EasyHealth, a startup focused on navigating the Medicare experience, announced a $135 million Series A round on Thursday. EasyHealth has a simple purpose: to help enroll, and follow-up with (more on this later), people eligible for Medicare. But the bigger picture is that the company is aiming to fill a major “information gap” facing insurance companies along the way.
EasyHealth was founded in 2020 (initially under the name Medicare Advisors 365, but has since rebranded to EasyHealth), and this most recent round represents the company’s total financing. The $135 million Series A consists of a $100 million credit facility, and $35 million in equity financing. The round was led by Anthemis Group and QED Investors and included Victory Park Capital, Nationwide Ventures, Healthy Ventures, Brewer Lane, and Operator Partners.
In some sense, EasyHealth is reminiscent of insurance brokerages – third parties that help people pick between Medicare-eligible insurance plans. EasyHealth can connect users with Medicare Advantage plans (Medicare-approved plans offered by private insurers) or other Medicare supplements or prescription drug plans that partner with medicare.
Picking these plans can be a fraught process. In New York alone, there are 280 Medicare Advantage Plans and 19 stand-alone Medicare prescription drug plans to pick from according to the Center for Medicare & Medicaid Services.
That’s a lot of insurance jargon to weed through. In response, about 96 percent of Medicare Advantage and Part D (the drug add-on) plans contract with agents to help sell plans. (Though some studies have suggested that these agents don’t represent all the available options).
EasyHealth represents about 30-40 percent of Medicare Advantage plans, said CEO David Duel.
So far, the company has managed to enroll about 40,000 people in Medicare-based plans, per Duel. However, its aiming to be more than a broker. EasyHealth is particularly interested in follow-up up with enrollees.
That is what Duel sees as a “core differentiation” between EasyHealth and an insurance broker.
“There’s a lot of brokers and a lot of great companies that support enrollment and support the brokerage function. We’re going beyond just enrollment and having these clinical functions in house by employing a network of nurse practitioners, doctors and medical assistants to do in-home assessments, and meet the members in their home.”
Once a broker helps someone enroll in a healthcare plan, insurers will occasionally send a healthcare professional (usually not someone’s PCP) in-person to do a home visit. These visits are designed to detect chronic conditions or other conditions that might indicate underlying health problems that an insurance company can’t know about before enrollment.
That “information gap” between a patient’s true health status and what an insurer actually knows is the pain point Duel is trying to address.
“If a health insurance plan or a PCP doesn’t know what conditions a member has, they’ll only find out if once the issue becomes chronic, or the guy ends up in the hospital. So having that first party collect preventative data is super, super critical,” he said.
Duel says that the company has conducted “a few thousand” home visits so far.
Home visits can also be a money-maker for insurance companies that partner with Medicare. These home visits allow insurers to detect conditions they may otherwise miss. That allows them to adjust “risk scores” assigned to each patient. Higher scores allow companies to bill Medicare for the higher anticipated cost.
In general, there’s some evidence that home visits can reduce hospitalizations. The Center for Medicare Services also encourages Medicare Advantage companies to conduct health risk assessments, including home visits, because they offer an opportunity to develop a plan of care, deliver an intervention, or adjust a care plan.
But these home visit health assessments have also been controversial. A 2014 report by the Center for Public Integrity found that home visits had skyrocketed, and had likely led to more payments for insurance companies, while government regulators cast doubt on their effectiveness for patients.
An Office of the Inspector General for the Department of Health and Human Services issued a report in September 2021, showing that 20 Medicare Advantage companies (a small proportion overall), had driven a disproportionately large share of Medicare spending through diagnosis made, in large part, through health risk assessments. The benefits patients were receiving as a result of this increased spending was not clear, per the report.
“It is possible that beneficiaries are receiving care, but plans are not submitting this data as required,” acknowledged Christi Grimm, Principal Deputy Inspector General of the. Department of Health and Human Services (HHS) in an op-ed summarizing the report.
“Regardless, plans that use risk assessments to gather diagnoses, but then take no further action, are clearly missing an opportunity for meaningful care coordination.”
Overall, the home visit can be a useful tool and an opportunity to improve care. But the concept has also faced criticism when it comes to spending and patient outcomes.
Duel, for his part, argues these home-visits do drive better care in the long-term.
“We are facilitating the shift from a reactive care to a proactive care model,” he said.
“The member gets a detailed education on their benefits and how to utilize them. The members get comprehensive clinical and social determinant screening which uncovers potential conditions and allows the providers to build the right care plan. If providers and payers are not aware of conditions due to poor engagement which is very common, they are unable to proactively manage care.”
So far EasyHealth has been able to get more people to complete home assessments. For example, with Bright Health, an insurance company partner, Duel says EasyHealth has led to an 80 percent visit completion rate, compared to industry averages “between five and 20 percent” he estimates.
EasyHealth plans to use the $135 million raised to drive this “independent broker space.” The $100 million credit facility portion of this raise will be used to provide technology tools and capital to independent brokers to help them enroll members in Medicare. EasyHealth can then “leverage that membership” to provide the clinical followup portion of its business (the visits).
Going forward, the membership enrollment will take a back seat to the clinical visit side of things – that’s EasyHealth’s internal core competency. Though the company will keep a hand in enrollment too.
