9 min read
The coronavirus wreaked havoc on the east and west coasts before reaching other parts of the country. But it wasn't long before parts of rural and Midwestern America were battling outbreaks, desperately trying not to fall behind in testing and tracking.
At the same time, a barely a year old healthcare solutions startup from Orem, Utah, called Nomi Health, was using its technical technologies to streamline administrative processes between employees / patients and providers. But both the Utah government and upper Nomi management realized fairly quickly that their fates would be intertwined.
Mark Newman (l) and Joshua Walker, co-founders of Nomi Health
Photo credit: Nomi Health
It wasn't long before Utah officially hired Nomi to ensure, according to the FAQs on its website, that "every step of the testing process works seamlessly – from camping to testing to tech." Soon Nebraska and Iowa followed suit, and virtually overnight Nomi juggled his original raison d'etre with an urgent mandate to coordinate efforts that could save thousands of lives and prevent a global public health crisis from spreading further.
One afternoon, just over a week before President Trump contracted the virus himself, Co-Founder and CEO Mark Newman and Utah co-founder and COO Joshua Walker called to explain how their state government called if they ever panicked got their mission and purpose and how close they believe we are close to a working vaccine that will be widely used.
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So the chicken-or-egg question first: did you reach out to the government and suggest that your company could support the Covid testing effort, or did they come to you?
Mark Newman: Utah County has 30 percent of the (state) population, but at this point it had less than 1 percent of the tests. That was in the middle of March. Because all of the major health systems were in Salt Lake County. Unfortunately, there are always deserts in healthcare. And when you speak to the health department they didn't think there was Covid in the county even though it is a commuter country. The second phase was when the announcements about test centers in grocery parking lots were released. Well, quite a few retailers said they didn't want a whole bunch of sick people to come into their stores.
Second, our office overlooked a large grocery store here, and the parking lot was full of people trying to fill their shelves before everything shut down. Because of our business model, we of course say: What it really is is that the providers don't have a business model for it and the supposed payers – the insurance companies – don't want to pay for it. So that is the first problem. The second part was they said, "We can't buy this stuff." That's because most people just bought things from the same old suppliers. We called a diagnostic company here in Utah that was doing Covid tests in Europe. And where everyone said no tests, they had two million of them. And we say, "This is silly. Why don't you use them in your own state?" And they say, "Nobody called." Impressive. OKAY. Well, we're calling. Drop us off for 50,000 and let's get started.
The third part of this was that our backgrounds were building high volume assessment processes. We knew it wasn't just about being great diagnostic testers. It was actually about throughput and flow. In all honesty, nobody thought we could do it. Within a couple of weeks we started everything and then we spoke to the governor's office and they said, "Can you keep doing this?" This is really a story where we raise our hand, show up and say, "Yeah, we can do this."
Is it worrying that it was ultimately up to the private sector to pave the way here?
Joshua Walker: State governments and federal governments don't have to be nimble and quick. That is the nature of their model for long-term stability. And we have found in our region that it is indeed the strong combination of the private sector and the public sector that come together to bring their unique skills together that has enabled a fast and nimble movement where we as a private organization are on the commercial side could mobilize the market very quickly. We could turn things up. We could design things. Our contractual frameworks are set up in such a way that they can move very quickly where their models of governance simply weren't set up at that time.
Some aspects of your model lend themselves to this transition, others probably less so. How did you compensate for that?
Walker: It really comes down to a couple of things. One of them is to approach the problem space from a brand new perspective. What has allowed us to go so fast is that we were unharmed and weighed down by the traditional approach of how to use what was already in the market to address this. We brought together a team with a wide variety of skills from many different industries so it was really all about execution. In just a few weeks we put together an end-to-end test solution for a state. A robust solution is not possible without a strong internal focus on where time, energy and resources are spent.
I'm assuming that with the contracts you've received from these states, you've likely hit some of your sales milestones faster than you expected. If so, how do you know where to move the goal posts and how to allocate your resources?
Walker: One thing I've done powerfully is that not only did we deploy our original solution to the state of Utah and say, "Hey, let's go. Good luck. I hope it works well for you You." As a partner with the states and our customers, we have stayed in the changing landscape. As Mark mentioned, we had grocery stores closed in March and people were asked to stay home. That was an environment. Resources were very scarce when it came to PPE and nasal swabs, as well as tests and machines. More tests are available now, but it's all about throughput and responsiveness. How to get schools going again. How do you get people back to work?
Newman: We're going to focus on constantly moving people's healthcare costs and generally lowering them. We will serve self-funded organizations so that employers, states and communities have our direct health claim payment platform that replaces large insurance carriers. We will continue to make Nomi's public health services a part of our business as this is a case study of what we are doing right. So it definitely adjusted our goals. If you had asked us at the beginning of 2020 (if we did) to do a few percentage points of all Covid testing in America in multiple states, we would have been like this: First, what is Covid? Second, probably not.
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I feel like the potential of Nomi's model is unlimited, but is there a realistic maximum capacity for how many more tests you can run?
Newman: We are very aware of how we implement our projects. There are certain pieces that scale better than others. The digital platform can be scaled very well and hires employees a little more slowly. We won't take on things that we won't deliver. The nice thing about this stage of the pandemic is that we have all realized that it's not a sprint – it's a fast running marathon. We can plan very deliberately and strategically with our clients to include new and new programs and support those that we have.
This was all a kind of stress test. Did it at least quickly reveal parts of your workflow that would ultimately turn out to be inefficient?
Walker: How little sleep you can get and still function. (Laughs) I have a 5 month old, so how little energy can Josh use. We would never have seen this in our lives if we hadn't been through the past six months.
Newman: We both have young children and spouses who have been able to support us while Mark and I tried upside down trying to move that solution forward and help our state and our states across the country.
Walker: The other part is that we both built businesses before. The strategic planning process for our programs was: delivering day in and day out, always putting points on the board, always making sure we are over-delivering to make sure our customers are served the best possible.
Newman: Every mountain that is put in front of you sprint over it. They just hit through.
The big question: does your performance underscore the fact that with full coordination we can potentially distribute a vaccine across the country without too many barriers?
Newman: Absolutely. There are so many parallel dynamics.
Walker: I feel like there is hope. There will be a lot of creativity and I believe there is a healthy intolerance to the status quo when it comes to mobilizing and advancing vaccines and vaccinations, so I am optimistic.