[hunter23]

I work in health tech. Here are some problems: * Helping patients select the right doctor. Currently most people use Yelp or through referrals. The problem is that Yelp has little correlation to quality of care. It's very difficult for patients to evaluate a doctor - usually what they end up doing is evaluating the customer service aspect of the doctor (did they speak to me nicely, did they make me wait for an appointment, etc.) but no one is able to evaluate doctors based on the quality of care. * Helping doctors and patients estimate costs - Neither doctors or patients understand costs. it is very routine for a doctor to suggest getting a lab test from X place because they have experience working with the center. They have no idea that for your specific insurance plan this will cost you 2x another place and so you with an unhappy patient who blames their doctor for ripping them off. There should be tools to patients and doctors estimate costs. * Helping patient select a health care plan from their employer or a marketplace - most patients have no idea what health care plan they are best on. However, theoretically if you have their history of claims and some guess on their future behavior, you should be able to tell them which health care plan makes the most sense for them * Helping patients manage their chronic conditions. Most people are very lax about managing their health conditions, they skip appointments, choose brand names over generics, ignore refills, etc. Technology should be able to nudge them in the right direction and help them optimize on quality and costs. * Building technology that encourages health behavior - A majority of the diseases attacking Americans are caused by lifestyle issues (diet, stress, drugs, exercise). If you could build technology solutions that help nudge people to healthier behavior, you would make solve a billion dollar problem for insurance companies; they would love to reduce the risk pool of their patients. This is a tough battle because even people who care about health are inundated with false information (think Dr. Oz or anti-vaxxers or people who insist every person in the world is a celiac and should go gluten free).

As you can see the bulk of the problems in the health care industry is understanding how to navigate the huge mess of the US healthcare system. A longer term solution is for us to build a single payer system and incentivize patient care over patient procedures but I doubt that will happen.

[twunde]

Fair warning: Healthcare has a long sales cycle, is heavily regulated and is difficult to break into as an outsider. Generally you'll want someone on the founding team with a significant healthcare background and connections (even better if they're a MD). Once you have found a way to sell you'll find that the competition is fairly minimal compared to other industries.

[hunter23]

Totally agree. All the problems I listed are quite hard and will monetize slowly. Sales are really long; the company I am a part of had an all star founding team with a history of exits so they gots lot of funding which helped give them a cash cushion to deal with the long sales cycles.

[Regardsyjc]

Are there any books you could recommend to learn more about why the American healthcare is a mess, how it became this way, as well as comparisons with other healthcare systems and why they work.

Could a PMR system help with some of these issues? Giving patients access to their records making it easier to aggregate data abiding with HIPAA?

I recently saw an episode of Dirty Money on Valeant. Is Valeant a good representation for most pharma companies and also a reflection of most for profit medical businesses whose primary obligation is to increase shareholder value?

What would be the best way to start aggregating and comparing prices in the USA? If it isn't possible, why do prices vary so much?

[hunter23]

Sorry can't recommend any books. The main reason US healthcare is a mess is because we have structured it to be a free market system when it lacks the key characteristics for a free market to work. Free markets work really well in some areas (say groceries stores) and would work terrible in others areas (a national military) See: http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

Patient medical records won't help with pricing issues, but data transparency would help with automated solutions to manage care.

There is no easy way to aggregate and compare prices. If you could get billions of health care claims then you could build algorithms to estimate pricing or perhaps you could convince the large health care companies to share their pricing with you (highly unlikely). Prices very widely because there each institution negotiates their own set of prices with a specific set of providers. Basically imagine your health care plan is basically a set of discount codes for a set of doctors and providers. Except those discount codes are never shared with you and vary for each doctor and each provider and can change at any time.

[slow_donkey]

What's your opinion on current healthcare startups like zocdoc or Oscar insurance? I've seen a lot of new doctor review sites popping up but like you mentioned that's only 1 problem out of many/bigger issues

[hunter23]

Doctor reviews are not correlated to patient outcomes. There are tons of excellent doctors with terrible bedside manner that have bad reviews and incompetent doctors with excellent bedside manner who get great reviews. Quality metrics should be based on data like patient outcomes (but even that is hard because surgeons currently will reject "hard" patients to juice their numbers). As a non doctor, you honestly are not qualified to assess the abilities of your doctor.

I do think Zocdoc is a great idea because anything that makes scheduling an appointment easies is a win. I'm just saying that patient reviews give people a false sense of security that their doctor is good. In reality, almost no one knows if someone is good or not unless you have directly worked with that doctor and have a lot of stats on their outcomes (which only anyways works on specialities that have a lot of procedures). Assessing doctor quality is a very hard problem.

Patient reviews are good for assessing if your personalities will mesh but beyond that they don't go far.

I am not really too familiar with Oscar; what are they doing?

[cvaidya1986]

Hi would you like to setup a call to talk more about these issues?

[hunter23]

Sorry I don't have time for a call but happy to give my perspective on HN if you have any questions.

[Thriptic]

> Helping patients select the right doctor. Currently most people use Yelp or through referrals. The problem is that Yelp has little correlation to quality of care. It's very difficult for patients to evaluate a doctor - usually what they end up doing is evaluating the customer service aspect of the doctor (did they speak to me nicely, did they make me wait for an appointment, etc.) but no one is able to evaluate doctors based on the quality of care.

We actually explored this for a startup idea. The problem is that it is difficult to find a group of people who can do the evaluations in a truthful and holistic way:

* Hospitals will never want to give out outcome data because outcome data will be used against them for ratings by people who don't understand it (for example, some community hospital in Montana may be rated higher than Mass General because of case complexity issues). Or worse, it will be used by people who DO understand it :D

* We explored having doctors rate other doctors in a variety of ways (which I think would reflect the "truest" measure of quality). Residents and fellows could rate attendings, but they might not know how attendings in their hospital compare to attendings in most other hospitals. Additionally, attendings or hospitals might apply pressure to these groups to provide good ratings. Specialists could rate other specialists in their field, but then you might see collusion, false negative reviews, or retaliation. How you would avoid these problems is not immediately clear to me.

* As you point out, patients are really only able to evaluate bedside manner and not quality of care.

One way we thought about it is having a rating system which would have public profiles for physicians and anonynmous reviews from other physicians and members of the care team. Ratings coming from other physicians in the specialty and providers at their institutions would be weighted more than ratings from other physicians. The highest rated physicians would also have more weight within their specialty than an average rated physician. You could bootstrap the system by asking specialists to provide the names of the top X people in their field. These people would automatically be rated highly.

Patients could log in and provide comments about patient experience; hospitals could log in and provide outcome data if they wanted.

I am not entirely sure how you would really monetize it. It's the equivalent of the dating app problem; the better you are at matching, the less money you make as users exit the platform. I do agree that it would be great if osmeone could solve this problem though.

> Helping doctors and patients estimate costs - Neither doctors or patients understand costs. it is very routine for a doctor to suggest getting a lab test from X place because they have experience working with the center. They have no idea that for your specific insurance plan this will cost you 2x another place and so you with an unhappy patient who blames their doctor for ripping them off. There should be tools to patients and doctors estimate costs.

We had a startup that came at this in an indirect way. We were trying to make it easier for labs and other providers to perform eligibility checks and facilitate prior auths in real time. Our proposed solution would have involved running the check during ordering, and then having the phlebotomist or lab tech at the hospital doing the sample collection contact the doctor and inform them that something would or would not be covered by insurance. The provider could then talk to the patient about out of pocket costs etc. I think this actually could have worked; our team imploded before we could prototype it however :(

While I like the other ideas, glhf trying to get people to practice lifestyle management or be adherent to a treatment regimen XD

[Arete31415]

As a frequent patient, I see such incredible need for "disruption" in healthcare, both in terms of transparency/ empowering the patient, and in terms of cost suppression. However, anyone who tackles this space has to be aware that there are some huge entrenched interests who like the current inefficiencies and cost opacity very much, thank you. Breaking into this space would be 1 part technical know-how to 10 parts legal jujitsu.

As an example, look upon the bloodied corpse of the failed startup Remedy, which was actually doing something really good -- helping users find billing errors and getting money back for them on bad charges. But incredible amounts of pushback stymied them:

https://www.fastcompany.com/40483774/remedy-wanted-to-cut-pe...

[kaicianflone]

I am also in healthcare tech and also worked with the idea of a doctor rating system focused specifically on using doctor procedure/diagnosis billing data and PQRS. We abandoned the idea due to lack of data for each healthcare field (cardiology, radiology, oncology, etc.) and hospitals not wanting to participate.

However, I have looked into incentivized, distributed platforms such as wings.ai or golem.network and believe that this could be applied to healthcare. If patients were incentivized on going to the doctor for a copy of the CPT/DGX codes on their bill and survey information around PQRS you would have a lot of useful data. This data could be used not only to provide a rating system of doctors, but also price comparison on CPT/RVU across the United States and the ability to provide PQRS data for doctors. Its an all in one, decentralized, healthcare platform for patients, doctors, and insurance providers.