Meet Circulo, the insurtech firm on a mission to disrupt Medicaid managed care

The insurtech market, which is characterized by fierce competition, recently saw a new entrant: Circulo.

Co-founded by Sean Lane — CEO of another health tech startup Olivethe new Medicaid managed care company launched last month with $50 million in new funds. Drive Capital and General Catalyst lead the Series A funding round, with Oak HC/FT and SVB Capital participating. 

Circulo will work with state Medicaid agencies to deliver health benefits to beneficiaries. But, like other insurtechs, it will go one step further and develop a managed care platform to make the delivery of Medicaid services more streamlined, said Jeff Grahling, president of Columbus, Ohio-based Circulo, in a phone interview. This is similar to Olive’s goal of automating routine administrative tasks for health systems to make them more efficient.

The platform will leverage artificial intelligence and machine learning technology to automate insurance-related services, like obtaining prior authorizations and verifying eligibility.

“By taking that approach, we hope to carve out some competitive advantage with respect to Medicaid managed care organizations and deliver a better member and provider experience,” Grahling said.

Circulo will use capabilities that already exist within Olive’s technology platform to build its system.

There is one other major advantage that Circulo’s connection with Olive will provide for the new company — an existing network. Circulo plans on leveraging Olive’s large footprint and customer base of 600-plus hospitals by integrating its new platform with Olive’s technology that is already in use.

The idea of using technology to improve health plan member experience is certainly not new. The insurtech industry is exploding, with companies like Oscar Health, Clover Health and Bright Health all tussling to gain a piece of the profitable pie. Just last year, insurtech funding reached an all-time high of $7.1 billion, according to a report by CB Insights.

So how does Circulo plan to compete in this crowded market? By focusing on Medicaid.

Other insurtech companies have had a fair bit of success in the Medicare Advantage market, but haven’t really focused on Medicaid, Grahling said.

The idea for Circulo came about last year when Olive’s Lane began having conversations with some of his backers about a company focused on improving Medicaid services, Grahling said. By early January, it became clear that all the original investors in Olive were interested in investing in the new venture and Grahling came on board.

Now that the funding is in place, the company plans to use it to build its platform and actively hire employees, Grahling said.

Grahling declined to mention or could not say for certain when the platform will go live, only that the bulk of 2021 will be spent in building it.

One major reason for focusing on the Medicaid market is rising enrolment. Early data shows that after three years of declines, total enrollment in Medicaid and the Children’s Health Insurance Program grew to 77.3 million last September, up by 6.1 million from enrollment in February 2020.

While enrolment is up, pressure on state budgets is intensifying, Grahling said.  

Amid this challenging landscape, Circulo aims to deliver the triple aim — higher patient satisfaction, better outcomes and lower costs to underserved communities — through the use of technology.

“…we think there is a whole lot of room for improvement in terms of the quality of the experience, in terms of the quality of outcomes for those members and in terms of efficiency,” he said.

Photo: Circulo