Initial care startups argue about the role of insurance in the future of care

Allegedly about the democratization of health care, a panel at the Tech Crunch Disrupt virtual event got out of hand last week when Forward CEO Adrian Aoun went on the offensive and called on the other panelists from Carbon Health and Cityblock Health about working with insurers to a lively debate about what role, if any, insurers should play in the future of healthcare.

“When you go to bed with insurers at the end of the day, your incentives are actually not right,” said Aoun. “You are not ‘doing what the consumer needs’. So at the end of the day you start a planning function, we start a heart health program. … You are starting a new way of billing me. I start cancer prevention.

“I think one of the most important things that we really, if you really believe in this idea of ​​how we should make products for the consumer, should try to democratize healthcare. Are we in bed with insurers?” Because that’s not the end customer. That’s not the consumer. And I think that’s the conversation we should have. “

Cityblock Health President Toyin Ajayi and Carbon CEO Eren Bali opposed this framing, telling Aoun that the only reason he had the luxury of turning down insurance was because his customers were wealthy.

“The binary that you are presenting here is that you will either get a reimbursement from the insurance company or you will build a consumer- or patient-centric business and in brackets that only very wealthy people can afford, ”said Ajayi. “What we found is that this is not the binary. There is another avenue that partners with insurers but takes the risk on the total cost of care and outcomes.

“So we don’t bill a community health worker who comes to your home and holds your hand and tells you that you are important and helps you understand what is going on in your life. But we are absolutely motivated to do so and innovate in this area because it enables us to provide health care to people and make them healthier. “

In addition to creating misaligned incentives, Aoun argued that insurance is driving up costs across the system.

“Our price will go down and yours will go up because that is what insurance does,” he said. “If we want healthcare to be democratized and we want healthcare to be affordable, we have to stop paying a 20% tax.”

At one point, Aoun Bali offered $ 1 million to stop taking out insurance.

“When the world changes and most people don’t need it, we will happily stop accepting insurance,” said Bali. “We don’t like interacting with the insurance companies. But it’s the reality. “

As much as it was about insurance, the conversation was also about the right approach to changing healthcare. Comparing himself to electric car entrepreneur Elon Musk, Aoun said his vision of an insurance-free world was like Musk’s vision of a carbon-free world.

“You can think of the Elon Musk of health care,” Ajayi said. “I see myself as a person who tries today to make the world a better place for sick and suffering people – eespecially people whose factors that determine whether they live or die have nothing to do with their bodies. “

Ajayi had the last word in the debate when he talked about the work of CityBlock and above all, how sensitive the startup is to social determinants of health.

“The way to start, I keep claiming, is not to build what that one percent or five percent needs and wait decades for it to trickle through,” she said. “If you really think your technology will solve my problems, open some free clinics. I start with the people I want to influence and build from there. “

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