Startup Pitfalls and Healthcare Horror Stories: Introduction to Value-Based Care

Value Based Care Advisory (VBCA) Podcast

This episode explores the rising tide of healthcare startups pursuing value-based care (VBC) with ambitious visions to improve patient outcomes and lower costs. However, without a robust patient acquisition strategy, many founders find themselves struggling to meet volume requirements, maintain contracts, and deliver quality care. Through candid dialogue and practical insights, host Alex Yarijanian addresses these pain points and offers actionable advice for navigating the competitive healthcare market.

Segment Highlights

Startup Realities in Value-Based Care

• Analogy to Streaming Service Overload: Alex compares the influx of VBC startups to the crowded streaming industry, highlighting how many of these startups lack a practical strategy, assuming that contracts with big payers alone will drive patient volume.
• Importance of Patient Acquisition: Building meaningful connections and community engagement is critical for driving patient volume—something often overlooked by startup founders. Alex discusses tactics like forming referral networks and partnering with local organizations to build a sustainable patient base.

Key Strategies for Healthcare Startups

• Understanding Payer Volume Thresholds: Alex underscores the need for startups to grasp the minimum patient volumes required by payers to maintain contracts.
• Patient Engagement & Marketing: Effective marketing and visibility are as essential as clinical quality. Engaging patients through tailored messaging and demonstrating value within local communities can solidify a startup's presence and relevance in the healthcare landscape.

New Segment: 'Tough Calls in Healthcare'

• This episode introduces a new segment, where Alex addresses real-world negotiation dilemmas faced by healthcare professionals. In this installment, he discusses:
• Negotiating Reimbursement Rates: Tips on understanding local market rates and using data to strengthen negotiation positions with payers.
• Handling Contract Amendments: Strategies for managing unilateral changes imposed by payers and knowing when to push back or walk away.

Key Takeaways

• Beyond Business Models: For startups, having a robust business model isn’t enough—securing patient volume is essential.
• Value-Based Contracts: These can be highly advantageous, but they require a substantial patient base to fulfill the value equation.
• Community Connection: Building credibility and visibility within the local healthcare ecosystem is crucial.
• Balancing Act: Startups must balance patient volume and care quality to sustain payer relationships.
• Negotiation Essentials: Effective contract negotiation includes knowing market benchmarks and maintaining flexibility.

Companies Discussed:

• UnitedHealthcare
• Cigna

Listeners can expect a blend of in-depth analysis, actionable advice, and fresh perspectives on how to navigate the complexities of launching and sustaining a healthcare startup focused on value-based care.

• Hospital ER fees: They’ve been secret. We’re uncovering them. | Vox
• ER bills: A baby was treated with a nap. His parents got an $18,000 bill. | Vox
• Cigna hit with class action alleging it used an algorithm to reject claims