TUCK KNOWLEDGE IN PRACTICE PODCAST: WHAT CAN LAUNDROMATS TELL US ABOUT UNMET HEALTH CARE AND HEALTH-RELATED SOCIAL NEEDS?

The following information was released by the Tuck School of Business at Dartmouth:

Tuck Clinical Professor Lindsey Leininger joins the podcast to discuss new research with alum Courtney Bragg T'18 on the unmet health and social needs of laundromat usersand what their findings reveal about health insurance gaps.

[This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of the Tuck Knowledge in Practice Podcast is the audio record.]

Lindsey Leininger: Now that we know this model can work, I think you're going to catch a lot of people. And there's a revenue opportunity to do this in laundromats. Laundromats are worth the outreach effort.

[Podcast introduction and music]

Kirk Kardashian: Hey, this is Kirk Kardashian, and you're listening to Knowledge and Practice, a podcast from the Tuck School of Business at Dartmouth. In this podcast, we talk with tuck professors about their research and teaching and the story behind their curiosity. Today on the show, we're going to learn about the role laundromats can play in connecting low-income people with healthcare and social services, and how a startup co-founded by tuck alumna Courtney Brag, T18 is helping to make those connections. My guest is Lindsey Leininger, a clinical professor of business administration at tuck and the faculty director of the center for Health Care. Lindsey specializes in data driven health policy with a focus on the health care safety net and community health. She has a long-standing interest in publicly funded health insurance programs with related research spanning quality measurement, risk segmentation, and program evaluation. Her community health work focuses on health education and promotion initiatives. Highlights include leading an award-winning crisis communication campaign during the Covid 19 pandemic, designing and delivering a nationally recognized curriculum for public benefits navigators, and leading the data and research efforts for a home visiting program for high-risk pregnant women in Wisconsin. At tuck, she teaches courses on data driven decision making in the health sector. Prior to tuck, Lindsey spent a decade designing and leading research and technical assistance projects for Medicaid agencies, both as an academic and as a think tank researcher. She holds a PhD in health policy from the University of Chicago's Harris School of Public Policy. Lindsey Leininger, welcome to Knowledge and Practice. Thanks for being here.

Lindsey Leininger: Oh, thanks for having me. I'm really excited about this paper. Before we started recording, I shared with Kirk that this is the most fun paper I've ever written in my career to date, so it's great to be here.

Kirk Kardashian: That's great. I'm excited to talk about it. So, the paper we're talking about is a new research paper, which is being published in the American Journal of Managed Care, and the paper is titled Unmet Health Care and Health Related Social Needs of Laundromat Users, which is an interesting paper. You don't see many papers with the word laundromat in it. Uh, correct. Which I think is maybe that has something to do with why this is the most fun paper you've done.

Lindsey Leininger: Absolutely.

Kirk Kardashian: Um, so some papers start with a research question. Others begin with a societal problem that needs a solution. And to me, this paper seemed to fall in the second category. So, if that's a fair way to describe it, can you talk a bit about the problem that motivated your paper?

Lindsey Leininger: Sure. And I like the structure of that question. And I think in my mind it's a bit of a mashup of the two goals. So, I think instinctively we suspect that people who use laundromats might have elevated unmet healthcare and social service needs, so that should be addressed. But I think what we don't know, and this is kind of the research question, is to what extent are these problems apparent. So, this is like what we call a magnitudes problem in research. How big is the problem. For whom is it the biggest. So we wanted to know what's the extent of unmet health care and social service need among folks who use laundromats? And also, is there any variations, like within the laundromat going population? So that was our that was our guiding research question. We also wanted to know, um, for whom might this be a market opportunity? Because we sit in a business school, right? And these data are from an alumna, Kourtney Brag. She's a t-18 who co-founded a startup set in laundromat. Laundromat based settings. Um, and so we're thinking about potential sources of revenue for people who go and do this outreach work in laundromats. So how big is the problem? For whom might this be a market opportunity? Where the driving forces behind the research.

Kirk Kardashian: Okay. Okay. Interesting. So it sounds like there's a bit of an assumption there that people who use laundromats have unmet health care related needs. Can you dig into that a little bit?

Lindsey Leininger: Sure. Yeah. So if we double click on what we know about people who use laundromats, which is very little in terms of scientific data there, I think I found two sources in the literature, in the published literature that actually had some data from laundromats on PubMed. So, um, this has not been well studied. To your point, there are not a lot of papers with the word laundromat in them. Um, but there is a little bit of industry data, and those data suggest that people who use laundromats are more likely to be renters as opposed to owners. They are likely to live in zip codes with higher social needs than zip codes without social needs. So I think what we know from industry data and from demographic data from the census would suggest that there would be elevated levels of need for folks who use laundromats, as opposed to those who don't. This was really the genesis of a of a partnership with Courtney. So and this is kind of a fun story. So I hope you don't mind a little bit of storytelling.

Kirk Kardashian: No, please.

Lindsey Leininger: Okay, great. Um, so I am the faculty director for the center for Health Care, and every year we have a coffee at reunion. So we do a coffee for our alumni who are back for reunion. And Courtney showed up to that coffee, and that was when I first met her. And so she and I hit it off immediately connected about our shared interests in Medicaid and public health. A little bit later, she reached out and she said, hey, do you think you can do something with my data? Can we learn something from these data I've collected in a laundromat? So the reason why the setting is in a laundromat is because that's where Courtney and her co-founder, Alistair Chang decided to launch their business. And I jumped on the chance to analyze data from a new setting. So I would be I would be not truthful if I suggested that, like, I had this brilliant idea to go study laundromats. I thought it was great, but it was really Courtney and Alistair's genius. Right? Because laundromats again, what we know from the industry data is they're in higher socioeconomically disadvantaged communities. And also, it's a captive audience. You have to come every week and you're usually there for two hours. So, like, let's make this productive.

Kirk Kardashian: Okay. And this company is Fabric health.

Lindsey Leininger: Fabric health is its name. That's right.

Kirk Kardashian: And what do they do?

Lindsey Leininger: They. So they connect people in laundromats with healthcare services and public benefits.

Kirk Kardashian: Okay. So their whole business model or their whole model is about laundromats and healthcare related needs.

Lindsey Leininger: 100%. Wow. Yeah. Which is really neat. So. And another reason why Courtney and I bonded and why I've just loved doing this research, is because my heart and my background is in community health as well. So I started at the age of 15, supporting community health workers in Latin America, doing things like digging latrines, vaccinating dogs and cats against rabies, building chicken coops to keep the rats out. So, you know, this is similar work. It's just domestically, right? So I thought it was a clever community health model. And so I was happy to learn from their data and support their RandD efforts.

Kirk Kardashian: Yeah. Yeah. So I mean their, their company, um, Like what is. I mean, the mission, I guess, is to help people who use laundromats, um, get more services that they need. Correct. Right. Um, is that a for profit company? How do you make money doing that?

Lindsey Leininger: Yeah. Great question. So what's the revenue stream? So they are a for profit company. Um, I believe they're a B Corp, which is a for profit company that also has a social mission. But regardless of whether or not you're doing laundromat, laundromat-based outreach as a for profit enterprise or non-for-profit enterprise, which is what we see a lot in community health spaces, you need revenue, right? So, like, what's the revenue stream? Yeah, right. Um, which was the second research question that we had. Right. Like where's the market opportunity here for what? So the revenue stream for these types of efforts often comes from health insurers, which I think is a surprising kind of nugget for people who are not in the community health space. But health insurers, especially managed care plans, which are health insurers that largely serve Medicaid and Medicare populations. Um, have a business case for going and finding new enrollees and keeping them on coverage. Right. So keeping them re-enrolled. So the revenue stream for Fabric Health or other outreach types of organizations is getting paid by health insurers both to find members and re-enroll them or find new members and enroll them and also address what are called their health-related social needs.

Lindsey Leininger: In regulatory parlance. So really, in the past decade, there's been a huge push by regulators to collect health related social need data on people in Medicare and Medicaid because they think that addressing people's social needs will improve health outcomes, reduce their visits to the emergency department, reduce their hospitalizations, hopefully. So the regulators have pushed out billions of dollars to health insurers to collect this information from its members and act on it. So downstream. So we see the feds through the centers for Medicare and Medicaid Services making this a policy priority, putting a bunch of money in it. They work with the managed care providers, the health insurers, and say, look, you got to start collecting these data and acting on it, and we'll pay you to do so. And then downstream, you have the community health organizations who can have a revenue stream from getting new people into these managed care plans and collecting information and addressing their social needs. So it's this nice, you know, I'm a health policy PhD. So to me, this is like a lovely case of how federal policy can really affect business models on the ground, like super local settings, like a laundromat.

Kirk Kardashian: Yeah. Wow. That's really interesting. So the feds are kind of, um, encouraging this data collection, and that's being passed down to companies like Fabric Health that are on the ground actually doing the data collection.

Lindsey Leininger: Exactly. With the middleman, like a big health insurer, for example. Centene is one, and this is like a major company that serves Medicaid enrollees in Medicare enrollees. And just for our listeners who might not know the distinction, which is totally fine, Medicare is the program that serves those 65 and older in our country. Medicaid is the program that serves low-income folks. Usually, there's about 80 million people on the Medicaid rolls at any given time.

Kirk Kardashian: Okay. Um, I think we all know what healthcare needs are, but we might not all know what health related social needs are.

Lindsey Leininger: Yes, absolutely. What is that? Yeah. So what are health related social needs? Um, so in kind of in industry parlance, they go by other terms like social determinants of health. I like the term social drivers of health because it's pretty clear why we care about them in healthcare beyond our humanitarian instincts. Um, often these are things like do you have enough food to feed your family. Do you have transportation to get you to work to get your healthcare appointments? Do you have utilities? Are you worried your utilities are going to be shut off? These are the types of issues. And then housing is a big one too. Like do you have secure housing. So these are the types of social drivers that are targets for these health insurer-based initiatives. And these policy initiatives coming out of CMS these days. And the ones that were captured on the fabric survey were food insecurity. So are you worried that you don't have enough food to eat? Do you have problems with transportation, specifically getting to healthcare appointments? Do you have a utilities need? Are you worried that your utilities are going to get shut off? And then last but not least, do you have internet at home? Because we worry a lot about the digital divide. And if you think about enrolling in health insurance or enrolling in public benefits, the front door to these things is digital these days. So if you don't have a computer, you might have a hard time filling in your Medicaid application, for example.

Kirk Kardashian: Right, right. And just getting information about public health issues.

Lindsey Leininger: 100%. Right. Like we so they worry a lot about the digital divide and supporting their, their clients via supporting them. You know, something as simple as like, hey, maybe we can help you fill out this application. I mean, that's not simple. Actually, that's a really hard thing, but that's a that's a key product that, that they offer at fabric. Yeah. Yeah.

Kirk Kardashian: So I'm envisioning people from fabric going into a laundromat and approaching a laundromat user and saying, hey, I'm from Fabric Health. Um, I'm we're asking if you have these, these unmet health related social needs. Um, can we help you sign up for Medicaid or can we help you? Um, you know, get on the get internet service. Is that kind of how it works or.

Lindsey Leininger: That's right. So they connect. So they are very mindful about only asking about needs that they can help address. Okay. Because trust is the cornerstone of this work. And as I think your question alludes to, this is pretty sensitive information. And if somebody came up to me in a laundromat, started asking me this, I'd be like, you're crazy. Like, who are you? Right. So there. So a lot of work actually happens before any of that. Okay. Any of the questions or information, you know, gets addressed. And this is very much in the style of what nurses call therapeutic communication. And I and I think fabric really is a great example of this. So first is trust. First establish personal connection. Be the person in the laundromat with a yellow shirt who's very friendly. Is there every week, knows your name, knows your family right. You got to establish trust in that community. Then you can go on to problem identification only after you've built the trust, right? So, hey, you know, Kirk, like in our conversation two weeks ago, you mentioned that you were confused by some paperwork you got in the mail about your kids Medicaid coverage. Do you want to talk about it? You know, actually, I can actually help with that. Right, right. So that's step two is just problem identification, where this survey results and this paper come into play. Right. And then step three, after you've established trust identified a problem that they want to work on. Right. Yeah. Then you work towards problem resolution. But only then. And you really can't skip those first two steps. And fabric, like all good community health groups, spends the most time on step one building trust.

Kirk Kardashian: Okay. Yeah, that seems like a really important step. And it probably doesn't. It takes a little while, right?

Lindsey Leininger: Oh, this is this is hard time intensive work. 100%. Because if we think about who goes to a laundromat, it might be people who have had a bad experience with a public benefit system like they their application got cut off accidentally due to an administrative error, or there's involvement with the justice system that has been frustrating or unfair. You know, there's a lot of reasons why we might think trust is low in laundromat settings. So really, it's important when you do this kind of work to whether in laundromats or whether in communities in Latin America or other community-based efforts. I've been involved in that. You empower people in the community to be the communicators, right? So fabric hires from the community because the lived experience gives you an understanding that's just unparalleled. Nobody, nobody wants to talk to me in an inner-city Philadelphia laundromat, right? I am not the right messenger.

Kirk Kardashian: Right?

Lindsey Leininger: Yeah, yeah. So hiring the right workforce is, like, such a key piece of these types of interventions.

Kirk Kardashian: Yeah. Wow. Really interesting.

Lindsey Leininger: I mean, can you imagine, Kirk, like, if you and I were standing in line at the CVS and in Hanover waiting for a meds, and somebody comes up to us and start asking us all these questions, we'd be like, you're crazy, right? Yeah. So the trust piece of it really is. Yeah. Foundational.

Kirk Kardashian: Yeah. Yeah. And that's, um, I think it's important for people to remember that, uh, people in the community will trust their community members more than anyone else.

Lindsey Leininger: 100%.

Kirk Kardashian: Right? Yeah. Um, so you can't just be. This company comes in and swoops in and tries to solve something. No. Right.

Lindsey Leininger: No. And they really say healthcare is a local business. And I think this is a good example of how that's true. Yeah. It's a trust business. And therefore there will always be a local component, no matter how much we all love technology. Ultimately there's always going to be like a local human component of healthcare.

Kirk Kardashian: Um, well, do you want to talk a bit about the survey and the data that you that you got to analyze?

Lindsey Leininger: Oh, yes. Absolutely. This is like I said, this was this was good fun. So I love talking about it and I appreciate the opportunity to do so. So fabric had, um, piloted a survey to about 2000 of its clients in laundromats asking them about their health care needs and their public benefits needs so they were able to gather data. This is the largest health related sample on laundromat goers ever. It might be the largest scientific sample on laundromat goers, period. Outside of healthcare, I don't know. But yeah, on the order of ten x, right. So the one other piece of data that really helps motivate my work is a sample that was taken in San Antonio, my home state of Texas, on 200 people at laundromats across the city. Right. So we have a sample size of 2000. Yeah. So this is a huge innovation, right, that we have this sample size that's much larger than anything that's been collected before. So what does that let us do? Well, not only does it let us look for broader trends because you have a larger sample size. It also lets you drill down within your sample into various subgroups. And that's a key part of this study is not only what's the overall level of need. So what's the overall health insurance coverage of the sample? What are the unmet needs and for whom are the unmet needs greatest? And it's really that third question that our sample allows us to do that's never been done before. So, you know, in broad strokes, what we find is about half of sample members have Medicaid coverage or covered by Medicaid.

Lindsey Leininger: About 20% are covered by private coverage. So think of coverage that you and I have through Dartmouth. Right. That's considered employer-based coverage. Private coverage. And then the rest are covered by Medicare. The program for the elderly is about 18% are uninsured. And then a small percent, about 5% are covered by both Medicare and Medicaid. That's called the duals. And they are the most vulnerable members of our society disproportionately. They are both low income and very sick. So we have about half of the sample on Medicaid. So again, for whom is this a market opportunity? Immediately, those data point to Medicaid managed care health insurers and that is indeed fabrics key client. Right. So that's confirmatory data. That fabric kind of already knew when they were when they were targeting. So that was kind of a useful benchmark that yeah, you know, the data suggests kind of what's already known. So we have about Medicaid is the largest payer. What's interesting too, among these findings, again, this fits with other data we've seen for Medicaid populations, is that social needs, social drivers of health are much more prevalent than healthcare needs. So 52% of the sample, over half of the sample had an unmet social need, with food insecurity being the highest, while only about 12% had an unmet health care need. So when we're thinking about building trust and we're thinking about the stories and the problems that the community are bringing to the fabric outreach workers. It's really the public benefits piece, the social needs piece that is much more pressing in their client's mind than the health insurance piece.

Kirk Kardashian: Okay.

Lindsey Leininger: Or getting connected to a primary care physician in network, for example. And then last but not least, again, we're really interested in subpopulations. That's a dorky research term, but we expect there to be some variation across laundromat users. And what does that variation look like? I'm going to tell a quick story again why I was really interested in this particular research aim. So when I was a graduate student at the University of Chicago on the South Side of Chicago, I used a laundromat. That was my laundromat going season of life. Like a lot of graduate students. And at that laundromat, there were graduate students. There were single moms with, you know, 4 or 5 kids. There were kind of middle-aged working adults. And then there were older people, too. Right. So there was everything in a laundromat. So my hypothesis was like, you know what? The needs are going to be really different across laundromat goers. Like they are not all going to look the same. Yeah. And we actually had the sample size to test that. And I think that that is our most surprising finding, although thinking back to my grad school days, maybe I shouldn't have been so surprised the data bear that out to be true. So even in the same laundromat, people who have Medicaid coverage are two times to five times more likely to have an unmet need than people with other types of insurance coverage.

Lindsey Leininger: Oh, wow. So this was like the big reveal and kind of the surprise finding which I really like, but it does fit with kind of my own personal anecdotes. So yeah. Okay. So why is this interesting or perhaps surprising? You could pretty easily tell a story that, you know what? Laundromats located in high need areas also happen to have more Medicaid recipients, right? Therefore, the high need has to do with the location, as opposed to who goes to a laundromat, right? Similarly, a laundromat in a in a more commercial area, it's going to have less need, and it's going to have more clients with private coverage. So these are like Airbnb owners who need like bulk laundry done, right, like their quilts and their sheets or something. Right. So we might just think this is a totally different market segment. So this has actually nothing to do with anything except for the fact you put these in different locations and that's not the case. Yeah. So Kirk, you and I are at the same laundromat, and I have Medicaid, and you have employer-based coverage. Our lives are wildly different. Our needs are wildly different. So the outreach opportunity for fabric health or for other types of outreach types of companies or nonprofits, look for the folks covered by Medicaid in the laundromats. Okay? One, there's a revenue opportunity, as I described earlier. And two, there's much more unmet need.

Kirk Kardashian: Wow.

Lindsey Leininger: So that that was the finding that I really, you know, when I go talk to researchers, what they nerd out about is that finding is the looking at the analyses within the same laundromat. What a huge marker of revenue opportunity and unmet need Medicaid statuses relative to other types of insurance coverage.

Speaker3: So we talked about.

Kirk Kardashian: Um, food insecurity. Um, what were some other unmet health related social needs that you heard about?

Lindsey Leininger: Yeah. So the digital divide piece, I mean, and some of the subpopulations based on health insurance coverage, up to 4 in 10 respondents did not have access to the internet. Now, we actually saw greatest levels of digital disconnection, if you will, among the dual enrollees. So those are the sickest, poorest people in society have the least access. So they're covered by both Medicaid and Medicare. And just the different programs pay for different services. And they are the least connected and they are the most vulnerable. Right. So I think that the digital divide piece of it just really kind of hit me between the eyeballs. Um, so that that one was really, um, really meaningful to me.

Kirk Kardashian: Yeah. And, um, what do you think can be done about that digital divide?

Lindsey Leininger: Well, that's a great thing. There are social programs. There are public benefits programs in Pennsylvania helping people connect up to internet. And we saw a lot of that in the pandemic. They pushed out money, um, for these sorts of efforts. And again, fabric was very intentional about only asking about social needs that they could help address. Yeah. So there is a public benefits assistance program that helps sort of bridge the digital divide.

Kirk Kardashian: Okay.

Lindsey Leininger: Yeah. So, um, I think when we think about community health in this day and age, digital health is a piece of it, right? Because if we think about the determinants of health, we think about health care. We think about social drivers like food, like, you know, places you air, you breathe. Yeah, these sorts of things. And then we also have to think about access to information. Yeah. That's a key determinant of health. And as we talked about earlier the front door to all this information is digital. So when I'm thinking about pockets who really lack access to digital sources. Um I'm worried, you know, we worry a lot about misinformation in this day and age. But with the populations I think can care about. I'm actually more worried about no information.

Kirk Kardashian: Yeah, yeah, yeah, that's a huge problem. Um, not having access to the information that you need to stay healthy.

Lindsey Leininger: To stay healthy, to keep your benefits.

Kirk Kardashian: Keep your benefits. Yeah, yeah. If you think about two people who work in who use laundromats, maybe this is an assumption in mind, but they might not have the kind of job where you can take part of your day to call your insurance company to, to get a problem sorted out.

Lindsey Leininger: 100%.

Kirk Kardashian: But if you have internet access at home, maybe you can log in after hours and, you know, fix something that's broken about your coverage, right?

Lindsey Leininger: You know, this is so true. And these are this is not a workforce that has access to the same sorts of benefits, like paid time off or just a flexible schedule, um, that those of us who work in universities, for example, you know, are lucky to enjoy. So to your point, one, bridging the digital divide so you can do it at home is hugely beneficial. Two those systems are so frustrating, right? Anyone who's wrestled with these digital front doors to public benefits has a story, you know, and, um, and I will tell you my story. So we had a wonderful woman who babysat our kids back in Chicago. We gave her an insurance subsidy as part of her compensation package, and I was helping her navigate these systems online, the marketplace, the Obamacare exchanges. And so we were doing this online. She kept trying to do it online. We ran into some errors as you do. She ended up on the phone with someone. That person sent her to a very unscrupulous health insurance broker who was trying to sell her an insurance product that was not covered by Obamacare, that did not have the basic benefits and protection. Oh, wow. So that's how wrong a digital front door can go. Now she had me. I am a healthcare, you know, quote unquote expert, whatever that means. I don't know if anyone can be an expert on healthcare, but I spend a lot of time in it. And so I got on the phone and like, that person heard a piece of my mind, right? But not everybody has.

Speaker3: A PhD in.

Lindsey Leininger: Health economics and policy, right? So I was pissed. I mean, usually I'm polite on the phone, but that was just, you know, so one the digital access is important. Two, the human savvy navigating is important. And that's what fabric health does.

Speaker3: Yeah.

Lindsey Leininger: Right. So they'll get on the phone for you. They will say no We sent you our income information. We sent you that W-2, you know, so these systems are both digital and human often. Yeah. And so I think the navigation piece of this is so critical. And what excites me about fabric health and about similar efforts is that they are doing this work like they are really helping people navigate these clunky public benefit systems, um, getting referrals to food banks, to childcare resources, to housing vouchers right there, doing that work on the ground. But that has a tech enabled touch.

Kirk Kardashian: Yeah.

Lindsey Leininger: So that's what's really cool. And if I can nerd out for one more minute, please. Um, so ours is a pilot descriptive study, but what makes me so happy is that it's coming out on the heels of a landmark, large scale, randomized controlled trial led by the centers for Medicare and Medicaid Services that demonstrate that adding this kind of resource navigation. Really benefits Medicare and Medicaid enrollees such that it lowers their emergency department benefits. Excuse me? Emergency department visits and their hospitalizations. Wow. So, you know, we have these cool data coming out from the community. And then we have this massive game changing, randomized controlled trial in the space. Like we think about randomized controlled trials for pills or devices. Right. But we have this beautiful randomized controlled trial evidence showing that resource navigation actually can lower emergency department visits, lower hospitalizations, which helps make the business case to invest more in companies like Fabric Health for people doing that kind of work. So, um, this is an exciting time in community health because we have novel models like Fabric Health, and we now have data that makes our business case for us, too.

Kirk Kardashian: Yeah, yeah, that's really exciting. I could see why insurance companies would be excited about it, because it's saving them money. Exactly. Like, um, not needing to pay for unnecessary care or care that could have been prevented.

Lindsey Leininger: Exactly.

Kirk Kardashian: Right.

Lindsey Leininger: Or dealt with in primary care. Right. And so now we have the gold standard type of evidence that this can be a money saver for insurers. And that gives us a revenue stream for community health organizations. Because remember where we started. It was like what's the market opportunity. Where's the revenue going to come from as health insurers? Right. And so now we have this great gold standard evidence that that this can actually work, that you don't have to do this out of humanitarian instincts.

Kirk Kardashian: Right, right. So would you say that's one of the key takeaways from this paper that that this, um, this model, this fabric health model, um, is, is reaching the right people, and it can be effective, uh, for, I guess, lowering health costs, but also improving people's health.

Lindsey Leininger: Yeah. So you know, this is not a treatment effectiveness study. This is a descriptive study about market opportunity. Right, right. So I think what we do compellingly for the first time is show that laundromats are worth the outreach effort.

Kirk Kardashian: Okay.

Lindsey Leininger: Right. So they're high need in terms of the clientele that they serve. And there's high market opportunity because there's a lot of Medicaid managed care insurers. So when we think about generalizing the results of this wonderful RCT data, we're like, okay, outreach works, navigation works, how the heck do we do this? And there are several narratives around there, right? And like, one of them is like smartphone like we're going to send people texts like, hey, you need help? Some of them are place based, like, let's go find them in laundromats, right? And that's where our data says, look here, look here. Like right now that we know this model can work, I think you're going to catch a lot of people. And there's a revenue opportunity to do this in laundromats. We've seen something similar in the past around barbershops. In fact, most researchers and public health people who I talked to this paper about are like, oh, this is like barbershops, but for moms because there's so many single moms in laundromats. Oh, wow. Um, so I think what our paper really does compellingly is demonstrate, like, hey, you can engage hard to reach people at laundromats, right? There's an opportunity here. So while we're thinking about all of the outreach strategies and all of the people we want to connect with health-related social needs, like you think of places like schools, you think of places like barbershops, you think of places like churches. Hey. Look here. Yeah, look at laundromats.

Kirk Kardashian: Yeah, yeah. Um. Looking ahead, do you plan on analyzing this data for other purposes, or do you or doing other similar types of studies?

Lindsey Leininger: That's our hope, right? So we hope that this is first of, of a series of, of papers, um, and I'm, you know, talking with Courtney and talking with her team. I've talked with the CTO, the chief technology officer. I'm. We're helping think like what measures should we collect? Both for business purposes, purposes but also research purposes. So I hope to have more to report out as time goes on.

Kirk Kardashian: Okay. Well we'll look forward to that. Well, Lindsey Leininger, thank you very much for your time. It's been great to talk with you.

Lindsey Leininger: Thanks for having me, Kurt.

Kirk Kardashian: I'd like to thank my guest, Lindsey Leininger. You have been listening to Knowledge and Practice, a podcast from the Tuck School of Business at Dartmouth. Please like and subscribe to the show. And if you enjoyed it, then please write a review as it helps people find the show. This show was recorded by me, Kirk Kardashian. It was produced and sound designed by Tom Whalley. See you next time.