Interview with Matthew Epperson, Business Director, Savvy Co-op

Could you tell us about yourself? How did you first get involved in working with cooperatives?

In 2009, freshly arrived at university in the southern United States (Athens, GA), I was introduced by a friend to my “gateway co-op,” Daily Groceries Co-op. I quickly became both an avid shopper, then working member, and then supervisor to the member labour program which operated this 1,400 ft2 (about 130 m2) grocery store. It was here I learned that I loved to educate members on the meaning of cooperation, teaching not only how to operate a cash register, but more importantly, what it meant to “own your labour and rent your capital” in a cooperative context. I later served on the board, and from there decided to pursue graduate studies in cooperative management through a Master’s of Management: Co-operatives and Credit Union program physically based in Halifax, Nova Scotia, which I attended virtually from 2012-2015. For my capstone project I focused on the state of cooperative technical assistance in the US South, identified a need, and thereafter in 2017 founded the Georgia Co-op Development Center to provide assistance to startup cooperatives across the state. I helped about 50 different cooperatives between 2017 and 2022, when I stepped down as Executive Director, and helped secure our first funding source: the Rural Co-op Development Grant of the US Department of Agriculture. I am the son of a career postal worker trade unionist, and a stay at home Mom, who always instilled in me the importance of finding work with dignity, and it’s been my honour to serve the cooperative movement these past 14 years.

What is the Savvy Cooperative about? Who are its members? How does it work?

Savvy Cooperative began as a platform healthcare research cooperative in 2016, when founders Jen Horonjeff and Ronnie Sharpe had the idea to help democratize access to health influencers in the United States, via a cooperative platform. In 2018, Jen and Ronnie enrolled Savvy Cooperative in the start.coop accelerator, thereby joining its inaugural cohort of startups. Later that year, Savvy Cooperative became one of the only cooperatives in the US to have taken on venture capital – on cooperative terms.

Savvy exists to both change who has a seat at the healthcare table in the US, and to add more seats, particularly for patients of color, advocating for the patient voice to be heard in the development of digital health applications, clinical trials, and more. We say #askpatients because we know there is both a business and moral case to be made for our clients to speak with patients, through Savvy, and to do so in a way that is respectful, properly remunerates patients as experts, and respects the ownership and proper use of any data they provide in research studies. We’ve even helped the American Medical Association better understand patients’ perspectives on privacy.

As a multi stakeholder cooperative, our members are patients (with majority dividend rights, and board representation), followed by the workers, founders, and finally non-voting investors. More or less, anyone can create a profile on our application, find a study and sign up (if they match the study inclusion criteria, i.e., they qualify for what we call a “gig”), and be paid for their time and participation, and/or receive a referral bonus for referring a qualifying patient to the study. While membership in our patient category is currently closed, we are still tracking the patronage of all patients who enroll in a study with us, whether they are members or not.

What are the main issues that Savvy cooperative aims to address for its members?

Savvy aims to address the access problem that exists in the US healthcare system today. It aims to help right and balance the power dynamic between medical patients and other system stakeholders such as pharmaceutical companies, health systems, and insurance companies. We do this by paying above fair market value for the insights contributed by our patients in our studies. We also hold our clients to strict standards of respecting that patients own their own personally identifiable information. They know that they may only use any such data in the ways which patients are aware of, and compensated for, and restricting any additional solicitation attempts that may arise from a client following a gig. We believe healthcare will improve for all stakeholders, the more power that can be garnered by patients through Savvy.

How do you think member-owned entities, like cooperatives, can help in co-creating innovative solutions in health care?

Healthcare in the United States is kind of like the “wild West.” In the absence of either strong government regulation, or organized patient, provider or other stakeholder power, many companies have pursued extractive profits from patients, and created products which either don’t solve patient needs, or do so poorly. Often, too, data is used and sold in ways that patients are unaware of, and would not approve of, or, are aware of, but feel powerless to address. But like any extractive industry, cooperatives in healthcare hold the power to address injustices in our system by disrupting the normalization of investor-owned firms reaping extractive profits from patients. Healthcare cooperatives can help rebuild trust in our healthcare system by doing better, consenting transparently, paying fairly, treating patients with respect, and delivering better health care goods and services that really address patient needs. Because we are more trusted entities, we can listen and hear more when we ask patients what they need, and thus solve more problems. We can also practice “truth and reconciliation” in the face of medical racism, by addressing the fraught history of medical experimentation and support of structural racism in the United States, and taking a reparative lens, creating more and more healthcare entities which center patients of colour in the delivery of healthcare.

Healthcare co-ops can innovate in the form of direct primary care clinics where doctors provide direct services to patients, without the need of insurance companies. Co-ops can pool funds and cost-share the expenses of healthcare, and can make health insurance (or quasi-health insurance) companies which cover claims fairly, and honor the direction of providers and patients, even when those directions may be more costly. We can form cooperative hospitals that are owned by citizens, as well as providers. Our system is in need of a revolution, and where the illness is extractive profit, cooperation is at least integral to the cure.

What are the challenges you think cooperatives in health care sector face? What is needed for a more conducive environment for cooperatives in the health sector?

I think cooperatives in the US healthcare sector face challenges on all sides, but primarily ours is a “first mover” problem. Most of the areas of healthcare lack cooperatives at present, whether that’s organizing patient purchasing demand, provider services, pooling costs, or performing research and development. Many home health cooperatives are left waiting far too long for too little money in reimbursement from the government for services performed. We seem, also, to lack the capital necessary in order to take on the giants of healthcare.

We absolutely need organized economic as well as political power in order to, for example, pursue more government partnerships to help curb costs on life-saving medications like insulin. We need patients, and doctors, and payers, to cooperatively organize with a mindset of “sufficiency,” and “wellness” rather than just growth and profit. There needs to be an incentive model that rewards wellness, not sickness (which is addressed by the direct primary care model, for example). There are many innovative attempts happening right now in healthcare in the US (and I credit the folks at the Lift Economy for opening my eyes to some of the initiatives cited herein), and I believe what is lacking is the coordination, and capital, for co-ops to compete with extractive capitalism in the healthcare system. We also need to be more boldly experimenting, and telling the stories of healthcare co-ops (whether startups, or conversions as in this case study with Kaiser Permanente), even those that have wound up, so that we can continue to learn, iterate, and disrupt the normalization of healthcare as wealthcare in the US. The many strides cooperatives have made in areas like banking, utilities, retail and agriculture can and should be made in healthcare – the need is urgent.