Israeli tech helping Americans pay for health care

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The quality of health care in the United States is superb. But the huge costs and uneven medical coverage leave about 66% of Americans worried they won’t be able to afford medical care this year, according to a recent poll.

Five years ago, one in four Americans said they had difficulty paying a medical bill. The problem worsened during the pandemic as 12 million American adults lost their health insurance due to unemployment. With a hospital stay costing an average of $ 5,220 per day and a doctor’s visit between $ 300 and $ 600, nearly one in three Americans delays getting treatment, tests or medication because of the expenses.

“If you are a patient being treated for anything in the United States, whether insured or not, you face substantial out-of-pocket expenses that can run into the thousands of dollars. US healthcare providers are facing a $ 40 billion unpaid care problem due to patients who cannot afford the high cost of treatment, ”said Srulik Dvorsky, co-founder and CEO of TailorMed.

This Israeli startup’s automated system identifies patients at financial risk and matches them with resources such as co-payment assistance, alternative drug programs, government grants, community, state, or specific foundation funds. illness, and programs that help cover living costs.

“We were founded in 2017 and now work with over 50 hospitals, 200 clinics and 300 pharmacies across the United States,” says Dvorsky of the TailorMed New York office. About 30 of its 55 employees work in R&D at the Tel Aviv office.

Srulik Dvorsky, CEO of TailorMed co-founders, left and CTO Adam Siton. Photo by Shlomi Yosef

Clients include Providence, the third largest healthcare system in the United States, whose venture capital arm led a recent $ 20 million round of investment in TailorMed.

“We work with hospitals like Henry Ford Health System in Detroit and Memorial Sloan Kettering in New York City, one of the world’s leading cancer institutes, and many small community and rural hospitals and clinics,” says Dvorsky.

For patients, TailorMed’s platform can reduce immediate direct expenses – sometimes to zero – and avoid care. It helps prevent “financial toxicity,” a term referring to the long-term side effects of treatment with expensive drugs for chronic disease or cancer.

“The statistics on the severe financial hardship associated with the cost of care are staggering and have reached a state of crisis. We recognize that the TailorMed platform ensures that patients don’t have to worry about how they will be able to pay for their care. ”

For healthcare providers and pharmacies, TailorMed’s system allows reimbursement by another entity rather than depending on the patient’s ability to pay.

“No one should have to make a choice between financial stability for their family and what is sometimes a life-saving cure for their condition,” said David Kereiakes, partner of Providence Ventures.

“The statistics on the severe financial hardship associated with the cost of care are staggering and have reached a state of crisis. We recognize that the TailorMed platform ensures that patients don’t have to worry about how they will be able to pay for their care. “

Help financial advisors do their jobs

Financial advisers in hospitals and pharmacies are trying to find sources of financial aid for patients, says Dvorsky, “but it’s manual and decentralized. That’s where we come in, using data from medical records, insurance claims and billing to automatically discover patients in financial need and the resources that can help them.

TailorMed’s algorithm considers “whatever data we can get to find the patients who need the money the most,” including demographics, treatment, diagnosis, and social determinants of health.

“Needs can be met early in the patient’s medical journey, not when the bill arrives or when the provider has to recoup the expense,” he adds.

One of its clients is the Cowell Family Cancer Center at Munson Healthcare in Michigan, which began providing financial navigation service to patients in 2013.

After adopting TailorMed technology to automate and streamline the process, the center reported “a significant improvement in both the funding it was able to secure for its patients as well as… improvements in productivity, a more proactive workflow and an increased ability to measure and track ROI [return on investment] the financial navigation program via the platform’s analysis and reporting product.

Trustees at the Henry Ford Cancer Institute and New England Cancer Specialists (Maine) told TechTarget that TailorMed has made it easier for their financial advisors to locate financial resources for patients, including very short-term grants. that could easily have been missed.

The need is great: A recent Journal of Clinical Oncology The study showed that even among insured cancer patients, 16% dropped out of treatment because they could not afford chemotherapy drugs, and patients with co-payments more. highs were 42% more likely to skip treatment.

“There are a few companies that are trying to match patients with financial assistance programs, but I think we’re the only ones leveraging the data to proactively identify patients in need and prevent them from being even billed. Predictive analytics is the uniqueness of our platform, ”says Dvorsky.

Strong technological talent

Over the years, caring for six family members with cancer has alerted Dvorsky to the unmet need for technology that could fill gaps in financial access to care in America’s burdensome healthcare system.

“We looked outside to identify needs and apply unconventional thinking,” says Dvorsky, a veteran of Unit 81, a technology unit in the Special Operations Division of the Military Intelligence Directorate of the Defense Forces. Israeli.

TailorMed co-founders Adam Siton, CTO and CEO Srulik Dvorsky. Photo by Shlomi Yosef

Co-founder and technical director Adam Siton served in Unit 8200, the main intelligence gathering unit of the Directorate of Military Intelligence. Many of Israel’s most successful startups were founded by 8,200 alumni.

“Adam has a solid background in software development and my career path has been as a computer hardware engineer and founder of technology,” says Dvorsky, who came to TailorMed after working in the medical device field.

“We’ve done a lot of homework to understand the dynamics and key players in the healthcare industry in the United States. There are so many factors in this value chain, from the pharmaceutical company to the patient. We needed to understand how this dynamic works and find a technological solution that works across the ecosystem and makes sense from a business perspective, ”says Dvorsky.

“The amount of data coming from different sources is so unstandardized in the US healthcare system that to automate these processes you need a system that can do it at scale and is very robust.”

In Tel Aviv, the founders had personal connections with software and dev-op engineers and product managers with the right skills, Dvorsky says.

“Having an ocean between us always pays off when you have access to this incredible talent,” he told ISRAEL21c.

Vision for the near future

The June funding round led by Providence Ventures included UnityPoint Health Ventures, Almeda Ventures, Bridges Israel, Discount Capital, Accelmed, Sanara Ventures and Triventures.

This $ 20 million infusion will help TailorMed grow across the healthcare industry in the United States, says Dvorsky.

“While we have been very successful in growing the business, it is still a tiny part of the market. We can build on the successes we have had so far to help patients and have such a profound impact on the financial performance of providers. This is the vision we will be working on over the next few years.

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