Cover My Meds

CoverMyMeds_Logo CoverMyMeds is a company in a brilliant niche. ePA РElectronic Prior Authorizations.

Usually a doctor’s prescription reaches pharmacy, which informs patient when to pick it up. If the drug needs the insurance company’s authorization, it’s up to the Pharmacist to notice that and get authorization process started (includes paperwork, calls, faxes). Patient may not even find out till they arrive to pick up medication.

This messy cycle happens 200 million times a year in US, costing $20-30 Billions dollars annually. Cover My Meds offer APIs and widgets to digitize this workflow with all stakeholders.

For example, on payer side it can enable automated routing to staff queues acc. to rules, auto-determination for some, electronic notifications to prescribers, reporting, etc. For pharmacies it can alert pharmacists about PA need, kick off approval workflow digitally, etc. For patients it means less prescription abandonment.

Most¬†fascinating aspect of Cover My Meds is its business model. It’s free for everyone who uses it. They make money by charging drug companies to pay for the service. Drug companies fund that from the revenue of what otherwise would have been unfilled prescriptions. That is a win-win all around… minimal barrier to adoption.

Cover My Meds started with a $250K seed in 2008. They were acquired by McKesson Corp. for $1.1B last month. A well-deserved unicorn exit in Health IT.

Heal Deal

HealDealLogoWhile we wait for President Obama’s public plan, the 46 million uninsured Americans need some options. Healdeal aims to bring the free market model to healthcare as one of them. The goal is to provide a marketplace for self-pay (uninsured) individuals to connect and transact with providers registered on the website.

There is scope for such services, for sure. There are significant number of people who need care that falls outside the realm of what insurance covers. Second opinions, cosmetic procedures, international travelers are some categories that come to mind. But as always, business model remains the Achilles heel. If you are operating a platform that matches supply with demand, its more straightforward to make money in commercial domains, much like eBay or eLance. But healthcare is different ballgame. Privacy, outcomes, benchmarking, feedback, transparency are some of the confounding issues that need to be taken care of.

Currently HealDeal is a social venture, with no subscription or advertisement model evident. Hopefully they have deep pockets or influential allies to keep themselves above water. It’d be interesting to have it as an app on Google Health though, especially if they can strike partnerships with other related, pro-self-pay businesses like Myca.

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SeniorEducators

senioreducatorslogo I found out about SeniorEducators during a trip to the bay area last year. They are a startup trying to help seniors make the most out of their medicare benefits.

Quick Medicare tutorial: It consists of Part A, B, C and D. None pays for all of a covered person’s medical costs. The program contains premiums, deductibles and coinsurance, which the covered individual must pay out-of-pocket. After 1997, beneficiaries were given the option to receive benefits through private health insurance plans, instead of original Medicare plan (Parts A and B). That’s why today Medicare insurance market is a complex landscape, filled with lots of insurance companies offering thousands of plan options.

It’s hard to understand it all, let alone find one that fits your health need as well as budget. There is competition, for sure-small (ehealthinsurance, healthinsurancefinders, medigap ) and big (United, Aetna, Cigna..). But I didn’t find many that were only focused on Medicare- most seemed like one-stop shops for all health insurance needs, trying to target everyone.

Notably, this consumer segment is predictably technology-averse with significant communication need. Which is probably why all SeniorEducator online content is in simple language with easy navigation, and they use toll-free numbers to connect with the customers. It’s a good strategy, and it’ll be interesting to see how much traction they can get in a mature market with big entrenched players.

March 2010 Update: Senior Educators is acquired by Hewitt Associates, a publicly-traded global human resources consulting and outsourcing company. Read press release here.

MEDgle

MedglelogoWith a play on google’s name, MEDgle offers symptom based health information search. The idea is to ’empower patients in their discussions with physicians’, by making relevant content easy to find.

The navigation is pretty simple and straightforward. MEDgle’s output is a probabilistic list of disease/conditions based on the user input. The content is authored by their 3-physician team and is based on publicly available information available such as the Center for Disease Control and National Institutes of Health. Where probability estimates were not available, they have used their own practice experience to fill in the gaps.

The need for a healthcare vertical search engine is widely realized, and like everything else, it opens up the ability for potential (ab)use with self-diagnosing hypochondriacs. Skepticism aside, I did a search using a common symptom (difficulty in walking, heel pain) and found it easy to navigate to a list of links and information around bone spur and plantar fasciitis. The “Related Local Doctors” section for finding local providers relevant for your symptoms is a neat idea too.

There is an obvious limit to the utility of such tools- Alexia Estabrook’s blogpost talks about MEDgle’s performance for a more complex query. Although that points to the Achilles heel of any diagnostic decision support system today; it’s hard to model the entire spectrum of disease-symptom relationship in an all-inclusive, 100% accurate way. It has more to do with the ever-expanding body of medical knowledge than the lack of technical prowess. That why medicine is a science and an art.

PS: You can read the interviews of some of MEDgle team members here and here.

Vimo

Vimologo

Vimo is a consumer portal focused on comparison shopping for healthcare needs. Founded in 2005, Vimo provides a platform for users to research, review, compare and price the following:

  • Hospital Procedures
  • Individual & Group Health Insurance Plans
  • Health Savings Accounts
  • Doctors

Compete.com data shows pretty good visitor count (more than 100Kvisitors/month), so they must be doing something right. Their services are free which makes the surgical procedure pricing tool even more impressive. I tried their doctor search tool too, and it worked pretty well for my location (returned more info than usual). Neat interface, fast results.