Rubix Health Columbia 015

RUBIX HEALTH

Chaitanya Kanitkar (ck2565)Abhinav Mishra (anm2147)

Day 5: 10 InterviewsTotal Number: 54 Interviews

A Fully-automated Web Platform for transforming a physician’s diagnosis into billable codes

Here’s what we thought

Direct Distribution Channel is what makes most sense to sell our product to physicians in hospitals and in private practice.

SquareSpace

& Website Domain

HIPPA Cloud Platform for NLP Engine

and WebApp

Customer Segments

Private Practice Physicians

• Much less patients/record to deal with

• Are more willing to use new EMR/EHR systems with coding inbuilt

• Still spend around half an hour each day on medical coding

• Less Important

Physicians in Hospitals/IT Admins

• Many patients to deal with• Hospitals have spend 30-50 million

dollars in EMR systems (~4-5 years ago)

• Spend around 30mins-1 hr a day on coding even though they have billers-> priority

• Physicians are required to hire billers and pay 5-12% of the total payment

• Most Important

Here’s what we thought (cont’d)

Our only channel was the web application running on a HIPPA Compliant cloud.

Primarily physicians would buy our product. Billing departments in hospitals and billing outsourcing companies were much less of a concern.

The NLP Engine to translate billable codes would be hard but with some knowledge is doable in a few months.

That the main value propositions were simply efficiency/time and money saved.

Business Model Canvas (Day 1)

Key Partners

HIPPA-Compliant Cloud Platform • Aptible/

TrueVault

Hospital Systems • Wayne

State/Detroit Medical Center Hospital System

Key Activities

MVP • Prototype the User Interface/Web

PlatformAdvertising• Emails/connect with hospital systems and

physicians (ex. Wayne State University School of Medicine)

• Website consolidation • Prototype sign-up listPitch• Consolidate all work• Consolidate doctor feedback• Develop pitch deck Coding Engine• Research NLP algorithm to translate

unstructured doctors’ notes into billable codes

Value Propositions

Cost Reduction • Reducing cost of

medical reimbursement by eliminating the need for trained medical coders

Convenience/Usability• Fully automated

and consistent coding engine that translates doctors’ EMR diagnoses to billable CPT/ICD-10 codes

Customer RelationshipsGET• Reach out to physicians, visit

hospitals, and get involved in hospital networks

• Website to gauge & generate interest in platform

KEEP• offer consistent and high quality

service• continually reach out to customers

for feedbackGROW• Increase involvement in hospital

networks• Government/larger hospitals• Expand Services to include EMR and

extended billing service

Customer Segments

• Private practice physicians

• Physician groups

• Hospital IT Admins

• Government (Medicare/Medicaid)

Key ResourcesFinancial Capital • Friends, family, individual investment,

Angel Investors, Accelerators, VCHuman Capital • Software Developers/Graphic Design• Legal Advisor• Marketing/Sales• Doctors for testing

ChannelsWeb Application (Saas) • Powered by a HIPPA-Compliant

Cloud

Cost Structure• HIPPA-Compliant Cloud• Human Resources (Developers, Designers, Marketers)• Website Maintainence/Domain

Revenue StreamsSAAS• Monthly/yearly subscription model• Percentage of Reimbursement

Here’s what we learned: Confirming the Problem

• 5-12% of total collections going to billers-> lot of money!!!• Doctors spending 30 mins-1 hour looking up codes every day • It’s a big headache for doctors, especially for those who are at

hospitals as depending on their dept., they tend to have less control over the billing process

Here’s what we learned: Customer Segments!

Here’s what we learned: OEM

Sales Team to Partner with Billing Outsourcing and EMR Companies

NLP Engine gets built

and becomes part of

software package or

billing consulting

service

Software is sold by

distributor companies

Here’s where we Ended: Customer Archetypes

Day 1Start Day 3Day 2 Day 5Day 4

1 Physiciansin hospitals

Value Prop: Platform Agnostic, Cost Savings, Efficiency

2 Private Practice

Value Prop: Smarter billing, small monthly cost, easier to test

EMR/BillingCompanies

3

Competitors

Value Prop: Use our NLP Engine as part of their product, less billing experts needed

4Hospital Bill Dept./Informatics

Value Prop: Makes dept’s life a lot easier when teaching new codes to doctors


Key Partners


TrueVault



• Hospital Billing Depts for testing

Key ActivitiesMVP • Prototype the User Interface/Web PlatformAdvertising• Emails/connect with hospital systems and


• Website consolidation • Prototype sign-up list• Generate interest in research circles +

community forums-> crowdfundingPitch Customer Discovery• Consolidate all work• Consolidate doctor feedback• Develop pitch deck Interview stakeholders• Figure out how much physician groups are

actually paying for coders/billersCoding Engine• Research NLP algorithm to translate


• Sit with billers, coders, and physicians to see what these diagnoses look like

Value PropositionsCost Reduction



Platform Agnostic

Analytics• Practice insights

obtained and analysed to learn what is successful in practice


hospitals, and get involved in hospital networks hospital billing depts, interest groups for interest in testing

• Website to gauge & generate interest in platform, website: get early access

• have community forum for billing

• commit to one or two practices for dedicated support

• generate research interest KEEP• offer consistent and high

quality service• continually reach out to

customers for feedback

GROW• Increase involvement in

hospital networks• Government/larger hospitals

Customer Segments

Key ResourcesFinancial Capital • Friends, family, individual investment, Angel

Investors, Accelerators, VCHuman Capital • Software Developers/Graphic Design• Legal Advisor• Marketing/Sales• Doctors for testing

ChannelsWeb Application (SaaS) • Powered by a HIPPA-Compliant

Cloud• Website/Forum/Blog

Cost Structure (above and below)• HIPPA-Compliant Cloud

Revenue Streams (above and below)

***Private practice physicians -> extend SaaS into full revenue life cycle management

Physician groups in larger hospitals (these hospitals usually have separate departments)

Hospital IT Admins and billing departments at major hospitals


Consolidate doctor feedback, level of priority

learn about current EMR systems used in hospitals IT dept

Reducing cost of medical reimbursement by eliminating/reducingtrained medical coders

Percentage of Reimbursement (5-8%), may prefer subscription model

Monthly/yearly SaaS subscription model (200-400 dollars), less than what other EMR companies charge

web application that requires no extra installation and is independent of EMR System used

• Informatics Departments

• Billing outsourcing companies• EMR Companies

EMR Companies: Dr. Chrono, CareCloud, EPIC, CureMD,

• ask private practices for alpha testing using EMR

• Human Resources (Developers, Designers, Marketers)

• Website Maintenance/Domain

Why you should invest in us

significant interest and need has been seen form multiple customer segments

minimally invasive and no IT infrastructure overhaul

huge economic potential in terms of cost and time savings for all customer segments

opportunities to partner with smaller EMR startups as a distribution channel (estimated 9 billion dollar market)

NLP engine research can be catalyzed by initial funding and testing at smaller practices and hospitals

What we need to do next

develop functioning and detailed MVP to demonstrate basic features

generate significant interest in research communities through website, blog, early access button

shadow billers and coders to learn extensively the entire process

get physicians directly involved as stakeholders in company

NLP research: figure out details of algorithm

partner with 1 or 2 hospital departments for testing purposes

Direct Distribution Channel: Website

www.rubixhealth.com (community forum not included yet)

pl\

http://www.rubixhealth.com/

THANK YOU!!

APPENDIX


Key Partners


TrueVault



Key Activities

MVP • Prototype the User Interface/Web

PlatformAdvertising• Emails/connect with hospital systems and


• Website consolidation • Prototype sign-up listPitch• Consolidate all work• Consolidate doctor feedback• Develop pitch deck Coding Engine• Research NLP algorithm to translate


Value Propositions

Cost Reduction • Reducing cost of







KEEP• offer consistent and high quality

service• continually reach out to customers

for feedbackGROW• Increase involvement in hospital

networks• Government/larger hospitals• Expand Services to include EMR and

extended billing service

Customer Segments

• Private practice physicians

• Physician groups

• Hospital IT Admins




ChannelsWeb Application (Saas) • Powered by a HIPPA-Compliant

Cloud

Cost Structure• HIPPA-Compliant Cloud• Human Resources (Developers, Designers, Marketers)• Website Maintanence/Domain



Key Partners


TrueVault



EMR Companies • Examples

include:• Dr. Chronos• CareCloud• Cerner • EPIC• CureMD

Key ActivitiesMVP • Prototype the User Interface/Web

PlatformAdvertising• Emails/connect with hospital systems

and physicians (ex. Wayne State University School of Medicine)

• Website consolidation • Prototype sign-up listPitch Customer Discovery• Consolidate all work• Consolidate doctor feedback• Develop pitch deck Interview

stakeholders• Figure out how much physician groups

are actually paying for coders/billersCoding Engine• Research NLP algorithm to translate


Value PropositionsCost Reduction • Reducing cost of




Platform Agnostic• web application

that requires no extra installation and is independent of EMR System used


obtained and analyzed to learn what is successful in practice




• Showcase MVP to physiciansKEEP• offer consistent and high


customers for feedbackGROW• Increase involvement in

hospital networks• Government/larger hospitals• Expand Services to include

EMR and extended billing service the whole revenue life cycle management (future)

Customer Segments

• Private practice physicians -> extend SaaS into full revenue life cycle management

• Physician groups in larger hospitals (these hospitals usually have separate departments)

• Hospital IT Admins and billing departments at major hospitals




ChannelsWeb Application (Saas) • Powered by a HIPPA-

Compliant Cloud

Cost Structure• HIPPA-Compliant Cloud• Human Resources (Developers, Designers, Marketers)• Website Maintenance/Domain



Key Partners


TrueVault



EMR Companies • Examples

include:• Dr. Chronos• CareCloud• Cerner • EPIC• CureMD



• Website consolidation • Prototype sign-up listPitch Customer Discovery• Consolidate all work• Consolidate doctor feedback• Develop pitch deck Interview stakeholders• Figure out how much physician groups are



• Sit with billers, coders, and physicians to see what these diagnoses look like and how are the codes are inputted to doc




Platform Agnostic






KEEP• offer consistent and high


customers for feedbackGROW• Increase involvement in


Customer Segments




Cloud


Revenue StreamsSAAS

Private practice physicians -> extend SaaS into full revenue life cycle management


• Hospital IT Admins and billing departments at major hospitals


Showcase MVP




• Government/ Larger Hospitals

• Expand Services to include EMR and extended billing service the whole revenue life cycle management (future)






Key Partners


TrueVault





• Website consolidation • Prototype sign-up listPitch Customer Discovery• Consolidate all work• Consolidate doctor feedback• Develop pitch deck Interview stakeholders• Figure out how much physician groups are



• Sit with billers, coders, and physicians to see what these diagnoses look like and how are the codes are inputted to doc




Platform Agnostic






• have community forum for billing

• commit to one or two practices for dedicated support

KEEP• offer consistent and high


customers for feedback

GROW• Increase involvement in


Customer Segments

Key ResourcesFinancial Capital • Friends, family, individual investment, Angel

Investors, Accelerators, VCHuman Capital • Software Developers/Graphic Design• Legal Advisor• Marketing/Sales• Doctors for testing


Cloud


Revenue Streams

***Private practice physicians -> extend SaaS into full revenue life cycle management


Hospital IT Admins and billing departments at major hospitals









• Billing outsourcing companies• EMR Companies

EMR Companies: Dr. Chrono, CareCloud, EPIC, CureMD,

• ask private practices for alpha testing using EMR

Market Opportunity

Total Available Healthcare IT Market: $53.8 bn/year • Growing at an annual rate of 16% (MarketResearch.com)

Served Available Market for Medical Records and Health Info IT: $7.8bn/year• Number of jobs * average salary

=205,000*$38,000 (U.S. Bureau of Labor Statistics)

• Number of jobs projected to increase 22% from 2012-2022. Higher demand for coders due to increasingly aging population expected to increase salaries as well.

Target Market : $4.8bn/year• Medical/surgical hospitals,

physicians’ offices, outpatient facilities

• Number of jobs * average salary per category

• (http://www.medicalbillingandcoding.org/jobs/)

TAM: $53.8 bn

SAM: $7.8 bn

Target: $4.8 bn

Value Proposition for Hospitals/IT Admin

Problem: The medical coding and billing reimbursement process is • costly• inefficient,• time-consuming.

Solution: • Platform

agnostic software• Fully automated

technology• Reduce cost by

lowering billing staff or saving physicians’ time spent in coding

Value Proposition: • Cloud-based/

web app that automates coding process using NLP engine.

• Translates doctor’s diagnoses into billable codes

• Increases flexibility for current EMR software

• No infrastructure overhaul

• Analytics for practice

Value Proposition for Private Practices

Problem: The medical coding and billing reimbursement process is • costly (5-12% cut)• inefficient,• time-consuming

(30-45 days).

Solution: • Platform

agnostic software• Fully automated

technology• Reduce cost by

lowering billing staff

Value Proposition: • Cloud-based/

web app that automates coding process using NLP engine.

• Translates doctor’s diagnoses into billable codes

• Increases flexibility for current EMR software

• Allows private practices to transition to other EMR software without having to pay for billing part

• replace human coders

• Analytics for practice

Initial MVP

Initial MVP

Distribution Channels

Direct Channel : Website

MVP and Get Early Access Email Popup

Community Forum for discussing billing

Web Application Portal

OEM: EMR Companies

Examples include EPIC, CureMD, or billing oursourcing company such as Empire

Provide NLP Billing engine built into EMR Product

No Web Portal

Direct Distribution Channel

SquareSpace

& Website Domain

HIPPA Cloud Platform for NLP Engine

and WebApp

~$110/year

~$150/month

Using our predicted monthly subscription cost of around 200-300 dollars per month this leaves us with around 100 dollars per customer

OEM Distribution Channel

Sales Team to Partner with Billing Outsourcing

and EMR Companies

NLP Engine gets built

and becomes part of

software package or

billing consulting

service

Software is sold by

distributor companies

5-10% of each payment goes to us

~9 billion dollar market for EMR Software and 31.6% market share for billing outsourcing

Customer Relationships Petal Diagram

Customer Workflow

Patient EMR• contains written

diagnosis by doctors• doctors will not need to

add any codes by looking it up online or in software

Rubix Health•upload EMR as PDF/Word document to portal

•NLP Engine will scan through document and generate codes

•EMRs sorted by date/patient on portal for easy use

Reimbursement• biller/coder does not have to do anything except look at codes and write form

•less billers/coders needed• send form to insurance companies

Customer Relationships: GET (Direct)

Website: Put more relevant terms that are searched for when searching for medical billing (track through Google)

Get Early Access popup right at the top of website for easy way to get customers to sign up (similar to Robinhood)

Community Forum: Empowers physicians and other experts in the field to discuss and share problems in medical billing

Blog: To tell our insights and provide a social forum

Continue to talking to physicians in private practices and hospitals

Commit to one-two groups for actually developing and testing the product

Customer Relationships: GET (OEM)

Can only be done after development and testing of product (through partnering with hospitals such as Wayne State or private practices)

Start with billing consulting companies-> ask how much they could save through our product. This might be the best place to start with because they have to hire actual experts

Get demos from EMR/EHR companies to see where exactly their products could be lacking (IT invasive?, not as smart?)

Partner with larger tech companies who are interested in the healthcare IT sector such as Citrix, VMware, Flatiron

Hypothesis & Experiment 1

Hypothesis: Medical billing is a cumbersome, costly, and time-consuming process for everyday physicians.

Experiment: Ask physicians how much time they spend in learning about CPT, ICD-9, and ICD-10 codes.

Can they be spending that time elsewhere?

How much money does a physician/group of physicians spend on coders/billers?

Compare responses between doctors in private practice and those working in hospital groups to see where demand is greatest and how specifics vary.

If doctors spend a lot of time (~30 mins/hr per day) and money with coding and reimbursement-> success

Learning from Hypothesis/Experiment 1

Hypothesis: Medical billing is a cumbersome, costly, and time-consuming process for everyday physicians.

Experiment: Ask physicians how much time they spend in learning about CPT, ICD-9, and ICD-10 codes.

Result: Most physicians, especially those in larger hospitals, are spending on average 20-30 minutes writing codes themselves

Around 5-8% of the total payment goes to billers (12% for academic hospitals)

About 60% of the doctors expressed that the billing process was extremely inefficient (one even said it was laughable)

Iteration: Keep collecting insights from other doctors. Also ask more details about why the coding process itself is cumbersome (for example: does it involve looking up a lot of codes)?

Iteration Result: It is a cumbersome process because of the details involved in the diagnosis, especially if a patient has a lot of history (more time with patient-> more reimbursement). Moreover, billing outsourcing companies are expensive and not preferred by hospitals.

Second Iteration: Shadow doctors, billers, and coders to be able to visualize the problem. This will help when it comes to creating the product and the NLP engine itself.


Hypothesis: Current EMR/auto-coding solutions do not eradicate the problem of medical coding for physicians. They’re only a temporary fix. Doctors and their IT departments are still not satisfied with these technologies.

Experiment: Meet current physicians using these new technologies and ask about whether they like using these new all-in-one software solutions or not.

Ask IT admins about the effort required to integrate this new product into the practice.

If a majority of physicians and IT admins are using/willing to change to new EMR technologies-> fail, else-> pass

Learning from Hypothesis & Experiment 2



Results: Around 30% of the doctors we spoke to have transitioned to using newer software systems. However, all of these doctors were in private practice.

Most Physicians in large hospitals such as New York Presbyterian said that the hospital has already spent 30-50 million dollars in EMR systems. Changing to a new EMR system is just simply an hassle. More open to using platform with drag and drop or upload of EMRs.

Iteration: Show physicians our MVP/Website. Ask if anything needs to be added or changed to the MVP. Talk to IT departments about our solution and see if it follows the IT guidelines for the hospital.




Results: Around 30% of the doctors we spoke to have transitioned to using newer software systems. However, all of these doctors were in private practice.

Most Physicians in large hospitals such as New York Presbyterian said that the hospital has already spent 30-50 million dollars in EMR systems. Changing to a new EMR system is just simply an hassle. More open to using platform with drag and drop or upload of EMRs.

Iteration: Show physicians our MVP/Website. Ask if anything needs to be added or changed to the MVP. Talk to IT departments about our solution and see if it follows the IT guidelines for the hospital.

Results: MVP is not detailed enough. Need more in terms of showing an example demo, even if it’s not a real example. However the UI is simple like Dropbox and that was approved. Website looks nice but it is very wordy. Needs to be more organized.

Second Iteration: Change website, make it more organized and appealing. Add stuff to blog and finish get early access feature.


Hypothesis: We believe that a SaaS monthly subscription model is the most appealing payment method for a healthcare provider.

Experiment: Ask providers are current methods of payment to other companies and services that the provider utilizes. Do they want to see any changes?

Would they rather go with another route (such as percentage cut) ?

Pass/Fail: Propose the monthly model with a reasonable price (~200 dollars/a month which is on the low end of medical software companies). If the doctors/providers approve of the number then pass, else->fail




Would they rather go with another route (such as percentage cut) ?

Pass/Fail: Propose the monthly model with a reasonable price (~200 dollars/a month which is on the low end of medical software companies). If the doctors/providers approve of the number then pass, else->fail




Results: Private practices who are using EMR/HER software approve of the monthly subscription model. However, there are some extra hidden costs that come into play when extra features are needed.

Larger hospitals use the percentage of the total payment to pay billers and doctors aren’t pleased with this method. It leads to extra money going to coders/billers, especially when many of the doctors are doing a lot of the coding themselves.

Iteration: Start with monthly model and come up a more concrete number by taking important factors into account (such as number of EMRs processed, length of documents, etc.). Ask doctors if that number is reasonable and repeat if it is not. Also ask doctors what factors should be considered in payment itself.


Hypothesis: We believe that billing outsourcing companies and possibly EMR/EHR companies would be willing to partner with us if the NLP Engine is truly accurate and intelligent. The payment method that would work best would be a percentage of the total payment.

Experiment: Reach out to these companies and present our solution. Ask how much money it could save them to get an idea whether they could be possible partners or not?

Ask how they currently get revenue to get an idea of which payment method is preferable (might depend on scenario).

Pass/Fail: If companies say yes or show signs of interest and approval then pass, else->fail


Hypothesis: We believe that aside from visiting customers, our website will be a major channel for reaching customers, especially if has social media features (such as forum/blog).

Experiment: Ask physicians if/how they communicate the pains they have in the current medical billing process. Ask if they would like the forum and blog features and whether they would generate more social awareness on the problems in medical billing.

Set up analytics engine to see how many people are currently visiting website.

Pass/Fail: If doctors say yes and are eager to use the feature->pass, else->fail

Education

Rubix Health Columbia 015