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CareLedger (YC S15) Aims to Provide Free-to-Employees Medical Care (techcrunch.com)
32 points by katm on July 22, 2015 | hide | past | favorite | 18 comments

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.

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

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.

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.)

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

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.

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

How can employees trust your recommendation? i.e. why should they believe that you are steering them towards high quality low cost providers instead of low quality low cost providers? Why should they believe in the quality of your recommendations?

Great idea. Where do you get the cost of a medical procedure? Any resistance from medical providers for providing 'quotes'?

Thank you so much!! We contract directly with the medical providers so we know the prices. The best providers want more patients and have been really receptive.

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.

Free medical care in this case means that an individual with health insurance would NOT need to pay the additional out-of-pocket costs associated with a procedure or test. This out of pocket component is comprised of the deductible, copay, and coinsurance. Currently, if you have insurance and get a $5,000 procedure, you have to pay several thousand after the fact. CareLedger rewards the individual for going to a high quality, cost effective doctor and facility -- in this case free care.

The care is not free. Someone is paying for it--the employer, the government... someone. My issue is with the click-bait title that doesn't accurately convey what it is you folks claim to do. "If you have insurance" is a huge if; it means either the employer is paying for some or all of that insurance, or the employee themselves is paying for it. Have you see insurance premiums lately? Are you aware of how much they are projected to increase next year?


Let's not get hung up on the wording of the title. Obviously no one is claiming to eliminate all health care costs. The intention is clearly to spare employees out-of-pocket expenses. We'll change the title in an attempt to make it less ambiguous, but please let's stick to the substance from now on.

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.

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.)


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

It's a combination of all those factors, plus other factors like lawsuits and such, that, in my opinion, combine to make medical care so expensive here.

I'm not sure how your question relates to my comment.

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.

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