Deal Radar 2009: Triveris

From nurses’ shift planning to physician billing to electronic records, old and often expensive ways of healthcare administration are being challenged by entrepreneurs with new digital solutions. Deal Radar continues to navigate the maze of the American healthcare system, presenting companies working to cut its high costs so that more patients can be accommodated within it. Today we focus on Triveris, which offers value-based plans that try to tailor co-payments towards groups of patients.

Triveris was founded with the aim of ‘helping as many people as possible get the right care the first time.’ It is an end-to-end platform that can support both simple and complex value-based plan designs, which are used by some of the US’s largest health insurers and employers such as United Healthcare, GE and Hewlett-Packard. The New Jersey-based company’s single integrated platform – from which all health benefit administrative and medical support functions are administered – has either been developed exclusively by Triveris’ technology and medical research staff or in conjunction with leading edge firms such as HealthEdge.

Triveris is the holding company for two divisions: SeeChange Health and Health Insight. SeeChange Health is a new insurance company that will focus solely on value-based plan designs. It plans to launch in three California markets in 2009 and is expected to expand into additional markets in California and five other states over the next four years. Health Insight (formerly HNA Triveris) provides value-based administration and services to the large self-funded employer market and to health insurance payors, such as United Healthcare.

The company was founded in 2008 by Martin Watson, CEO, who has been in the health insurance industry for almost 20 years. He built two start-ups and was a senior executive at Aetna. Most recently, he was SVP of strategy for United Healthcare’s product division. EVP of Operations John McDonald has over 20 years of experience with healthcare networks and service operations. Mike Christy, CFO/Underwriting, was head of United Healthcare’s $30 billion underwriting business for key accounts and small business for more than eight years. SVP Product and Marketing Janice Rahm was part of the original Definity Health foundational team and most recently the SVP of Product Innovation for Meritain. Triveris raised a Series A round of $40 million from Psilos Group on March 13, 2009. 

Triveris differentiates itself from other health insurers by providing value-based plan designs for both the individual and group markets. SeeChange Health provides fully insured value-based plan designs to small employer groups. These vary at an individual level based on preventive and disease-specific compliance measurements. Using Triveris’s technology, clients can design a variety of value-based plans tied to individual behavior and that offer rewards in the form of significant financial incentives. Health Insight Now is a dynamic interactive personal health record that provides continuous updates to all health records via medical, pharmacy and biometric claims data, keeps people apprised of their current health status and provides reminders for both upcoming and past due health actions. Additionally, employers receive an aggregate report identifying current risk and projected health claim costs given the demographic distribution of their employees.

Triveris will launch in California and has acquired an entity that provides 24 additional state licenses. The company plans to be in six markets within California ultimately and expects a 300,000 member penetration over five years. SeeChange Health focuses on the individual and small business employer segment of 2-100 employees. HealthInsight services large self-funded companies and supports traditional insurance carriers like United Healthcare, with their value-based efforts.

Triveris currently has 102 employees. As it is a new company, financial data is all based on their projections. The company had projected 2009 revenue to be $8 million and has now increased this figure to $9 million. The company expects to break even for both entities by Q3 2010 and reach revenues of $200 million by 2013.

Health Insight has a robust pipeline of insurance carrier contracts and expects to be supporting over 10 million members by the end of 2011. SeeChange is expected to grow through normal sales channels, from 500 members in 2009 to 100,000 members by the end of 2013. On the subject of an exit, CEO Martin Watson said, “If the IPO market ever returns we would look at that option; and we are probably an attractive acquisition target.”

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This segment is a part in the series : Deal Radar 2009