Meeting with Adam Pelavin, Comprisma in the foyer of the Westin Hotel, Georgetown.
Adam is pure mathematician, sci-fi fantasy writer and is know to, and associated with Esther Dyson.
Comprisma was a self-funded health insurance regulation startup associated with the affordable care act whereby insurers were no longer able to make more than 20% margin (i.e. medical loss ratio > 80%) on their books. This unintentionally created a market for high cost members and an opportunity to pool and trade their risk to insurers operating with more than 20% margin, thereby making them conformant with the new policy – in effect, a cap and trade system for health insurance risk. This required fancy mathematics associated with combinatorial optimisation (software used was called CPLEX).
A very interesting insight that Adam shared with me was the need for the business to build out short- and long-term yield curves so as to bridge the cashflow gap that existed between the short and long-term incentives. i.e. start off with getting rid of low value care which would generate more immediate returns, but then top up with more strategic prevention based interventions associated with longer term revenues.
It was also important that the populations being considered were of a manageable size such that community focused interventions could be attributed to desired outcomes. In an interesting way, this means that remote Australian communities could present ideal opportunities for this idea to be deployed to.
Adam also referenced Jeremy Store (UK/US) who is looking at bundling wound care with social impact bonds.
Adam also mentioned Mikey Dickerson, US Digital Services Administrator and the guy who fixed healthcare.gov when it broke in 2014.
Key questions from Adam to me:
1. How much is a life-year worth to life insurers?
2. What kind of interventions are they interested in?
Follow up email:
Hi Paul,
It was a pleasure meeting you as well! It’s a rare pleasure to meet someone else who’s really trying to shift the financial incentives surrounding health. I’m fascinated by your life insurance approach; I’d love to learn more at some point about what life insurers’ incentives look like (i.e. how much a life-year is worth to them), what kind of interventions they might be interested in, etc.–and just to know how your thinking evolves. Please do keep in touch!
Best,
Adam
On Tue, Apr 14, 2015 at 9:34 AM, Paul Nicolarakis <paul.nicolarakis@loricahealth.com> wrote:
Hi Adam,
Thank you for meeting up yesterday. It was great to connect a bunch of dots, but also learn of your literary ambitions.
The story of Comprisma was very informative to the focus of my fellowship and I look forward to remaining in touch as the journey continues.
In particular, I found the discussion regarding the financing of healthcare (and/or prevention) for defined communities interesting as it relates to care provided to remote communities in Australia.
I am hoping to meet with Esther in two weeks and will be sure to reference our conversation at the time.
All the best for the novel and I look forward to remaining in touch on the health financial side.
Regards, Paul
