From reducing missed appointments… to
enabling social service referrals Day 1 Transportation for at-risk patients to decrease missed appointments. Market Type: New Market Now Platform for insurance companies to manage non- medical service providers. Market Type: New Market Tori Seidenstein Han Lin Aung Ruben Amar Sehj Kashyap Sarah Jacobson Picker MBA & BS Computer Science Hacker MS & BS Computer Science Hustler MBA & MS Engineering Designer MD & MS Bioinformatics Picker MBA & MS MS&E 140 Interviews

Pivot #1 The Climb This
is our 10 week journey - 3 pivots, 3 MVPs. Pivot #2 Pivot #3 MVP #1 MVP #3 MVP #2

Value Prop High-touch collaboration to
integrate with existing IT systems Ongoing maintenance and support Direct sales Publish randomized control trial Avert costly emergency visits by ensuring patients receive emergency care Customer Relationships Lyft and Uber Non emergency medical transportation providers Appointment data and health data Sales team Software and ML engineers Capture $180 missed revenue per appointment Save time Integrate with healthcare system data Build ML model to predict which patients will miss appointments Provide data to healthcare system Key Partners Server costs, text messaging costs Integration costs Marketing and sales costs Annual contract with clinic + per-ride fee CFOs at insurers Key Activities Key Resources Customer Segments Channels Revenue StreamsCost Structure Capture missed revenue ($180 per appt) Save time Avoid costly emergency visits Insurance CFOs Clinic managers Value Prop Customer Segments

Identified a need! $25B lost
revenue 51% of missed appointments due to transportation Week 1Chaiyachati et al., JAMA Internal Medicine 2018 Missed appointments are a problem because of lack of transportation.

“Is transportation a problem?” No
- Pacific Dialysis Clinic No - Summit Medical Center No - DaVita Los Angeles No - Satellite Dialysis Center No - Laguna Surgery Center No… (9 more times) Pit of despair We were wrong. 0 out of 14 clinics said that transportation was a reason for no-shows. Week 2

PIVOT to billing Hypothesis #2:
transportation providers need help with billing. Week 3 “Would you pay for a faster billing solution?” No - Del Norte Taxi No - Absolute NEMT No - JBL Med Transport No - Medi-cab No - Ridgecrest medical transport No… (3 more times)

PIVOT to satisfaction Hypothesis #3:
insurers want to improve member satisfaction. Week 4

Two insurers said they wanted
to measure satisfaction across service providers. Week 4 ” Our Medicare Advantage five-star status is worth one billion dollars a year to us. — Kaiser EVP “ ”

So we built MVP #1
to give insurers insight into how their members rated each service. Week 4

Deeper pit Insurers say they
care about satisfaction, but don’t actually want to uncover complaints! Then they would have to report it. — Domain expert ” “ Week 4 Aha moment

6 out of 6 insurers
told us they want to connect their members to social services. Week 5 Eureka!

PIVOT to social services So
we set out to improve the way insurers connect with social service orgs. Step 2: Figure out the $$$ Step 1: Map the process Step 3: Find a customer Week 5

We thought the referral process
would be simple. Step 1: Map the process Week 5

Case worker calls patient Patient
discharged from hospital Case worker gets alert from PBM Screening by physician during appointment Patient learns about benefit (via mailer or online) Patient files grievance Social service org invoices insurer Insurer initiated Provider initiated Patient initiated Doctor loops in provider case worker Patient calls insurer ( 1- 800 line) Provider caseworker contacts insurer case worker Social service org delivers service Instead, we learned it’s manual and time consuming for caseworkers. Week 5 Social service org calls patient & coordinates service Case worker calls multiple social service orgs to refer patient Referral Process Conversation with case worker about social needs

Case worker calls patient Patient
discharged from hospital Case worker gets alert from PBM Screening by physician during appointment Patient learns about benefit (via mailer or online) Patient files grievance Social service org invoices insurer Insurer initiated Provider initiated Patient initiated Doctor loops in provider case worker Patient calls insurer ( 1- 800 line) Provider caseworker contacts insurer case worker Social service org delivers service Instead, we learned it’s manual and time consuming for caseworkers. Week 5 Social service org calls patient & coordinates service Case worker calls multiple social service orgs to refer patient Referral Process Conversation with case worker about social needs

Case worker calls patient Patient
discharged from hospital Case worker gets alert from PBM Screening by physician during appointment Patient learns about benefit (via mailer or online) Patient files grievance Social service org invoices insurer Insurer initiated Provider initiated Patient initiated Doctor loops in provider case worker Patient calls insurer ( 1- 800 line) Provider caseworker contacts insurer case worker Social service org delivers service Instead, we learned it’s manual and time consuming for caseworkers. Week 5 Social service org calls patient & coordinates service Case worker calls multiple social service orgs to refer patient Referral Process Conversation with case worker about social needs

Case worker calls patient Patient
discharged from hospital Case worker gets alert from PBM Screening by physician during appointment Patient learns about benefit (via mailer or online) Patient files grievance Social service org invoices insurer Insurer initiated Provider initiated Patient initiated Doctor loops in provider case worker Patient calls insurer ( 1- 800 line) Provider caseworker contacts insurer case worker Social service org delivers service Instead, we learned it’s manual and time consuming for caseworkers. Week 5 Social service org calls patient & coordinates service Case worker calls multiple social service orgs to refer patient Referral Process Conversation with case worker about social needs

Value Prop Insurers GET: Direct
sales teams KEEP: Data on member outcomes GROW: Up-selling features, custom integrations Direct sales Publish randomized control trial Customer Relationships Social service orgs Government (Center for Medicaid and Medicare) Network of social service orgs Software infrastructure (AWS) Implementation team for CBOs Integration team for payors Scale caseworker efficiency Measure impact of social services on health outcomes Decrease medical costs Improve operational efficiency Win new contracts with payors Build integrated network of engaged social service providers Build digital referral platform for caseworkers Collect data when the service was performed Key Partners Headcount: engineering, sales, implementation & ops Technology: AWS Marketing: Conferences, Google Adwords, Direct outreach SAAS ($1-$4 per member per month) paid by insurer Free, freemium (based on size), or tiered (based on features) for CBOs Health insurance supplemental benefit manager Non-profit owner Patient Key Activities Key Resources Customer Segments Channels Revenue StreamsCost Structure Scale case worker efficiency Decrease medical costs

MVP #2: We connected 4
people with social services and learned how difficult it is. ? Week 7

Value Prop Insurers GET: Direct
sales teams KEEP: Data on member outcomes GROW: Up-selling features, custom integrations Direct sales Publish randomized control trial Customer Relationships Social service orgs Patients Government (Center for Medicaid and Medicare) Network of social service orgs Software infrastructure (AWS) Implementation team for CBOs Integration team for payors Scale caseworker efficiency Measure impact of social services on health outcomes Decrease medical costs Improve operational efficiency Win new contracts with payors Build network of social service providers Build digital referral platform for caseworkers Collect data when the service was performed Key Partners Headcount: engineering, sales, implementation & ops Technology: AWS Marketing: Conferences, Google Adwords, Direct outreach SAAS ($1-$4 per member per month) paid by insurer Free, freemium (based on size), or tiered (based on features) for CBOs Health insurance supplemental benefit manager Non-profit owner Patient Key Activities Key Resources Customer Segments Channels Revenue StreamsCost Structure Social service orgs Value Prop Build engaged community network

Step 2: Identified value prop
Case workers said they would love a digital referral platform to be more efficient. Week 6 It can take 2 hours to do referral for a single patient — Case worker “ ”

So we built our MVP
#3 that aggregates local services and enables seamless referrals. Week 6

We followed the money and
learned insurers would pay $1-4 per member per month. Step 3: Figure out the $$$ $3 per member per month 50k members in Year 3 12 months X $2M annually in Year 3 Week 7

Step 4: Find a customer
We found a customer willing to pay for our product! How can I ensure that a member gets to the service quicker, sooner, more effectively? That is an unmet need that we pay for. - Medicare Advantage Manager “ ” Week 8

This can be a $20M
business in 3 years. $5M $21M$1M 30 customer s Number of regional insurance plans 10 255 PMPM ($) $3 $3$3 Sales (annual) Headcount (Sales reps + Marketing) 17 329 Total # of members 25,000 150,000 575,000 Year 1 Year 2 Year 3 x12 x12x12

What’s next for Merity Continuing
with Merity Continuing with Merity Pursuing another business in the space Interning at Facebook Pursuing healthcare informatics

Thank you to the Lean
Launchpad Teaching team and our mentor, Nancy Deyo!