While I do not opine on healthcare-related services and innovations with any great regularity, the sector is so complex and fraught with acronyms that I feel a bit out of my depth, a couple of things recently caught my eye that I thought were worth mentioning.
The first involves the concept of “direct primary care”, i.e. cutting out the insurance middleman, in an effort to extend care, reduce costs, and improve outcomes. In a June 19th article on TechCrunch entitled “The Most Important Organization In Silicon Valley That No One Has Heard About” – http://tcrn.ch/kHXEu2 – Dave Chase introduces us to Dr. Samir Qamar and his startup MedLion – http://medlion.com. Chase does an excellent job of framing the perverse role that “insurance” has played in regards to healthcare.
“It is a relatively recent phenomenon to have day-to-day medicine paid for through insurance. Unlike all other forms of insurance designed for rare events, insurance became encumbered in day-to-day healthcare (i.e., we use insurance for the healthcare equivalent of getting one’s car tuned up where we wouldn’t dream of using insurance). The result has been what some call a 40% “insurance bureaucrat tax” unnecessarily adding to the nation’s healthcare cost burden.
Fortunately, pioneers such as Dr. Qamar have shown there’s a better way. Dr. Qamar originally setup a concierge medicine practice catering to the well-healed. He remains the House Doctor for the world famous Pebble Beach Resorts. As much as he has enjoyed his Pebble Beach practice, Dr. Qamar wanted to serve a broader population so he opened a practice with a dramatically lower price point. For only $49 per month and $10 per visit, MedLion is able to provide high quality medicine at a price point nearly any family can afford.”
Dr. Qamar states, “For the same amount they may pay in co-pays with an insurance policy, we can offer complete primary care without the added cost burden of insurance. We believe that a farm worker deserves access to primary care just as much as an executive at Pebble Beach.”
Having eliminated the “insurance bureaucrat tax”, Dr. Qamar and his colleagues have also freed themselves of insurance company reimbursement rules written with the 20th century in mind. You see, insurance companies pay physicians for face-to-face visits with their patients, this in spite of the fact that Dr. Qamar finds that more than half of his patient interactions are via electronic means. By cutting down on the insurance industry’s antiquated, in-person, fee-for-service business model, patients gain the added benefit of more promptly gaining access to their doctors – no waiting three weeks to be seen – as well as wasting less time in the actual waiting rooms themselves.
While Dr. Qamar aspires to make primary care available to a greater number of people, he also aims to enable primary care physicians to make a healthy living outside of today’s insurance-centric model. With alarms being rung regarding a potential shortage of primary care docs throughout the country – see http://nyti.ms/jHy7Rc – any developments that help bolster the number of primary care physicians is welcome. From the TechCrunch article:
“Studies have consistently shown that the higher the percentage a country or a county in the U.S. has patients with a “medical home” (i.e., one has a specific primary care physician they go to), the better the health indicators are. A byproduct of these better health indicators is less money is spent on healthcare. Denmark has had so much luck with increasing primary care that they have reduced the number of hospitals in the country by over half – they simply weren’t necessary anymore.
In the U.S., the early results are similarly promising. That is, by deploying a more primary care centric model, a pilot program is Ohio has shown it can save $500MM per year just in their Medicaid population with diabetes once they scale the pilot. As Bill Gates’ recent TED Talk on State budgets highlighted, these are monies that can remain in education rather than a further draining of education budgets. At a time when Silicon Valley needs more education, not less, this is critical for the future of the industry.”
Shifting gears a bit, while also acknowledging that insurance companies will be a part of the healthcare delivery system for the foreseeable future, a number of startups have recently popped up to help us keep track of our medical bills. The overarching idea/pitch is to do for medical-related paperwork what Mint – https://www.mint.com – has done/is doing for personal financial paperwork. While fraught with privacy challenges, HIPAA is no joke, I think that the idea has merit, especially in an environment where more and more costs are being pushed down to the consumer, to say nothing of personal Health Savings Accounts (HSAs) or Health Reimbursement Accounts (HRAs). Two promising startups in the field are Simplee – http://simplee.com – and Cake Health – https://cakehealth.com. From a TechCrunch profile of Simplee – http://tcrn.ch/lCezqu:
“Just like with Mint and your financial accounts, you give Simplee access to your medical insurance accounts. It then brings in all of your medical, dental, and pharmacy bills and presents them in an easy-to-understand dashboard. Simplee tells your total medical costs, how much you’ve paid out-of-pocket, your deductible, and how many doctor’s visits you and your family have had.
This is all pretty basic information, but health insurance statements are so obtuse that most people have no idea how much they spend on health care. I know I don’t. Simplee does a good job of breaking it all down and showing you what you’ve spent, how much your insurance has paid, what you’ve paid, and how far along you are towards your deductible. It does this for every member of your family under the same insurance plans.
Simplee lets you drill down to individual claims to see what your insurance paid, the negotiated discount, and what you owe. It’s like a statement of benefits that actually makes sense. Simplee currently supports eight of the largest health plans in the U.S (including Aetna, United Healthcare, Cigna, Empire BlueCross BlueShield, and BlueCross BlueShield of California), and is adding more every week.”
Cake Health’s pitch is very similar. Both are part of what the kids are calling do-it-yourself (DIY) health reform. More on that here: http://tcrn.ch/jKSjmX.
