Lirio is a company that provides an AI-driven behavioral engagement platform that uses personalized machine learning to guide individuals toward better health decisions and improved clinical outcomes. Pulse 2.0 interviewed Lirio Chief Behavioral Officer Amy Bucher, PhD, to gain a deeper understanding of the company.
Amy Bucher’s Background
Could you tell me more about your background? Dr. Bucher said:
“I call myself a behavioral scientist these days, but my formal education was in psychology. I earned my A.B. magna cum laude at Harvard, where I studied the influence of subtly communicated stereotypes on people’s behavior, and then went to the University of Michigan for my master’s and Ph.D. Looking back, I see I was always interested in how subtle environmental shifts can influence individual behavior.”
“After grad school I took a research job at a marketing agency focused on healthcare and knew I’d found my industry, if not quite my niche. Then I was hired at HealthMedia, a University of Michigan startup that blended behavioral science and technology to create personalized digital health coaching to support better health for patients. I was hooked! HealthMedia was acquired by Johnson & Johnson while I was there, giving me some incredible global and cross-sector industry experience, and I went on to spend time working for the Digital Innovation Lab at CVS Health after I moved back to Boston and then consulting as a behavior change design specialist for a design and strategy firm called Mad*Pow.”
“Across all of these jobs, I was able to apply behavioral science within the healthcare industry in support of helping people start, but more importantly, sustain behavior changes. At some point, I realized what I was doing was unusual and that other people wanted to learn it, so I published my book, Engaged: Designing for Behavior Change, in 2020.”
“I joined the team at Lirio in 2021. Lirio seems like the natural continuation of my earlier career steps – it uses cutting edge AI technology to personalize patient experiences, and behavioral science is the heart of our approach. I love that all these years later, I’m still working on crafting changes to the experience architecture that lead to behavioral impacts, and feel lucky I’ve been able to take advantage of an evolving toolkit to do it.”
“One of the things I love about Lirio is that even as we mature, we have a startup mindset. To be a Lirian is to be a (specialized) utility player. This means I have the opportunity to work on a wide variety of tasks any given day or week, digging in wherever I’m needed.”
“As Chief Behavioral Officer, I serve on our executive team and help set our corporate strategy, then lead our behavioral science team in bringing it to life through product innovation and outcomes. In terms of what this actually looks like, you’ll find me in lots of external conversations learning about the competitive market and customer needs and crafting how Lirio’s Precision Nudging can help accomplish complex healthcare objectives. Internally, I may be meeting with my team to discuss the logic model for a new intervention, review research findings and discuss implications for product design, or refine content and visuals for maximum impact. We also work cross-functionally which means contributing to platform requirements, collaborating with our AI team to infuse our algorithms with behavioral science expertise, and helping to develop case studies and product packages to improve our market penetration. Finally, my team is client-facing, and hyper-focused on ensuring that we’re supporting our clients in creating positive patient experiences that support outcomes, which means you may find us reviewing a scheduling action path, crafting patient education materials or call center scripts, or advising on the design of a patient support program. Every day is different!”
Favorite Memory
What has been your favorite memory working for the company so far? Dr. Bucher reflected:
“This is a really tough question! Many favorites are times I’ve been able to be in person with my colleagues. Two come to mind. First is a boat cruise the behavioral science team took on the Cumberland River last summer as part of our annual team strategy meeting. It was a great opportunity to take in beautiful weather and scenery while bonding as a team. The second would be when our executive team debriefed from our first investor meeting in Nashville. The meeting itself felt like a huge milestone because we were able to share the significant progress we’ve made since founding, and being able to celebrate that as a team afterwards was fantastic.”
Core Products
What are the company’s core products and features? Dr. Bucher explained:
“We call our core capability Precision Nudging. It is our intelligence capability which uses a combination of artificial intelligence and behavioral science to personalize outreach to people in order to achieve complex objectives like improved population health, patient engagement and retention, appropriate service utilization and associated cost savings, and the like. Understanding why people act is as vital as knowing who they are – that’s what makes the combination of behavioral science and AI absolutely necessary to drive meaningful change. We do this by nudging people around a set of healthcare behaviors that ladder into these meaningful outcomes, which requires us to orchestrate across a universe of possible behaviors and then construct individual nudges that tap into people’s reasons for taking action . . . or help them overcome their barriers. Our ultimate goal is to empower people to be their own health champions and captains. As we nudge people over time and across behaviors, we generate a new knowledge set around their behavioral determinants that comprise our Large Behavior Model.”
“To make it less abstract, imagine that you have diabetes, and your insurance company is working with Lirio to improve population health. They may have a goal to reduce the proportion of their members with diagnosed diabetes who have an HbA1c above 9, consistent with 2030 Healthy People goals. Our Precision Nudging would take account of your health history, engagement with healthcare to date, and other profile factors that might influence your health behaviors like where you live or your financial means, and begin to present you with opportunities for action.”
“The set of behaviors we’d nudge might include clinical encounters with your providers, measuring your blood sugar and taking medication according to your provider recommendations, picking up prescriptions or switching to mail order, consuming diabetes education, improving your diet, increasing physical activity, and having specialist visits like eye exams and foot checks. Which specific behaviors we nudge at any given time, and how we nudge you, would be intelligently determined by our algorithms based on the behavior’s importance and your propensity to respond. So you might receive emails with easy scheduling links when it’s time to see your doctors, quick text messages to remind you to check your blood sugar on days you haven’t already logged, and push notifications on your phone to encourage a brief walk to meet your step goal. We meet people where they are–and where they are headed. By evolving with each patient across their health journey, we deliver personalized nudges that inspire action when it matters most.”
Challenges Faced
Have you faced any challenges in your sector of work recently? Dr. Bucher acknowledged:
“From a 10,000 foot behavioral science field perspective, there are so many challenges working with a science that is still finding its stride. We’ve experienced a reproducibility crisis as well as high profile malfeasance with faked data and publications which can shake confidence in the approach. There’s also been discussion about whether nudges work given their small effect sizes when applied across broad populations. We are actively working through these challenges by doing our work as transparently as we can, being judicious about the evidence we use, and scrutinizing data to adjust our approach. I also firmly believe that the small effect sizes of an individual nudge are not a problem as long as we remember that nudges are meant to be applied within larger systems in tandem with other tools, and work best when personalized for the recipient and context. It’s silly to expect any one nudge type or behavior change technique to be a magic bullet given how wonderfully different people are and how affected we are by context.”
“From a Lirio-specific point of view, there are always challenges with using an approach like artificial intelligence and balancing its needs against other considerations. For example, AI does best when it has a lot of data to work with, but many healthcare companies are understandably cautious about sharing more data than is absolutely necessary. Thinking of the individual end user, people appreciate the benefits of a really personalized approach but also find it creepy when a technology knows more about them than they expect.”
“We approach the data challenge in a few ways. First, we prioritize data security. We have earned and maintained our HITRUST CSF certification and our SOC-2 Type 2 attestation, and developed an industry-leading AI governance approach. Second, we focus relentlessly on user experience and continually conduct research with patients to understand how we can develop content that hits just the right level of personalization to be effective without being unsettling. Fortunately, people do expect their healthcare organizations to know something about them, so the sweet spot can be quite personalized.”
Evolution Of The Company’s Technology
How has the company’s technology evolved since its launch? Dr. Bucher noted:
“Reinforcement learning has always been a core part of Lirio’s technology story. One of the big shifts has been how we design our behavioral logic models in order to create machine readable content libraries that work well with a reinforcement learning approach. Where initially the focus was on creating large and broad sets of behavioral science content, we’ve since evolved to embed specific characteristics aligned with behavioral science models into our content. Everything we write is suited to purpose and can be tied to specific behavioral science techniques, mechanisms of action, behavioral determinants, and demographic probabilities. This means that our AI can go beyond the semantics of the content in its selections and recognize meaningful patterns in the content that influences behavior.”
“Our platform has also grown much more sophisticated in recent years. For example, we now engage patients in bidirectional communications that help direct them to information or resources that support behavioral conversions. We are leveraging some generative AI as well as natural language understanding to communicate with patients. Not only can we use patients’ replies to nudges to help select meaningful content, but we can also analyze their intent to better train our agents to deliver optimal nudges for each person. By prompting people to self-motivate to take healther actions, we amplify human agency and encourage healthier living. With our international work, you will see some of our recent innovations in acculturation and multilingual deployments. And since we recognize our nudges are most powerful when incorporated into an overall journey, we have diligently worked to integrate with systems such as Dynamics, Epic, Salesforce, and Oracle Health’s Cerner in order to create seamless experiences for our clients and patients.”
Significant Milestones
What have been some of the company’s most significant milestones? Dr. Bucher cited:
“We recently launched our first international technology client with a Precision Nudging implementation in Costa Rica and others to follow in the Middle East and Asia. I’ve long loved international behavioral science work, so this is fulfilling personally, but it also signals the global impact Lirio is poised to have.”
“Our technology is also advancing fast. Lirio is also now listed on the Epic Showroom and Microsoft Azure Marketplace, both of which testify to our commitment to investing in technology infrastructure. We’ve rolled out bidirectional communication capabilities over the last year or so along with natural language processing AI that extend us into the conversational design space. And we’ve invested in increasingly sophisticated behavioral science logic models that enable a type of AI-driven personalization I haven’t seen anywhere else.”
“Throughout this process, we’ve stayed grounded in our belief that technology should enhance–not replace– the human connection. That belief shapes how we design our workflows: to support care teams and encourage healthy actions that feel personal, timely and relevant.”
Customer Success Stories
Can you share any specific customer success stories? Dr. Bucher highlighted:
“Definitely! I am really proud of our work in cardiometabolic conditions, and we’ve seen great success in getting people with diabetes and hypertension into needed care and ultimately better health. In one case, Lirio’s Precision Nudging resulted in 60% of a cohort of unengaged patients who hadn’t received any care for 3+ years completing at least one primary care visit, which delivered a significant ROI and helped improve patient health. In another cohort of patients with diabetes, 52% achieved clinically meaningful HbA1c improvements within 6 months. We’re also currently working with one health system’s high risk hypertension clinic and have seen 37% of patients with meaningfully improved blood pressure within 9 months after receiving a Precision Nudge. A lot of our innovation work is focused on supporting chronic condition management with at-home behaviors like biometric monitoring, medication adherence, and lifestyle changes, so I see huge opportunity here.”
“I’m also very proud of our vaccination work, especially with the challenges of a global pandemic and the subsequent politicization of vaccines. We worked with a major retail pharmacy in the last several years and were able to get tens of thousands of older adults vaccinated against RSV when the new vaccine became available, and hundreds of thousands of people vaccinated against flu, COVID, and other diseases. We exceeded the performance of some of the best nudging work out there in the scientific literature and earn our client strong market share. This work is meaningful for public health and demonstrates how personalization can amplify already strong behavioral science approaches.”
Total Addressable Market (TAM)
What total addressable market (TAM) size is the company pursuing? Dr. Bucher assessed:
“Looking at the patient engagement market size, the total addressable market for Precision Nudging in the United States is upward of $80 billion annual within the next few years. However, we believe the actual market is much larger if you consider global opportunities and the value that Lirio can deliver in terms of meaningful health outcomes and ROI.”
Differentiation From The Competition
What differentiates the company from its competition? Dr. Bucher affirmed:
“I knew Lirio was different as soon as I began interviewing to join. I’ve never encountered another company that centers science the way Lirio does, nor have I ever had the opportunity to work with a cutting edge technology approach like reinforcement learning as a personalization tool at any other company. Lirio has built the only platform in healthcare capable of delivering deep personalization at scale. Not only do we not have to argue that behavioral science should be considered in designing digital health tools, it’s taken for granted that behavioral science will take the lead.”
“Another thing I love about Lirio is the shared thoughtfulness and mission-driven mindset of our teams. Since this was my first foray into an AI company, I asked every senior leader during my interviews about the ethics of what Lirio does. Each person I asked had clearly spent time thinking about doing this work in the most ethical possible way. I’ve found that we continually wrestle with using AI and behavioral science in a way that truly benefits people and it drives many of our decisions. I’ve also found that most Lirians, including myself, have a personal story about why it’s important to them to work in healthcare and empower people around their health. It means the company culture remains focused on the human impact of our work, not just creating business value. It’s special.”
Future Company Goals
What are some of the company’s future goals? Dr. Bucher emphasized:
“Lirio’s 2025 theme has been ‘Growing Global.’ That’s a great catchphrase for our ambitions; we want to continue our expansion beyond the United States market to support patients globally.”
“In terms of our product, you’ll see continued rapid expansion of our intelligence capabilities into new touchpoints and systems. We believe Precision Nudging is most effective when it powers a holistic health journey across the places people live, work, and play, so watch for our intelligence layer working with wearables, apps, enterprise software systems, etc. As we work with more partners, we can also provide a continuity of experience for people who manage their health across health systems, pharmacies, insurers, and consumer tech.”
“A personal goal for me as a behavioral scientist is to accelerate our scientific contributions. As a scientist, I think it’s essential to share our research innovations so others can benefit from them, and I believe this can be done without threatening our commercial advantage. My team of scientists are skilled researchers and communicators and I hope you will find us publishing and speaking about our work.”
Additional Thoughts
Any other topics you would like to discuss? Dr. Bucher concluded:
“Lirio gets categorized as a patient engagement company, but I think we do ourselves a disservice if we limit ourselves to that. Obviously I think engagement is important; my book is called Engaged! But really what we are doing is empowering people so they can engage with their health – not us. I don’t care if someone keeps engaging with Precision Nudging indefinitely if we’ve been able to help them overcome their behavioral barriers and effectively engage with their holistic health needs. By honoring human difference, respecting individual agency, and reinforcing healthier behaviors, we’re nudging people to improve their lives, one decision at a time.”
