Affordable healthcare for all. But how?
Decent’s path to serving 1 billion people.
My company, Decent, administers affordable health plans for self-employed people. I wrote the below for our team before we launched in Austin, Texas, on April 1st, 1 year after getting seed funding. I’m publishing it with minimal edits so you can see our mission and strategy and hold us accountable. Our plan will change with time and progress. Our goal — serving 1 billion people — will not.
If this resonates with you, let’s talk about it. We’re building an early community to help inspire us and kick the tires on our vision. Please reach out today and make your voice heard. We need your help to make Decent work for everyone.
Decent team,
On April 1st, 2019, Decent will launch affordable health insurance.
In Texas. For self-employed people and sole proprietors. As the best deal for those who don’t qualify for ACA subsidies.
This is a great start, but it’s a long way from our mission of affordable healthcare for all.
The purpose of this doc is to explore all the ways we can fulfill our mission. We may not do all of these things, but we ought to have a sense of the levers available.
HOW WILL WE SERVE PEOPLE WORLDWIDE IN THE FUTURE?
- Start local, and radiate out. 4 of the 11 largest US cities by population are in Texas (Houston, San Antonio, Dallas, and Austin) — also 4 of the biggest metropolitan areas in the top 30 — and Texas leads the country in population growth. State-specific healthcare regulations will also make it easier for us to add new cities in Texas before expanding to new states.
- Expand into states with favorable regulations for self-insured plans.Most large U.S. employers self-insure, saving up to 30% on healthcare costs. Decent helps self-employed people band together for similar savings. This model is powerful, and we should learn how to make best use of it before diversifying our approach.
- Focus on the US to start. Unique economic and regulatory forces shape each country’s health insurance market. We will need to grow globally to hit our goals (U.S. population is only 330MM), but over the next several years that may initially come from self-service or joint-venture pools. Rather than expanding our office footprint internationally, we should use blockchain and other technologies to make our infrastructure for stuff like claims management and payment processing (eventually our protocol) efficient and flexible so locals can use it to spin up pools over time.
HOW WILL WE SERVE NON-SELF-EMPLOYED PEOPLE IN THE FUTURE?
- Focus on serving the self-employed first. Our first plans are for self-employed people (e.g. sole proprietors, freelancers, and independent contractors).
- Consider partnering with additional groups and companies that serve or work with self-employed people. Groups and companies that bring their own members with similar characteristics to those we serve should require less incremental work to serve than entirely new firmographics. They may also have unique requirements we can learn from.
- Expand to serve businesses only after delivering great plans for the self-employed. Serving businesses will add various new stakeholders with new requirements impacting customer service, reward routing, SLAs, etc. We should not target businesses until we are on track to establish ourselves as the best option for the self-employed people we serve.
HOW WILL WE SERVE PEOPLE AT ALL INCOME LEVELS IN THE FUTURE?
- Make our business as efficient as possible. Reward cost-effective health decisions and pass savings back to members. Build a flexible protocol/infrastructure to account for regulatory variation and change. Use price discovery and economies of scale to get better rates. Develop the flywheel(s) of our business (illustrative example below).
- Offer lower-cost products. Given the market appetite for lower-cost plans, prove out innovative models that can reduce plan cost (e.g. a virtual direct primary care plan with a specialty network wrapper). This will allow us to serve people in rural communities too.
- Use subsidies. Closely follow legislation that could make subsidies available for non-exchange plans as soon as 2020. In parallel, explore the feasibility and timing of getting on the exchanges in some or all states in the future. Separately, consider whether and how to subsidize some or all of our plans directly based on overall performance, potentially via logic at the protocol level.
The opportunity here is to help everyone.
