having a three-way conversation between the patient, the AI, and the doctor. There are some interesting ways we can think about doing this. But yes, in general, we need to blow up how we do healthcare delivery, and by the way, blow up how we do food and a bunch of other stuff, which probably won\u2019t happen, because things are difficult to change. But there we go.<\/p>\n<p class=\"wp-block-paragraph\"><em>[laughter]<\/em><\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">You never know. Sometimes things do change. That\u2019s why we all do what we do, too. We\u2019re trying to change stuff, and hopefully our little work on the margins will have a bigger effect.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Which is why I\u2019ve been asking you about this great stuff. All right, I\u2019ve been talking with Amy Bucher. She is the Chief Behavioral Officer \u2014 did I get your title right?<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">That\u2019s correct. Chief Behavioral Officer of Lirio.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Matthew Holt, THCB<\/strong><\/p>\n<p class=\"wp-block-paragraph\">A company which is doing a lot of interesting work, as you\u2019ve seen, in the behavior change space for healthcare organizations. Amy, thank you very much for your time.<\/p>\n<p class=\"wp-block-paragraph\"><strong>Amy Bucher, Chief Behavioral Officer, Lirio<\/strong><\/p>\n<p class=\"wp-block-paragraph\">Thanks, Matthew. Nice talking to you.<\/p>","protected":false},"excerpt":{"rendered":"<p>Lirio Health is an interesting under-the-radar company, which works with plans, providers and others to try to influence the behavior of their members and patients. Of course, everybody wants to change the behavior of human beings, and it\u2019s been proven over the years to be very hard. Lirio probably has more PhDs per square foot&#8230;<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-16625","post","type-post","status-publish","format-standard","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16625"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=16625"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/16625\/revisions"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=16625"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=16625"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=16625"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}