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HealthCorum

Network Optimization for Health Care Payers

USA, Massachusetts
Market: Consulting, Medicine, Insurance
Stage of the project: Prototype or product is ready

Date of last change: 04/18/2019
Min investment
$  50.000
Total required
$ 500.000
Rating
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Idea

HealthCorum NOW is a cloud-based platform which helps health care payers reduce the prevalence of unnecessary care that is of low value to patients. We save money for payers by providing intelligence to identify the most efficient providers and facilities for their network based on the intensity of practice patterns, clinical results, and patient experience data. Our proprietary benchmarking process creates a level playing field of risk-adjusted metrics for providers nationwide.

Current Status

Our flagship offering, HealthCorum NOW, is live and ready for use. We have validated the product-market fit through extensive interviews with target customers and are now seeking to implement our first pilot program.

Market

Our target customer is any payer organization managing a network of health care providers. Within this target, actual end-users will be Network Managers and Contract Specialists. The US health care analytics market accounts for over $65 Billion in annual spending, of which 40% is attributed to payer organizations. This leaves us with a total addressable market of approximately $25 Billion, which is projected to nearly double over the next 5 years.

Problem or Opportunity

US Health care costs continue to rise, while efforts to curb unnecessary spending at the point of care have faltered. As patients, we witnessed the outrageous bills being sent to our insurers for unnecessary procedures firsthand. Low-value health care spending is expected to eclipse nearly $1 Trillion annually by 2020. Payers (insurance companies, health plans, etc.) need a better way to identify network liabilities and optimize for cost efficiency.

Solution (product or service)

Meet HealthCorum NOW, a cloud-based platform which helps health care payers reduce the prevalence of unnecessary care that is of low value to patients. We save money for payers by providing intelligence to identify the most efficient providers and facilities for their network based on the intensity of practice patterns, clinical results, and patient experience data. Our proprietary benchmarking process creates a level playing field of risk-adjusted metrics for providers nationwide.

Competitors

Our most direct competitor is a company called Rowdmap, which reached an ARR of over $15 Million in 2017 and was acquired by Cotiviti for $100 Million. Cotiviti was itself acquired by Verscend a year later, leading to the exodus of all original Rowdmap team members. Our position is that Rowdmap proved this market, and has since left a vacuum waiting to be filled by an agile new solution such as HealthCorum NOW. Other alternative solutions used are manual analysis done internally by network managers or outsourcing of the work to consulting agencies. HealthCorum fits as a complimentary solution to these existing efforts.

Advantages or differentiators

- Aggregation, storage and analysis of patient experience data on over 3 million providers nationwide since 2016
- Predictive modeling of CMS claims data to deliver optimization scenarios
- A solution which stands on its own, with no integration or data sharing required

Finance

Our pricing starts at $100,000 for an annual subscription, with that number increasing based on the number of providers currently included in the customer's network. We anticipate annual recurring revenue of over $20 Million in the next 5 years. Key indicators include:
- Quantity of pilot users and paying customers.
- Pilot to customer conversion rate
- MRR and ARR
- CAC and LTV
- Inbound qualified lead velocity
- Churn Rate
- Cash on hand

Business model

HealthCorum NOW will be sold as a traditional SAAS offering, where customers pay an annual licensing fee plus additional fees for professional services. Customers will have access to on-demand analytics coupled with individualized reports, to be curated by the HealthCorum team.

Money will be spent on

Currently, HealthCorum is self-funded and operating with a very low burn rate of about $4,000 per month. An investment would be spent on 3 main categories: sales, product development, and new talent. Since this is a sales effort and not much of a marketing play, a large portion would be spent on accelerating customer traction beyond the individual efforts of the founders.

Offer for investor

HealthCorum is seeking $500,000, either in exchange for an equity stake or in the form of a SAFE, with the accompanying ownership percentage still to be determined.

Team or Management

Risks

The main risk we have identified is the possibility of a large company, such as Optum, attempting to replicate our process and build a competing solution. The sheer quantity of resources available would expedite their ability to "catch-up" to what we have built. However, we anticipate that it would be cheaper to acquire HealthCorum than to build a competing solution, so the risk could ultimately become a lucrative exit opportunity.

Incubation/Acceleration programs accomplishment

n/a

Won the competition and other awards

n/a

Invention/Patent

The process of applying back-propagation machine learning to identify potential low-value care procedures.

Website address

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Idea
Current Status
Market
Problem or Opportunity
Solution (product or service)
Competitors
Advantages or differentiators
Finance
Invested in previous rounds, $
Business model
Money will be spent on
Offer for investor
Team or Management
Mentors & Advisors
Lead investor
Risks
Incubation/Acceleration programs accomplishment
Won the competition and other awards
Invention/Patent
Photos
Product Video
Website address