Using AWS, MetroPlusHealth Reaches Out to 80,000 At-Risk New Yorkers

When the COVID-19 pandemic reached New York City in March 2020, Manhattan-based nonprofit insurer MetroPlusHealth and its more than 570,000 members found themselves in one of the epicenters. MetroPlusHealth staff wanted to reach out proactively to the organization’s most vulnerable members with resources that could help, but there was no way to contact tens of thousands of members quickly enough to address their urgent needs with traditional outreach methods like phone calls.

Through the NYC COVID-19 Rapid Response Coalition—a collaboration of leaders from the private and nonprofit sectors focused on helping at-risk New Yorkers—Amazon Web Services (AWS) connected with MetroPlusHealth president and CEO Dr. Talya Schwartz and offered to build a pro bono technology solution to reach out to vulnerable members. The result was a chatbot that interacted with 54,000 members in the space of just 3 weeks, connecting New Yorkers with resources that addressed their physical, social, and emotional needs.

At the end of April 2020, MetroPlusHealth took over the initiative. “We ran the program and reached an additional 26,000 members in just a few more weeks, totaling 80,000 New Yorkers to date,” says Dr. Schwartz. “We were excited by the results of this initiative and thankful to all those who helped set us up in record time. We plan on conducting this critical member outreach throughout the COVID-19 pandemic crisis and beyond.”

MetroPlusHealth is a wholly owned subsidiary of NYC Health + Hospitals, the largest municipal health system in the United States. The organization offers health insurance coverage to eligible New York City residents at low to no cost. “Most of our members are vulnerable,” says Dr. Amanda Parsons, MetroPlusHealth deputy chief medical officer. “About 72 percent of them are on Medicaid, meaning they qualify for health insurance by dint of their income level. They have high rates of disease burden, but they also have high rates of social stressors, like inadequate access to healthy foods, quality housing, and other things like that. As such, they are more vulnerable in times of stress.”

When the COVID-19 pandemic hit New York, MetroPlusHealth’s analytics team identified 85,000 members who were at high risk for severe complications by using an algorithm that flagged members for risk factors like asthma, diabetes, heart disease, and obesity. Dr. Parsons hoped to reach out to these members to connect them not only with medical help but also with food, housing, and emotional support if needed. But there was no way to reach such high volumes of people in time to help them. “With our traditional member outreach, we can successfully reach about 50 people a day,” says Dr. Parsons. “So with 85,000 members, it would have taken us about 1,700 days, or a little over 4.5 years, to reach all of them. That’s a total of about 12,000 employee hours.”

That’s when Dr. Parsons received the offer from AWS to create a solution. “It was one of the best emails I’ve ever gotten in my life,” she says. In addition, Bain & Company, a management consulting firm, offered to manage the project pro bono. For the solution, AWS conceptualized a chatbot that would reach out to vulnerable members by text, directing them to a questionnaire about their needs and connecting them with meaningful services based on those specific needs. The services included a city-sponsored hotline, by which people who might be experiencing symptoms could speak with a doctor; a statewide emotional-support hotline; and MetroPlusHealth’s nonprofit partner, AIRnyc, which could help with food, housing, and employment insecurity.

To build the chatbot, AWS deployed Amazon Lex, a service for building conversational interfaces into any application using voice and text. Amazon Lex provides advanced automatic speech recognition, which enables users to convert speech to text, and natural language understanding, which enables machine reading comprehension. These two features enable Amazon Lex to create engaging, lifelike conversational interactions with users.

In addition, AWS used Amazon Connect, an omnichannel cloud contact center. This service enables organizations to connect with customers or constituents in a personal, dynamic, and natural way through voice or chat. By using Amazon Connect, MetroPlusHealth could reuse the same automated interactions over and over to create chat flows. It could also make changes to the chat flows simply using the service’s intuitive user interface, which doesn’t require any coding.

Amazon Pinpoint, a flexible and scalable outbound and inbound marketing communications service, enabled MetroPlusHealth to segment its members and personalize its messages with the right content. Other AWS services within the chatbot solution included Amazon Simple Notification Service (Amazon SNS), a fully managed messaging service that enables application-to-person communication, and data storage through Amazon DynamoDB, a fast and flexible NoSQL database service for any scale.

Throughout development, AWS Solutions Architects met with MetroPlusHealth staff for interactive design meetings about the scripting and order of the chat flow. “The AWS team members were phenomenal,” says Dr. Parsons. “For example, they linked us up with an expert who could look at the long language we had drafted and reduce it to three clear, helpful words.”

When MetroPlusHealth launched the chatbot program, it reached 54,000 members over the next 3 weeks, contacting as many as 10,000 people per day at its peak. Nine percent of these members engaged with the chatbot, with half of them sharing at least one medical or social need through the questionnaire. The chatbot was able to directly and instantly connect those 2,400 vulnerable people with the services they needed.

Dr. Parsons says MetroPlusHealth may continue to use the chatbot program throughout the COVID-19 pandemic, adapting the chat flow and resources for members’ arising needs, such as keeping track of school closures. She says MetroPlusHealth may also use AWS for other emerging technologies, such as a new health app where members and providers can manage insurance plans, as well as for the expansion of a telehealth service for medical and behavioral needs.

According to Dr. Parsons, the best part of using AWS on the chatbot solution was the effective teamwork. “I really felt like the AWS team members understood our business drivers—what we were trying to do and what the technology needed to deliver,” she says. “And they didn’t tell us what the technology should look like. Instead, they said, ‘What do you need it to do?’”

Dr. Parsons says she cherished the opportunity to help vulnerable people during an unprecedented global crisis alongside AWS, Bain & Company, and AIRnyc. “It felt like everybody was at the table ready to participate and roll their sleeves up,” she says. “It really helped me personally to feel like, during this crazy time, we were contributing to a solution.”

To learn more, visit thinkwithwp.com/lex.