I’ve started a new company to try to fix U.S. healthcare. It’s an AI-native health insurance brokerage focused on continuous optimization of employer health plans: we believe your health insurance should get better year-round, not just once a year. And it’s called Decent, again.
Why this company? Several years ago, a big insurance carrier increased my startup’s level-funded health plan rates by 27% in January, because an employee had started an expensive treatment the February before. I asked the insurance carrier why they hadn’t said anything sooner, and they said it was my data so it was my fault for not looking at it. I consoled myself that night thinking that even if I had known in February, there was probably nothing I could have done. And even if there was, it would have been bad for the employee. Right?
Wrong. The employee volunteered to me later that she drove over an hour for her treatment; she would have preferred to have been treated in the comfort of her own home, eliminating facility fees and reducing total cost by 30%. She owed a share of the cost that easily reached her plan’s out-of-pocket maximum; she would have preferred an equally effective treatment that cost 25% less and could have been made free to her. Clinical dose optimization might have cut another 20% of cost with no negative impact on her health and could have reduced her side effects. Most of the cost to the plan and to the member was waste, the byproduct of me taking my eye off the ball in a system that rewards cost escalation over effective patient care.
My cofounder Andrew Budker and I met 16 years ago working on the Kindle at Amazon, and we've wanted to start a company together ever since. He spent the last several years leading engineering for Metamate, Meta’s internal AI assistant and agent platform. Since we started parsing plan data, we have found waste again and again. A one-time surgery gets priced into next year’s rates as if it was recurring. Small business owners get charged for former members who haven’t been on their plans for months. Employees using the ER as a first stop incur costs that could cover Direct Primary Care memberships for their whole team.
Why now? I believe the conditions have finally emerged to fix what’s broken in healthcare. For the first time in history, most small business employees are on self- and level-funded plans, which produce auditable claims data constantly. And with the rise of AI, we suddenly have the capacity to use that data to optimize and personalize coverage and care at scale, each year, month, week, day, hour, minute, and then second, for the company and for the member.
In the future, we will think it was silly that we got most of our healthcare via health insurance but only changed our plans once a year. As silly as locking in a year of ads up front in the age of ad platforms. As silly as buying servers annually in the age of AWS. Those things changed. We’ll change this one, too. And we’ll do it as a brokerage, getting paid by the insurance companies you choose to work with, so we can be free to you.
If this sounds interesting, you can book 15 minutes to talk to me, or use our self-serve tools to quote the market (think Kayak for health plans) without talking to a human at all. We’ll look at every option to help your team save money and improve your benefits, and then we’ll work to make your plans better all year. If you already have a broker you love, we’re happy to be a second set of eyes any time during your plan year. If not, now you have me.
Why Decent? FDR’s Second Bill of Rights promised Americans a decent living, a decent home, and the opportunity to achieve and enjoy good health. I still believe in that promise. Some people think decent just means good enough. To me, that’s kind of the point. U.S. healthcare should be good enough to keep you healthy and safe: physically, mentally, and financially. Good enough to be trusted to take care of the people you love. Good enough to make you proud to be an American.
Today, U.S. healthcare is a broken system creating broken outcomes. I’m still working to fix it because I didn’t get it right the first time. New entity, new team, new vision, same mission: Affordable healthcare for all. I still believe U.S. healthcare should be Decent.
I'm also doing this for my sons, Boone and Ben, who deserve to believe work can still mean something. For my dad, my partner, my colleagues, and my friends. For my mom. The fact that she isn’t here anymore wakes me in my sleep sometimes. I still want to make her proud.
And when I think about what we can do, with the help of millions of good people working in and around healthcare, it’s easy to find meaning in the work. I feel like waking up early tomorrow to put on my pirate shirt and keep trying.
That's enough talk. It's time to get moving.
It’s never too late to save the world.
