Kat Utecht and Arjan Schütte at Core Innovation Capital are two of Decent’s earliest and most helpful investors. With the coronavirus hitting markets hard, most VCs are understandably focused on themselves and their families, their existing founders, and potential new investments.

I just got the email below from Core and asked if I could share it. I admire how much farther their focus extends: to employees, to end users, and to the everyday people it’s their mission to serve. This is what empathy in venture capital looks like. I’m proud to work with them.

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Core CEOs:

One of the reasons we love investing is when entrepreneurs see problems, they act. We have an unprecedented issue, so let’s act.

At an organizational level, many have put together guides on preparedness, process and best practices. We love this crowdsourced encyclopedia and Sequoia’s much cited case for quick and decisive action.

As you know, our mission is to enable economic mobility for everyday people, to fix the kitchen table economy. Clearly, we need to put on the oxygen mask before helping others, as we’d be reminded if we were flying anywhere this week. But let’s make sure we’re doing all we can to help others. If things are hard for us, they are 100x harder for those living paycheck to paycheck, with fewer resources, fewer networks, fewer options, less coverage. A server at the salad restaurant near our office may lose their job if they don’t show up to work. A security guard in Austin without SxSW drawing 400,000 people next week can easily lose their home or worse. Here are some things you can do:

Figure out your cash position and financial situation. If you have less than 18 months of cash assuming your revenues are cut by 50%, let’s talk. Figure out if you are playing offense or defense given the virus. This may dictate how generous you can be with your policies. Even if you’re on the defensive, you have options.

Have more flexible team policies:

• Allow team to work from home — most of our companies have migrated to this. Check to make sure people have good internet connections. If not, pay for it.
• Make sure your laptops are inventoried and distributed to workers. Have extra in case of issues.
• For those in highly regulated industries, there are vendors that can help work for home be compliant. We have suggestions depending on what you need. Let us know.
• For support folks that aren’t working from home, we recommend giving them extra paid sick days and stress that if they are sick, they should stay home. Too many are paycheck to paycheck and you don’t want them to feel financial pressure to come in when they are sick.
• If you can, keep paying your workers as you would have in ordinary circumstances. This will gain loyalty.
• If you have to lay off people, speak to your investors. There are open roles in those companies playing offense and you may be able to transition people throughout your investors’ portfolios. If you need to lay off, please send us the laid off worker’s information and we’ll help them find a place. It’s a lot better if you can say, “We need to eliminate this position due to circumstance, though we have found you a place at X, Y, and Z if you are interested.”
• Interview virtually.
• If in a defensive position, freeze hiring.

Do more for your end-users:

• Point people to resources: for instance, if you are laid off and need health insurance, you can enroll via our portfolio company, HealthSherpa. Most of their customers are spending sub-$50 per month for a silver plan.
• We have a couple of companies in elder care and now is a time to push out content on how caregivers can act and precautions elderly take.
• Make it easy to save more. Setup some auto savings plan. Offer a match or higher yield. Savers are the most loyal customers.
• For lenders: more flexible repayment terms — allow people to skip payments or change the term of their loan. More payment options. Point people in the right direction. While we are inundated with information, some of your end customers may be hearing all sorts of fake news. Take the time to communicate with them. Your engagement and flexibility will gain loyalty.

Help people around you:

• When you’re out, tip double or triple what you normally would. This will help soften the blow for those working in retail.
• Check in with your friends and family members in retail and help them weather the storm. What most people need is more money, and in these trying times, that is truer than ever. Most of us are fortunate enough to have money to give to those that are close to us.
• Talk to your elected officials to step up. A one-time payment to everyone with 2019 taxable income below a fixed threshold will do more to get money in the hands of those who need it most and stimulate economic activity than broad-based tax relief.

Tech has been bashed in recent years and now is our time to shine. Let’s show we can connect the world virtually and can also provide financial services and insurance so our kitchen table economy can weather the storm. This virus sucks. But what doesn’t kill us will make us stronger. Step up.

Kat, Arjan and the Core team

January

• Molly quarterbacked our 290 page regulatory filing to operate in Texas.
• We signed our first DPC partners: Drs. Ikbal, Larson, Miller, and Nguyen.
• Derric made our shirts: “You work for yourself. Decent works for you.”

February

• Our dev team shipped its first code to production.
• Marshall moved to Austin to meet customers. I and others would follow.
• Suzanne and Ryan recorded our phone tree messages, in a Seattle closet.

March

• Decent got licensed as a TPA, and Charlie, Marshall, and I as brokers.
• We started to build our network of >60 brokers in Austin.
• We got the go-ahead from counsel on plans to reward cost-effective care.

April

• We launched with TX approval and paying customers, in less than a year.
• First hires Suzanne and Molly hit 1 year and got tickets to fly anywhere.
• Our dev team + Suzanne gathered at our office in Gdańsk, Poland.

May

• We paid our first claims, via our PBM partner Costco Health Solutions.
• I published this post on how Decent will use blockchain.
• I presented Decent to 300 DPC doctors, and got >50 expansion requests.

June

• We added HCA, the largest hospital system in the world, to our network.
• We partnered with Vericred and Catch to distribute our plans online.
• We launched our new Pathfinder bronze plan with lower premiums.

July

• We published our goal to cover one billion lives.
• We added hundreds of new imaging centers via Green Imaging.
• We made Austin’s #1 TV news show and spoke at several events.

August

• We added 700 doctors to our network via HCA’s Capital Area Providers.
• We established our first live/work office in Austin — thanks Jessica!
• I did a 5 minute segment on Cheddar (CNBC for Millennials).

September

• Molly did a TV interview helping Austinites with Open Enrollment.
• We designed our bestselling Lonestar plan: $0 medical deductible!
• We gave State Bar of Texas members discounts via our partner program.

October

• We set our 2020 rates: Austin’s cheapest for nonsmokers.
• We added 125 providers from the Austin Diagnostic Clinic.
• We made plans with virtual DPC, for people who live far from doctors.

November

• We shared new rates to 0% churn: 80% of members’ rates went down.
• We partnered with Rise and The Riveter to discount members’ rates.
• We freaked out when we saw our billboards live in Austin.

December

• We soundly beat our enrollment targets, and signups are still coming in.
• Members chose in-person and virtual DPC plans, direct and via brokers.
• Our DPC partner Dr. Larson purchased a plan, and made a video on why.

It’s been an incredible year, and we’re just getting started.

We’re scheduling fundraising meetings in January to fuel 2020 opportunities we can’t even talk about yet.

We’re cutting out the middleman in insurance. Wait until you see what we do next.

Thanks for reading,

Nick and the Decent team

Headlines

• We’re getting national media attention. Check out the 5 minute segment below with Cheddar (CNBC for millennials) and this feature in BenefitsPro (#1 news source for brokers).

• We’re heading to Austin for Open Enrollment. I’ll be there early September through mid-December along with several other team members. Big thanks to the friend of Decent who gave us a great deal on a sweet place to stay.

• We partnered with HCA’s Capital Area Providers to bring up to 700 additional doctors and specialists into our Austin network.
• We did our first two in-person sales trainings, with the sales teams at our broker partners Kind (top online broker based in Austin) and Member Benefits (administrator of the private insurance exchange for the State Bar of Texas). Both teams are lovely, and chomping at the bit to serve self-employed people in Austin with Decent plans.

Have a lovely Labor Day, and think a little bit about the future of work. We’ll be there.

Thanks for reading,

Nick and the Decent team

Headlines

• We made Austin’s #1 TV news show with a happy customer, and Molly, Suzanne and I spoke at events. 👉Watch 4 minutes of highlights.👈

• We’re testing a plan with 50% lower premiums than market built around virtual direct primary care, to serve people who don’t live near a doctor.
• We published our goal to serve 1 billion people, and signed on dozens of brokers to sell to sole proprietors, freelancers, and 1099 contractors.
• We closed a national medical imaging deal with Green Imaging.
• We brainstormed with IDEO on how to inspire smart health choices.

Details below.

We made Austin’s #1 TV news show with a happy customer, and Molly, Suzanne and I spoke at events. 👉Watch 4 minutes of highlights.👈Molly prescribes blockchain to fix healthcare’s “busted economics” at 2:24, Suzanne talks about how we offer plans for 20%-30% lower premiums than market at 2:44, and I predict the future of insurance at 3:10. We told Decent’s story on the Forward Thinking Founders podcast, HCAA’s 2019 Executive Forum, the Hint Summit, the TF Blockchain Podcast, the Seattle Blockchain Conference, and Health Tech Austin, where Molly inspired the tweet and art below.

We’re testing a plan with 50% lower premiums than market built around virtual direct primary care, to serve people who don’t live near a doctor. Per the article below about our partner Dr. Chris Larson, DPC saves money.

We published our goal to serve 1 billion people, and signed on dozens of brokers to sell to sole proprietors, freelancers, and 1099 contractors. 1 billion people will require new pools, plans, and partners, and we’ve added dozens of Austin brokers to our roster. Our new Agency Management lead Elijio Salas came ready to work: Texas brokers interested in selling for us can learn more and get appointed at our dedicated broker page here.

“Just to validate your business, I’m in on the phone with a 100,000 life association and a 1.3MM life association and do you know what they need? An individual and sole prop health plan that’s better than the [stuff] that’s in the marketplace today.” — Michael Haffey, Managing Partner at Pendella

We closed a national medical imaging deal with Green Imaging. Decent works with high value care providers and passes savings back to members. With more than 400 imaging centers offering MRIs, CTs, and ultrasounds for as little as 10% of the U.S. average cost, Green Imaging joins Costco Health Solutions and HCA as an early partner with national scale.

We brainstormed with IDEO on how to inspire smart health choices. The IDEO team invited Decent to explore an intriguing question — “How might we inform conversations about care that lead to more net cost-effective choices?” We had a fruitful brainstorm with their designers, investors, and physician-in-residence. One key takeaway: patients want guidance from doctors, and doctors want better data. We’re on it.

How you can help 🙏

• Please retweet or share our news story (personal messages welcome). 🙏
• If you have ties to large brokerages or online brokers that sell in Austin, please let me know. 🙏

Thanks for reading,

Nick and the Decent team

Decent July update was originally published in Decent on Medium, where people are continuing the conversation by highlighting and responding to this story.

My company, Decent, administers affordable health plans for self-employed people. I wrote the below for our team before we launched in Austin, Texas, on April 1st, 1 year after getting seed funding. I’m publishing it with minimal edits so you can see our mission and strategy and hold us accountable. Our plan will change with time and progress. Our goal — serving 1 billion people — will not.

If this resonates with you, let’s talk about it. We’re building an early community to help inspire us and kick the tires on our vision. Please reach out today and make your voice heard. We need your help to make Decent work for everyone.

Decent team,

On April 1st, 2019, Decent will launch affordable health insurance.

In Texas. For self-employed people and sole proprietors. As the best deal for those who don’t qualify for ACA subsidies.

This is a great start, but it’s a long way from our mission of affordable healthcare for all.

The purpose of this doc is to explore all the ways we can fulfill our mission. We may not do all of these things, but we ought to have a sense of the levers available.

HOW WILL WE SERVE PEOPLE WORLDWIDE IN THE FUTURE?

• Start local, and radiate out. 4 of the 11 largest US cities by population are in Texas (Houston, San Antonio, Dallas, and Austin) — also 4 of the biggest metropolitan areas in the top 30 — and Texas leads the country in population growth. State-specific healthcare regulations will also make it easier for us to add new cities in Texas before expanding to new states.
• Expand into states with favorable regulations for self-insured plans.Most large U.S. employers self-insure, saving up to 30% on healthcare costs. Decent helps self-employed people band together for similar savings. This model is powerful, and we should learn how to make best use of it before diversifying our approach.
• Focus on the US to start. Unique economic and regulatory forces shape each country’s health insurance market. We will need to grow globally to hit our goals (U.S. population is only 330MM), but over the next several years that may initially come from self-service or joint-venture pools. Rather than expanding our office footprint internationally, we should use blockchain and other technologies to make our infrastructure for stuff like claims management and payment processing (eventually our protocol) efficient and flexible so locals can use it to spin up pools over time.

HOW WILL WE SERVE NON-SELF-EMPLOYED PEOPLE IN THE FUTURE?

• Focus on serving the self-employed first. Our first plans are for self-employed people (e.g. sole proprietors, freelancers, and independent contractors).
• Consider partnering with additional groups and companies that serve or work with self-employed people. Groups and companies that bring their own members with similar characteristics to those we serve should require less incremental work to serve than entirely new firmographics. They may also have unique requirements we can learn from.
• Expand to serve businesses only after delivering great plans for the self-employed. Serving businesses will add various new stakeholders with new requirements impacting customer service, reward routing, SLAs, etc. We should not target businesses until we are on track to establish ourselves as the best option for the self-employed people we serve.

HOW WILL WE SERVE PEOPLE AT ALL INCOME LEVELS IN THE FUTURE?

• Make our business as efficient as possible. Reward cost-effective health decisions and pass savings back to members. Build a flexible protocol/infrastructure to account for regulatory variation and change. Use price discovery and economies of scale to get better rates. Develop the flywheel(s) of our business (illustrative example below).

• Offer lower-cost products. Given the market appetite for lower-cost plans, prove out innovative models that can reduce plan cost (e.g. a virtual direct primary care plan with a specialty network wrapper). This will allow us to serve people in rural communities too.
• Use subsidies. Closely follow legislation that could make subsidies available for non-exchange plans as soon as 2020. In parallel, explore the feasibility and timing of getting on the exchanges in some or all states in the future. Separately, consider whether and how to subsidize some or all of our plans directly based on overall performance, potentially via logic at the protocol level.

The opportunity here is to help everyone.

Affordable healthcare for all. But how? was originally published in Decent on Medium, where people are continuing the conversation by highlighting and responding to this story.

Headlines

• Added HCA (the largest hospital system in the world) to our network.
• Hired Elijio Salas, former Associate Commissioner of the Texas Department of Insurance, as our Austin-based Broker Relations Lead.
• Launched a bronze plan, with the lowest bronze premiums in Austin for nonsmokers age 18 to 40. It’s preferred 4-to-1 in surveys vs. competition.
• Partnered with Vericred to distribute our plans via thousands of brokers.
• Partnered with Catch (YC W19) to serve self-employed people. Kristen from Catch thinks Decent could be a “billion dollar company.”
• We’re getting lots of investment interest and will fundraise after summer.

Details below.

Added HCA (the largest hospital system in the world) to our network. HCA ($47B 2018 revenue) has 185 hospitals and thousands of affiliated facilities and clinicians nationwide, including Austin’s St. David’s and The Austin Diagnostic Clinic. Hospitals are the “anchor tenants” of health plans. This partnership will help us serve Austin members and expand quickly.

Hired Elijio Salas, former Associate Commissioner of the Texas Department of Insurance, as our Austin-based Broker Relations Lead. Elijio was a top broker before leading TDI’s Financial Licensing Division. He’s a sharp, kind, and connected lifetime Austinite. We’re delighted to make him our first Austin hire.

Launched a bronze plan, with the lowest bronze premiums in Austin for nonsmokers age 18 to 40. It’s preferred 4-to-1 in surveys vs. competition.

Partnered with Vericred to distribute our plans via thousands of brokers. Vericred offers a data translation layer between carriers and insurtech companies — think Plaid for health plan data. Their universal API will push our plan data to top online brokers and benefits platforms like BenefitMall, Gusto, Kind, GoCo and Stride — unlocking one-to-many distribution to help us grow fast during open enrollment and beyond.

Partnered with Catch (YC W19) to serve self-employed people. Kristen from Catch thinks Decent could be a “billion dollar company.” Catch’s personal benefits platform serves the 80MM people who don’t have access to employer benefits. Cofounder Kristen Tyrrell gave us a surprise shout out on the Forward Thinking Founders podcast — listen here at 21:09. Excerpts:

“What company most people don’t know of do you think is going to be really big in a decade?”

KT: “I could list companies that went through YCombinator with us, but all of us are still pretty early … Decent. Decent.com. Health insurance is just too freaking expensive. We’re at the mercy of these big companies that have just terrible plans, high deductibles, really high costs. At the end of the day, we need better and cheaper insurance products. So Decent is taking a look at how do you rethink what that plan is? Can we make it more affordable? Can people pay less and have better care? It’s really hard, but there’s so much room for good, and obviously if they can crack that nut they’ll be a billion dollar company.”

We’re getting lots of investment interest and will fundraise after summer. We are proud of the progress we’ve made in a year. Huge thanks to the investors who have supported us so far.

How you can help 🙏

• New HRA rules will let employers make tax-advantaged contributions toward independent contractors’ (1099s) premiums, making our plans an even better choice for large blocks of skilled 1099s. Our broker partners can’t wait to sell Decent into this market, and I want to make sure we give them exactly what they need. If you know leaders of businesses that employ many skilled 1099s, I’d love to talk with them. 🙏
• We are considering raising debt in conjunction with our Series A to help cover regulatory capital reserves. If you have advice or connections in debt finance for insurance, let me know. 🙏
• Listen to Kristen Tyrrell from Catch’s full 3 minute quote on Decent at 21:09 here, and then retweet this. 🙏

Decent June update was originally published in Decent on Medium, where people are continuing the conversation by highlighting and responding to this story.

We’re solving a big problem for direct primary care (DPC) doctors.

Decent’s wraparound health plans put direct primary care (DPC) at the center: members get unlimited primary care included in their monthly premium. DPC restores the doctor-patient relationship at the heart of healthcare, supporting happier patients, happier doctors, and better and more cost-effective health outcomes. DPC doctors get paid to keep patients healthy, not to pack 10 minute appointments with lab test orders and referrals to specialists. They’ve joined the DPC movement to reject the churn-and-burn fee-for-service model driving healthcare cost escalation in America. And they believe, as we do, that DPC is the future of health.

But today’s DPC doctors have a problem. Most want their members to have insurance as a backup — in case they get hit by a car. But traditional insurance plans include fee-for-service primary care and don’t cover DPC membership. So DPC members have to “pay twice” for their primary care coverage, or go without insurance and risk financial ruin. And for DPC doctors who would prefer to quarterback their members’ care, sending members out alone into the mess of healthcare outside the DPC office feels like putting them on field without a play.

Decent presented our model to 300 DPC doctors at the Hint Summit and got clear validation that it solves their problem. Please watch my presentation here, or below.

After the event I got >50 emails from DPC doctors around the country who want to work together, including Garrison Bliss, the godfather of the DPC movement. Here are some of the things these visionaries had to say:

• “It was great meeting you Nick. Everyone in the DPC community is sitting on the edge of their seats for you to expand into their area. Let us know if there’s anything we can do to help you and Decent in any way. Thanks again for all your amazing work!”
• “Great to hear all the amazing things you are doing at Decent, Nick! I enjoyed hearing your passion for making a difference.”
• “I would be interested in talking further when you get to California. The broker and employer community here expressed tremendous interest in this DPC/wrap model.” … “I’m definitely interested when you get to Arizona.” … “We would of course love to work with you guys to get your product into the Oregon market.” … “MICHIGAN” … “I am in NY. Get it in here!!” … “Please add me to your wait list — especially for Central FL.” … “Get us on the list. We are in Utah” … “Let us know when you are able to move into the Ohio, Kentucky or Indiana markets.” … “Absolutely interested and ready to be a big pitch guy for you here in the Peach State.” … “We would love to have y’all in the DFW area!” … “Excited about the work you are doing. Unlikely that you will ever come to our part of the world — rural Colorado — but keep up the good work.”

We’re solving a big problem for health insurance brokers.

Health insurance brokers sell >80% of individual and group health plans in America, and Decent is partnering with them as our primary sales channel. They are licensed, trusted professionals who help individuals, groups, and companies find the right plans.

But today’s health insurance brokers have a problem. Most don’t have any viable options for self-employed people. Brokers who serve individuals want better and more affordable plans. Brokers who serve groups and companies want plans that will accept independent contractors (1099s). And many of these same groups and companies even want to contribute to 1099s’ monthly premiums to build loyalty and take care of their people. The need is large and growing: by many estimates, more than half of American workers will have worked as independent contractors by 2027.

Decent is the solution brokers can offer for this surging demographic. We have already partnered with 15 brokers, including top online broker KindHealth based in Austin, Texas. One broker already helped a top independent real estate firm in Austin choose our plans as the recommended option for its >500 self-employed real estate agents, and we are in conversations with many other brokers, companies and groups that work with and for self-employed people. When we asked a large group broker if he needed more information to help his team sell our plan, he replied, “I told them we now have a solution for 1099s. What more do they need to know?”

We’re solving a big problem for self-employed people.

• Based on feedback from members and brokers, we’re bringing Austin’s must-have facilities and specialists in-network, and launching a new lower-premium bronze-level plan soon. Stay tuned for Pathfinder!

• We paid our first claims. This was a huge milestone— kudos to Mike and the dev team who built our product, to Ryan and Charlie who run operations and CS, and to our launch partners Costco and Hint who helped make this a seamless experience for the members we serve.
• We have now “seen every part of the roller coaster.” In one year, we’ve received regulatory approval to operate; built a network of physician partners; designed, priced, and marketed a plan; enrolled members and taken payment; provided excellent customer service; and processed claims. Now all we have to do is do it bigger and better! To get a more visual sense of what this means, see below. It’s a lot.

• We’re all excited about the future — open enrollment and beyond. With that in mind, I wrote about how Decent will use blockchain. TL;DR: “To align incentives and reward smart choices; to make price and quality data transparent; and to cut waste and take the middlemen out of health insurance. … Decent is a healthcare company using blockchain, not a blockchain healthcare company: in fact, members will be able to use Decent without needing to understand or even think about blockchain.” As always, we use technology in service of our members.

Thank you, and how you can help 🙏

• Please tweet this (personalization is welcome). 🙏
• Based on market feedback so far, we believe we are in the early stages of building something that will help a lot of people. One broker told us his personal goal is to bring 3,000 1099s onto our plans in the next year from a single deal he’s working on. Another went deep on the advantages of our model and then wrote this in an unsolicited email: “Decent is going to upend, and eventually dominate the health plan market in the USA.” We know we still have a lot of work to do, and we appreciate our community’s support. Thank you. 🙏
• We anticipate kicking off fundraising in Q4. We’re drawing up a short list of potential Series A leads and would welcome your thoughts. 🙏

Thanks for reading,

Nick and the Decent team

Decent May update was originally published in Decent on Medium, where people are continuing the conversation by highlighting and responding to this story.

Maybe you and your friends would put money in a shared account for a year. Anyone who needed healthcare could take some out. If money was left at the end of the year, you might each take a share, or just leave it in for next year.

Now imagine that a few of you went skiing. Remarkably, you all fell and hurt yourselves and needed MRIs. Your friends went to hospitals that charged $2000, and they each took $2000 out of the account. You went to a top-rated imaging center that only charged you $1000, and better yet, they said they’d offer the same deal to everyone else with your “insurance.”

What if you took $1000 out of the account to pay for your MRI, and also got to keep a portion of what you saved the group — say $200 — for finding a place you could all get more affordable MRIs in the future?

Everyone wins. Economists would call this incentive alignment. Your friends would just call it a good deal.

You’d be helping to make healthcare more affordable, transparent, and fair.

Isn’t that how healthcare should be?

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U.S. healthcare today isn’t affordable — it’s so expensive that people stay at jobs they hate just to keep their health benefits. It’s not transparent — it’s impossible to predict what you’ll pay before leaving your house. And when47% of Americans can’t cover a surprise $400 medical bill, it’s not fair. No wonder Americans hate their health insurance more than everything but Comcast.

Making healthcare affordable, transparent, and fair is why Decent exists.

As of April 1st, 2019 in Austin, Texas, we are administering comprehensive health insurance plans at below market rates, initially for self-employed people who buy insurance for themselves. Designing and administering affordable health insurance plans is what we do.

Blockchain is a big part of how we do it. Decent is a healthcare company using blockchain, not a blockchain healthcare company: in fact, members will be able to use Decent without needing to understand or even think about blockchain. Technology is valuable only if it solves real problems. It should always be part of how.

The biggest problems with incumbent insurers — too little trust and too much waste — mirror the natural strengths of blockchain. Only 7% of Americans trust their health insurance company, in part because incumbent insurers have deeply misaligned incentives with the members they serve. There are one trillion ($1,000,000,000,000!) dollars of waste in U.S. healthcare every year, and 75% of spend goes through insurance payers — the money-moving middlemen of healthcare.

So how will Decent use blockchain? To align incentives and reward smart choices; to make price and quality data transparent; and to cut waste and take the middlemen out of health insurance.

Short term: to align incentives and reward smart choices.

The root cause of healthcare’s problems is that all key stakeholders, except the patient, benefit when costs go up. Most health insurance companies are governed by a medical loss ratio: they have to spend 80 cents of every premium dollar on care, and can hold up to 20 cents back to cover administrative costs and profit. This means they actually make more money when the total cost of care goes up — they’re taking a fixed percentage of a growing pie. They pay lip service to value, but their incentives reward cost escalation.

Decent isn’t a health insurance company — we help groups of people band together and self-insure for better rates. We aren’t governed by a medical loss ratio, and because of that, cost escalation isn’t part of our business model. Like the members and direct primary care (DPC) doctors we serve, we benefit when members get affordable and high-quality care. Members will play an essential role in making Decent work, and they should be compensated for it. We will use blockchain tokens to reward smart health choices (like in the MRI example above). Savings will be passed back so everyone wins when members get high-value care, and used to expand into new geographies and demographics so we can realize our vision of affordable healthcare for all.

Medium term: to make price and quality data transparent.

The lack of price and quality data in healthcare makes sense once you realize that the incentives of most hospitals and insurers reward cost escalation. They have little economic incentive to promote high-value care, or to understand the relationship between costs and outcomes.

At Decent, we want to make price and quality data transparent, so all patients and doctors can make smart care choices.

We will collect and publish price and quality data to a distributed ledger so no one can hide it, tamper with it, or shut it down.

As we expand, we will be able to draw statistically significant correlations between prices and de-identified outcomes data to find the highest-value options for care.

Long term: to cut waste and take the middlemen out of health insurance.

The operations of a health insurance company are fundamentally a series of simple decisions: Is this enrollment form complete? Should this claim be paid? Is this doctor credentialed? Some of these decisions are already being automated to cut waste: most claims management today is done by software. Where human judgment is required, people making these decisions need to be qualified, and they need to be compensated. But in the future, they won’t need to work for a centralized insurance company. Blockchain technology will let them prove their qualifications, get paid, and operate independently.

Decent will use blockchain to streamline and automate core administrative functions like billing, payments in near realtime, and claims management, to cut the costs of administrative overhead, fraud, and human error. As continued development pushes blockchain technology forward, we will cut waste relentlessly to deliver more value to members.

The deeper problems with America’s health insurance oligopoly come from its centralization. Centralized decision making lets a small group of companies decide who and what gets covered, with the world’s largest industry lobbies pushing a one-size-fits-all model. These monoliths enrich themselves by trading key healthcare data — from prices and quality to sensitive and valuable health records — and keeping it out of the hands of patients. And their centralized operations siphon hundreds of billions of dollars in profit and admin overhead — money that would be better used to pay for care.

Over time, Decent will use blockchain to responsibly decentralize core operations: to add flexibility in who and what gets covered, to give you access to key healthcare data, and to pass savings back to you. All using transparent infrastructure so you can see where your money goes and don’t have to trust a middleman.

You should be able to join a plan that covers what you want. You should have the data you need to make smart choices. And when you choose high-value care, you should be rewarded too.

Our goal is to build an increasingly decentralized organization that lets anyone in the world set up and run a legal health insurance pool with no middleman (including us) required.

If you have questions, email us at hello@decent.com.

If this all sounds crazy to you, stay tuned.

How will Decent use blockchain? was originally published in Decent on Medium, where people are continuing the conversation by highlighting and responding to this story.

Maybe you and your friends would put money in a shared account for a year. Anyone who needed healthcare could take some out. If money was left at the end of the year, you might each take a share, or just leave it in for next year.

Now imagine that a few of you went skiing. Remarkably, you all fell and hurt yourselves and needed MRIs. Your friends went to hospitals that charged $2000, and they each took $2000 out of the account. You went to a top-rated imaging center that only charged you $1000, and better yet, they said they’d offer the same deal to everyone else with your “insurance.”

What if you took $1000 out of the account to pay for your MRI, and also got to keep a portion of what you saved the group — say $200 — for finding a place you could all get more affordable MRIs in the future?

Everyone wins. Economists would call this incentive alignment. Your friends would just call it a good deal.

You’d be helping to make healthcare more affordable, transparent, and fair.

Isn’t that how healthcare should be?

*

U.S. healthcare today isn’t affordable — it’s so expensive that people stay at jobs they hate just to keep their health benefits. It’s not transparent — it’s impossible to predict what you’ll pay before leaving your house. And when 47% of Americans can’t cover a surprise $400 medical bill, it’s not fair. No wonder Americans hate their health insurance more than everything but Comcast.

Making healthcare affordable, transparent, and fair is why Decent exists.

As of April 1st, 2019 in Austin, Texas, we are administering comprehensive health insurance plans at below market rates, initially for self-employed people who buy insurance for themselves. Designing and administering affordable health insurance plans is what we do.

Blockchain is a big part of how we do it. Decent is a healthcare company using blockchain, not a blockchain healthcare company: in fact, members will be able to use Decent without needing to understand or even think about blockchain. Technology is valuable only if it solves real problems. It should always be part of how.

The biggest problems with incumbent insurers — too little trust and too much waste — mirror the natural strengths of blockchain. Only 7% of Americans trust their health insurance company, in part because incumbent insurers have deeply misaligned incentives with the members they serve. There are one trillion ($1,000,000,000,000!) dollars of waste in U.S. healthcare every year, and 75% of spend goes through insurance payers — the money-moving middlemen of healthcare.

So how will Decent use blockchain? To align incentives and reward smart choices; to make price and quality data transparent; and to cut waste and take the middlemen out of health insurance.

Short term: to align incentives and reward smart choices.

The root cause of healthcare’s problems is that all key stakeholders, except the patient, benefit when costs go up. Most health insurance companies are governed by a medical loss ratio: they have to spend 80 cents of every premium dollar on care, and can hold up to 20 cents back to cover administrative costs and profit. This means they actually make more money when the total cost of care goes up — they’re taking a fixed percentage of a growing pie. They pay lip service to value, but their incentives reward cost escalation.

Decent isn’t a health insurance company — we help groups of people band together and self-insure for better rates. We aren’t governed by a medical loss ratio, and because of that, cost escalation isn’t part of our business model. Like the members and direct primary care (DPC) doctors we serve, we benefit when members get affordable and high-quality care. Members will play an essential role in making Decent work, and they should be compensated for it. We will use blockchain tokens to reward smart health choices (like in the MRI example above). Savings will be passed back so everyone wins when members get high-value care, and used to expand into new geographies and demographics so we can realize our vision of affordable healthcare for all.

Medium term: to make price and quality data transparent.

The lack of price and quality data in healthcare makes sense once you realize that the incentives of most hospitals and insurers reward cost escalation. They have little economic incentive to promote high-value care, or to understand the relationship between costs and outcomes.

At Decent, we want to make price and quality data transparent, so all patients and doctors can make smart care choices.

We will collect and publish price and quality data to a distributed ledger so no one can hide it, tamper with it, or shut it down.

As we expand, we will be able to draw statistically significant correlations between prices and de-identified outcomes data to find the highest-value options for care.

Long term: to cut waste and take the middlemen out of health insurance.

The operations of a health insurance company are fundamentally a series of simple decisions: Is this enrollment form complete? Should this claim be paid? Is this doctor credentialed? Some of these decisions are already being automated to cut waste: most claims management today is done by software. Where human judgment is required, people making these decisions need to be qualified, and they need to be compensated. But in the future, they won’t need to work for a centralized insurance company. Blockchain technology will let them prove their qualifications, get paid, and operate independently.

Decent will use blockchain to streamline and automate core administrative functions like billing, payments in near realtime, and claims management, to cut the costs of administrative overhead, fraud, and human error. As continued development pushes blockchain technology forward, we will cut waste relentlessly to deliver more value to members.

The deeper problems with America’s health insurance oligopoly come from its centralization. Centralized decision making lets a small group of companies decide who and what gets covered, with the world’s largest industry lobbies pushing a one-size-fits-all model. These monoliths enrich themselves by trading key healthcare data — from prices and quality to sensitive and valuable health records — and keeping it out of the hands of patients. And their centralized operations siphon hundreds of billions of dollars in profit and admin overhead — money that would be better used to pay for care.

Over time, Decent will use blockchain to responsibly decentralize core operations: to add flexibility in who and what gets covered, to give you access to key healthcare data, and to pass savings back to you. All using transparent infrastructure so you can see where your money goes and don’t have to trust a middleman.

You should be able to join a plan that covers what you want. You should have the data you need to make smart choices. And when you choose high-value care, you should be rewarded too.

Our goal is to build an increasingly decentralized organization that lets anyone in the world set up and run a legal health insurance pool with no middleman (including us) required.

If you have questions, email us at hello@decent.com.

If this all sounds crazy to you, stay tuned.

How will Decent use blockchain? was originally published in HackerNoon.com on Medium, where people are continuing the conversation by highlighting and responding to this story.

We launched our pilot on schedule 4/1 in Texas, with paying customers.

• We got the last regulatory approvals we needed on April 1st, and began to serve plan members in Austin and booked first revenue the same day.
• We all dug deep and feel proud of this milestone. Many people told us it was impossible to launch a health plan in under a year. We did it anyway. Big thanks to our investors, to our partners including Hint, Costco, and Healthcare IP, and to the DPC doctors we serve.
• The Department of Labor’s new rules for Association Health Plans were challenged in court last week. We’ve worked with counsel and confirmed that thankfully this won’t impact us, since our current and future operations are compatible with but not dependent on the challenged rules.

Our team keeps getting stronger.

• Suzanne and Molly celebrated their 1 year anniversaries with Decent. The team gave them each a poster with the many reasons we love them, along with a golden ticket for a trip anywhere in the world (h/t Gusto).

• We hired Stacey Aikman to lead our work with brokers, and drive growth as our boots-on-the-ground in Austin. Stacey was glowingly recommended by many partners and has 20 years of benefits experience, most recently as Director of Marketing for Austin-based HMO health plan Vista360health.
• Suzanne, Shine, Sean, and Mike visited Decent’s Gdańsk office to help get launch over the line, tour castles, and eat pierogis with our Polish team.

We’re bullish on the long-term value of blockchain for our business.

• Our friends at the Blockchain Association featured Decent in a post called “How open blockchain networks can lower the cost of health insurance.”
• I’m now co-chair of the Insurance SIG in the Enterprise Ethereum Alliance.
• The SEC’s recent guidance on digital assets and securities law included 3 welcome messages for Decent: 1) scammy ICOs will no longer siphon away money and credibility from the crypto space, 2) teams who follow the law can still fundraise by selling tokens if desired, and 3) there is an increasingly clear path for tokens sold as securities to stop being securities as services become decentralized in the future.

How you can help 🙏

• If you know businesses in Austin that work with large groups of 1099 contractors in skilled trades, please let me know. 🙏

Thanks for reading,

Nick and the Decent team

Decent April update was originally published in Decent on Medium, where people are continuing the conversation by highlighting and responding to this story.