I work for a healthcare MCO which is focused on the Medicaid and Medicare population. Over the last year or so faced with rapidly rising medical costs in our member population we launched a coordination of benefits(COB) cost management initiative aimed at identifying members who may have other health insurance while covered by us. In the health insurance world Medicaid should ALWAYS be the payer of last resort and if a member has other health insurance Medicaid should never pay the bill.
I was able to develop a fairly straightforward two-step utility to 1) identify members who have other health insurance and 2) identify what if any claims our MCO paid for those members. I ran this process across our population and the numbers were staggering... showing tens of millions of dollars that we could potentially recoup...and are now starting to recoup from providers who routed those claims erroneously to us.
Given that coordination of benefits (COB) is a core function with significant opportunity but where there is little automation I decided to launch a start up to drive this as a cost management or profit initiative where technology would play a key role in addressing the problem. My research shows that poorly managed COB function is costing hundreds of millions of dollars across the entire population of insured so the opportunity and ROI to clients would be significant.
So I'm basically looking for persons to partner with on this effort - strategic advisors, developers etc. While I have a developer background I have long graduated from coding and my focus is more on strategy and analytics. I know healthcare is not 'sexy' and this is not some shiny new social mashup but it is a big problem and the opportunity is significant.Your feedback is appreciated - it is a bit lonely in the health startup world - and if anyone wants to go deeper with this you can email me at: techy4health@gmail.com.
