2020
Portrait of Dr. Stacy Tessler Lindau, AM '02 and Rachel Kohler, '89
Photography by Lucy Hewett

Prescribing and Personalizing Whole-Person Care at NowPow

A cross-campus collaboration rooted in UChicago research has given rise to a thriving woman-led tech startup and a new vision for reimagining health care in the US.

BY ALINA DIZIK

When Dr. Stacy Tessler Lindau, AM ’02, a professor, gynecologist, and director of a research lab in the Biological Sciences Division at the University of Chicago, was working in 2014 to commercialize a tool that connects patients to community resources, her advisors had one question: Who will be the CEO?

Recognizing she lacked CEO experience, and shouldering a host of other commitments, Lindau needed her first hire to be the chief executive. And the job needed to be filled quickly. Two years earlier, in 2012, Lindau’s lab had received a $5.9 million award from the Center for Medicare and Medicaid Innovation to roll out a technology linking patients to community services. The clock was ticking. It was a three-year award, and Lindau only had a year before the end of the study. Lindau and her advisors knew she needed to bring a CEO on board to build the business that would come to be called NowPow.

“They kept saying the guy is out there; you just have to find the guy,” she recalled. “‘The guy’ turned out to be Rachel.”

For the NowPow CEO role, Lindau tapped Rachel Kohler, ’89, a longtime executive and director at her family’s kitchen and bath manufacturer, Kohler Co.; principal of her own social impact investing firm, KoHop Ventures; and a UChicago trustee.

“In addition to her business expertise, Rachel was passionate about scalable solutions with high potential for near-term, positive impact on people’s lives, and she shared my strong sense of urgency and love for Chicago’s South Side,” Lindau said.

On a chilly day this past December, Lindau recalled NowPow’s startup story to date, sitting in the company’s offices tucked into the Del Prado overlooking Lake Michigan. The historic Hyde Park building is a stone’s throw from UChicago’s main campus. Nearby, Kohler is poring over investor slides in her cozy office.

Despite pressure to keep the momentum going, Lindau and Kohler carefully and deliberately considered the idea of working together. “We took the process seriously, vetting each other through our own networks and aligning on what each of us expected from the partnership,” Lindau said.

Six years later, the duo has grown NowPow into a 90-person startup supporting about 24,000 care professionals serving more than 7.4 million patients. Described as a personalized community referral platform to support whole-person care, NowPow makes it easy for care professionals (at health systems, health plans, and other non–health care agencies) to connect people to highly matched and highly qualified community resources that empower them to stay well, meet basic needs, manage illness, and care for others. (See “How NowPow Works,” below.)

Kohler is co-owner and serves as the company’s CEO, while Lindau, who still practices medicine, is the startup’s founder, co-owner, and chief innovation officer.

The two are laser focused on executing their shared vision: creating a personalized community referral platform that powers whole-person care for everyone across all of life’s ages and stages.

How NowPow Works

Identifying potential users: Referral senders, which can include health systems, health plans, and other non–health care agencies, can use NowPow’s platform to identify patients’ needs, taking into consideration screenings, condition codes, risk factors, and more. They can then use the platform to check for eligibility, match referral recipients with community resources that can best meet their identified needs, and connect them with those resources.

Finding a match: People who visit a doctor or end up in the hospital leave with a list of referrals made on the basis of individual characteristics such as needs, language(s) spoken, and proximity to their home. Referrals can cover not just someone’s own health or social needs; they can also help a person manage the needs of loved ones, for instance a relative struggling with substance abuse.

Shared resources: The personalized list of referrals is given to users via email, print, or text message. Users also get text-message reminders or “nudges” about their referrals to encourage compliance.

Tracking results: NowPow then acts as an intermediary between health care organizations and community organizations and tracks the outcomes of those referrals, especially for populations with the highest risk. Their personalized community referral platform integrates with major hospital and doctor electronic record systems.

 

A Prescription for Wellness

Most of us know that living a long, healthy life depends on a host of factors. For instance, access to nutritious food, counseling support, and social resources can all influence longevity and quality of life. “Doctor visits and medication only determine about 20 percent of life expectancy—the rest depends on the care received beyond the four walls,” said Kohler.

Portrait of Rachel Kohler, '89 Rachel Kohler

NowPow focuses on the other 80 percent, and in doing so, is reimagining what health care visits can offer.

This premise that health outcomes are inextricably linked to social, environmental, and behavioral conditions outside the health care system is not new. In the United States, there has been rapid growth of interventions to minimize dependence on costly hospital-based care and increase access to social and health-related resources in the community. But most of these interventions to date have tended to focus on disease-specific populations or rely on costly ancillary staff, such as case managers and community health workers.

Efficient and scalable strategies are urgently needed to address unmet social and health-related needs. That’s why NowPow is working to create a modern digital infrastructure that can easily link people to community-based organizations equipped to support those unmet needs, the pair said.

NowPow’s personalized community referrals come in the form of what the company calls a HealtheRx. Care professionals can prescribe these referrals to patients in much the same way a doctor would prescribe medications. The referrals can be tracked to close the loop with partnering community-based organizations.

For example, when someone with diabetes visits a health care provider, that patient may also have issues paying for food and rent—factors that heavily influence the person’s ability to manage the condition. Using NowPow, the health care provider can offer not just a prescription for medication, but also a personalized referral for a food pantry near the patient’s home and another referral to a nonprofit that provides access to an optometrist, podiatrist, or nutritionist at low or no cost.

The referrals are tailored to a patient’s unique characteristics and needs. They can assist anyone, from those who are healthy and want to prevent disease, to those with chronic or behavioral health conditions, to caregivers for dementia patients and parents caring for children with disabilities, and many more. “My interest has always been in caring for whole people rather than just treating a disease,” said Lindau.

At the core of the startup lies the pair’s belief that “knowledge is power,” a conviction so deeply held that they named the company NowPow as a play on the expression. Ultimately, through the NowPow platform, Lindau and Kohler hope to inspire a revolution in how patients are treated, by giving both providers and patients crucial knowledge and easy-to-find, easy-to-access resources that go far beyond the doctor’s office.

“Health doesn’t happen in the doctor’s office,” said Lindau. “Health happens in the community and at home. If we don’t acknowledge and act on that, we are never going to move from a sick-care system to a health care system.”

The NowPow platform supports organizations across a wide variety of sectors such as health care, child welfare, housing, and schools and universities, which use NowPow to not only share resources, but also track referrals or coordinate care.

For example, NowPow helps large health systems monitor their most vulnerable populations, by tracking whether they have acted on referrals. In this way, NowPow is filling health systems’ critical need to figure out whether their patients are actually accessing the resources.

NowPow uses text messaging and “nudges” to prompt engagement and better adherence to referrals, added Kohler.

There’s so much more we can do by optimizing the resources we already have in health care and in our communities to achieve impact.

Stacy Tessler Lindau

NowPow’s clients also use data from tracked referrals to assess the supply and demand of resources across a community. This helps determine which community resources are equipped to meet needs, and also where gaps and weaknesses exist. That information can in turn drive evidence-based investments and policy decisions. 

The startup has expanded quickly. It already ranks as one of the nation’s largest multidirectional community-resource-referral platforms. It currently operates in 14 states, with more than 60 customers comprising health systems, health plans, and other non–health care agencies. In 2019 alone, NowPow’s technology made more than 750,000 referrals.

Research-Backed Rationale

NowPow is rooted in years of Lindau’s research. The three-year study in 2012 that was funded by the Center for Medicare and Medicaid Innovation’s Health Care Innovation Award resulted in a digital referral platform called CommunityRx, which became the proof of concept for NowPow. The study offered to Medicare and Medicaid patients tailored lists of community-based resources and generated more than 250,000 personalized, community-based referrals for more than 113,000 patients of all ages.

Patients who received the CommunityRx intervention tended to be less likely to use high-cost health care, an evaluation by an independent assessor found. Three years after the intervention started, primary-care use was higher and hospital admissions were lower for Medicare patients, and emergency department admissions were also lower among Medicaid patients, compared with those who did not have the CommunityRx referrals.

Two other studies, both published by Lindau and colleagues in peer-reviewed journals, showed that nearly half of patients who received a referral prescription spread the word about it to others. And adding bidirectional text-messaging capabilities increased engagement 70-fold, encouraging patients to act on the referral they received.

Since Lindau’s original research began, systematically connecting patients to community-based resources has become a cornerstone of modern health care. And even though several other new startups have joined this space, NowPow stands apart for its personalization, referral quality, and ability to address a full spectrum of needs, such as lack of exercise, food insecurity, a new cancer diagnosis, trouble paying bills, and even loneliness.

Today, NowPow is building upon lessons learned from the CommunityRx studies and examining how its technology can reduce health care spending by supporting people’s self-management of illness and caregiving efforts.

Children’s Minnesota, a pediatric health system based in Minneapolis, recently rolled out NowPow’s offerings to track referrals across two hospital locations. One of the offerings uses NowPow’s platform at their Family Resource Center to address food insecurity among patients and families. Children’s Minnesota uses NowPow to refer patients and families to the hospital’s internal food pantry and tracks the entire referral process. Since rolling out the NowPow pilot, the program has seen the percentage of patients who follow through with obtaining internal food procurement resources rise from 20 percent to 83 percent.

Closer to NowPow’s home base, Advocate Aurora Health, one of the largest health care providers in the Midwest, started using NowPow to prescribe resources throughout Chicago in 2018. “NowPow is an excellent example of how tapping into technology and using nontraditional approaches can accelerate our population health impact,” said Dr. Alvia Siddiqi, vice president of population health at Advocate Aurora Health, in the health system’s 2019 Value Report. She added, “We expect to see reductions in emergency room visits, avoidable readmissions, and total cost of care, while improving the overall health across populations.”

NowPow’s quality of referrals and its execution of its mission continue to win over executives such as Siddiqi. In the past, referrals for affordable or free services such as smoking cessation classes or food pantries were often spread by word of mouth, and the resources potentially hadn’t been vetted for quality or proximity to the patient.

“In the past, it’s been done very inefficiently on a sticky note or on the back of a business card,” Kohler said. “It’s wasteful and stressful to do this work manually.”

Booth-Led Startups Transforming Healthtech

As the entrepreneurship ecosystem at UChicago grows, several alumni in addition to Kohler and Lindau have founded health-focused tech startups that aim to address some of the industry’s most pressing problems.

CareMerge: The startup provides technology to senior-living communities including solutions for resident engagement, family communications, and voice-integrated tech. Founder Asif Khan, ’03, now serves as chairman.

Janus Choice: The artificial intelligence–enabled platform matches patients with the best postacute care providers to reduce hospital readmission rates and lengths of stay. Founder Alexandra Goodwin, ’15, founded the company while a student at Booth.

Physiq: The startup applies AI to wearable sensor data in order to detect personal changes in physiology. The company is growing. In 2017 founder Gary Conkright, ’82, closed a Series B round for $8 million.

ExplORer Surgical: The interactive operating-room software guides the activities of medical staff during surgical procedures. Jennifer Fried, ’15, won second place in the Edward L. Kaplan, ’71, New Venture Challenge (NVC) in 2015 and closed a $5 million Series B round in 2019.

AgileMD: The digital health startup is reinventing how physicians interact with clinical data and tools at the bedside. Cofounded by Borna Safabakhsh, ’11, the startup won the NVC in 2011.

Building a Partnership

Even as Kohler and Lindau move forward with the business, they often remind each other about how their partnership started. They first met in summer 2014, when Kohler decided to attend a seminar at UChicago presented by Lindau about the ethics of sustainability. Lindau noticed her curiosity. “She was the most engaged student; there were clearly light bulbs going off,” Lindau recalled.

After partnering up to bring NowPow to market, Lindau encouraged Kohler to take a desk at the UChicago Polsky Center for Entrepreneurship and Innovation. Kohler agreed. For the startup’s first two years, they operated from a few desks at the Polsky Exchange coworking space on 53rd Street as part of the inaugural class at the Polsky Incubator, a program designed to grow early-stage companies. During that time, the idea went from the research lab to tech startup, with the help of the Polsky Center’s mentorship and networking opportunities.

“We were able to augment a truly one-of-a-kind idea emerging from one of our lead faculty and create new value,” said E. J. Reedy, senior director of the Polsky Exchange.

As a practicing physician and a researcher, Lindau had long focused her work on engineering solutions to injustices in health care with the communities she serves. Being part of the incubator gave her a clearer path to scale the business. “I never thought of myself as an entrepreneur,” she said.

For Kohler—who signed on formally as CEO after working with Lindau for six months—the time at Polsky provided “a safe space to ask what might seem like basic questions” for a first-time entrepreneur. “In the important early days they make the startup world less scary and prevent costly mistakes,” Kohler said.

Portrait of Dr. Stacy Tessler Lindau, AM '02 Dr. Stacy Tessler Lindau

While navigating the early days of their entrepreneurial venture, Lindau and Kohler discovered many similarities that helped cement their partnership. They may have been new to the tech startup space, but both women spent decades in successful careers prior to NowPow. Lindau majored in political science at the University of Michigan, went to Brown University for medical school, and came to Chicago for a residency at Northwestern. She arrived at UChicago for the Robert Wood Johnson Foundation Clinical Scholars Program and to earn her masters at the Harris School of Public Policy, and never left. “The path to NowPow for me was never planned. It evolved from caring for patients as best I can,” said Lindau, who later joined the faculty at UChicago Medicine and is now a tenured professor.

After majoring in politics at Princeton, Kohler went off to Wall Street. “I’ve always done hard and lonely things,” she recalled. “I worked in junk bonds during the heyday in the 1980s, an area with few women.” After getting her MBA from Booth, she worked in operation restructuring at Booz Allen Hamilton, a management consulting firm. Later, she headed the luxury home furnishings brands portfolio at her family business, Kohler Co., known for its plumbing fixtures. She remains a member of the Kohler Co. board of directors and the Kohler Foundation. Outside her corporate life, she developed an interest in social impact issues, youth employment, and musical education for underserved populations.

The similarities extend to their personal lives. Both are married (Kohler to fellow Booth graduate and Hyatt Hotels CEO Mark Hoplamazian, ’89; Lindau to attorney Peter D. Lindau) and they each have three children. And both women have spent much of their careers surrounded by male peers, something that feels a world away from their lives as part of a women-led tech startup. “One of the bonuses of working together is that we are at a similar life stage and we both worked vigorously throughout our motherhoods,” Lindau said. “And now it’s helpful having a glimpse into another woman’s working-mother life. It normalizes some of what I’ve experienced.”

Data-Driven Growth

As the number of company employees climbs closer to triple digits, NowPow continues to focus heavily on data. In particular, one current goal is to refine and further personalize how to track outcomes for various interventions and evaluate referrals on a large scale—an example of the power of the data-driven approach that Kohler learned at Booth.

For instance, NowPow considers where patients live, what their language preferences are, and what transportation barriers they face, and then layers on top of that the health conditions a person might have (for example, cancer or diabetes) to understand each patient user and make highly personalized, highly matched referrals. The company uses an additional 50 proprietary algorithms to make the right matches. The platform also makes recommendations for special populations such as at-risk youth or veterans. “I’m a facts and data person, and Stacy is a scientist—we are driven by quality and outcomes,” said Kohler.

I’m a facts and data person, and Stacy is a scientist—we are driven by quality and outcomes.

Rachel Kohler

They are also thinking ahead. For one, they are making referrals even more targeted. For example, they are piloting a function that enables NowPow users to rate the quality of the community resources, which will help health providers and community partners better understand the services and limitations of each community-based partner.

In the long run, they aim to use their accumulated data on community-resource-referral transactions and processes to give everyone in the health and social services sectors quality, safety, performance, and improvement insights that can be used to invest wisely in population health and keep costs down. This data will also arm community-based human and social services organizations to demonstrate their value to promotion of population health. By empowering community organizations to promote wellness within the local community, it will take away some of the burden—and costs— from hospital systems, added Kohler.

If there’s one takeaway that Lindau and Kohler want people to understand after hearing about NowPow, it’s the idea that as a society it’s critical to rethink our definition of health care if we want to control rising medical costs while improving health outcomes, they said. NowPow’s solution involves caring for the whole person.

“If we continue to operate health care in a way that’s primarily geared toward the delivery of drugs and devices, we will run out of resources,” Lindau said. “There’s so much more we can do by optimizing the resources we already have in health care and in our communities to achieve impact.”

A Hyde Park Commitment

Walk down 53rd Street past the Polsky Exchange today and you’ll see NowPow’s signage adorning the ground-floor windows of the historic Del Prado building the company calls home. Just three blocks east of where they launched, it’s a short walk that represents a long journey.

“Because community-based organizations are key to NowPow’s impact, we work to ensure our visibility in the community,” Kohler explained. “We are proudly signaling that we, too, are here in the community.” They hope the vibrant signage makes the firm more noticeable in the neighborhood, Kohler pointed out.

Inside a mostly residential Del Prado building, some offices and open floor areas boast sweeping views of Lake Michigan and nearby parks. There are quirks too. With apartments on most of the floors, dogs and their owners wander the same lobby where NowPowers meet for afternoon meetings. Employees and residents mingle amid the marble columns, oversize windows, and wood-paneled nooks with bright seating in the newly restored lobby of the Hyde Park landmark.

Logistically, the location helps too. For instance, NowPow is only a mile away from Lindau’s research lab. Kohler can easily attend UChicago Board of Trustees meetings nearby. Since Lindau spends most of her time outside of the NowPow office, they talk by phone at the beginning and end of most workdays to touch base about the business, but she’s close enough to drop in.

Right now, NowPow is one of the biggest faculty-founded companies operating on a national level that has remained based in Hyde Park, Lindau pointed out. “By headquartering NowPow in Hyde Park, we are returning meaningful jobs and tax base to the region where the original ideas were created,” Lindau said. “Employment is critical for health.”

Another plus: having access to a pipeline of talented associates. To keep up with growth, the company regularly hires employees as interns or full-time team members from the pool of nearby students. “Undergraduates tend to have grit and smarts. And they can handle the pace,” Kohler added.

As NowPow grows, Lindau and Kohler are determined to continue to support the neighborhood where their platform first launched. NowPow works with the neighborhood’s United Church of Hyde Park to offer group meals for users who are referred. Nearby, the Cathedral Missionary Baptist Church offers utility payment assistance. Both organizations worked on more than 200 referrals through NowPow’s platform in 2019.

Both Lindau and Kohler aspire to engage, hire, and serve from the community where it all began. “NowPow’s approach is informed by the evidence that a person’s health is heavily determined by the community where they live,” Lindau said. “This community is ideal for bringing ideas to life in Chicago and beyond.”