Access HealthNet Raising $3M for Tools Aimed at Cutting Care Costs

When a patient with health insurance is in need of an expensive medical procedure, the actual cost of the procedure may not seem material to her once it’s clear that it will exceed the deductible—the amount the patient must pay out of pocket—set in her insurance plan.

For instance, a patient whose health plan covers all costs beyond a $1,000 deductible on a hip replacement surgery may not feel compelled to shop around when she knows she’ll be paying the same dollar amount for a procedure that costs $32,000 as one that costs $26,000. That’s according to Eric Haberichter, co-founder and CEO of Access HealthNet, a Milwaukee-based startup that’s developing software aimed at helping employers save money on their employees’ healthcare.

Access HealthNet’s service is mainly used by employers that self-insure, meaning they’re responsible for paying the majority of their workers’ bills when they receive care. The company provides tools that help employers determine, among all the hospital and clinic networks covered under an employee health plan, which provider charges the least for a particular procedure or treatment, Haberichter says. He adds that Access HealthNet focuses on “episodes of care” where costs tend to vary from provider to provider—meaning those that could offer the highest potential savings.

“We ask providers, ‘What is your best price, day-in, day-out, for that hip surgery that you want to put on our [website]?’” says Haberichter, adding that Access HealthNet then promotes prices to the employers and insurance brokers it works with. “We’ve taken more than 1,000 such episodes of care, ranging from very simple things to complex spine surgeries. It’s an apples-to-apples comparison” between different providers, he says.

Investors think Access HealthNet is onto something. The company has raised about $5.2 million in equity financing since launching in 2014, says chief financial officer Mark Wiesman. That total includes about $800,000 million committed by investors as part of Access HealthNet’s Series A funding round, he says, adding that the company is hoping to raise a total of $3 million in the round. The BrightStar Wisconsin Foundation, Wisconsin Super Angel Fund, and several individual investors are among the participants in the round, Wiesman says.

Wiesman declined to comment on the valuation Access HealthNet received as part of the Series A round, or say what the company’s revenues were in 2016.

Access HealthNet plans to use some of the money raised in its latest round of financing to continue developing its digital tools, Haberichter says. The startup, which currently has 39 employees, will also likely expand its distribution and customer service teams in the near future, he says.

Haberichter says that before Access HealthNet entered its current growth phase, he and other early employees spent a lot of time developing a methodology for bundling all of the different charges that make up a certain procedure or episode. That work involved speaking with stakeholders—self-funded employers, brokers, and healthcare providers—in the specific area of the health insurance industry where Access HealthNet concentrates. The startup then began building software designed to “bring all of those folks together in the least adversarial, most collaborative way” possible in order to help employers reduce their healthcare costs, Haberichter says.

Access HealthNet’s products function as a “layered-on” service, meaning employers don’t have to make any changes to their workers’ health plans to use the company’s tools, Haberichter says. Typically, organizations will try to persuade employees to select the lowest-cost provider for a particular treatment by waiving their deductibles or co-pays, he says. According to Haberichter, providing those types of incentives to employees also saves hospitals and clinics from having to collect deductible payments from patients.

Haberichter says Access HealthNet makes money by charging employers a “facilitation” fee—in most cases 6 percent of the total medical bill, he says.

Currently, about 20 employers that together manage the health plans of approximately 60,000 employees and their family members use Access HealthNet’s service, Haberichter says.

The startup’s competitors include EmployerDirect Healthcare, of Dallas, and Oldsmar, FL-based PriceMDs, says Wiesman, who is also Access HealthNet’s chief operating officer.

Before helping to launch the company, Haberichter co-founded another Wisconsin-based startup, Smart Choice MRI, in 2006. (Access HealthNet’s other two founding employees, both of whom are still with the company, are Leslie Kolowith and James Kolb; Kolowith is also a Smart Choice MRI co-founder.) Smart Choice MRI, which is now headquartered in Chicago, operates a chain of imaging centers that charge patients a flat rate of $600 or less for scans.

Many patients who get scans at one of Smart Choice MRI’s locations pay out of pocket. The company has capitalized on the trend of deductibles in patients’ health plans increasing in recent years.

Haberichter says both Smart Choice MRI and Access HealthNet are part of the move toward consumer-driven healthcare, and a “retail-ization” of the industry, where more care is delivered in lower-cost settings like strip malls, rather than in hospitals.

Another major trend in healthcare, and one which the introduction of new software and technologies is helping to accelerate, is the move to so-called value-based care. This emerging paradigm replaces fee-for-service payment models, where insurers reimburse providers for individual lab tests, procedures and other units of care. With value-based care, providers are instead reimbursed based on patient outcomes. The goal is somewhat similar to Access HealthNet’s: try to lower costs for patients and health plans by holding providers accountable.

“If I am able to look at a patient and say ‘I can do that hip surgery for $30,000 and I’m going to be held to it and provide a warranty for it,’ that’s predictable and that’s sustainable,’” Haberichter says.

Trending on Xconomy