Chief Medical Officer - Oregon Health Authority
Senior Vice President Population Health - MODA Health Plans
Board Certified Radiologist
Healthcare Focused MBA
Co-Founder - Dermio Teledermatology
Consultant - Spry Health
MD physician with experience starting a health insurance plan, a telemedicine start-up, and running a state Medicaid health plan. I can help you learn how to approach healthcare payers and providers to use your product and services.
I know there are a number of healthcare incubators in the US such as Start-Up Health. This is a community of healthcare start-ups with some connection to the delivery system entities in Avia.
Yes, I think in general you should think about "government," "professional society" and "industry" regulations or standards. For instance, take an MRI scan. The government, i.e., CMS, will approve an MRI for payment, a professional society such as the American College of Radiology may need to be the entity to develop what the definition of delivering an MRI is, and an industry entity may define specific parameters around what the technical pieces are for an MRI. The takehome message is you should keep this framework of government, professional society and industry in mind when communicating messages around healthcare. Each may have a different take on the service/product.
The web site Patients Like Me is a great place for you to gain access to a network with the specific conditions you are looking for. Also, you might want to try various professional societies to tap into the network of providers treating the individuals with the specific health conditions. For instance, if you are looking for people with heart disease, look at the American College of Cardiology and see what they offer for patient support in terms of networks, blogs, etc. Also, Linkedin in and Facebook, of course, have groups for people with specific health conditions.
Consider going to a large professional society meeting. For instance, the RSNA in Chicago every year attracts thousands of radiologists. Other professional societies have similar large events. When there you can approach the professionals in person, try to attract them through Twitter or set-up an interview booth and offer them something for their time such as an invitation to a happy hour after the conference.
Consider looking at medical school alumni associations. You can look for docs who graduated in the 1950's who are likely headed into retirement. You may be able to sponsor a reunion event or provide a contribution for mailing which could include your brand. Also, working with a professional society such which may have demographic information on its members it may be willing to sell is an option. For instance, in the US the American College of Radiologists is an organization 90% of radiologists belong to. Similar organizations exist for other professionals internationally.
Yes. Six months is an incredibly short amount of time in the health insurance industry. Most of their contracts are a minimum of a year with purchasers if not longer and multiyear. The six month would be a great time for you to gain experience and working out any issues. It could also creat and element of FOMO with their competitors. I work for a health insurance plan and typically don't ask for any type of exclusivity when we use vendors. If anything, I want others using the service so our provider networks and populations are not pushed into using a very narrow solution. I'd love to learn more about your solution and help more.
It depends. Is there a hardware component? Do you have a strategic partnership with a healthcare system? Do you want this published in a peer reviewed journal? Is the audience the FDA, academics, payers, providers, all of the above or a mix? How long will the pilot last? Do you need a dedicated FTE? Do you need access to an EMR or HIT? I'm happy to discuss more and have experience designing and implementing these types of trials.
Good question, are you sure you want to sell to providers? Of course, providers want to deliver great care as well as keep/make their patients healthy, but what is their financial incentive to do so? Do they have risk based performance contracts with healthcare payers? What are the metrics they are trying to attain? Do they receive care management fees from a payer for delivering specific types of care/health management? Understanding the payment model of the providers you think you want to target it crucial. It might be you want to actually target the payers directly with your solution? Happy to discuss mote. Thanks!
Press Release - Try to put out a press release to local newspapers, trade journals, business journals etc. You can write your own or use a national service like PR newswire and ask them to include your local market. Write the release as if it were a story you would like to read and follow-up directly with a reporter. I did this and was front page of my local paper. The paper likes it because you give them valuable content and help with the work.
Have you thought about why a hospital or provider network would purchase this? Do they have any metrics they need to met with specific payers or accrediting bodies your app can help them meet to generate value for them? Happy to help you think through this more to help make this appealing to purchaser.
DPC and TPA are very different. Most large traditional insurance companies now act as more of a TPA as purchasers/employer groups bear the financial risk for health care and use "insurance companies" to act as a TPA. Typically the TPA will have a strategy to health, quality, and financial management they bundle as a product. Wellness services are part of the product. You need to figure out how to become part of the wellness service strategy and demonstrate your value to a TPA. This could involve performance guarantees, risk based contracting etc. Happy to talk more to help you frame this as an offering/pitch to a TPA.
thanks again Jim for a lot of valuable advice and looking forward to further discussions.
Great call with Jim. I was provided with clarity on insurance medical billing and the best way to facilitate this fee structure. He also followed up with me with a guidelines document to help me further understand the parameters. I would definitely reach out to Jim again if any other follow up questions.
Very knowledgeable about the health insurance business. Perfect person to talk to.