Insurance Reimbursement Essentials for Healthcare Startups
In a recent MedStart workshop, Thom Schilmeyer shared key strategies for navigating the healthcare startup ecosystem, emphasizing the importance of understanding stakeholders and the complex reimbursement process.
Strategic Approach
Schilmeyer highlighted the need for a clear strategy in medical startups. He compared the process to survival shows, explaining that just like survivalists must understand their environment to succeed, entrepreneurs must thoroughly know their business landscape. Key stakeholders in healthcare include insurers, doctors, patients, and pharmacies, all interacting in complex financial relationships.
Understanding the Ecosystem
In healthcare, reimbursement isn’t straightforward. Schilmeyer stressed that new products rarely get immediate insurance coverage. Entrepreneurs must explore various revenue strategies beyond insurance reimbursement, such as fee-for-service or direct-to-consumer models. He advised startups to build credibility, develop a phased approach to revenue, and identify key stakeholders for collaboration.
Real-World Example
Schilmeyer shared his own journey of building a successful revenue cycle management company. He addressed unmet needs by offering discounted medical supplies to doctors, which built trust and scaled his business quickly. His success came from understanding the ecosystem and solving stakeholder problems.
Overcoming Reimbursement Hurdles
Reimbursement is a long and difficult process, and Schilmeyer warned that startups must be prepared for delays. He suggested focusing on alternative revenue streams while working toward insurance approval and advised partnering with doctors, associations, and industry players to build advocacy for new products.
Conclusion
Thom Schilmeyer’s workshop emphasized that success in healthcare startups requires more than just a great product. A deep understanding of the ecosystem, phased revenue strategies, and strong relationships with stakeholders are crucial for growth and long-term success. Entrepreneurs who embrace this approach will be better positioned to navigate the challenges of the healthcare industry.
About Thom Schildmeyer
Thom is an accomplished executive and entrepreneur with nearly 30 years of experience in the healthcare industry. A trusted healthcare business consultant, coach, and advisor, he has a proven track record of delivering impactful results, with a focus on strategy and growth for businesses and their leaders.
Complementing his deep knowledge of business leadership, strategy, and growth, Thom has spent the majority of his career in the areas of healthcare technology, services, and programs, including revenue cycle management and insurance reimbursement. With an emphasis on the healthcare ecosystem and its various stakeholders (provider, payer, and patient).
In addition to his corporate healthcare leadership experience (Allergan, Inc., Vision Services Plan), Thom founded and successfully sold his own healthcare business, Aesyntix Health (now part of Modernizing Medicine), and has since launched TLS Strategy Solutions to help other entrepreneurs and leaders develop their businesses.
