From Business Record innovationIOWA: Predictive Health Partners seeks to slash health care prices

Predictive Health Partners, with founder Jim Lewis, is the only local startup represented in the Global Insurance Accelerator’s 10-member cohort for 2019. It’s also one of only three Iowa startups that have participated among 36 since the GIA’s first cohort in 2015.

Based now in West Des Moines, Lewis, a serial entrepreneur, thinks of Predictive Health Partners as 35 years in the making before the startup launched in early 2018.

“I’ve interviewed, comfortably, I could say, 350 individuals one-on-one ranging from CEOs to brokers, insurance companies, third-party administrators … [to] moms and dads, finding out how the buying [of health plans] is done and what is going wrong,” Lewis said.

He decided that entities are viewing employees the wrong way when it comes to providing health insurance — and that retooling the system to treat employees like customers would bring down many of the costs plaguing health care.

Predictive Health Partners has two faces to one product: a smartphone app, purchased by companies and offered to their employees for free; and artificial intelligence-powered predictive analytics for the company, which anonymously identifies the higher-health-risk employees who may account for up to half of a company’s total health costs.

The HIPPA-compliant platform can target employees who have high health care costs with preventive appointment reminders and other services to help the employees control their own health care costs – passing the savings on to both employees and employers, Lewis said.

“It gives us a way to identify costs and try to predict and prevent them from happening,” Lewis said. “The predictive analytics of claims data identifies individuals who have prevention opportunities — they haven’t had their annual exam for maybe their eyes … and it also allows us to identify gaps in care.”

“These are individuals who are struggling with managing their diseases and forget they have certain things that they should be doing. We’ll remind them, and we’ll make it very convenient for them.”

The app is a one-stop product for employees to manage their company benefit plans, including disability insurance, retirement savings and health savings accounts; access doctors through telehealth appointments; compare prices for medications at different pharmacies or services at different facilities; locate and schedule appointments with providers; and submit health care bills for review to Predictive Health Partners staff, who will identify expensive errors in the billing for employees.

Three companies are currently using the app, and more than 50 percent of those employees have downloaded and use the app, Lewis said. “Each one of those three [companies] have already gotten more than their money back in the first 90 days,” Lewis said.

High-deductible health plans are “a growing trend” for employers, Lewis said.

“[Companies are] shifting this cost increase to the employees. We’re trying to keep the premiums as low as we can, so we end up putting out almost an inferior product, because you have such a high annual deductible, and you don’t have savings for this,” Lewis said.

While those high-deductible plans grow, the errors in health care billing are adding up, contributing to the problem. A Consumer Reports survey of 1,000 insured adults found that more than one-third of respondents reported paying bills they weren’t sure they owed. Twenty percent of that group reported paying more than $1,000.

“When the bill comes from the insurance company, and the insurance company says ‘We’ll review that bill for you,’ most people don’t believe or trust the insurance company is really going to be on their side,” Lewis said. “So therefore, a lot of people don’t do anything about it.”

Through the Predictive Health Partners app, users take a picture of medical bills and send it to through the app, which uses artificial intelligence and human oversight to review. Once errors are identified, users are notified and asked if they want Predictive Health Partners’ assistance resolving errors with health care providers.

On top of his work during the GIA accelerator, Lewis is seeking to hire account managers and sales managers for Predictive Health Partners. By early 2020, he expects to have grown from two to a dozen full-time employees.

“We’re at the stage of looking for the right strategic investors … companies who have a vested interest in our success,” Lewis said. “They bring so much more than just the investment. They get you ready for that next round that comes down the road.

“I’m getting so much encouragement right now, that I know I’m on the right path.”

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