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First of all congrats on the launch, we need more innovation in the space and I applaud your efforts. Here are some thoughts / questions if you want to answer t
by pierre 5y ago
First of all congrats on the launch, we need more innovation in the space and I applaud your efforts. Here are some thoughts / questions if you want to answer them
> We have [...] benefits that exceed the best plans from legacy insurers.
You claim that your product is better than some of the competition, but do not demonstrate it (here or on your website). At this point it seems to me that every insurer claim that they have the best plan with no way for me to know easily.
I think the key issue of the industry as a whole is that there is no way for client to compare insurance product beyond pricing. A product that could look better at covering lenses for example because it cover up to $2000/year vs another that cover up to $350 may actually be worse because of some widely applicable exclusion written into the contract.
What are your thoughts on this point?
> On top of that, we reduce premiums by up to 20% for employers. We can do this because we are a software company that owns an insurance carrier. We automate roughly half the tasks involved with claims, care coordination, underwriting and back-office operations. We aggregate data from disparate sources (claims, clinical, pharma, lab, and wellness data) to make superior decisions and aid patients. Our technology helps members identify and treat conditions earlier and more effectively. We also have a much better user experience—a single portal to access telehealth, care concierge, claims data, wellness plan, doctor lookup, rewards card, etc.
You claim to be able to reduce cost because of your tech, and I believe compare to legacy carrier, your IT / Process are cheaper to run today (I believe that legacy carrier spend ~5-10% of their revenue on IT). From my observation the insurance industry is quite bad at getting ride of legacy systems (for compliance, once you decommission a system you sometime need to prove that the new system run the old policy the same way, or just because to many process optimisation software has been build on top of the legacy system making it extremely costly to sunset).
How do you plan to maintain this cost down once you extend to new states / product /over time, to keep this cost advantage?
> Since half of Americans get health coverage through their employer, we’re focused on companies to maximize impact.
I understand that B2B distribution is easier than B2C, but this can go against your mission of changing healthcare incentives for mutual benefits. You customer are the Employers, and their incentives are to reduce cost and to maintain their employee healthy short term, whereas employee would like to have better access to healthcare (higher cost) and to stay healthy Long term.
How will you find balance here? What happen when a a major client as you to cut cost for their plan to the expense of the employee coverage and you need to keep them as a client to keep the company afloat.
- jstartz26 5y agoProduct comparison: that’s fair – only so much you can fit in an announcement post. We completely agree it is difficult to compare benefits (even for competent HR departments) but it is even more confusing for individuals. We try to make this clearer and transparent when working with employers during the quoting process. Benefit coverage gets boiled down to “actuarial value” and quantified as a number relative to the benefits mandated under the Affordable Care Act. This is presented alongside the financial quote and compared to competing bids. It also helps to actually read through our Schedule of Benefits Coverage– even at the individual level it is apparent what the differences are in our benefit plan vs every other SBC we have seen. If you were to judge the quality only by price (all else equal), underwriting for this segment is done at the employer level – so savings can vary significantly from company to company. We’ve had quotes that matched other bids, and we’ve presented offers as much as 35% less (on a cash basis, not actuarial) than other insurer’s annual price hikes. Overall, I cannot agree more with your comment that comparison is hard. There is not a lot of transparency in this market segment because of the unique considerations that go into underwriting each group. Plus, a lot of the companies (startups included) that people find appealing are playing games with coverage, especially playing around with deductibles and copays. It’s currently very difficult to make it super clear without just sitting down with the person/employer and talking through the benefits.
- pierre 5y agoRegarding product comparaison it is possible to build a computable model of your policy and the major competitor, and from there automatically benchmark them to find key difference in coverage (what is the maximum delta) or running them through a set predefined claim scenario. It will however require ~3-5 day of work per policy to build the models. Beyond the marketing effort this models can also be reused for risk management / claim management / leakage prevention if implemented right.
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