Shift Health (YC S19) – Understand Your Healthcare Costs Pre-Visit

Hi HN,

We're Lance, Lance, and Dallin (Yes...2 founders named Lance :)). We are the founders of Shift Health ( We help patients understand what they will owe pre-visit and provide flexibility to pay overtime.

Purchasing health care is unlike anything else you buy in our society today. You wouldn’t expect to walk into a grocery store, take home a loaf of bread not knowing the price and then receive a surprise bill 3 months later. So why is this the standard experience for buying health care services? The surprising thing is that the standard experience for doctors offices is not much better. Antiquated billing processes compounded with the fact that patients are responsible for more and more of the bill out of pocket is creating a scenario where doctors offices are only collecting 40% to 60% of the patient out-of-pocket responsibility. We partner with doctors offices to tell patients what their expected out-of-pocket price is before they see their doctor and provide flexibility to pay overtime. Our mission is to make healthcare costs understandable and affordable for all.

We all met working on a marketing venture together that we have since exited. While working on our marketing company we carved out time each Friday to discuss big problems that we had the right talents to solve. Those Super Duper Friday’s (as we called them) were really valuable for us. Lance R. (Rodela) has worked in healthcare tech for most of his career (Medicity, Aetna, SolutionReach), and he cued us into the trend of High Deductible Health Plans (HDHP’s). These plans are being rapidly adopted and are having adverse impacts for patients and healthcare organizations. Patients owe more and more out of pocket (up 12% just last year), and healthcare organizations are ill equipped to collect effectively from patients. We set out to validate the problem, and everyone else we talked to agreed that medical billing is almost never a positive experience. So we set off to fix it.

Even with Rodela’s background we didn’t realize how hard this was going to be in the beginning. Healthcare has been very resistant to disruption to date. Antiquated legacy systems abound, political lobbyists hover over everything and administrative staff have to be extra cautious not to find themselves on the wrong side of countless regulations and legislation. In’s gnarly. Not sure if it was insanity or inspiration that drove us forward, but onward we went. First, we went out and talked to clinical leaders near us. It did not take us very long to find an excited pilot partner to innovate with us. We did a lot of discovery work with their billing, front office, and operations teams to understand their workflow and requirements. Next we spoke with dozens of patients to better understand their needs, pain points, and challenges. Once we had a firm grasp, we presented mockups and prototypes to the clinic and to their patients to refine an MVP. Finally, we set to work constructing our solution.

As we neared completion on the MVP the next hurdle (prior to even getting launched) appeared. We needed to integrate with the practice’s Electronic Medical Record (EMR) system. Fortunately, our partner had a strong relationship with their EMR provider, which saved us months of what would have otherwise been frustrating back and forth. Whew… we made it, right? Yup! Well, we made it to stage one at least. We launched the pilot and saw excellent feedback from both sides. Patients would text us saying “I love love love this” and our pilot partner saw patient collections grow by 30%.

We are not stopping there though. To build the best estimations we needed to build into insurance networks and more, and that is what we are pioneering today. There is still a lot of tech to build (calling all health tech pros hungry to work on something big!), but we are excited to announce that today we are able to text obstetrics patients 48 hours before their appointment how much their care will cost them out of pocket with 95% accuracy.

Healthcare payments have been a giant mess for a long time, but all of this is approaching a massive tipping point for change with 3 important market forces:

1. Financial Forces: Due to the rapid adoption of HDHP’s, patients are financially responsible for more of their bill. Doctors offices are ill-equipped for this paradigm shift and are collecting less (40%-60% of patient balances are written off). Patients want to know their costs ahead of time, and we have proven that doctors will collect more when they communicate ahead of time and provide flexible payment options.

2. Social Forces: Healthcare costs and spending has been catapulted to the center of the upcoming presidential debates, and an executive order requiring price transparency in the United States was signed in June 2019.

3. Technological Forces: Platforms are emerging providing more health data access than ever before.

I've recently seen some posts on HN about the executive order and price transparency ( so we’re looking forward to a really good discussion.

Please reach out with your ideas, help, and connections!

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andrey azimov by Andrey Azimov