Patients have to navigate too many hurdles when enrolling for and managing their Medicaid coverage.
From glitchy portals operated by state and county governments to submitting forms through the mail or faxing documents, patients face a lot of pain points in a healthcare system that is already challenging for underserved individuals.
"For somebody who is already underserved by the healthcare system, there are many steps and barriers to just understanding from an eligibility perspective, whether you're eligible and then going through enrollment and actually ending up on your plan and also knowing where you should go for care, all of that can be extremely challenging," entrepreneur and former investor Nikita Singareddy told Fierce Healthcare. "It's become a very convoluted system over the decades as far as how Medicaid has been designed, unfortunately, for people who are trying to navigate their eligibility and enrollment process,"
Singareddy has faced these challenges first-hand as she was born on public assistance and has spent time on Medicaid herself. She understands the frustration of making phone calls and spending hours waiting on hold to navigate recertification.
She teamed up Cydney Kim and Ben Wesner, two other healthcare operators with direct Medicaid experience, to tackle these problems.
Fortuna Health launched earlier this year with the aim of helping the 90 million individuals on Medicaid seamlessly enroll and renew their coverage. The startup's self-serve, mobile-first platform enables consumers and the teams that support them to easily check Medicaid eligibility and manage their coverage and eliminates the need to interact with state portals and physical forms, executives said.
Fortuna Health developed a one-stop solution that takes on the challenges of enrollment and recertification so enrollees don't have to, much like a tax expert at TurboTax streamlines the process of filing taxes, executives said.
The product screens for Medicaid eligibility in under 60 seconds with fast enrollment and recertification in more than seven languages. The solution provides support end-to-end from eligibility and enrollment to renewing coverage, according to executives.
The company works with providers and health plans and enables visibility into account statuses and consumer next steps. With enhanced consumer data that includes tracking transitions from Medicaid to ACA/marketplace plans, teams are better equipped to serve their consumers with Fortuna’s analytics, according to the company.
Fortuna Health has partnered with organizations that support Medicaid members in Minnesota, New York and Pennsylvania.
"When we think about the future direction of the company, we just see so many ways that Medicaid needs basically different forms of infrastructure and technology to enable it as a market. The technology that has been built in healthcare has not addressed and unfortunately not reached the nearly 90 million Americans who access healthcare through Medicaid," Singareddy said. "If we allow that to keep happening, health equity issues that we see just get overly exacerbated as technology doesn't reach the populations who are already underserved."
Singareddy's experience includes heading up special projects at Truepill, leading population health work at Oscar Health and she worked as an investor at RRE Ventures.
The startup picked up $4 million in seed funding to drive its state expansion. It also plans to ink more partnerships with managed care organizations, health systems and service providers in the Medicaid space. The funding was led by Andreessen Horowitz (a16z) Bio + Health with participation from BoxGroup and Y Combinator.
Fortuna’s seed round includes notable healthcare angels and advisors including Cyrus Massoumi, the founder of Zocdoc, Jeff Gerard, former president of Sutter Health Bay Area, PillPak founder Elliot Cohen, Iyah and Sylvia Romm, a founder and former Chief Health Officer at Cityblock), Summer Health founder Ellen DaSilva as well as singer, entrepreneur and social advocate John Legend.
“A core component of health equity is making healthcare coverage easy to understand, navigate, and access. Fortuna Health's approach resonated with me by making Medicaid truly simple and intuitive. I'm proud to support their journey to combat health disparities and ensure patients get the care they need,” Legend said in a statement.
Over 90 million Medicaid beneficiaries encounter challenges with enrollment and recertification. These issues range from accurately screening for Medicaid eligibility to submitting long applications and tracking fluctuating renewal dates. Each state Medicaid program has a unique set of eligibility requirements and renewal dates, alongside hybrid digital and manual processes for enrollees to manage their healthcare coverage.
Adding to this complexity, at least 11 million people have been disenrolled from Medicaid during the unwinding of the Medicaid continuous enrollment provision, according to the latest data published by a KFF tracker. Across all states with available data, 71% of all people disenrolled had their coverage terminated for procedural reasons, such as form errors, language barriers or missed mail.
Loss of Medicaid coverage produces huge downstream consequences: managed care plans lose over $36 million from churn and providers suffer from $20 million in lost patient revenue and uncompensated care. Delayed enrollment also increases the total cost of care and worsens outcomes.
"As Medicaid becomes even more difficult to navigate post-COVID, we're excited to be backing the Fortuna Health team as they do the essential work of modernizing the pathway for consumers to maintain eligibility and consistent enrollment in their health plans," said Julie Yoo, general partner at a16z Bio + Health, in a statement.