Progress in medicine has improved the lives of billions, through immunizations, germ theory and the invention of anesthetics, to name just a few examples. Modern entrepreneurs continue that tradition and are looking at medical advances from a very different angle. Data science, artificial intelligence (AI) and machine learning are all driving change in healthcare, providing solutions to a new set of challenges, including reducing costs, improving outcomes and making healthcare accessible to all.
Healthcare and business professionals who are interested in healthcare entrepreneurship should explore healthcare MBA programs, in which they can learn about the challenges the industry faces.
Entrepreneurship in Healthcare
The entrepreneurial spirit has always been alive and well in medicine. As scientific knowledge has expanded throughout the centuries, innovation has grown with it. Examples of civilization-changing healthcare inventions abound. These innovations rarely remain static, as subsequent generations continue to improve on them.
The artificial heart is one healthcare business idea with a long evolution. Inventors built and patented prototypes in the 1940s and 1950s, but the first device, the Jarvik-7, wasn’t successfully implanted into a patient until 1982. These devices are bulky and are meant to keep a patient alive long enough to get a heart transplant. However, scientists aren’t stopping there. Researchers have posited that long-term artificial hearts are close to becoming available, thanks to advances in batteries, robotics, biocompatible materials and energy transmission.
6 Entrepreneurs in Healthcare
The following six healthcare entrepreneurs have built their companies around providing innovative solutions to some of the most challenging problems in healthcare. These healthcare business ideas combine technical and financial knowledge, entrepreneurial creativity, and experience in talent acquisition to create groundbreaking products and services. For those with a passion for becoming an entrepreneur in healthcare, examples like these can provide both inspiration and insight.
1. Malinka Walaliyadde — AKASA
The problem: The complexity of healthcare finance and the patchwork of billing systems and payers means that hospital billing can be highly inefficient. This drives up costs and causes billing errors, wasting time and increasing patient frustration.
The solution: AKASA’s technology plugs into a hospital’s existing system, automates tasks and learns from the process how to make each revenue cycle more efficient.
AKASA takes aim at administrative inefficiencies in the healthcare industry. The company offers software technology that uses AI to automate back-office tasks, such as patient billing and insurance payments. AKASA helps healthcare administrators deal with the complex world of the healthcare revenue cycle, handling eligibility, claims, denials and payments from patients and insurers.
By streamlining workflows and processes, AKASA technology manages high-volume account processing; this can relieve overworked administrative staff. It can also help with rising demands placed on hospital and healthcare systems to improve the patient experience while increasing revenue.
The founder: Healthcare entrepreneur Malinka Walaliyadde originally worked for venture capital firm Andreessen Horowitz, helping create the firm’s healthcare investment team. It was there that Walaliyadde worked with startups that were developing AI and machine learning technology that would revolutionize medical care. He asked whether this advanced technology could also be used to improve back-end financial systems, which often relied on outdated technology and weren’t up to the challenge of handling complex transactions involving patient care, insurance, diagnoses, follow-up care, and coding and billing issues.
2. Robbie Hughes — Lumeon
The problem: Hospitals and care providers need to manage the patient experience, from intake to discharge, more efficiently.
The solution: Lumeon’s technology is designed to help hospital staff, including doctors, nurses and administrators, manage each patient’s stay in the hospital. Lumeon’s Care Journey Orchestration platform works within a hospital’s existing electronic health record (EHR) system to ensure that everyone knows everything about patients and their conditions at every step.
Workflow products include the following:
- Preoperative readiness. Nurses can use personalized preoperative checklists for each patient, taking advantage of all of the information already entered about the patient.
- Patient self-scheduling. Patient self-scheduling relieves the administrative team of the onerous task of patient scheduling, freeing them up to manage more complicated tasks.
- Patient outreach. Automated outreach messaging can improve patient health by ensuring that patients receive important information about their treatment and follow-up care. It can also improve revenue realization.
- Patient intake management. Patient intake management automates the collection of patient data and ensures that all of the patient data is easily accessible to everyone on the care team.
- Chronic disease. Chronic disease management can be time-consuming. When automated, it can help reduce readmissions by helping coordinate care and improving patient compliance.
- Discharge readiness. When the discharge process is automated, it ensures that discharge criteria are followed properly.
The founder: Robbie Hughes trained as an engineer, and he brought that engineering mindset to bear on the problem of fragmented patient services. He developed Lumeon to bring together patient care staff, clinical teams and administrative staff to streamline the patient process, from intake to follow-up visits, and close the loop on billing.
3. Meghan Gaffney — Veda
The problem: Administrative expenses make up 34% of healthcare costs in the United States. Health insurance companies need to reduce costs while improving data quality.
The solution: Veda uses AI and machine learning to automate data entry, replacing cumbersome manual data input and ensuring data accuracy. Products include the following:
- Quantym provides real-time analysis of provider data, allowing insurance companies to modernize their provider directories and streamline claim processing. Quantym also cleans and corrects data fields, reducing inaccuracies.
- Replacing manual workflows with an automated process, Velocity reads, identifies and formats roster files. It also checks data accuracy against external sources, such as Medicare.
The founder: Meghan Gaffney has had a career as a consultant and in government. Working in Washington when the Affordable Care Act passed in 2012, she saw the need to modernize the U.S. health insurance sector. Her healthcare business idea targets administrative costs revolving around claims and poor data quality bloated by inefficient processes. The health insurance industry is further hampered by computer technology that’s outdated, which increases inefficiencies.
4. Sean Lane — Olive
The problem: Patient data is siloed, and healthcare providers and insurance companies can’t share necessary information.
The solution: The goal of Olive is to provide an Internet for healthcare. Olive uses AI to automate manual patient data tasks and allow clinicians, patients and insurance companies to access the same data. The company’s main product, Olive Helps, provides a library of AI services that feed information to staffers when they need it.
The company named these services Loops, after feedback loops, because each time a worker calls a Loop, the AI learns from the action. Olive develops Loops itself and also works with partners to develop other Loops. This crowdsourced development process is part of Olive’s goal to open up healthcare to technological innovation.
Loops allow workers to access various patient information, including the following:
- Diagnostic codes
- Healthcare dictionary
- Patient forms
- Patient network status
- Claims and benefits
Developers even plan to expand the program to include social determinants of health, such as where people live, food security and housing access.
The founder: Sean Lane began his career in the military, working in intelligence. He’s founded several technology companies based around data science and AI His goal in founding Olive was to address the disconnect between technological innovation in healthcare and the lack of resources in data entry and administration. He hopes that modernizing healthcare technology will free up clinical providers from the burdensome task of collecting patient data and entering it into a computer system.
5. Chrissa McFarlane — Patientory
The problem: Highly sensitive patient data needs to be protected while remaining accessible to healthcare providers and patients.
The solution: Patientory uses blockchain technology, a digital ledger system that’s highly secure in the way it prevents data from being accessed or altered. The company provides two solutions:
- Patientory’s consumer app, dApp, lets users access their health information on their mobile device. It compiles EHR data, data from wearables, genomic information, lab results and more. The goal of dApp is to give patients knowledge through their own health data, which lets them make informed choices.
- Neith is Patientory’s enterprise software application. It collects patient health information and compiles it according to Health Insurance Portability and Accountability Act (HIPAA) requirements. However, Neith does more; it can connect with patient data compiled on dApp and can integrate this lifestyle data into care plans. It also collects and helps analyze population health metrics.
The connectivity between dApp and Neith can help healthcare professionals provide value-based care to their patients, using the data to improve health before patients become sick. It can also help hospitals and other providers better manage risk, a key factor in patient outcomes.
The founder: Healthcare entrepreneur Chrissa McFarlane has had a long career in the healthcare industry. During her work for a telemedicine company, she experienced the frustration of trying to collect patient information when it was scattered across many different sources. Her goal in founding Patientory is to create health management solutions that are personalized, secure and consumer-centric.
6. Graham Gardner — Kyruus
The problem: Patients are often frustrated by the experience of finding and scheduling an appointment with a doctor in their health system.
The solution: Kyruus uses provider and scheduling data and parses it according to a powerful algorithm. Patients can schedule care with multiple providers, making access to care more efficient. The company offers solutions for hospital and health systems, medical groups, and healthcare plans. These solutions include the following:
- Patients can look for providers via a health system’s website, call centers or a doctor’s office. Users can search by keyword, even using nonmedical terms, to find the doctor they need and make sure the provider is in network.
- ProviderMatch Analytics. Medical groups and other providers can analyze the data in ProviderMatch to understand how patients found them. They can use that information to improve their search engine optimization (SEO) activities, making it easier for patients to connect with them and book an appointment.
- Kyruus-HealthSparq. The Kyruus-HealthSparq platform streamlines scheduling via a health plan’s provider directory. Kyruus acquired HealthSparq in 2021.
The founder: Graham Gardner has a background as a cardiologist with Beth Israel Deaconess Medical Center and Harvard Medical School, as well as a career in venture capital at Highland Capital Partners. Gardner’s goal in developing Kyruus was to make it more efficient for people to find doctors and care for themselves and their families. That required making hospitals (and other care providers) and health plans more open to consumer behavior, easier to find via search engines and more convenient to navigate within their own websites.
Addressing Current Healthcare Challenges
The great number of challenges in healthcare means that opportunities abound for entrepreneurs. These challenges impact patients, clinical staff, cost of care, and the health and safety of healthcare workers. Business-savvy entrepreneurs can combine their experience with that of health industry professionals to identify healthcare business ideas that may literally be lifesaving. Even if a solution isn’t directly related to medicine, it can increase access to healthcare or make doctors and nurses more effective.
For example, administrative AI technology can help doctors and nurses identify sicker patients who need immediate care. Data science tools manage the vast sea of healthcare data, allowing researchers to more quickly analyze the information and identify what’s relevant. Also, hospital risk-management measures help improve the quality of care.
Promising areas of healthcare entrepreneurship include the following:
Improving Cancer Diagnoses
Medical researchers and oncologists point to the importance of early diagnosis in effective cancer treatment. Many experts say that data science and AI have a huge part to play in diagnosis and treatment. The National Cancer Institute identifies five areas in which data science and technology can impact cancer treatment:
- Cloud computing. Researchers around the world can access 2.3 petabytes of data via cloud-based data commons. Making use of this data requires tools and workflows.
- High-performance computing. The worldwide healthcare sector generates 30% of the world’s global data, according to research by RBC Capital Markets. High-performance computing is needed to sift through this data.
- Digital technology. The popularity of smartphone health apps has exploded, resulting in the production of valuable patient data outside of a medical setting. Entrepreneurs may find opportunities in this consumer health tech arena.
- AI has already made a mark on the healthcare industry. AI can parse data faster than individual researchers can, aiding in cancer risk assessments and diagnoses, and helping identify the most effective drugs for treatment.
- Digital twin. The emerging digital twin technology uses computational modeling of a cancer patient’s digital avatar. Scientists can conduct studies on this digital twin, helping predict how cancer will progress or respond to different treatments.
Data science and AI aren’t the only way to improve cancer treatment. Since early diagnosis is a major factor in the success of cancer treatment, increasing access to screening tools may be a promising area for entrepreneurs who are looking for healthcare business ideas. Mobile CT and radiology units that go out into the community can help identify patients before their symptoms start.
HIPAA requires healthcare providers to safeguard all patient data. The risk of HIPAA violations has grown, especially with the increase in cyberattacks on hospitals. Common HIPAA breaches include snooping by healthcare workers, denying patients timely access to their medical records and being liable for impermissible disclosures of patient data. Healthcare providers must perform regular risk analysis to ensure that patient data is protected. The tools, services and training to manage HIPAA compliance are an essential part of a provider’s risk-management process.
Modernizing Healthcare Payment Models
The traditional model of fee-for-service healthcare is going away. Under that model, providers billed insurance companies and Medicare for each patient service. This incentivized testing and procedures, but didn’t always improve the quality of care. Value-based care reimburses providers for the quality of care based on patient outcomes, readmissions, preventive care and other metrics. As doctors and hospitals transition to value-based billing, they’ll need payment systems that can keep up with the change and patient data systems that prove the effectiveness of care.
Healthcare providers have increasingly turned their focus to the patient experience. Often called patient-centered care, this change requires doctors and nurses to include patients in health decision-making, improving patient satisfaction. Patient-centered care has been linked to quality of care and patient outcomes. In turn, patient outcomes can impact a hospital’s risk profile and financial results. These metrics can have a cascading effect. Poor patient outcomes can reduce reimbursements under value-based payment models.
Population Health and Health Equity
Population health looks at the overall health of a community. It identifies the metrics that define health, such as chronic disease, infant mortality and overall mortality rates. Healthcare experts have long noted that overall health outcomes can be pinpointed at the ZIP code level. Known as social determinants of health, these metrics take into account environmental impact, financial stability and food security. Population health research is part of the move toward addressing health equity, which seeks parity for patients of all incomes and ethnic groups.
Reducing Per Capita Costs
Annual healthcare spending in the United States reached $4.1 trillion in 2020, according to the Centers for Medicare & Medicaid Services: roughly $12,500 per capita. Despite that expenditure, the United States doesn’t have better healthcare outcomes than other nations, according to research by The Commonwealth Fund. Healthcare providers and government officials have long wrestled with this problem. The fact that healthcare costs don’t reflect care quality may offer promising opportunities for entrepreneurs with innovative healthcare business ideas.
The issue of burnout among healthcare workers, particularly nurses, has gained a good deal of attention during the COVID-19 pandemic. Overwork causes burnout, a condition that often results in fatigue, depression and emotional exhaustion. It can lead to medical errors and impact patient outcomes. Hospitals and health experts recognize burnout as a problem for the industry. Solving burnout among healthcare providers is a thorny issue, potentially a winning idea for an entrepreneurial approach.
Be Part of the Future of Healthcare
These examples of entrepreneurs in healthcare show that where many people see challenges, healthcare entrepreneurs see opportunities. The industry needs innovative leaders now more than ever, to make sure that healthcare meets its promises to everybody. Learn how you can be part of the future of healthcare by exploring the George Washington University online healthcare MBA program, and see how you can make a difference in millions of lives.