Healthcare is much easier to navigate when one is aware of their options.
In this episode of Bite the Orange, Sam Vasisht, co-founder and CEO of shopMD, talks about transforming healthcare and contributing to the cause by helping patients navigate industry services with accessible cost options. His personal interest in healthcare stemmed from experiencing inconsistencies and high costs, and as a curious engineer, Sam set himself to create a platform that would provide low-cost options for the services they needed and thus help democratize healthcare. He shares a couple of examples he experienced himself to emphasize the importance of price transparency and explain how insurance deductibles and coinsurance can pose financial burdens on their users. Sam also discusses some challenges he’s faced throughout this journey in healthcare, like the lack of accurate data, technology-driven solutions, and market efficiency.
Tune in and listen to how shopMD is making a transformative impact on the way patients get their healthcare!
FULL EPISODE
BTO_Sam Vasisht: Audio automatically transcribed by Sonix
BTO_Sam Vasisht: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange. And today we have a very special guest with a very interesting background, and his name is Sam Vasisht. Please correct me if I'm wrong on it. I want to make sure ... I pronounce the name correctly, and he is quite interesting with a very interesting background and interesting schools, and we had a chat prior to the interview, but I would like for him to do it himself in case you don't know him. So, Sam, tell us, who are you?
Sam Vasisht:
Hi, Manny. I'm glad to be here. So I'm Sam Vasisht, you were close enough. I would recognize that you were saying my name, the way you said it. I'm the co-founder and CEO of shopMD, we are an early-stage startup company, and I grew up in India. I moved to the US to go to graduate school. I stopped going to graduate school after one semester for reasons we can get into and then continued my education a few years later at Babson College, and most of my career since then has been in high-tech. I've worked across many different industries, I've built and launched products for the first half of my career, and more recently, I've been running marketing for various tech companies, mostly venture-backed startups, but also some small and large public tech companies.
Emmanuel Fombu:
I'd like to highlight something that you mentioned there, Sam. Your background is in engineering, correct?
Sam Vasisht:
Yes.
Emmanuel Fombu:
Was it?
Sam Vasisht:
Electrical engineering.
Emmanuel Fombu:
Electrical engineering. And I'll tell you, when I was in college, I had, I was doing pre-med, and I had some friends in my class that were studying electrical engineering. And I happened to sometimes go to them in my molecular biology class, and they went to electrical class, I followed them. I was a freshman, they were seniors. So I'd go in their class, and I would see all the different things they'll do with like a computer chipboard and things that they could do with it, then I got to play with it, which I think is a very different kind of mindset of an engineer, and I've seen a lot of engineers in this particular space of digital health. As a clinician, I was not trained in engineering, so clearly, I can't even put IKEA furniture together. Okay, so to get that perspective for someone who's listening to us right now. Tell me the skill sets of that, of engineers, what kind of training engineers have that puts them in a very good position, right, to actually drive this transformation in healthcare that we're looking forward to?
Sam Vasisht:
Yes, one of the first things I learned in engineering school is that you really have to be analytical about things, right, and methodical step by step. When you look at how something works, you have to break it down step by step, and that was interesting to me because I always considered myself to be more of a creative person, so engineering school really taught me how to be analytical and methodical about things. So to me, that is probably one really good aspect of engineering, and that becomes even more important when you talk about coding, which is software engineering or software development, because every line of code matters, and you mess up somewhere, or you write something poorly, you know, it has a trickle-down effect. I think, to me, when I see a lot of engineers starting companies and businesses, I think that's a representation of two things. One is the technical skill set that it takes to build stuff, but I think it also takes a inherent skill set in being able to look at things at a granular level, but also having a big picture in mind.
Emmanuel Fombu:
Which is quite fascinating because if you look at healthcare in general, I think there's a huge challenge, and that challenge is that adoption of change. We have multiple problems that we know is very common for us to hear. Healthcare in the US system is broken, right? We hear that all the time, right? But yet, when we have solutions that people could adapt, people don't easily go about adapting them. And I think it's because we don't usually look at the problem and go backwards and then say, hey, how do we go about solving it? Which is probably something you learn in engineering school. I'm sure there's a philosophy, there's a way of thinking as a clinician, I look at things from a business perspective, right? So if someone is sick, so then you go, okay, what caused it, and you follow that process. But in terms of organizational structure, how things work, that's not something clinicians are trained in, right? And I think that's why it's beautiful, I think, that collaboration between engineers like yourself, even software developers, wherever it is, to come together with different skill sets that we have to actually make this happen. So what got you interested in healthcare?
Sam Vasisht:
My healthcare journey started about 10 or 15 years ago, and it was not intentional that I would get into healthcare. There was a phase of my career where I was moving from company to company very quickly, and the reason for that was that I was coming into companies because they wanted an exit which is either being acquired or sold, etc, and so I would come into a company, I would turn them around, and I would sell the company, and this would take about 16 to 24 months. So every, let's say, on average, every 24 months, I was in a new company. And I was living in Boston at that time, and I had the same doctors and the same hospitals that I was going to, but my health plans were changing every couple of years, drastically changing because every company had a completely different carrier. And I started to notice some oddities, which was, I would go in for the same procedure or the same encounter, similar encounter to what I did under a different plan, and I would have completely different insurance piece or deductible applied to it and things like that. In other words, I was paying different price than what I did under a different plan. And so, I started to also notice that the doctors were billing the different carriers, very different rates for the same things. And so that got my curiosity going in terms of, what is this industry, how does all this work? Why is this the way it seems to, the way I'm experiencing it? And I just started reading about healthcare, and I started to go to medical conferences just to see who are these people behind all this stuff. I mean, I had no intention of doing something in healthcare, it was just pure intellectual curiosity that got me going. And I even studied the coding book, the medical coding books that people use when they want to get certified as a medical coder, I looked into those. I called up one of the actuarial companies that does actuarial work for health plans and asked them, you know, if I want to create a new health plan, how would I go about it? And this was just for the fun of it, I was not thinking about doing anything in healthcare, and so the consequence of that was that I started to figure things out, and I started to make choices on my own about how I navigated healthcare as a patient. And that got to a point where I was doing things very differently from what my doctor was telling me to do and what I saw other people do. And fast forward, I got to the point where I was telling people what I do, and they didn't know how to go about it. And that really was the genesis of me saying, I know how I can solve this problem at scale for people if they want to take charge of what they're experiencing in healthcare, which is costing them a lot of money that they're not happy paying, happy about paying.
Emmanuel Fombu:
And that's very interesting, that's a big challenge that people face. I'm sure this is a problem across the board when you have private payers to make this complicated, right? And that's a big challenge in terms of looking at value-based care in the long term, and for insurance company, I think it's a problem that everyone faces, but it's the reality of things. But I really like that you had a problem and you go about solving it, and I'm sure a lot of, everyone listening to this, if you have a job, you end up having a problem because most of us are covered through our health insurance, through jobs, right? That got you to the point, now you have multiple roles along this, in every role, I'm sure you had a unique experience, but that brought us to shopMD, your current company that you're working on. So tell us, what does shopMD do? What is the vision?
Sam Vasisht:
The vision is actually very simple, which is that patients have options about doing things that would benefit them when it comes to medical encounters or their patient journey, and most of us don't utilize this opportunity or these options. So the vision of shopMD is, and I don't like to use this term because it's often used, but it's really about democratizing healthcare for trauma patients' perspective to the extent that we can, and so that's really what got us started here.
Emmanuel Fombu:
So if I go on your website, for example, to make that question, actually, a lot more clear. So shopMD, I think the name speaks for itself, I like the name. So if we're looking at it, let's say I have no experience what shopMD is. I think the idea is to shop around for doctors, correct? Is that what it is? Do you have, so if I come on, what is my user experience? Why should I come to shopMD?
Sam Vasisht:
All right, let me give you an example, Manny. So a couple of years ago, I was required to get an MRI. And what happens? I'm talking from the patient experience standpoint. What happens is my doctor tells me I need an MRI, she goes to a computer, prints out a couple of names of places I should go call to get my MRI. Now, these are part of her hospital system that she's part of now. She's not employed by the hospital, she's a primary care doctor, but she is affiliated with it, and the network that she operates in is that hospital system. So obviously, the name she prints out are part of that network, which is different from the insurance network, by the way. I call these places, and they tell me that your, I say, how much is it going to cost me? Because I have a deductible on my plan and coinsurance and things like that. The lowest price they get is $5,500 for the MRI.
Emmanuel Fombu:
Was that in-network or out-of-network?
Sam Vasisht:
It was in-network, so this is not unusual for an MRI to cost a few thousand dollars at a hospital. Now, knowing what I know, I went to a different place and got my MRI for $300, and both these places are within a couple of miles of where I live, $300. A few months later, I was to get a colonoscopy, the same thing happened. She said, get a colonoscopy, these are the places you can call. I call those places. The price I got, the lowest price I got was, or base price was $6,000 and $2,000 for any pathology that might be involved, plus some uncertainties around other costs that might be incurred.
Emmanuel Fombu:
Just add to that point ... , I need to ..., my friend. I want to add to that point so someone that's listening that does understand how this works, when you have an insurance, even though you have insurance, the price still matters to the user because you have to pay that deductible, right? So in case, you have a high deductible. So, in this case, that means that Sam, in this particular case, has to put up that $5000 based on what, let's say, his deductible was $10,000. He has to pay out of pocket until he gets to $10,000. And so it's more important for him to actually spend that thousand dollars to get the MRI because clearly, I'm sure, it doesn't matter how rich you are, you don't have $5,000 sitting around waiting to pay a deductible in the beginning of the year, so this is pretty bad. You have continuous ...
Sam Vasisht:
Absolutely, and then, beyond the deductible, you also have co-insurance, which is, even after you meet your deductible, there's a portion of your services that are not covered by insurance. You have to pay that, and the insurance pays the rest, and that, till you get to your out-of-pocket max. Right, so these are things that the average person doesn't understand. For the longest time, I didn't understand. I used to pay whatever I was told to pay till I figured out that there were choices. And so, going back to the colonoscopy, I got my colonoscopy for $1,200, $100 for every pathology. So I ended up spending about $1,700 on the whole thing, which would otherwise have cost me $8000 or $9000 out of pocket, and the insurance company would have been billed another $3000 or $4000. So given all this, I created shopMD so that other people can have the same experience. Because when I tell people you can do this, they would say, how do I go about it, or how do I do this? And so I would explain to them, pick up the phone call, get the prices, you'll find there's a disparity in prices. But if you call the wrong place, you get the runaround. They can't give you the price, or they tell you, hey, I got to call the billing department, call your insurance company. So people, my friends were telling me, you say you do this, but I call these places, and I got a runaround. What do I do? So I said, I'll just put up a site that has all the providers that have these low-cost prices, and that's what is shopMD. So when you come there, it's a front door to be able to get to the floor of the price spread, that's what I call it, the floor of the price spread, because there's a price spread in healthcare, is about 10 to 20 times, something that costs $1,000 can cost $20,000 somewhere else, right? And so, we basically identified the providers across the country that operate at the floor, and we made that available to anybody who comes to shopMD. Now, keep in mind, we're only focused on outpatient specialty care for the simple reason that outpatient specialty care is somewhere is the thing that people can actually plan for they have time to shop around, and it costs a lot of money, and it's usually not covered by insurance, as well as preventative care and other things are covered.
Emmanuel Fombu:
Which is quite interesting because I think what you're doing is actually making people more comfortable going to see a doctor, in this case, which actually helps prevent people from getting worse, because I know people that get sick, and they imagine the cost of care, and they decide to just wait until things get really worse. So you put this information out there, but this is quite interesting. How did you know about doing this? Because, as a clinician, I could not navigate everything you just did. I mean, I don't want you to give your secret sauce, of course, I want them to go to shopMD, everyone to go shopMD to find out. But how did you find a way to do this? Because even now, for example, I know, the government, for example, is mandating hospitals to create price transparency. There's a book published recently by one of the physicians out of Hopkins called The Price You Pay. So how did you go about this all, which, I like what you're doing?
Sam Vasisht:
Yeah, it's a special sauce. So here's the thing, Manny. When I first thought of doing this, my impression was, hey, this is going to be straightforward. There's all these companies dealing in provider data, and I'll just go to them. And I had my criteria because I've been doing this for years, so I had these criteria of what to look for when you're looking for a high-value provider. And so I said, I'm just going to call these guys up. And some of these are multi-billion dollar companies, and they've been around for ten years or more. And I said, I have these criteriam can you get me the providers that fit into this criteria? And they said, absolutely. And I said, great. I thought I'd just get this data, put it up on a website and let it run. I knocked around for six months or so with all these companies, I couldn't get the data. The data they were sending me was wrong, and it wouldn't have done the job. So then we realized, This data doesn't exist, we need to create this data, and we've applied, my co-founder has a doctorate in data science and machine learning and AI and all those kind of things, and so we spent a considerable amount of time basically figuring out how we can use technology to collect this data based on the criteria we had. So that's how we've gone about it, and we've got data across the country for all specialties at this point.
Emmanuel Fombu:
That is quite incredible. I think that's a particular pinpoint that you're going, you're actually saving, you bring a lot of value to the patient or the end user, which is all of us. Everyone could benefit from this particular platform. What are the challenges that you've faced so far?
Sam Vasisht:
Challenges in terms of going to market or challenges ...?
Emmanuel Fombu:
Yeah, go to market. I'm sure the idea makes sense, we agree with it, but I'm sure the roadblock, we're talking about healthcare here, right? So there's always a challenge. It wasn't easy.
Sam Vasisht:
Anything in healthcare is challenging. I've had opportunities to work with or interact with a lot of doctors that had ideas about things that they wanted to do, and/or they'd come to me and say, let's do this. And I looked at it and said, we can build a product, but getting it to market is going to be the hard part because as soon as you insert yourself in the healthcare system, there are ways that things work and ways that things should be done, and if you don't fit that mold, it's going to be a tough slog. So the challenge is that we're, so what we've decided is that we're going straight to employers, and we've designed our solution in a way that employers don't need to change their health plans, they don't need to change their brokers, they don't need to do anything different from, than what they are currently doing, and they can just add shopMD onto it. The biggest challenge we've had is we talk to employers, the response we get is surprise. We didn't know this was possible. Or how is this something that hasn't come to us from our traditional existing partners like brokers or TPAs or carriers that we can do this? And, like, it's hidden in plain sight. Most of these providers that we have are part of your existing network, it's just that patients are not steered towards them. The way the system works, most patients are steered towards the higher end of the spread or the price spread. So there's a little bit of surprise and a little bit of, maybe a little bit of denial too, because nobody wants to be told that they didn't know something and they were paying. But we haven't really had too many challenges, we've had some skeptics, but for most part, we're looking for enlightened CFOs and/or CROs and CFOs who get it, and they recognize that they have this problem, they want to solve it. Because part of it is a lot of employers assume it is what it is with healthcare, right? They're paying what they're paying, and there's really no way to really drastically improve that situation, and they just accept it as normal state of affairs when it's not, it's a highly distorted experience.
Emmanuel Fombu:
And I really like what you're doing and where you're going here. And as we wrap up our first conversation, because I'm sure this is not the first time, hopefully, that we'll get you on the podcast, but I would like the listeners to know that the cost of healthcare, and I got this from your website actually, looking at it, that unlike the case where you get what you pay for, in healthcare it's not the same, right? So just because something is expensive in healthcare does not mean that you're getting the best service necessarily in healthcare, correct, Sam?
Sam Vasisht:
Absolutely, the cost-quality equation works in an efficient market. So the main thing people should know is that healthcare is not an efficient market. I wouldn't, I don't even know if I can call it a market because it works with a great deal of opacity. And you mentioned price transparency, some of these things are coming out, and these are small pieces of the puzzle that help, we're a small piece of the or part of the puzzle. But the big picture is that healthcare is opaque, and it's, it works in a relatively inefficient manner relative to other markets.
Emmanuel Fombu:
That's quite incredible, and I wish you incredible good luck on this journey. Please, of course, if anyone listens, if you listen to the show right now, please reach out to Sam. We'll have Sam's contact information in the show notes. And Sam, I would love to invite you again down the road to see how things are going. But I think you're a great candidate for this podcast, Bite the Orange, and I think you're doing something bold. I would like to keep track of you in here, so hopefully, you can come again. Thank you for coming on the show today.
Sam Vasisht:
My pleasure, Manny. Thank you for having me.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Sam Vasisht:
Sam Vasisht has been a business executive at venture-backed startups, large- and small-cap public tech companies. He prides himself on figuring out product-market fit from being a product and marketing guy through successive stages of his career. He’s been instrumental in five successful company exits over the past 10 years and numerous turnarounds by establishing product-market fit in crowded B2B and B2B2C industries. He has generated the first revenue and/or exponential growth across multiple companies.
Sam is the sole inventor of the issued patent, US 9,363,709, which is now the foundation of one of the most widely adopted industry standards in wireless.
Things You’ll Learn:
The analytical and methodical mindset of engineers makes them well-suited to drive healthcare transformation.
shopMD aims to democratize healthcare by providing accessible options and price transparency, particularly in outpatient specialty care and preventative services.
Empowering patients with options and knowledge can help prevent delays in seeking necessary care.
When one has insurance, price still matters because one has to pay out-of-pocket until the deductible has been spent.
Obtaining accurate healthcare data can be challenging, which is why there is a need for innovative technological approaches to collect it and put it to use.
Patients tend to be steered towards the higher end of the price spectrum of healthcare services.