Uphold Health, a Chicago-based technology and care planning services start-up, is poised to expand to the Boston and Houston markets this year. In addition to technology solutions, the company provides social workers, dubbed care navigators, to help guide families through the health system during serious illness up to the end of life.

Founder and CEO Margaret Norris launched the company to help patients and their loved ones address some of the challenges that her own family faced when both her father and stepfather were suffering from terminal cancer.

“I lost my dad and stepdad to cancer in my early 20s; I was their primary caregiver along with my sister and my mom.” Norris told Hospice News. “We found that navigating the health system, trying to figure out what we needed to know to give them the best possible care, was a really frustrating situation and experience.”

Norris recently spoke with Hospice News about the importance of advance care planning and how technology and professional guidance can guide consumers through that process.

Uphold Health

Your company is a start-up, how did it come to be? What propelled the idea forward?

I studied psychology at Northwestern University and later ended up learning how to code. So I formed this idea of how we could approach end-of-life through technology.

Now, nearly two years later we have evolved into something quite different in terms of our product and our offerings, but we are still attacking the same problem: The challenges families face navigating the health care system at the end-of-life.

How does your business model work?

What we do is begin engaging patients at the time of diagnosis through to end of life. We pair them with a licensed clinical social worker who is their personal care navigator throughout the journey, and we pair that service with technology that provides education and resources and also documents their care decisions.

Our system shares those decisions in the form of advance care plans, not only with their providers, but with their insurance plans and their families, so everyone is on the same pave as far as what they want and when they want it.

Currently we are direct to consumers as well as having some channel partnerships with providers in the home care space, and we are early in talks with a health plan. We work with home care providers, skilled nursing facilities, even small oncology departments that want to offer additional support that maybe they don’t have the resources to do.

How did you begin testing your programs?

There was a research project at Northwestern University as well as a pilot program. We worked with 17 physicians across various different specialties, including oncology, palliative care, family practice, primary care and others to really look at the current status quo in health care, identify their struggles. We investigated how we could help physicians providing advance care planning and how we can help improve those services and how we could better serve that population.

How did that research inform Uphold’s operations?

We found that [physician’s struggles with advance care planning] is really a matter of time and resources.

Physicians spend 10-15 years learning really hard sciences, and their jobs are to diagnose and treat illnesses. So to then layer on an expectation of having these really tough, complex and emotionally charged [advance care planning] conversations with families within those 15-to-20 minutes time slots that they have for each patient is unreasonable.

These conversations tend to get pushed down to the nurses or to hospice workers, but even then hospice is often not engaged early enough in the process.

We found quite a few barriers mostly due to time and resources but also found that a lot of physicians within a health system don’t have the purchasing opportunity to buy products and services or technology that could improve the lives of their patients. Those decisions come through administrators. So it was an interesting opportunity to talk with physicians about how they feel about the whole process and hear them tell us that they really need resources to help with this that don’t put another tax on their time or existing workflows.

What can you tell me about the care navigator service?

We operate on behalf of the patient. We are independent of the health care system, so we are able to ensure that patients are getting the resources and services that are precisely what they choose.

We are really focused on driving consumer-driven care at the end of life, really putting not only patients but their family caregivers in the driver’s seat to address their care as a family issue, because it won’t only impact the individual; this will affect the family and their finances.

This is something that I experienced personally with my dad and how it impacted us as a family financially—the decisions that weren’t made, the plans that were not set.

Can you say more how about how this impacted your family?

If my dad had an advance directive, had he had more robust plans about how he wanted care at the end of life, it would have saved us hundreds of thousands of dollars. So we are really looking holistically at the whole family and asking how can we approach this in a meaningful way to ensure that you get the best care possible in a way that leverages the technology as well as maintaining the human touch.

How does your staff interact with patients? Are care navigators trained clinicians?

Each customer or patient is provided a licensed clinical social worker or equivalent to help navigate the care of that individual. The social worker is licensed in the state that they live in and is familiar with the health system. I think of it more like a sherpa, someone who knows the system, has been there before, and can help you navigate decisions.

How do patients pay for the services? Does insurance cover this?

Our service is entirely covered through Medicare. We actually have two billing codes that are related to advance care planning and another billing code that is for the telehealth service. A family can spend an hour with one of our care navigators, and the co-pay is less than $25.

Uphold is expanding to the Boston and Houston markets, why did you target those cities?

For two reasons: First, there is a high population of people older than 65 there, coupled with high density in the health care industry. There are a lot of health care providers and health care companies located in those areas, where they represent.

Our direct to consumer operations will open in both of those markets, and we are starting to gain traction and begin to build out relationships with community partners, home care providers, skilled nursing facilities, and so forth.

We provide the service to [health care providers’] patient population in terms of advance care planning and care navigation, and then we share in the revenue generated through Medicare, so it’s not only an option to improve the quality of service they provide, but it is also a solution to for increasing their bottom line.

Are you seeking investors to help support the expansion?

We raised a friends and family round 18 months ago, and we are seeking investment in a seed round that will be closing in the next three months.

We are at an interesting place in our journey as a company but also in terms of the market. Health care is a very hot market, and so is digital technology and tech-enabled services.

There is a lot of opportunity and a lot of movement in this space, and we are really looking for investors that have experience in health care and have deeper connections in health care who can provide the kind of mentorship and support that an early stage company needs.