1. 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
3. 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
4. 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.
5. “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
6. 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)
8. 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
“
”
9. So we built MVP #1 to give insurers insight into
how their members rated each service.
Week 4
10. 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
11. 6 out of 6 insurers told us they want to connect
their members to social services.
Week 5
Eureka!
12. 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
13. We thought the referral process would be
simple.
Step 1:
Map the
process
Week 5
14. 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
15. 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
16. 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
17. 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
18. 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
19. MVP #2: We connected 4 people with social
services and learned how difficult it is.
?
Week 7
20. 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
21. 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
“
”
22. So we built our MVP #3 that aggregates local
services and enables seamless referrals.
Week 6
23. 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
24. 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
25. 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
26. What’s next for Merity
Continuing with Merity
Continuing with Merity
Pursuing another business
in the space
Interning at Facebook
Pursuing healthcare informatics
27. Thank you to the Lean
Launchpad Teaching team
and our mentor, Nancy Deyo!
Notas do Editor
On day 1 we were …
Now we are …
Let me tell you the story of how we got there with 140 interviews, countless tests, and a lot of adventure
3
3
2
After starting on transportation, we hit rock bottom pretty quickly
We pivoted three times
We started with the problem Ruth faced needing to get to appointments but lacking transportation
Our first hypothesis was that clinic managers wanted to…
We also had cfo’s at insurance companies also wanted to get these … avert costs
We did our homework
None of us were experts in transportation so we trusted the first things that we heard
Many patients miss appointments due to transport
Costs 25B
We thought we had identified a real need
Get out of the building
We spoke to fourteen clinic managers
Are no shows a problem and is transportation a reason
At this point we had blown up
This is when stake in the ground (hypothesis)
Looking for a customer and a value prop -- our mentor Nancy just said to “put a stake in the ground”
So then we pivoted
At this point we wanted to test - can we help transportation providers
But then we talked to 7 transportation providers and none of them wanted - small businesses that are cash strapped
So we pivoted to look at insurers as the customer segment, because they have money and many were currently offering rides to the doctor to their members
We learned that members who had bad experiences with these rides would often rate the overall insurance company poorly
So we thought we could help insurers improve the member experience with ancillary benefits like transportation, meals, and others.
Two insurers told us they wanted to measure which service providers were providing good or bad experiences to their members
Kaiser told us that member satisfaction goes into their government rating and influences $1B of government funding.
Wow.
We had a fantastic opportunity to go out and talk to a lot of insurers and show them this MVP and hear about their needs.
And what we learned is that...
Insurer companies don’t want to measure satisfaction
Because if they find problems, they’ll have to report it, their plan rating might go down
Lesson in healthcare: what people say they want and what they actually want can be very different
At this point, we had pivoted 2 in 4 weeks
From here, we talked to to 6 insurers and the common theme was connecting their insurance members to social services!
We were really interested in this need and pivoted to help insurers connect patients to social service orgs dealing with services such as housing, meals or transportation. This connection of patients to social service known as the referral process!
And we had a daunting journey in front of us:
How this messy process works in order to find our value prop
Map how money flows in the business
Sell our solution!
---
As we hit pretty much it this pit, we started to then focus on interviews where it will be challenges that an insurer will have but will also be willing to pay. We looked a bit into more literature and experts on more macro trends in healthcare. There have been growing major changes in the space of social determinants of health where non-medical services such as meals, housing, and also transportation play a major factor in a person’s health. A segment of insurers, Medicare Advantage Organizations have started transitioning to work on the value-based models which focus on outcomes instead of volume of appointments and have looked into this. One major pain point we then keep hearing from not just one but multiple stakeholders from providers, patients, and insurers is this referral process. The referral process is for transferring patients who need social services over to the community service providers.
In the beginning, we thought the referral process looks something like this:
Before in the video, we mentioned Ruth who needs transportation service. In the referral process, someone in the insurer, known as the case worker that takes care of Ruth’s medical case, identifies her social need, and calls Ruth to enroll her in a transportation service which she can then just get access to immediately.
We assumed that the process would just have one of case workers in the insurer calling up the patient to enroll him/her for an appointment in a social service organization and the patient can just go get the social service they need
---
As we hit pretty much it this pit, we started to then focus on interviews where it will be challenges that an insurer will have but will also be willing to pay. We looked a bit into more literature and experts on more macro trends in healthcare. There have been growing major changes in the space of social determinants of health where non-medical services such as meals, housing, and also transportation play a major factor in a person’s health. A segment of insurers, Medicare Advantage Organizations have started transitioning to work on the value-based models which focus on outcomes instead of volume of appointments and have looked into this. One major pain point we then keep hearing from not just one but multiple stakeholders from providers, patients, and insurers is this referral process. The referral process is for transferring patients who need social services over to the community service providers.
Reality is the referral process looks something like this, a convoluted and manual process.
Today, someone from the insurer will call the patient, first figure out what social needs, transportation, housing or food, they have, then they call multiple service providers, play phone tag with them and have back and forth conversations. And social service org will then call the patient to set up appointment and have more phone tag. Its a ton of work for the case worker at the insurance company and members often don’t get connected to the service they need.
Reality is the referral process looks something like this, a convoluted and manual process.
Today, someone from the insurer will call the patient, first figure out what social needs, transportation, housing or food, they have, then they call multiple service providers, play phone tag with them and have back and forth conversations. And social service org will then call the patient to set up appointment and have more phone tag. Its a ton of work for the case worker at the insurance company and members often don’t get connected to the service they need.
Reality is the referral process looks something like this, a convoluted and manual process.
Today, someone from the insurer will call the patient, first figure out what social needs, transportation, housing or food, they have, then they call multiple service providers, play phone tag with them and have back and forth conversations. And social service org will then call the patient to set up appointment and have more phone tag. Its a ton of work for the case worker at the insurance company and members often don’t get connected to the service they need.
Reality is the referral process is a ton of manual and convoluted work.
Today, someone from the insurer will call the patient, first figure out what social needs, then call multiple transportation providers, play phone tag with them and have back and forth conversations. And then the service provider will then call the patient and play more phone tag to enroll them in the service and coordinate the time. Its a ton of work for the case worker at the insurance company and members often don’t get connected to the service they need.
Based on our mappings, we then updated our value proposition
For our value prop:
1) we learnt that we can scale insurer’s caseworker efficiency by targeting the manual process for referrals
2) decrease medical costs by improving health outcomes through enabling better access to social services for patients
We went out of the building to learn more about local service service organizations by building a second MVP to do the referral process ourselves
We met Eddie at the Palo Alto library who needed help with housing.
So we decided we could help him connect with a housing assistance program, a social service organization
We expected it to be hard but it was really hard to get in touch in housing organizations for Eddie and get follow-ups from these organizations. We then realized that having a quality social service organization as our key partners is very important in this referral process.
----
, and can’t get follow-up
Patients didn’t always follow-up with social service organizations
For our key partners
We solidified social service orgs as
We realize that to improve this referral process, we need to build an engaged network of social service organizations that can provide timely and quality service to patients
At this point, we realized we have identified the value proposition and start looking more into how we can save case workers time. It turns out that case workers would love a digital referral platform as currently, it can take 2 hours to even refer a single patient.
---
We decided that we could simplify the referral process in which a case worker connect a member to a social service provider - like housing, meal vendor, transportation more seamlessly.
So we set out to mock up an MVP to save case worker’s time from this current manual workflow.
Now, once the case worker at the insurance company has identified which needs the patient has, they go onto Merity and select a recommended provider and make a digital referral. Instead of playing phone tag, the service organization accepts the referral, can initiate the enrollment process and reaches out to the person to initiate service.
---
We started showing this to a lot of insurers and we found that this would save case workers time and help patients get the services they needed.
And the most important services to connect to are housing, food and transportation.
We work closely with curated list of social service organizations to build deep integrations
Thrilled to learn insurers would pay $1-4pmpm
50,000 members -> how much that is a month (potential contract size). We’re talking about big numbers!
---
As we hit pretty much it this pit, we started to then focus on interviews where it will be challenges that an insurer will have but will also be willing to pay. We looked a bit into more literature and experts on more macro trends in healthcare. There have been growing major changes in the space of social determinants of health where non-medical services such as meals, housing, and also transportation play a major factor in a person’s health. A segment of insurers, Medicare Advantage Organizations have started transitioning to work on the value-based models which focus on outcomes instead of volume of appointments and have looked into this. One major pain point we then keep hearing from not just one but multiple stakeholders from providers, patients, and insurers is this referral process. The referral process is for transferring patients who need social services over to the community service providers.
We set out to understand how referrals work
---
As we hit pretty much it this pit, we started to then focus on interviews where it will be challenges that an insurer will have but will also be willing to pay. We looked a bit into more literature and experts on more macro trends in healthcare. There have been growing major changes in the space of social determinants of health where non-medical services such as meals, housing, and also transportation play a major factor in a person’s health. A segment of insurers, Medicare Advantage Organizations have started transitioning to work on the value-based models which focus on outcomes instead of volume of appointments and have looked into this. One major pain point we then keep hearing from not just one but multiple stakeholders from providers, patients, and insurers is this referral process. The referral process is for transferring patients who need social services over to the community service providers.