easyhealth Raises $135M Series A to Simplify Medicare

EasyHealth Secures $135 Million to Enhance Medicare Navigation

EasyHealth, a company specializing in simplifying the Medicare process, recently announced a $135 million Series A funding round on Thursday. The firm’s primary objective is to assist individuals in enrolling in, and subsequently managing, their Medicare benefits.

Company Background and Funding Details

Founded in 2020, initially as Medicare Advisors 365 before rebranding to EasyHealth, the company has now completed its total financing. This latest $135 million Series A round is comprised of a $100 million credit facility alongside $35 million in equity investment.

The funding round was spearheaded by Anthemis Group and QED Investors, with participation from Victory Park Capital, Nationwide Ventures, Healthy Ventures, Brewer Lane, and Operator Partners.

Bridging the Information Gap in Medicare

EasyHealth functions similarly to insurance brokerages, acting as a third party to guide individuals through the selection of appropriate Medicare plans. The company facilitates connections with Medicare Advantage plans – those offered by private insurers approved by Medicare – as well as other Medicare supplement and prescription drug plans.

Selecting the right plan can be complex. For instance, New York State alone offers 280 Medicare Advantage Plans and 19 standalone Medicare prescription drug plans, as reported by the Center for Medicare & Medicaid Services.

Navigating this extensive array of options requires deciphering considerable insurance terminology. Consequently, approximately 96% of Medicare Advantage and Part D plans utilize agents to assist in plan sales, although some research indicates these agents may not present all available choices.

EasyHealth’s Approach: Beyond Enrollment

According to CEO David Duel, EasyHealth represents approximately 30-40% of available Medicare Advantage plans.

To date, the company has successfully enrolled around 40,000 individuals in Medicare-based plans. However, EasyHealth aims to provide more than just brokerage services.

A key differentiator for EasyHealth lies in its commitment to post-enrollment follow-up care.

“We extend beyond simple enrollment, incorporating in-house clinical functions through a network of nurse practitioners, doctors, and medical assistants who conduct in-home assessments and engage with members directly in their homes,” Duel explained.

In-Home Assessments and Data Collection

Following enrollment facilitated by a broker, insurers sometimes dispatch healthcare professionals for in-home visits. These visits aim to identify chronic or other health conditions that may not be known to the insurer prior to enrollment.

Duel identifies a significant “information gap” between a patient’s actual health status and the insurer’s knowledge as the central issue EasyHealth is addressing.

“If a health plan or primary care physician is unaware of a member’s conditions, these issues may only surface when they become chronic or require hospitalization. Proactive data collection is therefore critically important,” he stated.

The company has already completed “a few thousand” home visits.

Financial Implications for Insurers

These home visits can also generate revenue for insurance companies partnering with Medicare. Identifying previously undetected conditions allows insurers to adjust “risk scores” assigned to patients, potentially leading to increased reimbursement from Medicare.

Evidence suggests that home visits can contribute to a reduction in hospitalizations. The Center for Medicare Services also encourages health risk assessments, including home visits, as opportunities to develop and adjust care plans.

Controversies Surrounding Health Risk Assessments

However, these in-home health assessments have also sparked debate. A 2014 report by the Center for Public Integrity revealed a surge in home visits, potentially leading to increased payments for insurers, while raising questions about their actual benefit to patients.

A September 2021 report from the Office of the Inspector General for the Department of Health and Human Services indicated that 20 Medicare Advantage companies accounted for a disproportionately large share of Medicare spending through diagnoses made during health risk assessments. The report noted that the benefits patients received from this increased spending were unclear.

Christi Grimm, principal deputy inspector general of the Department of Health and Human Services, acknowledged in an op-ed that “it is possible that beneficiaries are receiving care, but plans are not submitting this data as required.”

Grimm further emphasized that “plans that use risk assessments to gather diagnoses, but then take no further action, are clearly missing an opportunity for meaningful care coordination.”

EasyHealth’s Vision for Proactive Care

While acknowledging the potential for misuse, Duel maintains that EasyHealth’s home visits ultimately lead to improved patient care.

“We are facilitating a shift from reactive to proactive care,” he said.

“Members receive thorough education on their benefits and how to utilize them. Comprehensive clinical and social determinant screenings uncover potential conditions, enabling providers to create appropriate care plans. Without proactive engagement, providers and payers may remain unaware of conditions, hindering effective care management.”

Improved Assessment Completion Rates

EasyHealth has demonstrated success in encouraging patients to complete home assessments. For example, in partnership with Bright Health, the company has achieved an 80% visit completion rate, significantly higher than the industry average of “between five and 20%,” according to Duel.

Future Plans and Strategic Focus

EasyHealth intends to utilize the $135 million in funding to bolster the “independent broker space.” The $100 million credit facility will provide technology tools and capital to independent brokers, facilitating member enrollment in Medicare. EasyHealth will then leverage this membership base to deliver its clinical follow-up services.

The company plans to prioritize the clinical visit aspect of its business, while continuing to support enrollment activities.