The quality of healthcare in the United States is superb. But staggering costs and spotty medical coverage leave about 66 percent of Americans concerned that they won’t be able to afford medical care this year, according to a recent survey.

Five years ago, one in four Americans reported trouble paying a medical bill. The problem worsened during the pandemic as 12 million US adults lost health insurance due to unemployment. With a hospital stay costing an average of $5,220 per day and a doctor visit costing $300 to $600, nearly one in three Americans delay getting care, tests or medication due to the expense.

“If you are a patient being treated for anything in the United States, whether insured or not, you face substantial out-of-pocket expenses that can amount to thousands of dollars. American healthcare providers face a $40 billion uncompensated care problem because of patients who cannot afford the high cost of treatment,” says Srulik Dvorsky, cofounder and CEO of TailorMed.

This Israeli startup’s automated system identifies financially at-risk patients and matches them with resources such as co-pay assistance, replacement drug programs, government subsidies, funds from community, state or disease-specific foundations, and programs that help with living expenses.

“We were founded in 2017 and now work with more than 50 hospitals, 200 clinics and 300 pharmacies across the United States,” says Dvorsky from TailorMed’s New York office. About 30 of its 55 employees work in R&D at the Tel Aviv office.

Clients include Providence, the third largest health system in the United States, whose venture arm led a recent $20 million investment round in TailorMed.

“We work with hospitals like Henry Ford Health System in Detroit and Memorial Sloan Kettering in New York, one of the world’s leading cancer institutes, and many small community and rural hospitals and clinics,” says Dvorsky.

For patients, TailorMed’s platform can reduce immediate out-of-pocket costs – sometimes to zero — and avoidance of care. It helps prevent “financial toxicity,” a term referring to the long-term side effects of treatment with high-cost medication for chronic conditions or cancer.

For healthcare providers and pharmacies, TailorMed’s system enables reimbursement from another entity rather than relying on the patient’s ability to pay.

“No one should have to make a choice between the financial stability of their family and what is sometimes lifesaving treatment of their health condition,” said Providence Ventures Partner David Kereiakes.

“The stats around severe financial distress associated with cost of care are staggering and have reached a crisis state. We recognize that TailorMed’s platform makes sure patients aren’t left questioning how they will be able to afford their care.”

Helping financial counselors do their job

Financial counselors at hospitals and pharmacies attempt to find patients sources of financial assistance, says Dvorsky, “but it’s manual and decentralized. That’s where we come in, using data from medical records, insurance claims and billing to automatically discover patients with financial need and the resources that can help them.”

TailorMed’s algorithm considers “anything we can get from the data to find those patients in most financial need,” including demographic characteristics, treatment, diagnosis and social determinants of health.

“The needs can be addressed early on in the patient’s medical journey, not when the bill comes or when the provider needs to write off the expense,” he adds.

One customer is the Cowell Family Cancer Center at Munson Healthcare in Michigan, which started providing a financial navigation service to patients in 2013.

After adopting TailorMed technology to automate and streamline the process, the center reported “a significant improvement in both the funding it was able to secure for its patients as well as … improvements in productivity, a more proactive workflow and increased ability to measure and track the ROI [return on investment] of the financial navigation program through the platform’s analytics and reporting product.”

Administrators at Henry Ford Cancer Institute and New England Cancer Specialists (Maine) told TechTarget that TailorMed has enabled their financial counselors to locate financial resources for patients more quickly and efficiently, including very short-term grants that could easily have been missed.

The need is great: A recent Journal of Clinical Oncology study showed that even among insured cancer patients, 16% quit treatment because they could not afford chemotherapy drugs, and patients with higher co-payments were 42% more likely to skip treatment.

“There are a couple of companies trying to match patients with financial assistance programs, but I think we are the only one leveraging the data to proactively identify patients in need and avoid them even getting billed. Predictive analytics is the uniqueness of our platform,” says Dvorsky.

Strong tech talent

Over the years, caring for six family members with cancer alerted Dvorsky to the unmet need for technology that could bridge gaps in financial access to care in America’s unwieldy healthcare system.

“We looked from the outside in to identify needs and apply unconventional thinking,” says Dvorsky, a veteran of Unit 81, a technology unit of the Special Operations Division of the Military Intelligence Directorate in the Israel Defense Forces.

Cofounder and CTO Adam Siton served in Unit 8200, the Military Intelligence Directorate’s main information-gathering unit. Many of Israel’s most successful startups have been founded by 8200 alumni.

“Adam has a strong software development background, and my career path was as a hardware engineer and technology founder,” says Dvorsky, who came to TailorMed from the medical device space.

“We did a lot of homework to understand the dynamics and main players of the US healthcare industry. There are so many factors in that value chain, from pharma company to patient. We had to understand how that dynamic works and find a technology solution that works throughout the whole ecosystem and makes sense from a business perspective,” Dvorsky says.

“The amount of data from different sources is so non-standardized in the US health system that to automate those processes you need a system that can do it at scale and be very robust.”

InTel Aviv, the founders had personal connections to software and dev-ops engineers and product managers with the right skillsets, says Dvorsky.

“Having an ocean between us still pays off when you have access to this amazing talent,” he tells ISRAEL21c.

Vision for near future

The June financing round led by Providence Venturesincluded UnityPoint Health Ventures, Almeda Ventures, Bridges Israel, Discount Capital, Accelmed, Sanara Ventures and Triventures.

This $20 million infusion will help TailorMed expand throughout the US healthcare industry, says Dvorsky.

“While we have done well in growing the business, it’s still a tiny portion of the market. We can leverage the success stories we’ve had so far in helping patients and having such a profound impact on providers’ financial performance. That’s the vision we will be working on in the next few years.”