
Launch HN: Shift Health (YC S19) – Understand Your Healthcare Costs Pre-Visit - Hydrick3232
Hi HN,<p>We&#x27;re Lance, Lance, and Dallin (Yes...2 founders named Lance :)). We are the founders of Shift Health (<a href="https:&#x2F;&#x2F;shifthealth.io" rel="nofollow">https:&#x2F;&#x2F;shifthealth.io</a>). We help patients understand what they will owe pre-visit and provide flexibility to pay overtime.<p>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.<p>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.<p>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.<p>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%.<p>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.<p>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:<p>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.<p>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.<p>3. Technological Forces: Platforms are emerging providing more health data access than ever before.<p>I&#x27;ve recently seen some posts on HN about the executive order and price transparency (<a href="https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=20275097" rel="nofollow">https:&#x2F;&#x2F;news.ycombinator.com&#x2F;item?id=20275097</a>) so we’re looking forward to a really good discussion.<p>Please reach out with your ideas, help, and connections!
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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.

~~~
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/](https://xkcd.com/1831/)

~~~
VRay
All these guys are missing is a blockchain

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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.

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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

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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

~~~
ceejayoz
This would be a great argument if we didn't have literally all of Europe,
Japan, Australia, etc. to conclusively debunk it.

> The U.S. spends about twice what other high-income nations do on health care
> but has the lowest life expectancy and the highest infant mortality rates, a
> new study suggests.

[https://www.reuters.com/article/us-health-spending/u-s-
healt...](https://www.reuters.com/article/us-health-spending/u-s-health-
spending-twice-other-countries-with-worse-results-idUSKCN1GP2YN)

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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 :).

~~~
aaron425
FHIR APIs are definitely becoming more and more broadly deployed, which is
awesome! Scaling wise, it might be worth looking into the interoperability
partners that specialize in standing up FHIR endpoints for providers like
Datica & Redox.

~~~
kyloon
Agree on FHIR APIs are becoming ubiquitous especially with Apple Health
pushing its adoption in consumer facing applications, not so much on the
legacy enterprise side from what I've seen thus far (I work primarily in the
clinical trials side of things) and we prototyped our own integration stack to
help with wrangling with different standards (more like the lack thereof). It
is worth actually building that ourselves in the early days as we have learned
so much about the challenges to integrate with our partners and will at some
point looking into interoperability partners as we scale.

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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).

~~~
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.

~~~
claudeganon
I’m just curious, from a moral perspective, how does it feel to bet against
many of the poor being lifted out of death and medical bankruptcies for the
sake of your own profit?

~~~
sidlls
Your question is a bit harsh, but it strikes at one of the more insidious
truths in this space right now: most if not all these health tech companies'
business models simply wouldn't work if we had a functioning health care
system, and they end up participating in the negative feedback loop that
further entrenches the problems they claim to want to solve.

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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).

~~~
Dpalm
We have seen that trend of more and more cash-pay only physicians and think it
is great!

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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?

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

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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.

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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.

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novalis78
Good luck guys! Any attempt to better this abhorrent mess gets my biased
upvote.

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Hydrick3232
Thank you! We're looking forward to tackling this head on. Appreciate the
support!

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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.

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davedx
Typo in front page:

We integrate with with over 50 EMR systems

(extra with)

Good luck!

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

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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.

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pjc50
The NHS costs are limited to £9 per prescription (England only, waivable on
low income). Hospital visits are free; people complain about having to pay for
parking, because they lack all perspective on how bad it might be.

The tax is not hypothecated but is about £3k each.
[https://www.bbc.co.uk/news/uk-42950587](https://www.bbc.co.uk/news/uk-42950587)

(Dental and optical you may have to pay up to a few hundred £ for)

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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.

