Payers
other on 5 shows · 17 statements across 15 episodes
Acquired 
Innovators & Investors 
American Optimist 
Capital Allocators 
the a16z Podcast
17 statements about Payers, every show
Schappell: Healthcare enterprise sales cycles usually take 12 to 18 months
“Sales cycles are, you know, we're high-fiving if you get a 12 month sales cycle. Everything else is, you know, usually 12 to 18 months before you get a decision maker to sign off and say, you know, let's, let's move forward.”
Anderson: Health insurance payers never cover prevention by mandate
“If you ask most payers, payers will tell you they don't ever cover prevention. It's not even in their mandate.”
Jain: Calling healthcare payers twice yields different answers 25% of time
“So you call the same payer twice for the same patient, and you will get different answers 25% of the time.”
Healthcare payers hold structural leverage over hospital systems
“So the payers are always gonna have a tremendous amount of leverage over individual physicians, small hospital systems, even larger hospital systems. So you really need to be extremely buttoned up and extremely standardized and extremely auditable because you'…”
Joel Martin: Insurance provider directories are often only 50% to 60% accurate
“So the big payers spend millions and millions of dollars on bringing this data into their systems. And they basically get inaccurate data despite spending all that money in a lot of places in the industry, you see maybe 50, 60% accuracy for provider directorie…”
Perry: Major US Health Insurer Manually Processes One in Eight Claims
“Yeah, actually, I know there's a large payer, ah, that I know manually processes one in eight claims because their adjudication system doesn't do it. It's a large payer. We'd all know the name of it.”
Perry: Candid Health Can Sell Its Pre-Adjudication Engine Back to Payers
“I 100% think we could because if you think about what we're doing, we're pre-adjudicating the claim. We know how the payer's, we know what the payer wants on their claims. We know, like, what their rules are for how to submit a claim. And there's a bunch of no…”
Rod Wong: Payer pushback on drug pricing is biotech's top long-term risk
“You know, I think one of the things I'm most concerned about is payers and the pressure that we're seeing on paying for innovation in drug development. That's probably my number one long-term concern.”
Roger Batnigi: Controlling care levers requires transitioning to full global capitation
“For example, if you needed to control and in your care model, you know, all of utilization management, you know, the claims payment network design. Well, there's probably no other way for a payer to let you have those keys other than moving to a true global ca…”
Rughani: B2C2B lets health startups engage users before contracting payers
“While B to C to B can be more complex to execute, it gives startups the power to acquire and engage users directly without first contracting with the payer.”
Hogg: Payers now treat virtual care as a standard reimbursable service
“Now with virtual care we are a normal product. It is a normal clinical service, and it is in the eyes of a payer. They know how to pay for these types of services.”
Advanced cell and gene therapies require novel pricing and reimbursement models
“If we're gonna make this widely accessible to patients that need them, it's gonna have to be affordable. So we'll need new models for how pharmaceutical companies charge for this, and we're seeing early days of this. We're going to need new models for how paye…”
Butte: Early-stage healthcare startups cannot serve both payers and providers
“Either you're going to go after providers or payers. You're rarely going to do both as a startup.”
Ott: Only 20% of new diagnostic tests receive full reimbursement
“If you're looking at the average statistics, generally when you're launching a diagnostic test, only about 20% of the tests that you sell actually get fully reimbursed.”
Otte: Insurance payers and clinicians are blocking diagnostic innovation
“It's really the payers and some of the clinicians that are being the inhibitors to this progress.”
Kindler: Payers will force pharma to adopt widespread data sharing
“The payers probably have more and better real-world data than the pharma companies do, and one of the reasons that the pharma companies will eventually, in my opinion, have to do data sharing, as Andrew suggests, is that the payers are going to aggregate their…”
Conde: Healthcare payers are value assessors, not cost cutters
“But the reality is payers aren't cost cutters. They're assessors of value. And if you have transformative drugs, or if you can transform how we think about diagnosing and screening disease, the payers are willing to pay for that value.”