Spoke Health offers surgery savings through one-on-one care navigators

By Jonah Comstock
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Denver, Colorado-based Spoke Health, a startup that makes a platform called SurgeryHub to help employees find lower prices for surgery, has launched out of stealth mode with an undisclosed round of seed funding. The round comes from a combination of angel investors, friends and family, and the managing director of a private equity fund.

Spoke Health is aiming to tackle the process of healthcare price transparency from a different angle then most companies. While insurance companies tend to negotiate with providers based on volume, Spoke partners with employers to assign employees individual care navigators who present them with a list of surgical options sorted by both price and quality scores. The results can be impressive, CEO Richard Coyte told MobiHealthNews in an email.

"One example that we like is in Wichita, Kansas," Coyte said. "The average cost for a knee replacement in Kansas is about $30,000. We got a fully bundled case at one of the top centers in the country, everything included, fully bundled for $20,000. Right there immediately, we can capture a $10,000 [in savings] for an employer who’s close to Wichita. In fact, the price is so low that we can actually take employees from multiple states and fly them to Wichita and still save their employer a ton of money."

Coyte says Spoke Health's approach is based on bringing the way healthcare price negotiations work elsewhere in the world to the United States. But Spoke's personal one-on-one approach is about more than just cost savings. The company uses data analytics to identify employees most likely to need surgery, then their care navigator works with them to make sure they're aware of all options, including second opinions and non-surgical options. If a patient needs a surgery, Spoke's search engine presents them with choices, and the company will offer incentives to choose the options at the optimal intersection of cost and quality. The care navigator then stays with them for the whole process, including helping make sure they adhere to post-surgical instructions (an area where nonadherence is especially costly).

"We enter an employee’s life at a time of concern and potentially great fear," Coyte said. "And people lack confidence to make big health decisions and they have great difficulty navigating their insurance coverage, identifying what their out of pocket pay is actually going to be, figuring out all of their benefits programs from their employer, so we facilitate all of those things for them and help them understand their options and what those options mean for them."

While the one-on-one nature of the system might not seem very scalable, Spoke uses technology to maximize the efficiencies of the care navigators, reducing the time they need to spend interacting with each patient or researching the patient's options.