Portsmouth entrepreneur’s new business offers health care cost comparisons

By Dave Solomon, New Hampshire Union Leader

PORTSMOUTH — Here’s something that research in the medical field has taught us that we probably could have figured out on our own — when consumers have to pay for more of their medical care, they are more likely to do more comparison shopping.

That’s where entrepreneurs like Mark Galvin come in. His latest venture, MMS Analytics, with nine full-time employees working out of the Congress Block in downtown Portsmouth, aims at a market segment that is just beginning to emerge: the cost-conscious medical consumer.

His cost-comparison website, mymedicalshopper.com, is like the state’s NHHealthCost.Org on steroids, with a free version for consumers and a paid version for businesses.
Galvin is convinced that the era of mystery surrounding medical pricing is over, to the benefit of consumers and employers, if not the health-care industry, and he hopes to ride the wave.

Since the fall of 2013, he and his partners have been working on what they hope will become the gasbuddy.com of health care. They’ve plugged directly into the state’s “all claims payer database,” and developed algorithms that extract and present the comparative claims data for 9,000 different procedures, at providers large and small, profit and nonprofit, throughout the state.

Actual claims paid by insurance companies are considered the most accurate reflection of charges by providers, and the state has required health insurers to submit their claims data to the Insurance Department for more than a decade.

“It’s pretty comprehensive for research, but it’s not something accessible for commercial purposes,” Galvin said. “We worked with the state and HHS to get an agreement to access enough information so that we could make sense of it, through algorithms and the beauty of high-speed computing and large databases.”

The data is also used on the state-run cost comparison website, which has undergone several upgrades over the years, including just recently.

Market dynamics

In addition to cost comparison websites, companies like Tandem and SmartShopper have built a business around helping health care consumers find the lowest-cost provider, with many companies offering cash incentives for employees to do their homework before getting that MRI.

The ordinary market dynamics have not applied to health care, Galvin said, because there was no basis for consumers to compare costs, and when the insurance company paid 100 percent of the bill, no one cared.

“If you lower the price, you get more customers, but in health care, that’s never really been true,” he said. “And the reason is, there is so much secrecy around the pricing, and a third-party payer whereby you may not even know what is paid on your behalf, so there is a very distorted marketplace.”

In health care, the old saying “You get what you pay for” just doesn’t apply.

“It’s been shown in study after study that in health care there is no relationship between price and quality,” said Galvin. “When you shine a light on pricing, you start to see a more normal market dynamic in this space.”

Serial entrepreneur

Galvin has been in New Hampshire since arriving here from Massachusetts in 1985. A software engineer by trade, he could be called a serial entrepreneur. He built a company in Salem that manufactured and sold digital networking gear, became entrepreneur in residence at Charles River Ventures in Boston, and started another company that built router components.

His largest venture, Cedar Point Communications in Derry, had almost 400 employees, building devices that enable digital telephone signals over cable TV networks.
In 2010, he worked with the University of New Hampshire in the development of the Innovation and Commercialization Center, that morphed into the AlphaLoft business incubator, where he worked on health care transparency.

At each step along the way, he became more and more troubled at the growing bite that health care costs took out of each venture, which ultimately led to the creation of mymedicalshopper.com.

Just getting started

The company is just starting, with about nine corporate clients so far, including Itaconix, a biotech firm in Stratham.

While the free product, downloadable on mobile devices, has many bells and whistles for the consumer, the real appeal to business owners is the “employer dashboard,” which graphically displays aggregated, not personal, claims information on employees.

“This is something that fully insured employers have never had access to. Even self-insured companies, who own their own claims data, don’t get this level of analysis and insight,” he said. “I can see where my employees are going and the number of times, and the low or high costs.” The cost is $90 a year per employee.

“A big part of my interest is to make New Hampshire more competitive than other states, and these tools can help drive that,” Galvin said. “As an employer, you can deal with higher medical costs by cost shifting onto employees, or you can be collaborative about it, and everyone can work together to reduce costs.”


Download the full Planning Guide
Ensuring Compliance with the No Surprises Act and Transparency in Coverage Rule