Why I Love (and Get Frustrated with) Healthcare

A Massive Opportunity to Solve Big Problems in Healthcare

A.T. Gimbel
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May 2, 2023

I find healthcare fascinating. It literally can save lives and have a tremendous impact on society. We all experience it as consumers of healthcare through receiving care. Yet behind the scenes there is a complex web of regulations, payers, providers, patients, pharma, etc. I have done consulting projects, startups, investments in healthcare, and founded the Atlanta Healthcare Entrepreneur Meetup. I may not be an expert at all the facets, but generally understand how it works. I wanted to highlight a recent experience that shows all the amazing opportunities for healthcare innovation.

Situation: I had a previous medical issue and wanted to get some further evaluation as things had worsened.

Challenge #1 (Patient Medical Records): I first tried to obtain copies of my past doctor notes and x-rays. While this provider has a portal, none of that information was in the portal. Upon calling the provider’s office and being transferred several times, I was ultimately passed on to a 3rd party service who could not help me. So after multiple people and 30+ minutes on the phone I decided to move on.

Challenge #2 (Scheduling Availability): I was able to get in with a provider at a large health system in town which was actually quite amazing. In many cases, you have to schedule months out to even get an appointment. I was lucky.

Challenge #3 (Value of Time): I had an appointment at 7:30am and was told to be there at 7:00am. Now I know they want people early because many people arrive late and do not always fill out the online paperwork. So I arrive at 7 and the facility is still not open (it did open shortly and they took me back on time). However, we have all been there where you have an appointment and the doctor is running significantly late. A patient is charged a fee for a no-show, but no compensation or communication is provided if the facility/provider runs late.

Challenge #4 (Referrals): After my visit (of which the provider and assistant were great), I needed further diagnostic testing. They naturally wanted me to do it at their location which was fine. I knew to ask for a cost estimate in advance, in which case I was delivered a written statement saying my insurance would cover 100% and my cost would be zero. Red flag, I knew enough that an error must have happened. But what if I had not spent an hour on the phone calling back and double checking the quote. I could have shown up and had a bill for several thousand dollars. But now to get the test done at another location was challenging. Those in healthcare are familiar with prior authorization (which is important to prevent fraud and other checks). But to those not in healthcare, imagine a system by which a necessary procedure takes 15 days for “review and approval” and that approval must be FAXED … yes, I probably should explain what a fax is those born in the last 20 years : )

Challenge #5 (Price Transparency): So when I received my revised estimate, there was both a service fee and a facility fee. Those facility fees vary widely from a hospital to a local facility. To try and compare alternatives I reached out to my health plan. After spending almost an hour on the phone waiting and getting to the right person, I was no further along. Yes there is an insurance portal where they list providers, but there is no pricing on the health plan website. I had to call providers individually to get a quote. Then when I call, I only get a self-pay price. They have to “submit information” to get an insurance quote and that will take a few days. How many other industries do you have to buy services without knowing the price and knowing they can hide the true price across multiple fee lines?

Challenge #6 (Outcomes): So you can imagine that most people turn away from the system after the above and just don’t get care. This could be care that they need and could prevent future adverse conditions down the road.

This is just one small example, but there are massive opportunities for the right entrepreneurs to build point solutions that address these challenges, as well as game changing companies that can fundamentally change how healthcare works. We would not design a healthcare system from scratch that looks the way it is today. If you are looking to tackle any of these challenges, please reach out to us about joining our Atlanta Ventures Studio

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