health insurance
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Y Combinator’s Vitable Health is bringing basic healthcare to underserved populations
Joseph Kitonga, the 23-year-old entrepreneur behind Vitable Health, first saw the need for a new kind of healthcare service growing up in Philadelphia and seeing the experience of the home healthcare workers who worked at his parents’ business.
The Kitongas immigrated to the United States a decade ago and settled down in Philadelphia, where they started a home-care business matching workers with patients in need. What was surprising to the younger Kitonga was that the people who worked for his parents taking care of others couldn’t afford basic healthcare coverage themselves.
It was that observation that provided the seed for the business idea that would become Vitable Health, Kitonga’s first business and a recent member of Y Combinator’s latest summer cohort.
The company provides affordable acute healthcare coverage to underinsured or un-insured populations and was born out of his experience watching employees of his parents’ home healthcare agency struggle to receive basic healthcare coverage.
A lot of caregivers make $10 per hour, which is too much to qualify for Medicaid and too little to afford health insurance, Kitonga says.
Even with the Affordable Care Act, many workers in the home-care business that Kitonga’s parents ran in Philadelphia were unable to receive care.
So Kitonga built a service that could cover everything but catastrophic coverage for lower costs than the company’s customers would have to pay if they went to an urgent care facility.
Vitable is able to lower the cost of care through its use of nurse practitioners instead of doctors to provide the care. For a small monthly fee, the company will send providers to make house calls or customers can receive a consultation over the phone.
“We focus on acute and preventive coverage,” says Kitonga. “Most high deductible plans are geared toward providing catastrophic coverage.”
What Kitonga saw with his parents’ employees was that they would wind up going to the emergency room and put $1,300 in charges on their credit cards rather than pay for insurance per month.
Vitable’s lowest plan levels start at $15 per month and the co-payment is $30, according to Kitonga. Vitable’s technicians will do in-home lab tests.
There’s just no low-cost care option available for the population that Kitonga wants to serve, he said. These are people who will be referred to emergency rooms by nearby care providers because they lack the necessary insurance. “The population that we service has been ignored by healthcare providers,” said Kitonga.
For now, the service is only available in Philadelphia, but Kitonga says there are already 1,000 people who receive care through Vitable. “We work with a lot of small businesses that might have 10 or 20 employees,” Kitonga said.
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Russia’s BestDoctor attracts international investors for its $4.5M round
The private medical insurance market is expanding year on year by over 5%, and that includes in Russia, where the insurance market — which grew by 4% in 2019 — has reached a value of almost $22 billion.
So it’s not that surprising that Russian insurtech startup BestDoctor has now closed its third round of financing for $4.5 million. Lead investors AddVenture, based out of Moscow, and Target Global, based out of Berlin, were joined by the London-based LVL1 fund, which had previously invested in the company.
BestDoctor is an online medical insurance platform offering private medical insurance for companies and their employees. As well as insurance, its also delivers 24/7 health support and medical consultations via its mobile app. Users also can get access to recommendations on preventive care and online support from BestDoctor physicians. The idea is that users save up to 23% on their annual medical expenses, and up to 95% of users renew the contract after a year.
Its clients largely consist of Russian corporates, including Voximplant, Faberlic, Ivideon, Prisma Labs and Rambler Group, which add up to more than 30,000 people. It also collaborates with 11,000 clinics across Russia.
Mark Sanevich, BestDoctor’s CEO and co-founder, says the need for online medical services was amplified during the pandemic: “Our business received a strong boost. Now we are going to focus on establishing a comprehensive platform on the basis of medical insurance.”
Target Global managing partner Mikhail Lobanov said: “BestDoctor is a rare example of a company that combines medicine and high-tech, while directly connecting employers with medical clinics. High-tech private medical insurance with the ability to consult a doctor 24/7 ensures transparency of all expenses.”
AddVenture managing partner Maxim Medvedev said: “By summer 2019, BestDoctor had a good head start: it had large enterprise clients, the company figured out the market’s problems and needs and dozens of product ideas were tested.”
BestDoctor plans to spend the newly raised funds on developing its software and also plans to expand its sales activity, concentrating on new product segments.
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How $20 billion health care behemoth Blue Shield of California sees startups
In the two years since Jeff Semenchuk took the reins in the newly created position of chief innovation officer for Blue Shield of California, the nonprofit health insurer with $20 billion in revenues has stepped up its investments in startup companies.
As one of California’s largest insurance providers with more than four million members, Blue Shield plays an outsized role in technology adoption among physicians, hospital networks and patients. With that in mind, and with the acceleration of entrepreneurial activity around the multitrillion health care market, Semenchuk was brought on board after serving as chief executive of Yaro (now Virgin Plus) and CIO of Hyatt Hotels and co-founder of Citi Ventures.
Semenchuk said he sees Blue Shield as working to create a new health care system: “It’s not to perpetuate the health care system we have today.” Increasingly, startups have a role to play in that revisioning of health care services in America, according to Semenchuk.
“What I would say has happened over the last two years is that we have really focused on transformational innovation,” he added.
Investing in those transformational technologies involves taking cash directly from Blue Shield’s balance sheet for investments. The company doesn’t operate a corporate venture capital fund in the traditional sense, instead making strategic investments under the auspices of Semenchuk or Chief Financial Officer Sandra Clarke.*
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Oscar Health now has 400,000 members and expects to bring in $2 billion by the end of 2020
Oscar Health, the upstart healthcare insurance company and technology developer, expects to have roughly 400,000 members insured under its healthcare plans, who collectively will bring in roughly $2 billion in revenue for the company by the end of 2020, according to slides of a presentation from the JP Morgan Healthcare conference seen by TechCrunch.
Those figures, based on the open-enrollment period that just closed, would represent 50% growth both in membership and revenue for the healthcare provider co-founded by Mario Schlosser and Joshua Kushner, founder of VC firm Thrive Capital and the brother of senior Trump advisor Jared Kushner.
Earlier today, Oscar announced that it was partnering with Cigna to provide services to small business owners. Commercial health insurance is a small but growing proportion of Oscar’s total membership, and it’s one area where the company hopes to expand. Essentially, Oscar can bring its technology-enabled healthcare services to small businesses in concert with the large healthcare networks with which businesses are used to working.
To date, Oscar counts around 375,000 individual members on its insurance plans, with another 20,000 coming through small-group insurance and the balance derived from Medicare Advantage customers, according to a person familiar with the company’s business.
Only three years ago, Oscar was a much smaller business, with only 70,000 members after retrenching its coverage and pulling out of markets in Dallas-Fort Worth and New Jersey. From a footprint that encompassed New York, San Antonio, Los Angeles, Orange County and San Francisco, Oscar now expects to operate in 29 markets by the end of 2020.
Fueling that expansion is prodigious capital infusions the company has received over the past few years. In 2018 alone, Oscar raised $540 million from investors including Alphabet, Founders Fund, Capital G (Alphabet’s later-stage investment firm) and Verily, Alphabet’s investment firm focused on life sciences. In all, Oscar Health has raised $1.3 billion to fulfill its vision of providing better healthcare services through technologies like a mobile app for telemedicine, physician consultations, booking appointments, prescription refills and a more concierge-like healthcare experience for its members.
Initially, the company took advantage of the Affordable Care Act’s creation of new marketplaces for individuals to buy health insurance when it launched in 2012, but is now looking to buoy its growth by adding more deals with insurance providers like Cigna for small businesses.
Ultimately, the company envisions a healthcare industry where employer-defined plans will disappear as more consumers turn to Individual Coverage Health Reimbursement Arrangements. In that environment, Oscar’s bespoke services — like the recent partnership with the startup Capsule Pharmacy to provide same-day prescription delivery for Oscar’s members in New York — or the company’s tight relationship with providers like the Cleveland Clinic, become competitive advantages.
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Substance abuse affects about 15% of American employees, Path wants to ensure they get help
America has an addiction problem.
It’s a problem that serial entrepreneur Josh Bruno has seen first hand. And it’s why he has launched a new company called Path, which pitches access to specialized substance addiction treatment professionals as an employee health benefit, to do something about it.
“I have unfortunately lost five friends now to alcohol and opioid overdoses. I went to five funerals in three years,” says Bruno. “Every time I would end up talking to friends and family afterwards… and everyone would ask, ‘What could we have done?’ “
Now Bruno is doing something.
While Alcoholics Anonymous and rehabilitation facilities provide one solution, Bruno says that neither one has the scope to address the enormity of the problem.
Bruno thinks Path may be the avenue to best address the issue. The idea is to provide near-instant access to specialized providers of substance abuse treatment as a benefit that employers can offer to their staff.
As the founder of HomeTeam, which provided in-home senior care and a software toolkit to manage that care, Bruno already has an understanding of the healthcare marketplace.
“We plug in to an employer and provide a holistic solution for the employees. We bring a doctor, a therapy and a coach,” says Bruno of the new service he’s launching. “We’re not a provider ourselves and we bring a network of providers.”
The business model evolved as Bruno began researching how things are currently done. “I have volunteered at AA and rehab facilities [and] I talked to labor union leaders across the country,” says Bruno. He also reached out to the nation’s 23 largest employers and shadowed treatment specialists to see how substance abuse treatment is currently handled.
“The first thing I saw is that 10% — or one in 10 adults across the U.S. — have a substance abuse disorder,” says Bruno. “That shocked people because it’s more than diabetes.”
What’s more, about 33% of mental health issues are actually addiction-related, which can add additional stress on an employers’ healthcare costs.
The founding team at Path, which includes Bruno and Gabriel Diop, who heads partnerships, and Greg Moore, who leads product development, all think of substance abuse treatment as an access issue. People looking for treatment simply don’t know where to go to get the most effective and affordable help.
“Today the health insurance company would give a list of in-network providers and it’s up to the patient to figure out where to go [and] 50% of time they go out of network,” says Bruno.
When Path works with a large employer, a phone call is made directly to the company and that call goes to a clinical social worker, who handles the intake of a prospective patient. The company has deals with addiction doctors in the geographies where it operates and can ensure that an assessment can be done within 48 hours.
After the assessment, a treatment plan is drawn up and the company will manage that process for the employer, and the physician as well.
Path is already talking to two Fortune 100 companies about deploying its service. “It’s a targeted, regional service,” says Bruno. “Not a national service.”
The Los Angeles-based company has raised $5.35 million to date in a round of funding led by Upfront Ventures, with participation from Sequoia Benefits, Radian Street Capital and angel investors including Barbara Wachsman, the former head of benefits at Disney; Amy Shannon, the former head of benefits at Chevron; and Howard Cherny, the former head of benefits at Cisco.
“Put simply, Path plans to work with the best addiction treatment providers across the continuum in the U.S., which is exactly what is needed. Finally, a team is focusing on core issues of quality and cost-effective treatment,” said Kelly Clark, a member of the Path Clinical Advisory Board, and the former president of the American Society of Addiction Medicine.
Not only can Path help to roll out access to treatment at scale, but the company can also reduce healthcare costs for companies, according to Bruno.
“It will lower the expense to the plan,” he says. “Approximately 30% to 50% of employees are going out of network for addiction treatment… that’s $25,000 to $50,000 per month.”
Path’s costs are substantially lower, and the company is only paid if members use the network, he said.
“Employers have made a commitment to the health and well-being of their employees. If mental health is a top priority for your organization, you can’t ignore [substance use disorders],” said Wachsman, in a statement.
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Amazon launches Amazon Care, a virtual and in-person healthcare offering for employees
Amazon has gone live with Amazon Care, a new pilot healthcare service offering that is initially available to its employees in and around the Seattle area. The Amazon Care offering includes both virtual and in-person care, with telemedicine via app, chat and remote video, as well as follow-up visits and prescription drug delivery in person directly at an employee’s home or office.
First reported by CNBC, Amazon Care grew out of an initiative announced in 2018 with J.P. Morgan and Berkshire Hathaway to make a big change in how they all collectively handle their employee healthcare needs. The companies announced at the time that they were eager to put together a solution that was “free from profit-making incentives and constraints,” which are of course at the heart of private insurance companies that serve corporate clients currently.
Other large companies, like Apple, offer their own on-premise and remotely accessible healthcare services as part of their employee compensation and benefits packages, so Amazon is hardly unique in seeking to scratch this itch. The difference, however, is that Amazon Care is much more external-facing than those offered by its peers in Silicon Valley, with a brand identity and presentation that strongly suggests the company is thinking about more than its own workforce when it comes to a future potential addressable market for Care.
The Amazon Care logo.
Care’s website also provides a look at the app that Amazon developed for the telemedicine component, which shows the flow for choosing between text chat and video, as well as a summary of care provided through the service, with invoices, diagnosis and treatment plans all available for patient review.
Amazon lists Care as an option for a “first stop,” with the ability to handle things like colds, infections, minor injuries, preventative consultations, lab work, vaccinations, contraceptives and STI testing and general questions. Basically, it sounds like they cover a lot of what you’d handle at your general practitioner, before being recommended on for any more specialist or advanced medical treatment or expertise.
Rendered screenshots of the Amazon Care app for Amazon employees.
Current eligibility is limited to Amazon’s employees who are enrolled in the company’s health insurance plan and who are located in the pilot service geographical area. The service is currently available between 8 AM and 9 PM local time, Monday through Friday, and between 8 AM and 6 PM Saturday and Sunday.
Amazon acquired PillPack last year, an online pharmacy startup, for around $753 million, and that appears to be part of their core value proposition with Amazon Care, too, which features couriered prescribed medications and remotely communicated treatment plans.
Amazon may be limiting this pilot to employees at launch, but the highly publicized nature of their approach, and the amount of product development that clearly went into developing the initial app, user experience and brand all indicate that it has the broader U.S. market in mind as a potential expansion opportunity down the line. Recent reports also suggest that it’s going to make a play in consumer health with new wearable fitness tracking devices, which could very nicely complement insurance and healthcare services offered at the enterprise and individual level. Perhaps not coincidentally, Walgreens, CVS and McKesson stock were all trading down today.
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YC alum Keeper raises $1.6M to help gig workers pay taxes
Every year around this time, Uber drivers, Wag dog walkers, Bird scooter chargers, social media influencers and other gig economy workers face the unsightly challenge of paying their taxes.
Companies like Uber and Lyft classify their drivers as independent contractors, which means you aren’t given any benefits and the company doesn’t withhold any of your taxes. This puts gig workers in a tough position come tax day, especially if they aren’t prepared to shell out big sums to the IRS.
Keeper, a startup that’s just graduated from the Y Combinator startup accelerator, is here to make taxes a lot easier for that demographic and to save them as much money as possible.
Founded by childhood buddies and former debate partners Paul Koullick and David Kang, the San Francisco-based company has raised $1.65 million on a $10 million valuation in a round led by Jake Jolis of Matrix Partners.
Keeper co-founders Paul Koullick (left) and David Kang
The pair entered YC this winter with a big idea and little to show for it. Come March, they had developed a full-fledged product and accumulated 200 paying customers. With their first round of funding, they plan to add to their small but growing team and acquire 10,000 customers in the next 18 months.
“There are some companies that are trying to go very broad and trying to cover the whole spectrum of benefits; we’re just trying to go really deep on taxes,” Kang told TechCrunch. “This is a pain point. This is where people are definitely leaving the most money on the table.”
Keeper guesses the average gig worker in the U.S. is overpaying their taxes by more than 20 percent, or about $1,550 for those making more than $25,000 per year. Why? Because these independent contractors aren’t claiming the tax write-offs available to them, like phone bills, car maintenance fees and even a Spotify subscription for drivers.
“If you’re a dog walker, there are so many things you need to be writing off, like your poop bags, your extra leashes, your parking,” Koullick told TechCrunch. “This population needs the guidance of an accountant, but they can’t afford one and we’re trying to create this third option.”
Like a personal accountant, Keeper monitors gig workers’ expenses all year in search of possible tax deductions, saving each user $173 per month on average, it estimates. The startup uses Plaid to follow its customers’ transaction history, and once per day sends a text message asking if there are any tax write-offs to note. Over time, it gets smarter and smarter, keeping the SMS questions to a minimum.
Keeper doesn’t fully file taxes for 1099 workers yet, but will begin offering a quarterly tax filing service in June. Next year, it plans to offer a full-year tax-filing service.
Koullick, Keeper’s chief executive officer, worked in product at Square before joining another startup, called Stride, where he built and scaled Stride Tax, a mileage and expense-tracking app. Kang, for his part, has spent most of his post-graduate career at a trading firm in Chicago, focused on quantitative modeling. The two toyed with a few startup ideas before landing on Keeper’s tax business.
“We wanted to build something that actually mattered to real people,” Koullick explained. “And we wanted to do it in the financial space where we were happy to wade through ugly details and systems on their behalf.”
Keeper isn’t the only recent YC alum focused on the growing gig economy. Another, Catch, sells health insurance, retirement savings plans and tax-withholding services directly to freelancers, contractors or anyone uncovered. Given the rapid rise of Uber and other gig platforms, it’s no wonder YC startups are tapping into the various business opportunities available there.
“We’re willing to tackle some of these topics that are kind of boring and mundane and really intensive,” Kang added. “Like the average person doesn’t want to think about taxes or filling out forms. We saw that as an opportunity for us to step in and be like, hey, we’ll take it.”
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Bringing affiliate marketing and outsourced customer acquisition to Brazil nets Escale $22.6 million
Despite not being Brazilian and having their first exposure to the country only a few years ago, the two co-founders of Escale have managed to raise $22.6 million for their company, which provides customer acquisition services to companies in telecommunications and healthcare across Brazil.
Their secret? A knowledge of search engine optimization technologies honed through side businesses the two ran back in the United States.
The state of online marketing and digital sales was so woefully bad in Brazil that co-founders Matthew Kligerman and Ken Diamond had a green field in front of them on which to build Brazil’s first true online customer acquisition service, according to Diamond.
“We fell in love with Brazil for its warm culture and natural beauty, but as consumers, we had terrible experiences acquiring the most fundamental products and services for our new lives: internet, cell phone plans, health insurance and basic banking needs,” Kligerman said in a statement.
The company’s largest customer, according to Diamond, is NET, the Brazilian cable and telecom operator. NET was the first company to sign on for Escale’s customer acquisition services, but the company’s roster of clients now includes some of Brazil’s largest companies, including Bradesco, Sul America, Claro, GNDI and Amil.
It’s that marquee client list that attracted QED Investors and Invus Opportunities to co-lead the $22.6 million round that Escale just closed. The company’s previous investors, Kaszek Ventures, Rocket Internet’s GFC and Redpoint e.Ventures, also participated in the funding.
Latin America is in the throes of a startup renaissance at the moment, with Brazilian companies like Nubank and iFood and the Colombian company Rappi reaching billion-dollar valuations. Meanwhile investors are committing more capital to the region. SoftBank, for instance, is committing $5 billion to a new Latin American-focused fund.
With the new funding, Escale intends to move deeper into the development of customer acquisition platforms across verticals like consumer finance, insurance and education with comparison shopping sites and informational services (à la Credit Karma in the U.S.).
“With millions of web and cloud voice interactions every month, Escale can transform each of those interactions into data points, and continually improve its proprietary acquisition platform, ‘EscaleOS,’ to create highly-intelligent, customized marketing and sales funnels, helping consumers at the right moment connect with the products and services they need,” says Nicolas Berman, a partner at Kaszek Ventures. “The more consumer interactions they have, the faster Escale’s data flywheel spins.”
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Jio Health combines online and offline healthcare in Southeast Asia, starting in Vietnam
The internet is often lauded for the potential to increase the impact of a range of primary services in emerging markets, including education, commerce, banking and healthcare. While many of those platforms are now being built, a few are finding that a hybrid approach combining online and offline is advantageous.
That’s exactly what Jio Health, a “full stack” (forgive the phrase) healthcare startup is bringing to consumers in Southeast Asia, starting in Vietnam.
The company started as a U.S.-based venture that worked with healthcare providers around the “Obamacare” initiative, before sensing the opportunity overseas and relocating to Vietnam, the Southeast Asian market of 95 million people and a fast-growing young population.
Today, it operates an online healthcare app and a physical facility in Saigon; it also has licenses for prescriptions and over the counter drug sales. The serviced launched nearly a year ago; already the company has some 130 staff, including 70 caregivers — including doctors — and a tech team of 30.
The idea is to offer services digitally, but also provide a physical location for when it is needed. Therein, the company ensures that “every element of that journey” is controlled and of the required standard; that’s in contrast to services that partner with hospitals or other care centers.
The scope of Jio Health’s services range from pediatrics to primary care, chronic disease management and ancillary services, which will soon cover areas like eye care, dermatology and cancer.
“Our initial research [before moving] found that healthcare in Vietnam was unlike the U.S.,” Raghu Rai, founder and CEO of Jio Health, told TechCrunch in an interview. “Spending is primarily driven by the consumer (out of pocket) and there’s no real digital infrastructure to speak of.”
Rai — a U.S. citizen — said doctors typically “have minutes per patient” and get through “hundreds” of consultations in every morning shift. That gave him an idea to make things more efficient.
“We can probably address north of 80 percent of consumers’ health needs,” he said of Jio Health,” but we also have referral partnerships with certain hospitals.”
Raghu Rai is CEO and founder of Jio Health
The process begins when a consumer downloads the Jio Health app and inputs primary information. A representative is then dispatched to visit the consumer in person, potentially within “hours” of the submission of information, according to Rai.
He believes that Jio Health can save its users money and time by using remote consultancy for many diagnoses. The company also works with health insurance companies for areas like annual checkups, and Rai said that McDonald’s and 7-Eleven are among the corporations that offer Jio Health among the providers for their staff; they’re not exclusive.
This week, Jio Health announced that it has closed a $5 million Series A funding from Southeast Asia’s Monk’s Hill Ventures . Rai said the company plans to use the capital for expansion. In particular, he said, the company is adding new care categories this month — including eye care and dermatology — and it is working toward expanding its brand through marketing.
Further down the line, Rai said the company hopes to expand to Hanoi before the end of this year. While there is interest in moving into other markets within Southeast Asia, that isn’t about to happen soon.
“We have begun to investigate other markets, but at this point feel the market in Vietnam is substantial in itself,” he told TechCrunch. “It’s very plausible that we’d be looking at international expansion plans in 2020… we’re going to be focused on Southeast Asia.”
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Alan raises another $45 million for its health insurance product
Paris-based startup Alan has raised a Series B round of funding of $45 million (€40 million). Index Ventures is once again leading the round, with partners of DST Global also participating. The company had raised a $28 million funding round only 10 months ago.
Alan is a software-as-a-service startup tackling a very specific industry: the health insurance market in France — and soon across Europe. The company wants to create a well-designed insurance product with transparent pricing and policies to make healthcare more accessible. And it isn’t just a marketplace — the startup has obtained an official health insurance license and is the first new health insurance company in France in 30 years.
In France, every employee is covered by the national healthcare system for basic reimbursements, as well as a private insurance company for more expensive treatments. In addition to that, legacy insurance companies have neglected those products as they usually don’t generate a lot of margins on that segment. It creates a huge market opportunity for Alan.
With today’s funding announcement, the startup has shared some numbers. In 2018 alone, the company grew from 5,000 insured people to 27,000, and revenue jumped from $4 million to $25 million (€3.5 million to €22 million). Alan has been focused on freelancers as well as small and medium companies, such as My Little Paris, Le Slip Français, Ledger and Converteo.
More interestingly, Alan is close to break-even right now with 64 employees. That gives you an idea of Alan’s margins.
Following today’s funding round, the company is going to hire a lot more people. There should be around 175 people working for Alan by the end of the year.
On the product front, the company is always looking at ways to make the experience as seamless as possible. “We’re trying to make the insurance process instantaneous, from quotes to coverage and reimbursements” co-founder and CEO Jean-Charles Samuelian told me.
But Alan has always been about healthcare at large, not just insurance products. So let’s see how they can use this influx of funding to simplify healthcare in general.
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