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Brave Care Has Closed

bravecare.com

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Re: Brave Care Has Closed

#51

Post by tptacek »

duk3luk3 wrote: post #49
tptacek wrote: post #46

Earlier quoted context omitted.

Providers determine your rates. Insurers are companies providers recruit to collect their bills. In the entire US health care system, the providers are the only ones whose cash flows are capped by statute. A provider can charge whatever it wants; over 80% of an insurers cash flows have to go to the provider by statute. (The health care industry is a mess, I agree!)

You seem to be implying that the providers set the prices, but isn't it true that insurers can pick and choose which providers they cover, and because of the large amount of patients they insure, they have a huge amount of negotiation power to exert downward pressure on what providers charge?

No, that's not true. All the market power is with the providers, which is why they're responsible for something like 9x total health care spend in the US than all health insurers combined.

Medicare is better than private insurers at regulating prices (to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated, and the governor of New York proposed a statute preventing them from doing it). But they still wildly overpay for services; in fact, what they pay is not really materially different from what private insurers do (it's less, but not by that much).

Re: Brave Care Has Closed

#52

Post by duk3luk3 »

tptacek wrote: post #51
duk3luk3 wrote: post #49

Earlier quoted context omitted.

You seem to be implying that the providers set the prices, but isn't it true that insurers can pick and choose which providers they cover, and because of the large amount of patients they insure, they have a huge amount of negotiation power to exert downward pressure on what providers charge?

No, that's not true. All the market power is with the providers, which is why they're responsible for something like 9x total health care spend in the US than all health insurers combined. Medicare is better than private insurers at regulating prices (to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated, and the governor of New York proposed a statute preventing them from…

> All the market power is with the providers

How does that work? Do the providers have cartels that set prices?

Re: Brave Care Has Closed

#53

Post by tptacek »

duk3luk3 wrote: post #52
tptacek wrote: post #51

Earlier quoted context omitted.

No, that's not true. All the market power is with the providers, which is why they're responsible for something like 9x total health care spend in the US than all health insurers combined. Medicare is better than private insurers at regulating prices (to wit: when Anthem tried to adopt Medicare's rules for anesthesiology comp, they were excoriated, and the governor of New York proposed a statute preventing them from…

> All the market power is with the providers How does that work? Do the providers have cartels that set prices?

Yes. I don't know if that's the primary factor that gives them their market power; it might be even simpler than that. But yes, they absolutely do.

Unless you're Kaiser, in which case you're the insurer and most of the providers, which is the whole idea behind Kaiser. But every other insurer --- and overwhelmingly, Americans aren't on Kaiser --- is beholden to providers. And of course, Kaiser competes with providers for service providers and vendors.

Re: Brave Care Has Closed

#54

Post by tyre »

mikebonnell wrote: post #47
t-writescode wrote: post #43

Earlier quoted context omitted.

Grr. Genuinely tempting, but I didn't wish it had to be in NY, nor hybrid :(

Huge +1 to that; make remote an option and expand your talent pool

It’s definitely a trade-off.

My team at Stripe was scattered all over, during COVID our company was fully remote, and prior to that I worked remotely on a presidential campaign. All of those were great experiences and, in their own ways, necessarily/understandably remote.

Compared to the early days at Gusto and my own startup, though, in-person has very real benefits that (in my opinion) are worth the challenges in hiring. I don’t know that it will always be true and can’t rule out that we’re wrong.

Having internal users and domain experts there in person makes a huge difference. It’s not impossible to do remotely, and maybe the tradeoff doesn’t make sense forever, but it’s worked well thus far.

Re: Brave Care Has Closed

#55

Post by pilotneko »

tptacek wrote: post #53
duk3luk3 wrote: post #52

Earlier quoted context omitted.

> All the market power is with the providers How does that work? Do the providers have cartels that set prices?

Yes. I don't know if that's the primary factor that gives them their market power; it might be even simpler than that. But yes, they absolutely do. Unless you're Kaiser, in which case you're the insurer and most of the providers, which is the whole idea behind Kaiser. But every other insurer --- and overwhelmingly, Americans aren't on Kaiser --- is beholden to providers. And of course, Kaiser competes with providers…

I acknowledge there are issues on the provider side, but it is disingenuous to say that providers set the prices alone. Payers introduce a ton of inefficiencies in billing and also remove money from the system, which negatively impacts care. They implicitly affect care patterns and pricing through denials.

HMOs, for all their problems, have many advantages as well, such as the aligned incentives you allude to.

Re: Brave Care Has Closed

#56

Post by Aurornis »

xyst wrote: post #4
toomuchtodo wrote: post #2

Kudos to their founders and team for trying to disrupt this space. https://www.ycombinator.com/companies/brave-care https://www.bizjournals.com/portland/news/2021/10/07/brave-c... | https://archive.today/Qd8fQ https://techcrunch.com/2019/09/09/yc-backed-brave-care-raise...

Very difficult to disrupt American healthcare when health insurance companies determine your rates, direct pay patients often the most vulnerable, and instead of focusing on patient care you have to focus on stupid administrative tasks to deal with different types of health insurance plans/pharmacy benefit managers/vendors. Thanks to decades of neo-liberalism (the idea of deregulation and "free market" economy). Amer…

> Very difficult to disrupt American healthcare when health insurance companies determine your rates,

This isn’t unique to America. In countries with government healthcare, the government determines your rates. Typically government rates are lower than private insurance rates in the US, too.

For as much as Americans like to complain about insurance companies, we actually get a lot more care and pay higher rates to providers than other countries. There’s a reason doctor pay in the United States is so much higher, among other things.

Re: Brave Care Has Closed

#57

Post by Aurornis »

tyre wrote: post #54
mikebonnell wrote: post #47

Earlier quoted context omitted.

Huge +1 to that; make remote an option and expand your talent pool

It’s definitely a trade-off. My team at Stripe was scattered all over, during COVID our company was fully remote, and prior to that I worked remotely on a presidential campaign. All of those were great experiences and, in their own ways, necessarily/understandably remote. Compared to the early days at Gusto and my own startup, though, in-person has very real benefits that (in my opinion) are worth the challenges in h…

I’ve felt similarly. In-person has benefits, but across my career it’s been easier to assemble top-tier teams when hiring remote than in-person.

For myself, I’m past the point of moving for companies. If they happen to be nearby I’ll make it work. If they’re not nearby, its either remote or I’m not at all interested anymore.

Re: Brave Care Has Closed

#58

Post by tptacek »

pilotneko wrote: post #55
tptacek wrote: post #53

Earlier quoted context omitted.

Yes. I don't know if that's the primary factor that gives them their market power; it might be even simpler than that. But yes, they absolutely do. Unless you're Kaiser, in which case you're the insurer and most of the providers, which is the whole idea behind Kaiser. But every other insurer --- and overwhelmingly, Americans aren't on Kaiser --- is beholden to providers. And of course, Kaiser competes with providers…

I acknowledge there are issues on the provider side, but it is disingenuous to say that providers set the prices alone. Payers introduce a ton of inefficiencies in billing and also remove money from the system, which negatively impacts care. They implicitly affect care patterns and pricing through denials. HMOs, for all their problems, have many advantages as well, such as the aligned incentives you allude to.

So, I don't disagree that there are inefficiencies with private payers, but I do disagree that they're significant, or the reason US costs are so high, or that insurers deny so many services. You can see this for yourself with Medicare's admin overhead. Admin overhead is, roughly, the ratio of money spent by insurers to money insurers pay to providers. Medicare has "low" admin overhead --- but that's in large part because they serve the most demanding segment of the market. If Medicare covered 30 year olds, their admin overhead would mathematically be significantly higher: same money in, much less money out.

I agree with you about the efficiency of HMOs, but customers hate HMOs.

A useful Google search: "National Health Expenditures by Type of Expenditure and Program: Calendar Year 2022". It's a single spreadsheet, and it's really something. It covers insurers (public and private), providers (hospitals and outpatient), facilities, state health care programs, even dental, all on one sheet. The numbers are hard to get around.

Re: Brave Care Has Closed

#59

Post by t-writescode »

tyre wrote: post #54
mikebonnell wrote: post #47

Earlier quoted context omitted.

Huge +1 to that; make remote an option and expand your talent pool

It’s definitely a trade-off. My team at Stripe was scattered all over, during COVID our company was fully remote, and prior to that I worked remotely on a presidential campaign. All of those were great experiences and, in their own ways, necessarily/understandably remote. Compared to the early days at Gusto and my own startup, though, in-person has very real benefits that (in my opinion) are worth the challenges in h…

I, personally, haven't found many situations where continuous in-person-ness is required for hardware-free, software companies, when the actual 1:1 time necessary to get requirements / etc exceed an hour or so at a time and couldn't be as efficiently done over a Zoom call.

There are obviously huge, huge exceptions to this the moment you add hardware to the situation; or you need something you can't replicate well with screen-sharing.

Addendum: but I'm also mildly frustrated because it's a type of work I would be interested in; but I'm on the other coast, so I can't easily apply :)

Re: Brave Care Has Closed

#60

Post by dr_ »

Sad to see a care organization like this shut down. But curious to understand what exactly they were disrupting? From the outset, looks like a pediatric clinic that accepts insurance (and has a cash pay option) - but this is how most pediatric clinics/urgent care that are not venture backed operate. There doesn’t seem to be a disruption in their revenue model (like a one medical style subscription service), and vbc doesn’t apply much to pediatric care. Not criticisms, just trying to understand what the goal was.
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