INVEST DH Pitch Perfect winner spotlight: How TALON is creating the model for price transparency regulations

battle, fight, money

battle, fight, money

Before creating healthcare price transparency platform TALON, Mark Galvin was a frustrated employer. An avid entrepreneur, Galvin has developed a dozen companies and was always trying to find ways to provide healthcare in a cost-effective way.

“The problem was that there was no symmetry in the data available to us as consumers,” he said in an interview. “You couldn’t find out pricing ahead of time, you couldn’t find out what your negotiated discount was. The doctor couldn’t tell you. Your insurance company couldn’t tell you. You couldn’t do a normal comparison.”

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

As the company grew and expanded its footprint, Galvin was invited to Washington D.C. 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 & Human Services, Treasury, Labor, the Centers for Medicare and Medicaid Services and the Office of Personnel Management, according to the Talon website. Eventually, the Transparency in Coverage Rule launched in July, which required plan sponsors to post pricing information for covered services and provide a consumer-friendly shopping tool. The people TALON met with during this time and who helped get this passed include Katy Talento and Andrew Bremberg, who both worked on the Domestic Policy Council, as well as Former Secretary of Health and Human Services Alex Azar and Former Secretary of Labor Alexander Acosta, according to Galvin.

“When the agencies wrote the mandate for Transparency in Coverage, what they had seen was what we had built and showed them in October of 2018,” Galvin declared. “So we were pleasantly surprised to find out that, while they didn’t name us by name, they by functionality describe precisely what our platform did. So that was a huge win for us.”

If that indeed was what transpired, the government officials weren’t the last ones to be impressed by TALON given its win last week.

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

“There’s a strong market opportunity,” Blum said. “Obviously some of it is opportunistic with the regulation change. Some of it is an inflection point of the company.”

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

“One of the reasons I think we took the prize is because we’ve hit the knee of the curve, thanks in some part to the tailwinds from the regulatory environment that’s now helping push us along,” he said.

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

There are other companies in the price transparency space, including HealthSparq, Healthcare Bluebook and Sapphire Digital, which has been acquired by Zelis. However, with the Transparency in Coverage Rule, these companies’ solutions are now outdated, Galvin declared.

“Others became obsolete when the rule was published because they hadn’t ever built architectures that could provide 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 surge in the price transparency movement, TALON’s goal is to educate people on healthcare costs and drive competition in the industry, Galvin said.

“There’s 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 is also good for society.’”

Photo: santima.studio, Getty Images