Why Health Insurance Needs Transparency w/ Ty Wang, Co-Founder & CEO, Angle Health

Nearly half of all Americans get their health insurance through a small business. Most of those businesses have no idea why their premiums go up every year and no real power to do anything about it.

Ty Wang, Co-Founder and CEO of Angle Health, joins host John Driscoll to discuss why legacy insurers benefit from keeping small businesses in the dark on costs, and how rebuilding the health plan stack from the ground up on modern, AI-native infrastructure is finally making transparency and customization possible for the employers who have always needed it most.

🎙️⚕️ABOUT TY WANG
Ty Wang is the co-founder and CEO of Angle Health, the first AI-native healthcare benefits platform built to give SMBs access to quality health plans.

Ty grew up in an immigrant family, where access to healthcare and healthcare literacy were significant challenges. He founded Angle Health to address these issues, focusing on providing transparency and simplicity in the healthcare system. Today, Angle Health partners with thousands of brokers and employers across the U.S., primarily serving small- and medium-sized businesses to offer affordable, high-quality healthcare coverage to tens of thousands of Americans.

Prior to founding Angle Health, Ty led major deployments at Palantir Technologies and spent several years in public service with the U.S. government across various foreign and domestic posts. He graduated from Washington University in St. Louis with degrees in electrical engineering and systems engineering.

🎙️⚕️ABOUT CARETALK
CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy. 

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Transcript

John: 0:07

Welcome to Care Talk, America's home for incisive debate for healthcare, business, and politics. I'm John Driscoll, the chairman of the UConn Health System, and today we have one of the, the great new innovators in health insurance, CEO and co-founder of Angle Health, Ty Wang. Ty, welcome to the show. Thanks, John. I'm excited to be here. So why in God's name would you take on health insurance- ... as a, as a, as a, as a, as a place to start a business?

Ty: 0:39

Yeah, I mean, I... We, we built the health plan. So, so a little bit of my, my background and my co-founder. Before starting Angle Health, we were, uh, both at Palantir, and there we were working on, um, building, really, uh, building these kind of early machine learning workflows at these large organizations. Healthcare is one of Palantir's biggest verticals, so we just got a very deep insight into how, uh, a lot of these large organizations operated, how the, the, the overall kind of healthcare ecosystem worked, and particularly on the payer side, the complexities that are involved when it comes to being able to, um, to deliver the kinds of products, especially when we've had over the past 10 years or so, this explosion of new ways of receiving medical services, things like, um, telehealth and telemedicine and behavioral health programs and, and digital health and chronic disease management programs and digital pharmacies. All of these, all of these pieces where, um, they were still primarily, uh, disconnected from the way that the vast majority of people actually access healthcare, which is through their health plan. So a lot of these companies were, were primarily distributed through things like, um, direct contracts with employers and through employer benefits on top of their existing health plans, when the reality is that a lot of these are clinical services that really should be tied into the core care coordination of a health plan. And, um, we, we, we saw kind of this evolving world or this evolving ecosystem of, of, of new ways of receiving healthcare services, but there was a very big disconnect between, um, uh, where those services were getting delivered to. And, and today, um, I mean, half of, almost half of Americans get their healthcare, work for and get their healthcare through small and medium sized businesses, and those are not the companies that, um- Before you

John: 2:33

go there, why health insurance? What, what... Why did you start there? It's fascinating to me as a, as a, as sometime insurance executive, given how complex, bureaucratic, regulated at the state and federal level, requiring a fair amount of capital even to show, show up and, oh, you know, open the doors day one. What got you excited and interested in insurance?

Ty: 2:58

Yeah, the, it's, it was, it's actually a pretty simple idea or thought that we had, or, or I, I would say, like, insight realization, is that the health plan, health insurance, for better or for worse, is the kind of central nexus, is the way that the vast majority of Americans access healthcare. It's, it's, uh, the nexus of all of the data, all of the finances of our healthcare system, um, and, and in many cases it's also the kind of final arbiter of things like medical necessity and whether someone is going to get access to a service or not. And, and the reality is if it's not covered by your health plan, for the vast majority of Americans you're, you're almost certainly not going to access it because you either don't know about it or it's just entirely cost-prohibitive. So, um, so we, we, we saw that as really the, uh, uh, the place to start because that is where all of the data flows through. And, and, um, and, and again, I'd say wh- when you look at how many of the largest health plans and insurance companies were formed over the last 30, 40, 50 years here, it's through consolidation, through M&A of all of these regional, uh, health plans, and they still operate very much like that, where you have, uh, y- when you have one large national health plan, it really consists of maybe, like, 50 regional health plans that all have their own systems, that all have, um, tens of systems for any given function, whether it's claims administration, whether it's utilization management, billing and invoicing, um, quoting, underwriting, uh, all of these kinds of functions, eligibility. And, and, uh, they don't talk to each other. And, and at the end of the day, it makes it very difficult to answer very simple questions for these, uh, large organizations, like whether a provider is even in network. Um, and, uh- So your solve, you've, you've

John: 4:54

taken up an incredibly complex data disconnected industry, and you can- Mm-hmm connect and, and, and, and given the new tools we have with machine language, artificial intelligence, and big compute, connect the dots better. What... And you've brought up the small, you know, the SM, the small enterprises that are typically overcharged for- Mm-hmm ... relatively poor commodity, I would argue, health insurance options. That's your, I think, as I understand it, your target audience. What can you do that's novel based on your talents and the technology you're bringing to bear? That help solve the cost, quality, and experience problem of the average small employer, who frankly isn't getting the best service or product typically from the large insurance companies.

Ty: 5:49

Yeah, and it's, it's not even that they're not getting the best service or, or, or product. It's, it's, it's, it's both the lack of access to the kinds of services that much larger businesses have and the, and the level of customization that they're able to, to, to bring to their employees. And it's the, and it's the small businesses lack the transparency behind all of their, their costs and, and, and, uh, and even any reason for why they're seeing these huge rate increases year over year. And what we're able to bring, because we've essentially rebuilt this health plan stack from the ground up on this very modern, highly integrated infrastructure, uh, and we're able to bring in all of these kinds of bells and whistles, these, these things like custom plan designs, these point solutions, specialty networks, care management programs. All these things that historically have been available for large enterprises with sophisticated HR and benefits teams and, and, and brokers that are being compensated, uh, uh, uh, huge amounts for, for, uh, bringing all of these pieces together for them. We're able to, we're able to bring that same experience all the way down to your local businesses, to your restaurant down the street, your, your grocery chain, your school district, municipal government.

John: 7:14

Is the right way to think about this, Ty, that because you have an advanced tech connectivity and flexibility that you can deliver a better product at a lower price to the small and medium-sized business markets?

Ty: 7:31

It's, it's really about delivering a better product that's much more tailored to the needs of, of these small businesses and their employees. And in turn, because of that, we're able to help them, uh, really control their costs and, and provide a much more transparency behind their costs as well. Uh, so that ultimately, uh, leads to stable, highly predictable year over year rates. And, um, one of the, one of the- Biggest complaints that we hear in the market all the time from our, from our employers, from brokers in the market is that, uh, everyone is kind of accustomed to their healthcare costs increasing year over year. That's something that, that's, that's, while unfortunate, is, is, is expected. What makes it extremely difficult for small businesses across the country today is not knowing what those rates are going to be. When you're talking about these small, medium-sized businesses, if they're offering healthcare benefits, if they're offering health insurance to their employees, that is one of the highest costs. That is one of their largest expenses, usually number two or three after payroll. Um, and when you don't know as a small business owner whether it's gonna... that, that cost is going to go up 5% or 50% year over year until two, three weeks leading up to the end of the year or until your renewal, it pretty much makes it impossible to, to actually budget or, or plan out your year. Do you give multi-year guarantees or, or trend guarantees that would help

John: 9:01

small- So-... Ty: businesses figure that out? So we d- we don't give multi-year guarantees, but what we do provide, which is something that, that the vast majority of these small businesses have never had before, is the transparency behind those costs and, and being able to provide that in real time or near real time and, and being able to provide that, uh, uh, throughout the year where they, m- there, there's no longer a surprise for what their rates are going to be because they have a clear understanding of exactly what their, what their, um, uh, company's healthcare costs are. So walk, walk me through an example of that. Let's say a, a, a, a small business has a number of folks who get pregnant in a year. Mm-hmm. That would have a big, uh, potential impact on trend. How would they, how would you figure that out, and then how would it translate into helping to manage their costs?'Cause you're on a r- it's, you're on a super- Yeah ... important issue. Of- often it is, health insurance is the second largest or their largest budget item, and it's the one with the, w- which you have the least amount of control or influence.

Ty: 10:10

Yeah. Yeah, so it, it's, um, it's a few things, uh, that I can touch on there. So one- It's not that we have unique access to this data that any-- that other health insurers don't have, it's that we're willing to provide the transparency behind it. So, so when you look at these large incumbent insurers, uh, they benefit from that opacity. They benefit from not sharing that, that level of information with their, uh, uh, with, with, with these small businesses because that gives them the ability to, to price or underwrite them based on, uh, not necessarily based on the actual costs of, of, of the employer, but based on whatever their business goals are. So, like, if they need to actually make up, uh, they need to retain a larger client and that-- and now they need to make up that margin through other, other clients, they can do that. And, and because the employer doesn't, doesn't actually have any of the data behind the scenes, um, they, they don't really... And because there's so few choices in the market, in, in, in any ki- given market, there's usually only maybe two or three, uh, options when it comes to health insurers. Um, they're, they're kinda left holding the bag there, like they don't, they don't have any other options. So, so it's being able to provide the, the transparency there, and then it's also being able to deliver them the services now that help to address the specific costs, the specific drivers for their costs. So, um, a great example is if there is a cancer patient, if an, if an employer has an employee or, or employee's family member with cancer and they need to go through, um, uh, uh, courses of, of infusions or chemotherapy, being able to deliver them the kinds of services actually reduce the o-- that help them manage those, those conditions and decrease the overall cost of that care, like bringing in, uh, we just announced our partnership with Leap Health earlier this year for at-home infusions. Uh, moving, moving the site of care outside of a, uh, a setting that is both a very poor experience in a hospital and, and, and, and significantly higher cost to, um, something that's at home where you're getting the exact same treatment, the exact same, same, um, uh, drugs, uh, at a fraction of the, of the cost. And, and that's how, that's how we're really stabilizing and, and, and, and, and, and bending the cost curves for our employers. So it's both the transparency and the ability to bring these kinds of, uh, tools and solutions that historically have not been available for these small businesses all the way down to, to that, this market.

John: 12:54

And a lot of your materials, and certainly your fundraising materials, talk about an AI-native, AI-first- Mm-hmm ... um, tech infrastructure that sits behind the full stack of, of, uh, offering that you've got. Tell me a little bit about why that's important and how it kinda powers the engine inside.

Ty: 13:13

Yeah. So it all starts with how we've built, how, how we built the company and, and, and what I mentioned before, where we've essentially rebuilt a lot of the stack on very modern, highly integrated data infrastructure. So all of our data sits in one place. We have very centralized data assets, and that's what powers all of our workflows. Um, everything from, from quoting and underwriting to our implementation of these custom health plans for these small businesses to, uh, the, the... our ability to actually deliver an elevated experience across things like member and, and, and patient support, provider support, um, employer and broker support, uh, and, and having the consistency of information across all of these, a-all of these pieces so that not only is it easier for our teams and now our, our AI agents to be able to serve up the kind of information that, that addresses their needs, um, but also, uh, where we've been able to... I mean, a big, a big piece is, is even unlocking the ability to deliver these kinds of custom products and these-- and, and integrate all of these various point solutions and vendors into, uh, into the health plan to deliver to the, to these small businesses. And, um, I mean, there's a, there's a reason no one else really offers these kinds of custom health plans to small businesses because historically, for, for any legacy, um, or incumbent carrier or TPA, it's a highly manual process. Um, every, every, uh, uh, unique plan design is manually configured by armies of, of, um, uh, implementation managers or implementation analysts. And I mean,

John: 14:52

I, I, I asked the same question to the founders of Oscar, but with the talents you have as a software and infrastructure provider that's powering this, did you ever think about just building a system and selling it to insurance companies as opposed to becoming the insurer yourself?

Ty: 15:10

It's a, it's a great question. Um, We did, but we, so when we started this company, we actually spent a lot of time thinking about the kind of company we wanted to build and, and, and, and what we wanted to deliver to the market. And we looked at-- we, we spent a lot of time looking at companies that are more of, uh, like the infrastructure layer, uh, on, on top of these existing health plans. Whether it's just a, whether it's, uh, just a TPA or just a care navigation service or, or just building like a claims system or what have you. And, and what we realized is that in order to truly see the, the... Our, our ultimate goal is to, is, is to change the way that people actually approach and access healthcare, um, and be able to democratize access to all of these, these kinds of modern healthcare services to the people that actually need it. People like my parents, who worked for small businesses, who didn't have time to, to, uh, couldn't take time off work to go to an in-person doctor's appointments and, and, and, and things like that. Um, we, we wanted to be able to, to bring these services over to, and, and deliver it to the people that actually need them. And, and, uh, to actually get the level of engagement that you need to, to truly bend the cost curve there, um, you need to be, you, you need to have all of the levers. So you need to be the health plan. The health plan is the biggest lever, honestly. Um, uh, you need to have all the, all of the, um... You need to have the control over, over, over the incentives that, that drive the kinds of behavior change and that drive the c- the level of engagement, uh, uh, into these sorts of programs so that they're actually effective. Building on a

John: 16:52

modern stack makes a great deal of sense to me, and integrated data, gosh, I mean, that's super powerful. How do you as a small, relatively small player selling to small businesses, get the access to the discounts for hospitals and doctors and pharmacists? I mean, how do you, you know, as a, as a, as, as the new player on the- Mm-hmm on, on the field, get access to what the larger franchises, the larger legacy players are getting?

Ty: 17:22

Yeah, that's a great question. Um, the, the short answer is today we, we partner with the, with, with provider networks and, and, and with other payers when it comes to accessing, um, whether they're large national networks or they're, or they're regional high performance networks. And, and the value of what a-we're able to deliver today is, is, um, navigating, both navigating within those bounds and being able to bring in additional types of services, like I mentioned, like these specialty networks or care management programs that, that address very specific needs of our members. And there's two pieces to that. There's the identification. So there's, there's being able to identify- Uh, uh, the, the right-- be able to match patients and members who meet specific, uh, criteria into the programs that, that are actually gonna be effective for them. Because one of the biggest challenges is that, especially when you look at digital health programs, chronic disease management programs, behavioral health programs, they're, uh, for the right profile of, of patient, they are highly effective, but they're not effective for everyone. And that's one of the biggest, uh, challenges that these, that these companies have. I mean, you've, uh, some of these companies have been around for, for ten, fifteen years now, companies like Omada Health and Livongo and, and, and, and, and all these, um, uh... But I don't know if they're still considered startups, but w- but were the kinda big digital health companies of their days. I think Glenn feels

John: 18:54

like he started and sold it, which he- ... did very effectively at Livongo. And, you know, Sean g- going, now going public with Omada, I think he doesn't think of himself as a startup, as a publicly traded company. But they're, they're definitely still around in one form- Yeah, yeah ... or another. But it's- And, and with some, and with some interesting results.

Ty: 19:12

Yeah. Yeah, and, and it's, it's-- the reality is, and I, I think we've seen this in the, in the data over the years, is that, um, there's a challenge with, with identifying and engaging the right patients into these programs. But engage- But it's also true that if- Engagement,

John: 19:25

engagement is, you know, is the, there are a lot of whitened bones on the beaches of healthcare innovation that failed on engagement. Great idea, can't find the members that matter, can't find the member who ca- members who- Yeah ... the members- And- ... or the patients

Ty: 19:40

who care. And to get back to your question about why we decided to build the health plan or the health insurer is because that, that is the, the, uh, one, that is where you get all the data to be able to drive these kinds of, uh, insights, and it's where you have all of the levers to drive the kind of engagement, uh, uh, to, to really incentivize the engagement into, into the programs that are gonna benefit your members and, and, and, and help them manage costs. So, um-

John: 20:09

Okay, so how's it going? Yeah.

Ty: 20:10

I mean,

John: 20:11

you know, you've been talking about what you can do and what you should do and what isn't happening. Yeah. You've got this really cool stack. How's it going?

Ty: 20:19

It's, uh, it's, it's good. I mean, we, we are probably one of, if not the fastest growing health plan in, in the country. We are-- We're a truly national health plan today. So, um, we have over four thousand small business clients across over forty states today. We have members in all fifty states. Um, we have six figures of membership and, and, um, uh, continuing to grow over a hundred percent year over year. And, and we've been able to, uh... One thing that, that we're really proud of, and, and again, we, we focus on small, medium-sized businesses. And, and again, these are, these are really your local businesses. It's, it's, uh... We do well, very well on, in the hospitality space. We have car dealerships, we have school districts, municipal governments. We have, uh, like local professional service firms, accounting firms, law firms, things like that. Um, uh, and the-- And, and, and what we're really proud of that we've been able to deliver to these small businesses is that we have some of the highest retention rates and, and most stable renewal rates year over year. Our median renewal rate for, for, uh, groups over the last twelve months that have renewed with us is about five percent. And it's about, it's, uh, about seven percent overall, which is half of, less than half of what the majority of small businesses are seeing today.

John: 21:41

And how are you-- how do people find you? How do you g- how are you distributing the product right now?

Ty: 21:46

Yeah. So we, we partner very closely with, um, brokers and, and general agencies and benefit consultants, um, HR payroll platforms, PEOs. Uh, it's primarily channel distribution and, and, and most of the, most of the small business market is really, um, uh, driven by and, and, and, and works with the broker community- Brokers. Um, with- Yep. Yep. And it's, it's a, it's a good thing because, because as the, as the-- I mean, most of the decision makers at these companies, they're-- it's, it's a CEO, it's a CFO, it's, it's, it's one of the owners of the business, and they're not experts in, in health insurance. So, um, so it's a, it's, it's, it's a great service that, that brokers and, and, and agencies are providing to them, especially when they're able to, to, uh, deliver a plan like Angle Health.

John: 22:38

What are your biggest challenges, Kai?

Ty: 22:42

Yeah. I mean, uh, as a, as a venture-backed company and, and as a, a Uh, I think as a new player in the space and in a space where, where it really is-- scale is definitely a, a, a big part of it. It's, it's growth. So, uh, I mentioned we're continuing to grow over a hundred percent year over year, uh, and we hope to keep that up over the next, uh, over the next few years here. And, and our goal is really-- I mean, we're, we're not just building a health plan today. We have, we have that core health plan product, but we are also really doubling down now on the healthcare services side with programs like Angle Advocacy, which is our concierge care navigation service, and, and behind that are partnerships with, with, uh, uh, the really the best-in-class care management, disease management programs and, and, and the, the, the solutions that we can bring to our employers. And, uh, I mean, our, our goal is to-- the, the beauty of the platform that we've built is that it's not-- although we, we are very much focused on the small, medium-sized business space today, um, the, the underlying frameworks and programs that we're building are, are... I would say, uh, we're, we're rebuilding the way that people actually access- They're, they're accessible these sorts of healthcare services from- Yeah. Yep, yep. And we're rebuilding them. We're really rethinking every piece of it from first principles to, um, to align both financially and, and- Now

John: 24:12

you're going back to Alex Karp, like your, your Palantir roots when you start to go to first-- th-thinking, thinking first principles. But maybe, maybe as a final question, Ty, what's the one thing you wish the rest of the health insurance industry did that it's not doing right now?

Ty: 24:28

The one thing that would, that, that would really level the playing field and really, really, I would say, provide societal good, especially in the system that we have today in the US and especially for the nearly half of Americans that work for these small businesses, is to be able to deliver the kinds of transparency, uh, behind these costs, behind these, the, the premiums and behind the claims costs, behind the pharmacy costs, so that these small businesses can really understand exactly what their costs are and, and, and, and, um, uh, and don't have to-- I mean, as a, as a-- I would say that, that, that I'm a small business owner as well, and we're running a startup. We are-- We, uh, have a relatively-- We have about a hundred full-time employees today, um, which I would say is still pretty lean for, for, um, the kind of business that we are. Uh, our healthcare costs are, are some of our highest costs as well when it comes to, when it comes to employee benefits, when it comes to our, our OPEX. And I think that, um, unlike us, many of our customers and many of, of, of- Uh, the people that we serve, um, and the people that, that I grew up knowing with my parents, uh, having worked for all of these small businesses as well, is that they, they don't have the benefit of, of outside financing. They are-- they, they don't have the benefit of, uh, of extremely stable cash flows and, and-

John: 26:12

Everybody... No, I mean, e-e-if you can solve this problem, even if you can put a dent in it, Ty, you're gonna make the fastest growing and most important part of the American economy, small businesses, effective. Um, but I think we should probably wrap there and let you get back to reforming the gajillion dollar ind- health insurance industry. Um, I'm John Driscoll, the chairman of the UConn Health System. This is Care Talk. If you like what you heard or you didn't, we'd love you to subscribe on your favorite service. And Ty, thank you, thank you for two reasons. One, for taking on this huge honking problem about fixing the connective tissue in the healthcare system by reforming and re- and, and, uh, try revolutionizing, hopefully, the health insurance industry, and sharing some of your ambitions and your successes with Care Talk today. Thanks for joining.

Ty: 27:04

Thanks,

John: 27:06

John. This was fun.