Finding The Best Doctors: Garner Health Brings In $12.5M Series A For Recommendation Platform

Health tech company Garner Health aims to highlight individual doctor performance so that its corporate clients’ employees can receive better health care experiences no matter which doctor they choose.

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“We looked at patient data and found that patients in the same geography, ones you would think would have the same outcome, ended up with different health and cost outcomes,” Nick Reber, Garner Health founder and CEO, told Crunchbase News. “One would go to the doctor and be okay, another one, not so much. The biggest determinant, and the driver of costs and outcomes, is which doctor the person saw.”

That patient data led the New York-based company to develop a platform that analyzes large amounts of medical insurance claims to identify the highest-quality doctors in a city or neighborhood. Partnering with employers, Garner guides employees to the best doctors, and if they use Garner to choose their doctor, the employer agrees to pay the employees’ out-of-pocket costs. The employers end up saving thousands on medical bills, an estimated 10 percent in overall health benefit costs, Reber said.

To aid in the company’s growth, it raised $12.5 million in Series A funding led by Founders Fund, with support from Maverick Ventures and Thrive Capital. In total, the company has raised $17 million, which includes a $4.5 million seed round in 2020, led by Thrive, according to Crunchbase data.

Brian Singerman, partner at Founders Fund, said in an interview that he used to work with Reber at Oscar Health, and while knowing him was a factor in the decision to invest in the company, one of the missions of Founders Fund is to cut the cost of health care.

“This is a space we have known and cared about for quite some time,” Singerman said. “A company giving people financial incentive to see better doctors and a great founder working on something like this is a no-brainer. It is hard to get outcomes data and to give people proper data, and Garner is doing that.”

Meanwhile, Garner’s platform currently serves more than 10,000 members in more than 30 states. Reber intends to use the new funding to build out Garner’s sales and engineering teams, as well as improve its data. And while much of its growth comes from word-of-mouth referrals, he would like to see that shift to include partnerships with health care brokers and health plans.

Although there are other platforms, such as Healthgrades, Yelp or Google, for searches, competitors aren’t able to provide the same kind of unbiased and transparent doctor rankings Garner Health can because the company has no financial relationship with health care providers, Reber said. Instead, recommendations are based on cost and quality analytics derived from hard data.

“Transparency tools help you understand what an MRI costs, but no one uses that because everyone trusts their doctor about where to go, rather than looking on the app,” he said.

Illustration: Dom Guzman

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A startup that raised $175 million to fix primary and urgent care is still struggling with what its CEO called the 'most complex' problem in healthcare

Summary List PlacementSome of healthcare’s problems are so complex that even the most well-funded startups struggle to fix them.
Carbon Health cofounder and CEO Eren Bali found out as much as his company tried to make prices for doctor’s visits, routine procedures like blood tests, and comparative prices for diagnostic tools like MRIs and x-rays transparent for patients, a feat that sounded simple at first but quickly ballooned into a much larger, systemic problem.
In a Twitter thread posted on December 27, Bali ran through the challenges he and his team had identified in trying to create a menu of sorts for different procedures and treatments for Carbon Health patients.
In the end, he ultimately said the fix lies with insurance companies — not healthcare providers — to fix the way patients and clinics are expected to pay for healthcare in the United States.
“The problem is on the payer side,” Bali told Business Insider. “The payer systems are old and antiquated, and that’s opaque to providers. We are doing all we can on the provider side.”
Read more: $1.5 billion digital-health startup Ro wants to be your online doctor. Here’s how its coronavirus response rooted in rapid at-home testing fits into the new unicorn’s long-term strategy.
Calculating prices ahead of visits proved difficult
Carbon Health serves a wide variety of patients with its urgent and primary care services. It offers booking through an app, and also added virtual visits to any patient seeking care but hesitant or unable to go into one of its physical clinics.
Ideally, Bali said, Carbon would be able to show patients the costs of these services upfront so that the doctor and patient can decide on the best course of treatment together, but hasn’t made as much progress as he would like.
Some relatively new healthcare entrants like Walmart have similar ambitions in making shopping for healthcare just as easy as shopping for groceries. Patients can find Walmart’s cash prices online, such as a primary care visit that costs $40.
Carbon Health has developed a system that works well for patients without insurance, Bali said, because pricing is more straightforward. It created a data analysis tool that looks at different inputs such as existing conditions, Carbon’s cost of service, and other factors to provide an up-front cost to uninsured patients, Bali said. For example, Carbon charges uninsured patients $195 for a primary care sick visit and $69 for a virtual visit, according to its website.
But it was when that same system was trained for patients with insurance that things started to unravel, Bali said. The calculated costs for patients with similar backgrounds, insurance plans, and symptoms only matched 40% of the time, Bali said.
“We can’t explain the difference,” Bali said.
Insurance companies are built on out-dated systems
Part of the variance can be explained by how complex insurance plans are, Bali said. Each plan is essentially unique to the individual that has it, and coverage can range widely even among similar plans offered by the same insurance company.
That’s not something that even the most sophisticated data analytics model can fix, Bali explained. If healthcare providers like Carbon want to tell patients how much they can expect to pay for a visit and associated procedures, insurance companies need to update how they bill both patients and providers.
“It’s driven around the inadequate system,” Angela Miles, head of revenue cycle at Carbon Health, told Business Insider. “We need to rebuild that from a payer standpoint to get to a more modern standpoint.”
More complexity leads to increased costs
Startups like Oscar Health are already attempting to bring insurance companies into a more modern model, Bali said, but larger companies have yet to shift in a meaningful way.
Those that do change, albeit in a more superficial way, actually make the problem worse by making it even more complicated, Bali said, because the added complexity adds time, which adds costs.
“A lot of work that goes towards decreasing healthcare costs is making the system more complicated,” Bali said. “My theory is that things that drive increased cost in healthcare is due to increasing complexity because you can’t be transparent and compete on price.”SEE ALSO: The founder of a healthcare venture fund that just raised $200 million shares why she wants to back founders that are building businesses for their communities
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