
Eligible (YC S12) Wants To Be The Stripe For Healthcare Transactions - acremades
http://techcrunch.com/2012/12/22/yc-grad-esther-dyson-backed-eligible-wants-to-be-the-stripe-for-healthcare-transactions/
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pinaceae
best of luck to them. very hard area due to regulation and compliance issues.
you better like being audited.

i just wonder if it's clear to them that this likely will be a national
company? scaling this past the US will be very, very hard - this is using
patient data, which is highly protected and in a lot of cases is not allowed
to be hosted outside national boundaries.

this is my first litmus test for enterprise start-ups btw - does this work
outside the US? the US market is big, but a lot of enterprise customers are
multi-national and do not purchase completely local solutions.

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rdl
Every insurer like this, however, is US focused, and a lot are per-state. The
only corner cases are US citizens overseas and visitors in the US.

Also, to a first approximation, the world healthcare market for private
insurance is the US.

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pinaceae
I don't get what you're saying?

There is a large private insurance market outside the US. A lot of private
insurance is augmenting state-run schemes, just look at Germany - the
Krankenkassen system is not that different (lots of players, government
mandated, plus private additions if you like shorter wait times or private
hospital rooms).

What I was trying to say that if you're limting yourself to a single market
like the US, the growth potential is not that big, same for your target market
size and ultimately the amount of money you can make. as an investor something
like Workday has more "fantasy" in terms of potential growth than something
that caters to a very limited, national audience.

The company I work for launched a similarly national product and killed it
after 6 months. Would have worked in the US, but then what? Our other stuff is
truly global, so now that we cover the US fairly well we still have a lot of
growth in OUS markets.

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rdl
The number of people outside the US is big, but the financial value of
secondary-to-national-insurance medical care is tiny, and the rules are really
simple and transparent (often, it's a single vertically integrated secondary
provider -- like BUPA in the UK -- billing for vertically integrated health
providers like Kaiser in the US is also fairly simple). I only know the US and
UK rules in detail, but the UK is actually simpler than even most US single-
payer systems (e.g. DOD TriCare duty) in terms of recordkeeping. (this is
largely a good thing for non-US countries!)

I'd be pretty comfortable building a health insurance eligibility service
which only covered California. Covering the entire US market is well over 50%
of the value in that market.

The unknown are places like China and Africa which have much more limited
health care markets today, but which are rapidly evolving. It's reasonable to
think they might adopt other systems than what they're using now (largely
government-direct or charity or cash private doctors). Maybe the big US
companies will be successful in promoting a damaging product (US-style health
insurance) to other countries, like we did with cigarettes, but I sincerely
hope not.

Stripe, on the other hand, absolutely must expand into other countries, or
else the "Stripe of Europe" or "Stripe of China" might someday be able to
challenge Stripe.com over who is the "Stripe of the USA". And Stripe is still
tiny compared to the market even just in the US.

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xoail
This is indeed a hard problem to solve. Glad to see someone attempting it. I
think partnering with one of the major insurance providers should help kick-
off the product at great scale and learn a lot.

All the best!

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ramoq
I think this works fine for basic eligibility checks where it's just a matter
of is it covered or not. But the real pain (and where hundreds of millions if
not billions of dollars are spent) is in radiology. There is a lot of friction
put into place (think RBM's) to make it difficult to order any imaging.

