"How I'm Building" with Glasha Marcon of Nuna

You lead the Meaningful Matches team at Nuna - whose mission is to help make high-quality healthcare affordable and accessible for everyone  - Tell us about this role and why Meaningful Matches matter.  

As the product manager for Meaningful Matches, my responsibility is to deeply understand the needs and challenges of individual people searching for primary care, as well as the needs and pain points of providers and health plans when it comes to connecting members to primary care. I conduct design research, develop product vision and roadmaps, and define features and capabilities and work with our data analysts and engineers to execute them. I center the experiences and needs of people most negatively impacted by our current healthcare system by overrepresenting their voices in design research, and collaborating with them in product design and development. I participate in sales calls and customer feedback sessions, and sometimes lead implementations of our product. I help figure out the business model and pricing. Most of all, I define our direction, make sure that our team understands the “why” behind their tasks, and guide us to focus on what’s most important so that we can achieve our mission.

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There is plenty of evidence that shows that if a person sees a primary care provider (PCP) at least once a year, they are less likely to develop serious health conditions that lead them to the emergency room (ER). However, Nuna’s research found that there is variation in PCP quality and cost that results in varied patient outcomes. So, our goal is to match each person to the best PCP for them.

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Today, there are a few main ways that people get connected to primary, two of which we focus on: Provider Search and Auto-assignment. Many of us are familiar with Provider Search - we go to the website of our health insurance plan or health system, put in a couple of criteria like our zip code and desired specialty, and we get many pages of results that we have to sift through in order to choose a PCP. Many people don’t have time for that, or lack the information they need to make a decision. This results in analysis paralysis - someone might visit that site many times and walk away without having chosen a PCP or scheduled a visit. Meaningful Matches has partnered with plans to power these search results so that the top matches are most available, accessible, and high quality providers for that member.

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Many Medicaid and HMO plans give their members 30 days to choose a PCP, and if the member doesn’t choose one, the plan “auto-assigns” a PCP to the member. The plan usually sends this information through a letter in the mail, or by printing it on a member’s insurance card. The member-PCP relationship is so important, and it’s critical that plans get it right the first time, or they risk a member going without primary care. So, health plans partner with us to power auto-assignments, so that - again - members are matched to providers who are available, accessible, and high quality… for them!

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Availability means that we are matching members to PCPs who are in-network, who are actually accepting new patients, and who have capacity in their panel. In a recent implementation, we found that 13% of our customers’ PCP roster had not seen a new patient in the last 12 months. We call these PCPs “Ghost Providers”.

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Accessibility means that we take into account member attributes to match people to PCPs who are easy to travel to, who speak the same language, who are available on the weekends or via telehealth - basically ensuring that a member can actually reach the PCP. Before using Meaningful Matches, the average member-to-PCP distance for one of our customers was 17 miles. We brought it down to 3 miles.

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And high quality means that we are matching people to PCPs who have a positive track record with members who are similar to them. We use our predictive models to match people to PCPs who they are likely to visit, stay with over time, and receive high quality care at a low price - helping members and helping the country lower care expenditures. Our matches have been shown to increase annual PCP visits, shift ER visits to urgent care, and reduce the number of days that members are in the hospital.

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There is a lot more we plan to do based on our design research - capabilities that help people understand why they were matched to a certain PCP, features that account for more elements of accessibility and quality. We’re excited to keep working on them!

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In this Medium article you discuss founder Jini starting Nuna for her brother, Kimong. Do you have a Kimong?

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I love this question. Similar to Jini’s story, I am first generation. My parents are from Russia and I was born in the US 5 months after they moved here to seek political asylum. I was the first to speak English in my family and often helped our family navigate various systems, including the healthcare system. I was on MediCal (California’s Medicaid program) in my childhood, and often went to the Berkeley Free Clinic for care because it was more accessible for us. Availability and accessibility were especially important to us because my mom was going to school, working, and raising kids - so time flexibility and cost were the main concerns.

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More recently, I have been one of the caregivers for my grandparents who do not speak English. I’ve had to take them to the hospital 5 times over the past 3 years, and each time I’ve had to advocate for them to get interpretation services and for their conditions to be taken seriously - it’s been incredibly frustrating. I wish that my grandparents had primary care that was better suited to their language and cultural context so that they could better manage their health and catch emerging conditions early. I also wish that their health system was more integrated so that primary care was talking to the hospitalists and specialists in a coordinated way - I truly believe they would have better outcomes if this were the case.

Tell us about a hobby of yours that exists completely separate from your work.

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Favorite topic. One of my favorite hobbies is going to the local Farmer’s Market in Oakland, CA. I love the smells, colors, freshness, and variety. I love getting to know the people who grow our food. I love observing seasonality, and understanding how I can live better with the seasons. And I love the sense of community that comes from seeing the same people every week. I also started growing my own food, which makes me appreciate our farmers even more! It’s one of the most important ways I align my money and behaviors with my values.

What does Onboard Health’s mission — “building an inclusive health workforce” — mean to you?

‍This mission resonates with me so much. I believe that in order to truly change healthcare for the better in the US, we have to have a workforce that is not only representative of our population, but a workforce that overrepresents the people who have been most negatively impacted by discrimination, bias, and oppression in the healthcare system.

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People who have found ingenious ways to keep their – and all of our – communities healthy and resilient despite inadequate resources. Onboard Health is cultivating that workforce. I’m thankful for this incredible community - I am inspired by you and I am grateful for the opportunity to learn alongside you.

‍How have you seen the field of health equity shift in recent years?

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I have seen the topic of health equity become much more mainstream. On one hand, that is a huge win, as it has brought a topic that was once marginalized and trivialized into the spotlight. On the other hand, as folks get more comfortable talking about “unconscious bias” and social determinants of health, they miss the important structural work that needs to be done to create a truly equitable health care system. A couple of trends that I’m seeing that make me hopeful:

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• A commitment from organizations to measure disparities. You can’t know what you need to fix until you identify the problem.
• An acknowledgment that health disparities are not just a Medicaid and Uninsured problem. Evidence shows that regardless of income, our systems disproportionately hurt Black, Indigienous, and Latinx people. There are also people with employer-sponsored health insurance that work inflexible jobs, and often have to choose between taking a sick day, going to see the doctor, and vacation time.
• An emergence of start ups and organizations that curate care options for specific identities and communities - like Health in Her Hue, Spora Health, Folx Health, etc…
• The increasing adoption and practice of Product Inclusion, championed by Anne Jean Baptiste in the book Building for Everyone.

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What pivots has your work seen throughout the pandemic?

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When the pandemic hit, a lot of the work I was doing in health equity suddenly got into the spotlight. This was compounded after the murders of Breonna Taylor, George Floyd, and the ensuing uprising. When I checked in with my health equity community, many of us were feeling the same things - why did it take a freaking pandemic and mass protests to get institutions to care about disparities? However, we also were ready for the call - and took advantage of the increased attention and resources to push through the health equity agenda.

Where are you drawing inspiration from lately?

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Nature! I’ve been on a journey to better understand natural and generative processes that have sustained living things since the beginning of time. A couple of years ago I took a permaculture design course, and I’ve sought out experiences to learn more about growing food, hosting bees, tree health and communication, etc… adrienne marie brown captures a lot of these lessons in Emergent Strategy. 

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What hopes do you have for health equity in the coming year?

‍My hope is that as an industry, we go beyond naming the problem and move toward the hard work of re-developing systems to center equity and justice. That is a big hope, and I know it will take more than one year.

A big step would be for large healthcare corporations to recognize that the way they lobby and funnel money to those in power might have a bigger impact than the health equity programs they fund or develop.

Where can the Onboard Health Community connect with you online?

Feel free to connect with me on LinkedIn or on Twitter.

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Glasha Marcon collaborates across sectors to measurably and equitably improve community health and resilience. She has worked on the frontlines as a Community Health Navigator, built global population health products at Optum (part of UnitedHealth Group), supported startups and the innovation ecosystem in Minneapolis, guided Rally Health’s corporate strategy and health equity initiatives, and now leads multiple products at Nuna.

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Glasha was born and raised in the Bay Area five months after her parents sought asylum in the US from the USSR. She studied International Health and Development at Macalester College. Outside of work, Glasha is jumping into the Pacific Ocean, frequenting farmers’ markets, practicing permaculture design in her backyard food forest, and co-creating solutions with people experiencing food insecurity and climate injustice in the Bay Area.

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