Launch HN: Shift Health (YC S19) – Understand Your Healthcare Costs Pre-Visit

[Hydrick3232]

Hi HN,

We're Lance, Lance, and Dallin (Yes...2 founders named Lance :)). We are the founders of Shift Health (https://shifthealth.io). We help patients understand what they will owe pre-visit and provide flexibility to pay overtime.

Purchasing health care is unlike anything else you buy in our society today. You wouldn’t expect to walk into a grocery store, take home a loaf of bread not knowing the price and then receive a surprise bill 3 months later. So why is this the standard experience for buying health care services? The surprising thing is that the standard experience for doctors offices is not much better. Antiquated billing processes compounded with the fact that patients are responsible for more and more of the bill out of pocket is creating a scenario where doctors offices are only collecting 40% to 60% of the patient out-of-pocket responsibility. We partner with doctors offices to tell patients what their expected out-of-pocket price is before they see their doctor and provide flexibility to pay overtime. Our mission is to make healthcare costs understandable and affordable for all.

We all met working on a marketing venture together that we have since exited. While working on our marketing company we carved out time each Friday to discuss big problems that we had the right talents to solve. Those Super Duper Friday’s (as we called them) were really valuable for us. Lance R. (Rodela) has worked in healthcare tech for most of his career (Medicity, Aetna, SolutionReach), and he cued us into the trend of High Deductible Health Plans (HDHP’s). These plans are being rapidly adopted and are having adverse impacts for patients and healthcare organizations. Patients owe more and more out of pocket (up 12% just last year), and healthcare organizations are ill equipped to collect effectively from patients. We set out to validate the problem, and everyone else we talked to agreed that medical billing is almost never a positive experience. So we set off to fix it.

Even with Rodela’s background we didn’t realize how hard this was going to be in the beginning. Healthcare has been very resistant to disruption to date. Antiquated legacy systems abound, political lobbyists hover over everything and administrative staff have to be extra cautious not to find themselves on the wrong side of countless regulations and legislation. In short...it’s gnarly. Not sure if it was insanity or inspiration that drove us forward, but onward we went. First, we went out and talked to clinical leaders near us. It did not take us very long to find an excited pilot partner to innovate with us. We did a lot of discovery work with their billing, front office, and operations teams to understand their workflow and requirements. Next we spoke with dozens of patients to better understand their needs, pain points, and challenges. Once we had a firm grasp, we presented mockups and prototypes to the clinic and to their patients to refine an MVP. Finally, we set to work constructing our solution.

As we neared completion on the MVP the next hurdle (prior to even getting launched) appeared. We needed to integrate with the practice’s Electronic Medical Record (EMR) system. Fortunately, our partner had a strong relationship with their EMR provider, which saved us months of what would have otherwise been frustrating back and forth. Whew… we made it, right? Yup! Well, we made it to stage one at least. We launched the pilot and saw excellent feedback from both sides. Patients would text us saying “I love love love this” and our pilot partner saw patient collections grow by 30%.

We are not stopping there though. To build the best estimations we needed to build into insurance networks and more, and that is what we are pioneering today. There is still a lot of tech to build (calling all health tech pros hungry to work on something big!), but we are excited to announce that today we are able to text obstetrics patients 48 hours before their appointment how much their care will cost them out of pocket with 95% accuracy.

Healthcare payments have been a giant mess for a long time, but all of this is approaching a massive tipping point for change with 3 important market forces:

1. Financial Forces: Due to the rapid adoption of HDHP’s, patients are financially responsible for more of their bill. Doctors offices are ill-equipped for this paradigm shift and are collecting less (40%-60% of patient balances are written off). Patients want to know their costs ahead of time, and we have proven that doctors will collect more when they communicate ahead of time and provide flexible payment options.

2. Social Forces: Healthcare costs and spending has been catapulted to the center of the upcoming presidential debates, and an executive order requiring price transparency in the United States was signed in June 2019.

3. Technological Forces: Platforms are emerging providing more health data access than ever before.

I've recently seen some posts on HN about the executive order and price transparency (https://news.ycombinator.com/item?id=20275097) so we’re looking forward to a really good discussion.

Please reach out with your ideas, help, and connections!

[sidlls]

How is your service different from the many other players in this space that have failed or are struggling to succeed?

To provide context: price transparency is basically a commodity, and the actual prices a patient will be deemed to owe for services rendered isn't just hard to predict, it's sometimes literally not possible. I've worked in this space for years. The problems with this industry aren't technology problems, they're people (political) problems. From what I can see, your company isn't actually doing anything that isn't already available and in some cases implemented. That's the motivation behind my question.

[jaredhansen]

>The problems with this industry aren't technology problems, they're people (political) problems

This is an underappreciated insight. I am working on something in a related field and I appreciate your insight here. I'd like to discuss with you at your convenience, but don't see any contact info in your profile. If you're up for more detail, can you please drop me a note via email in profile? Thanks!

[lawlorino]

> The problems with this industry aren't technology problems, they're people (political) problems.

This is a great point that I feel could be copy pasted to a lot of Show HN business ideas. This SV bubble mindset is that everything is an engineering problem and can be solved with some kind of tech, ignorant of understanding the real root of the problem.

Edit: Relevant XKCD https://xkcd.com/1831/

[Hydrick3232]

Great question. A lot of early success for us has been through our fully automated and integrated billing approach and our ability to communicate a customized estimate for a patient pre-visit. Also, timing plays a huge roll in success. Never before has there been such an emphasis on creating a retail like experience in healthcare.

[Hydrick3232]

Good to get the context. Yes, legislation will definitely help but we feel that technology can definitely make a large difference in healthcare.

[sourc3]

I was part of the founding team of a startup that did exactly this about 2 years ago. I wish you the best of luck but sales cycles are excruciatingly long and the larger players that are working with razor thin margins may find the 4.5% bit too expensive. Happy to chat and best of luck with the startup!

[Dpalm]

Thanks for the well wishes! We believe that the timing component is really important, and there is evidence that the winds of change are blowing right now. Would love to learn from your experience.

[treelovinhippie]

The US is an absolute joke of a country. Just vote candidates in who will make universal healthcare a reality rather than spawn new industries to further extract value. /Australian

[bhupy]

This is a solid step towards making universal healthcare a reality. Remember, universal healthcare != socialized healthcare. The US has “universal food”, as does Australia. Food isn’t just “free” for everyone.

[gigatexal]

That won’t change the costs if anything it will make them rise and rise faster. You have one payer: one large, infinitely wealthy entity paying the bill it’s human nature for participants to jack up rates

[technics256]

Awesome work. Are you planning on integrating with multiple EMR systems or just insurance systems themselves? What are your thoughts on Epic's AppOrchard etc, or FHIR?

Good luck, I work in the health tech space....it's "fun" ;)

[Hydrick3232]

We are planning on integrating with multiple EMR's to make sure we're able to offer a fully automated, fully integrated approach to practices. I love the steps Epic is taking to open up API's. My hope is that more EMR's will follow suit. Healthcare is fun...and challenging :).

[godelski]

Since there's a non-zero chance that America does get single payer healthcare in the next 5-10 year how would your company adapt? Or are you gambling that it won't happen (I would understand this gamble, because if it doesn't happen then this could be extremely useful to consumers/patients and is really needed).

[systemtest]

I'm from the Netherlands and I like this website. For us it can take months before you know how much your hospital visit will cost you. I broke my arm a couple of years ago and it took 6 months for the bill to arrive. I maxed out my €885 deductible, an additional €65 for uncovered medicine and €20 for the sling. I sort of knew this so I could save up for it but knowing this up front would have made me less nervous.

[Hydrick3232]

At this point the gamble is that Single Payer won't happen. There's a chance but we think it's slim. Our bet is that we're positioned well to take advantage of the recent Executive Order.

[surfmike]

Most candidates still support keeping private insurance and making Medicare 4 all one of the available options.

[ceejayoz]

> Doctors offices are ill-equipped for this paradigm shift and are collecting less (40%-60% of patient balances are written off)... our pilot partner saw patient collections grow by 30%.

I'm not seeing how a mission of decreasing patient costs fits with these stats.

[tl]

"Cash pay only" doctors compete with the existing system today. With the rising upfront costs each year, there's an increasing trend of a cash pay doctor's office visit being cheaper than the co-pay of your insurance provider.

Why this is true a separate discussion (possibly overhead of dealing with the healthcare system or insurer).

[Hydrick3232]

Ultimately more transparency leads to more competition which leads to lower costs.

[paulddraper]

Medical billing is very complex. Others have tried and shown mediocre results.

So 95% accurate is very impressive!

Anything you attribute the reliability to?

[Dpalm]

That is part of the secret sauce ;) And your right, this is all painfully complex!

[thiscatis]

Congrats on the launch even though this feels like a "faster horses" solution instead of something like, I don't know, universal healthcare like the rest of the developed countries (and actually also non-developed).

[bhupy]

Remember, universal healthcare != socialized healthcare. The US has “universal food”, as do most developed nations. In these countries, food isn’t just “free” for everyone.

[chintan]

Hey guys - this is a great initiative! Something i have been so frustrated about the current system. We work with large medical centers in clinical trials space (and worked with hl7, fhir, cqm, hipaa etc) - happy to help in whatever way i can. My profile has my contact.

[Dpalm]

Thanks so much for the offer! Would love to learn from your insights.

[novalis78]

Good luck guys! Any attempt to better this abhorrent mess gets my biased upvote.

[Hydrick3232]

Thank you! We're looking forward to tackling this head on. Appreciate the support!

[yding]

This is great. Healthcare is a mess. Glad you're working on fixing it.

[Hydrick3232]

Thanks! We agree healthcare needs to change. We're excited to be a part of that change.

[davedx]

Typo in front page:

We integrate with with over 50 EMR systems

(extra with)

Good luck!

[ftyers]

why is this even a thing. just use the NHS.

[systemtest]

You don't have healthcare cost under the NHS? I'm Dutch and I have lots of healthcare costs. A bit over €3000 in tax, €1100 in insurance, €885 deductible, €300 dental, €300 physiotherapy, €50 in uncovered medicine.

I would love a website that broke these costs down for me in a logical way so I could streamline my personal finances.

[Dpalm]

Only about 9% of the population is "literate" when it comes to health insurance. There are definitely some super users out there who can find tools and use them, but for most of the population we need to provide simpler tools and more straightforward explanations on their benefits and costs. That is where we come in.

[usaphp]

What is going on with a source code of that simple landing page? It's over 11Mb in size. Also you have over 500 declarations of @font-face, and inline css is just bizarre. I would recommend you taking a look into that, it's not good.

[Hydrick3232]

We'll look into it. Thanks for the heads up.