Spotlight on INVEST DH’s Pitch Perfect Winner: How TALON Creates the Model of Price Transparency Regulation

Before founding the healthcare pricing transparency platform TALON, Mark Galvin was a frustrated employer. A passionate entrepreneur, Galvin has grown a dozen businesses and has always tried to find ways to deliver health care profitably.

“The problem was that there was no symmetry in the data that we had as consumers,” he said in an interview. “You couldn’t know the prices in advance, you couldn’t know what your negotiated discount was. The doctor couldn’t tell you. Your insurance company couldn’t tell you. You couldn’t make a normal comparison.

Galvin therefore set out on its own to help consumers and employers understand and compare healthcare prices. This led to the start of Portsmouth, New Hampshire HEEL in 2014, which allows people to shop for health care prices in addition to other solutions. Last week, venture capital judges at MedCity News’ INVEST Digital Health conference in Dallas chose TALON as the winner of the Pitch Perfect competition among eight employee benefits startups.

As the company grew and expanded its footprint, Galvin was invited to Washington DC in 2018 to meet with the White House policy team working to improve price transparency in healthcare. This team included people from the Department of Health and Human Services, Treasury, Labor, Centers for Medicare and Medicaid Services, and the Office of Personnel Management, according to Heels website. Finally, the Transparency in the hedging rule launched in July, which required plan sponsors to publish price information for covered services and provide a user-friendly purchasing tool. People TALON met during this time who helped push through this decision include Katy Talento and Andrew Bremberg, who both worked on the Domestic Policy Council, as well as the former Health and Human Services Secretary Alex Azar and former Labor Secretary Alexander Acosta, according to Galvin.

“When the agencies wrote the mandate for transparency in coverage, what they saw was what we built and showed them in October 2018,” Galvin said. “So we were pleasantly surprised to find that while they didn’t refer to us by name, they described precisely what our platform did by functionality. So it was a huge victory for us.

If that’s what happened, government officials weren’t the last to be impressed with TALON given his win last week.

One of the judges was Matthew Blum, director of Cigna Ventures, who noted in a previous interview with MedCity why TALON was chosen as the winner.

“There is a strong market opportunity,” Blum said. “Obviously part of it is opportunistic with the regulatory change. Part of it is an inflection point of the business.

Galvin agreed that the change in regulations is a factor in why he was selected as the Pitch Perfect winner.

“I think one of the reasons we won the award is that we’ve hit the knee of the curve, in part because of the tailwinds in the regulatory environment that are now helping us move forward,” he said. he declares.

In addition to its purchasing tool, TALON provides a whole suite of solutions to help businesses stay compliant with the new regulations. This includes MyMedical Rewards, an incentive program that rewards members for selecting low-cost, high-quality healthcare options; Claims Hindsight, a claims data engine; and MyPlan Guide, which helps employees choose the plan that’s right for them. TALON’s solutions are aimed at employers, brokers and advisors, third-party administrators and insurers.

There are other companies in the area of ​​price transparency, including HealthSparq, blue book on health and Sapphire Digital, which was acquired by Zelis. However, with the transparency-in-coverage rule, these companies’ solutions are now obsolete, Galvin said.

“Others became obsolete when the rule was published because they had never built architectures capable of providing subscriber/payer/plan specific negotiated prices because they had always acted in the best interest of the payer, which was not in the best interest of the consumer,” he said.

Ultimately, with the recent push in the price transparency movement, TALON’s goal is to educate people about health care costs and spur competition in the industry, Galvin said.

“There are basically 212 million members on commercial health plans in the United States,” he said. “That’s a lot of people to educate, and we want to drive that education and say, ‘Here’s what you can do for yourself that’s also good for society.'”

Photo:, Getty Images

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