
CareLedger (YC S15) Aims to Provide Free-to-Employees Medical Care - katm
http://techcrunch.com/2015/07/21/y-combinator-backed-careledger-aims-to-provide-free-medical-care-to-employees/
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MJR
How are you going to compete with insurance companies who have all of the
data, existing relationships will their entire networks of providers and pre-
existing negotiated rates with providers? Insurers are already creating local
provider specific networks to serve this type of need and they have the
largest incentive to drive procedure costs down - because it allows them to
drive their rates down, increasing business or accounting for the losses
they're suffering due to the ACA.

How will you protect your business when they decide to cut out the middle-
man(you) and begin working with their networks directly to renogotiate
procedure costs and kick-back discounts to employers for using these selective
Cost+Quality networks? Truth is they're already doing this.

EDIT: My points may be moot - Are you only working with self-insured
companies? That's the only thing that makes sense here given that you're
splitting costs with the employer.

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thetakach
Yes, that's exactly right. We help self-insured companies build high-quality
narrow networks.

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Ntrails
Based on the article you seem less interested in "High Quality" than in
"Cheap". Similarly, a high quality and narrow channel without travel seems
extremely counter-intuitive.

The premise of centres of excellence is that paying fair rates for top quality
providers gives better outcomes _over the long term_ and reduces _overall_
costs to the company - not specifically the procedure costs.

Medical care free at point of use is one of the best things to aspire to in
the world imo, I'm just trying to make sense of your model.

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yummyfajitas
Here's why I'd be skeptical of using this service if I were a large, self-
insured employer. If I understand right, the model consists of making it easy
for employees to find cheap medical providers. However, am I right in
understanding that it also makes it easy for employees to actually find those
providers?

I.e., absent this service, would employees find it considerably more difficult
to get treatment? (The article doesn't exactly say this, but hints in that
direction.)

If so, I'd be concerned that it induces employees to consume more medicine. So
while one might save money on cost per procedure, the # of procedures would go
up.

(Due to RAND/Oregon, we also know it's unlikely that marginal increases in
medical consumption would improve health, so regardless of how much I might
care about my employees, this would be a bad thing.)

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reach_kapil
Are there any hidden costs? I mean how would you make money?

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thetakach
No hidden costs! We work on a shared savings model. We analyze the employer's
current paid price for each procedure and test. The delta between this current
average for a procedure and the actual price is the savings. We split this
savings between us, the employee (in the form of paying their out of pocket
expenses, and the employer. We only get paid when we actually drive savings.

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thetakach
Hey All! Co-founder here. Would love any and all feedback, and here to answer
any questions you might have.

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nathanaldensr
I'm sorry but "free medical care" is just click-bait--TANSTAAFL, and all that.
Medical care will continue to get more and more expensive as long as the
government, massive insurance companies, pharmaceutical companies with
monopolies over production, etc. continue to dominate medicine.

This is one case of "I'll believe it when I see it."

EDIT: I didn't notice this at first, but the first paragraph of the TechCrunch
article says "workers of the world," so this wild dream isn't limited to the
US, it seems.

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pbreit
Don't want to get too political but you do realize that the USA has the most
expensive healthcare and the least amount of government involvement? And the
worst outcomes.

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yummyfajitas
We don't have the least amount of government involvement. We're #3 in the
world in terms of government spending, at least. (Measuring regulatory
involvement, which includes things like lawsuit-preventative medicine, is
trickier.)

[http://www.forbes.com/sites/theapothecary/2014/10/01/landsli...](http://www.forbes.com/sites/theapothecary/2014/10/01/landslide-
in-referendum-swiss-voters-reject-single-payer-health-care-62-38/)

If you want to see little government involvement, look at India (that's where
I go when I need work done).

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radley
Where is your list of providers? That's usually the first thing I'd need to
check when considering a new insurance plan.

My current insurance only has a small list of specialists in my area, and only
one who was actually accepting patients and didn't have a 3 month wait list.

