Transcarent’s AI bot startup powered by GPT-4 simplifies health insurance – Forbes France

Livongo co-founder Glen Tullman has promised that his latest startup Transcarent will use AI to help patients navigate and pay for healthcare services, but that could be just another patch on the growing $4.5 trillion healthcare bill.

Article by Katie Jennings for Forbes USA – translated by Flora Lucas

For Glen Tullman, telehealth as we know it is dead. According to this venture capitalist and serial entrepreneur, the future is not video, but text. “All virtual care we provide today will move to chat”he said Forbesit is estimated that in three years, 80 to 85% of all telehealth interactions you have with your doctor will be written.

It’s a bold prediction from the man who sold his last company, Livongo, which facilitated diabetes care management, to telehealth giant Teladoc for $18.5 billion in 2020 summits of skyrocketing market growth. As of market close on Tuesday, May 14, he had Teladoc’s $2.2 billion market capitalization, which Glen Tullman pegged at a “bad management” and a high-cost, labor-intensive structure. Textual care and information with the help of the latest advances in generative artificial intelligence will cause a “Titanic Change”he declared.

Today, it’s announcing a new AI chatbot built on the same technology as ChatGPT as part of its latest venture, Transcarent, which announced a $126 million Series D funding at a $2.2 billion valuation earlier in May. The bot will try to answer health insurance questions that regularly confuse more than half of American patientsFor example: “How much will I have to pay for my health insurance? How much will I have to pay for this doctor visit? What is my deductible? Can you help me find a doctor? » It’s all part of Transcarent’s goal to become a single point of contact to help American patients navigate the opaque and often frustrating $4.5 trillion health care system.

A 24/7 chat-based basic care application

Transcarent, which offers an app with 24/7 chat-based primary care services, cheaper drug options, referrals and second opinions, has raised $450 million since its founding in 2020 from investors including 7wire Ventures, Glen Tullman and General. Catalyst. The startup also works directly with health systems to get better rates for major health events like surgeries and cancer care.

But experts say Transcarent’s business could be more of a Band-Aid than a panacea, although there is a growing market (estimated from Grand View Research to $10 billion) to help people find and pay for health care. Ge Baiprofessor of accounting and health policy at Johns Hopkins University, said Forbes that the only reason this opportunity exists is because of the dysfunction of the American health care system. “This system exploits a structural weakness of the current healthcare system, namely its extreme complexity and the fact that patients are at an informational disadvantage”, Ge Bai explains. Navigation services are rather a “retouch” one “a fundamental change”she added, but there is so much waste in the system that “Even a small retouch can make a difference”.

Most medical navigation services rely heavily on human call centers, which have high labor costs. This is where Glen Tullman sees the greatest potential for his new AI tool: cutting costs in half. The bot is currently built using the OpenAI GPT-4 broad language model and includes internal specialized models that can determine if the user has asked a medical question or is in an emergency situation, in which case a human must take over.

According to Glen Tullman, companies currently pay $10 to $15 per employee per month for human navigation services, while he plans to offer them for $5. “This is truly a generational milestone”” said Glen Tullman. “We’ve gone from a boring navigation that wasn’t really interesting to a one-stop-shop for all your care. » Transcarent will start offering this tool to its customers in January 2025.

Transcarent customers

These customers are largely employers, as Transcarent focuses on a specific type of health insurance: self-funded plans. About 134 million Americans receive health insurance through their employer, under a plan where the employer pays the total cost of health care for its employees. Department of Labor estimate for 2021. Those costs continue to rise, rising 7% to $8,435 in annual premiums for one worker in 2023, according to the health policy research organization KFF. These ever-increasing costs have spawned an entire industry focused on helping employers reduce their overall costs by guiding employees in their health care choices.

“This market is a bit of a niche right now”declared k Forbes Chris Whaley, professor of health policy at Brown University. “But as health care costs continue to rise and many employers face inflationary pressures, it is very likely that this market will begin to grow. »

In trying to break into that market, Glen Tullman faces a mix of start-ups like Carrum Health and Included Health and established companies like Quantum Health and publicly traded Accolade Health, which had $360 million in 2023 revenue and a market cap of $577 million to close on Tuesday, May 14. In the fourth quarter, Accolade also reported positive EBITDA (a good measure of a company’s operating profitability) for the first time, although the company reported a loss of $7.5 million for the year, Ge Bai said. Glen Tullman said that Transcarent is not yet profitable and that its turnover is approaching $100 million by the end of 2023.

“It’s the kind of background noise that resonates until someone has an event that prompts them to need help navigating the health care system. »

Jonathan Pas, Partner, MercerWELL

How the robot works

The new health benefits bot builds on Transcarent’s experience using an AI bot to help its doctors recruit patients, which the company bought from health AI startup 98point6 for $100 million in 2023. In addition to the bot, Transcarent has also acquired physician and employer group 98point6, as well as what Glen Tullman called “golden asset” which has not yet been published: 1 million conversations between patients and doctors over a five-year period. This data is now being used to validate and test the safety of the new tool.

When Forbes tested a prototype AI tool, the chatbot was able to determine whether a person was seeking medical help. When asked about shoulder pain, the chatbot recommended talking to a virtual physical therapist or seeing an orthopedist. He also recommended talking to a professional when asked about suicidal thoughts. Ben Nguyen, a physician and product manager at Transcarent, said that if the bot were asked a question about self-harm in a real-world situation, the conversation would immediately shift to a human.

The robot also successfully answered simple questions about health insurance, such as how much is left until the deductible is reached and the cost of seeing a primary care doctor. On the other hand, he struggled to answer some difficult questions and failed when asked to find a Spanish-speaking orthopedist in the San Francisco Bay Area and recommended a psychiatrist instead. On the other hand, he was able to correctly recommend a Spanish-speaking endocrinologist in the San Francisco Bay Area.

Competitors could simply create their own versions of the same type of chatbot based on GPT-4, but Glen Tullman isn’t worried about imitators. Although it is generally assumed that building AI tools from basic models is fast and cheap, it is still expensive. From the computing power to the training and validation needed to make a customer chatbot work well and securely, creating a similar chatbot would still cost millions, which Glen Tullman says would be too important a barrier for competitors.

Will employees actually use the app?

Even if the robot works well technically, a major hurdle remains: will employees actually use it? Healthcare consultancy Mercer, a division of MarshMcLennan, estimates that 46% of companies with 20,000 or more employees already offer some form of advocacy or navigation solutions to their employees, but adoption varies widely among companies. “One of the oldest challenges is that nothing really matters until it really matters”said Jonathan Pas, Partner at MercerWELL. “It’s the kind of background noise that resonates until someone has an event that prompts them to need help navigating the health care system. »

Pilot Flying J, a gas and convenience store chain bought by Berkshire Hathaway earlier this year and a Transcarent customer, said Forbes that approximately 53% of the 19,000 employees and family members eligible for the company’s health plan have downloaded the Transcarent app and that 77% of them are active users. Diana Morgan, director of benefits and wellness at Pilot, thinks that’s partly due to the premium discount Pilot offers to people who sign up, but it’s also about giving people “more power to understand what’s going on with their health”.

For Glen Tullman, it’s all about making the experience as easy as possible, like Livongo. He didn’t invent blood sugar monitoring, but he did get a device that made it easier for diabetics to manage their insulin levels and bundled it with perks like free test strips. Along with Transcarent, he also bought other companies to put the pieces together to make things transparent for patients. “It’s Creating a Form of Amazon for Health Care”he declared. “It’s a unique place where you get all the care. »

Also read: Healthcare chatbot: 5 best uses

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