Can the path to equitable healthcare avoid insurers?

There are few challenges messier and more fraught than the U.S. healthcare system, but a growing number of startups are looking at ways to address shortcomings in standards of care through tech. We had three such companies share our virtual stage at TechCrunch Disrupt 2021 this year, including Cityblock Health president and co-founder Toyin Ajayi, Forward CEO and founder Adrian Aoun, and Carbon Health‘s Eren Bali.

Let’s just say this conversation got heated — fast.

The main point of contention arose around defining what constitutes customer-centric healthcare and Aoun’s stance that, regardless of what else is involved in a company’s approach, starting from a point of working with insurers disqualifies a company from making any consumer-centricity claims.

“We keep saying that these companies are kind of consumer-centric,” Aoun said, referring to the panelists. “But in many ways I think one of the things that you realize is that when you get in bed with the insurance companies, which, whether it’s a Carbon or a Cityblock, at the end of the day, [if] you get in bed with the insurance companies, unfortunately, your incentive is basically not to go build a good consumer product.”

“Your incentives are actually not the right thing — they’re not what the consumer needs,” he added. “So at the end of the day, you’re [referring to Eren and Carbon] launching a scheduling feature. We’re launching a heart health program that eliminates high blood pressure for 40% of our members. You’re launching a new way to bill; I’m launching cancer prevention.”

Ajayi took issue with the binary Aoun was trying to establish and explained why it’s actually not such a clear-cut division between working with insurers and having a real and meaningful focus on patient outcomes.

“Adrian has said, either you get reimbursed by insurance, or you build a consumer or patient-centered company. And you know, in parentheses, that only very wealthy people can afford. What we found is actually that’s not binary; there is another path, which is partner with insurers, but take risk on the total cost of care and outcomes. So we do not bill for a community health worker coming to your home, holding your hand, telling you that you matter and helping understand what goes on in your life. But we absolutely are incentivized to do that and to innovate in that space, because that allows us to earn the right to provide healthcare to people that make them healthier.”