Nearly anyone would admit that the American health care system is broken. High premiums, ineffective systems and inequitable access keep millions of Americans from getting the treatments that they want and need.

At a time when government solutions like universal healthcare seem unfeasible, the private sector is stepping in, bringing us closer to health care for all through private innovation. Last week during the virtual Dartmouth Entrepreneurs Forum, a panel of Dartmouth alumni working in the health care industries gathered to talk about how the private sector is revolutionizing access to health care. 

The conversation was lead by Trey Jennings D’16, Senior Associate at Norwest Venture Partners. He spoke with Patrick Carroll Geisel ’84, an MD and Chief Medical Officer for Hims & Hers; Errik Anderson D’00, Tuck ’07, Founder and CEO of Alloy Therapeutics; and Alison Burkland Th’19, cofounder and CEO of Nanopath.

Confronting the challenges of the healthcare system

One of the biggest issues in the current health care system is access to care. Oftentimes, this comes down to cost. Even people with health insurance often delay or forego care because of high premiums. 

“If we drive down costs, we make everything more accessible,” said Anderson. 

Online platforms, like Hims & Hers, offer direct-pay options and upfront pricing. That allow people to get the care they need, without worrying about hidden costs or insurance approvals. 

“It’s about access, affordability and price transparency,” said Carroll. “That’s what we have to drive toward in health care.”

Cost isn’t the only barrier to care, however. In some communities, simply getting to a doctors appointment can be challenging due to transportation or lack of childcare. In those cases, providing diagnostics and treatment during the same appointment can ensure that people aren’t lost to follow-up, Burkland explained. 

Innovations like these could change the ways that people interact with the health care system dramatically. 

“It comes down to redesigning the system, with ways to make health care more accessible,” Anderson said.

Balancing innovation and access

In health care, there are two competing tenets. On one hand, most people believe that patients should have access to top-notch care, regardless of ability to pay. On the other hand, people also believe that innovators should be compensated for their intellectual property and work in developing new treatments. Society must continually evaluate how to balance those sometimes conflicting values, Anderson said.

The private sector can help with that by introducing competition into the space. 

“The only thing that gives you the combo of innovation and price control is competition,” Anderson said. 

The pandemic made many players in the health care space, including insurance companies, recognize that new ways of delivering health care can benefit all patients, practitioners and payers. A prime example is telehealth. 

"Somehow everything is more efficient,” Anderson said. 

The pandemic proved the efficiency of remote care for behavioral health. Now, Carroll is seeing insurance companies become open to the idea of remote primary care. 

“It’s been pushed by the pandemic, and it’s going to grow,” he said. “The new reality is that we’re going to be in this pandemic for a long time, so we need to find out how to deliver health care better.”

Hacking the health care system

Although the health care system is problematic, it presents the opportunity for private companies to create loopholes and work-arounds. For example, Nanopath was able to get higher reimbursement for testing by diagnosing multiple conditions on the same test. 

“People are reimbursed per target, so we can charge for everything we put on the test,” Burkland said. 

Other companies, like GoodRX, take advantage of the fact that the cash-pay price for prescriptions is usually lower than the price billed to insurance companies. 

As more companies take advantage of caveats like these, more effective options will emerge for consumers. 

“I think the private sector is solving this by and large,” said Carroll. 

Advice for health care entrepreneurs

When people think about revolutionizing health care, they often focus on hard-core science. In reality, however, the biggest changes in health care are coming from the way care is delivered, not necessarily scientific innovation. 

“Some of the most significant health care burdens are not the deep challenges,” Burkland said. “It’s easy to get lost in the science, but we need human-centered design. The science will follow.”

Prospective entrepreneurs in healthcare should be nimble and willing to take risks, Carroll said. 

"What limits you is your inflexibility,” he said. “Health care is a great field to be in. Be open. Be flexible. Be ready to challenge yourself. That’s how you grow.”