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Trusty.care

Precision benefits tools for professionals

USA, New York
Market: Insurance, Financial services, Artificial Intelligence
Stage of the project: Operating business

Date of last change: 11/14/2019
Min investment
$  250.000
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Total required
$ 2.500.000
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Idea

We deliver a precise benefit profile for each beneficiary by integrating disparate data points and optimizing them with AI and machine learning. We match individuals to every benefit they are eligible for and make sure they can cover their health care costs.

Current Status

In November 2019, we launched our V2.0 patent-pending Medicare plan finder designed for brokers. It’s the first affordable product that helps brokers more efficiently sell an appropriate plan to a beneficiary.
V3.0 will launch in Q1 2020 to cover additional benefits available to older adults. Our technology leverages a partnership with the National Council on Aging’s robust database of benefits. 10m people have accessed benefits from NCOA over the last 3 years.
The combination of these products will enable brokers to offer multiple touchpoints to their customers, and a path to easily increase their annual renewal commissions.
We have sold to 20 banks, 15 brokerages, and 3 large senior organizations.

Market

In 2019, one-third (34%) of Medicare beneficiaries – 22 million people – are enrolled in Medicare Advantage plans, similar to the rate in 2017 and 2018. Between 2018 and 2019, total Medicare Advantage enrollment grew by about 1.6 million beneficiaries, or 8 percent – nearly the same growth rate as the prior year. The Congressional Budget Office (CBO) projects that the share of beneficiaries enrolled in Medicare Advantage plans will rise to about 47 percent by 2029. Nearly 9 out of 10 adults over age 50 are on Medicare or expect to enroll.
The opportunity
There is an enormous and growing opportunity in the Medicare space as the rate of Baby Boomers reaching the age 65 increases. Trusty is approaching this opportunity through the lens of the impact of physical health on a boomer’s financial health and overall well=being. We have identified key stakeholders in this space who are looking for better ways to advise and guide their clients to make smart choices that will increase their quality of life during their retirement years.
Trusty.care integrates benefits navigation tools with healthcare and personal data to help industry players optimize benefits, insurance, and services. Trusty.care’s tools help improve patients’ economic and health outcomes, especially for older adults, low-income individuals, and military.

Problem or Opportunity

Problem 1:
Most people sel ect their insurance plans and associated benefits by following the advice of a broker, their best friend’s experience, or gut feelings.

As a result, people end up under-insured, over-paying for meds, unable to afford care, and eating into their retirement savings.


50% of available benefits go unused
25% of older adults can’t afford meds
700K people go bankrupt yearly due to medical costs
Problem 2:
Brokers, financial planners, healthcare providers, and social workers lack personalized tools that provide precise benefits guidance, so their advice to beneficiaries may not meet their particular needs.

In these professions that often use legacy tools, where faxes remain the norm, piecing together siloed and disparate data is impossible.

If these professionals want to remain relevant, especially with 40m entering retirement over the next 10 years, they will need to advance fr om basic calculators to easy-to-use tools personalized for their customers.

There are thousands of plans to choose from, but what is most complicated is that the beneficiary is moving from one system - obtaining insurance from an employer - to a new system - obtaining insurance from the government. Additionally, Medicare is not one thing. It is a group of products that work together. These products have deadlines and penalties, and beneficiaries must navigate the system without the help of an HR department to help them make choices, while avoiding costly mistakes.
The first hurdle for the newly eligible beneficiary is understanding her or his eligibility date for enrollment. If they miss this period, they will face a lifetime penalty. At the same time, the beneficiary is trying to weigh various packages of health benefits to decide what is the best fit, considering any number of variables. One concrete example: if the beneficiary moves back to the US after living overseas, they have 63 days to get signed up for Medicare or they miss their eligibility window and face penalties. No one tells you this. Another example: If the beneficiary didn’t spend enough years in the workforce (maybe they were a stay-at-home parent, or were divorced and remarried before 60, they could possibly not be eligible for full Medicare if their spouse is under 65. The list of rules and

exceptions like these is long and convoluted. And for a critical healthcare and financial decision, there are tens of thousands of plans to choose from with little guidance or concrete best practices.
Selecting Medicare coverage is not as simple as choosing a plan. The beneficiary must find a package that provides appropriate and complete coverage, while considering cost, convenience, quality, and network. Studies report that 85% of people have the wrong coverage for their needs.

A few research reports that cover this complexity:
https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15227
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194961/
https://www.thirdway.org/report/rethinking-medicare-enrollment-make-high-value-health-coverage-the-easy-choice
Trusty.care’s patent-pending technology took this baked-in complexity and built a model to help the beneficiary more simply navigate these variables, without risking missing a critical decision factor.

Solution (product or service)

Trusty.care’s technology delivers a benefits picture unique to each person, enabling professionals to match individuals to the right insurance and benefits.We combine disparate data points optimized with machine learning to deliver a precise benefit profile for the beneficiary.
Insurance matching
Benefits eligibility
Cost-savings
Benefits maintenance

Competitors

Medicare.gov Plan Finder
FMO / NMO (Connecture)
Sunfire Matrix
My Agent Ally
Picwell

Unexpectedly, in August 2019, Medicare.gov’s new Planfinder release effectively removed brokers’ capability to use it to cost-effectively track customers and recommend plans. This has had a dramatic negative impact on their business.

Size of opportunity: 4m people purchase a Medicare plan yearly
Target customers: 300K Medicare insurance brokers
Size of addressable market: $2B in broker commissions annually and $5B in renewal commissions.

Historically brokers have recommended plans using the following tools:
Big brokerages (100K brokers) - use expensive or proprietary software
Small-medium sized brokerages (200K brokers) - used Medicare plan finder to track and enroll beneficiaries. This is our target market.

Advantages or differentiators

Our product is the only one that has all of these advantages:
Access to Historical Medication, Doctor Data of Beneficiary
Decision Support (for Lead Qualification)
Electronic Plan Enrollment
Flexibility To Use Their Own Insurance Contracts (Carrier Lock-in)
Competitive Pricing (<$100K Integration Fee, <$10 Yearly Subscriber Cost)
Continual Consumer Engagement (for Renewals)
Robust tools and rapidly growing database for ongoing personalization

Finance

We sell on a SaaS model to professionals that service our market.
$100 per broker per month/$25 per profile
There are 300k brokers in the country

Pricing
We expect to do $100K MRR by end of December
$250K MRR by Feb. 2020

Our expectation is that we will be at $50m ARR by 2022

Business model

SaaS SMB sales to brokers
Large enterprise sales to financial institutions

Money will be spent on

Use of proceeds
$1.25m Product development

$500k Marketing

$500k Sales expansions and customer support

$250k invest in our future business development (insurance products, data sales)

Offer for investor

$2.5m pre-money $10m

Team or Management

Risks

The government could allow insurance companies to stop paying commissions (as they did with the ACA) and gut the broker market.

The government to could block access to health data from tech companies like ours.

A company, like Google, could take on benefits navigation for retirees.

Incubation/Acceleration programs accomplishment

We are in Plug and Play Fintech accelerator, VentureOut accelerator, and StartupHealth accelerator.

Happy to share about investors.

Won the competition and other awards

Won
Meet the Money StartOut Award
NGLCC entrepreneurial award
Finalist Accenture Health Tech

Invention/Patent

The Trusty proprietary precision matching tool continues to refine itself by looking at consumer data, health data, industry data and on an ongoing basis reviews to provide new recommendations, services and interventions.

Photos

Photo 1 - Trusty.care
Photo 2 - Trusty.care

Product Video

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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