About Graham Dodge, Founder, Garnish Health,
Graham Dodge is a mission-driven entrepreneur and patented inventor with experience designing and deploying large consumer health platforms and systems of intelligence. In addition to co-founding Garnish Health, he serves as the Executive Director of the Mid-Atlantic Gigabit Innovation Collaboratory (MAGIC) and as a Mentor-In-Residence to Johns Hopkins Technology Ventures. He has formerly served as the founding CEO of Sickweather and on boards and technical workgroups for the CDC, National VOAD (Voluntary Organizations Active in Disaster), the Kennedy Krieger Institute, and NASA. His lectures have been hosted by the Royal College of Physicians and Surgeons of Glasgow Faculty of Travel Medicine, and Kansas State University’s Department of Mathematics and Department of Electrical and Computer Engineering.
About Garnish Health
Garnish Inc is a public benefit corporation dedicated to helping people afford their medical bills. When insurance tells you to ‘GoFund yourself’ you can turn to Garnish Health!
At Garnish Health, we are a reciprocating donation platform. When insurance companies tell you to ‘GoFund yourself,’ you can turn to Garnish Health. Think of health cost sharing as a donation platform, but where all members contribute to each other’s costs instead of an individual promoting a single campaign. Visit https://garnish.health/.
Medical Travel & Digital Health News (MTDH): Tell me about yourself and how you got started in this business.
Graham Dodge (GD): I am the founding CEO of a company called Sickweather that tracks the spread of disease using social listening. I’ve gained a lot of experience in the healthcare world and have met with several different insurers over the years and learned a lot about how population health data can be leveraged for insurance purposes.
I’m also a mentor and resident at Johns Hopkins Technology Ventures, so I’ve gotten the opportunity to see many interesting healthcare startups along the way.
At one point, a cousin of mine who was a decorated Marine committed suicide in the VA parking lot. His suicide note mentioned that his healthcare, even as a veteran, didn’t include enough care for post-traumatic stress disorder (PTSD) and that his bills were exceeding $1,000 a month.
I thought, if he’s unable to get all of his healthcare costs covered, what hope do the rest of us have?
That tragedy prompted me to think more about how population health data could help inform decision making, whether it’s enrollment windows or claims adjudication.
I knew there had to be a way to create a health cost sharing network other than those offered by religious organizations. This became Garnish Health.
MTDHN: Are you venture funded?
GD: No, I’m bootstrapping it so far, along with two other co-founders and Watson as a technical co-founder, who’s building it right now.
MTDHN: Can you tell the readers how you are going to let people know that they can participate and how it works?
GD: Basically, it’s kind of like the early days of the mutual insurance plan where people are all part of the same pool and everyone contributes to the same pool.
If you go to the hospital, you pay cash up front and tell them you are a self-pay patient, which almost always means a discount. You submit costs for reimbursement, depending on your share limits. You might have to cover your own cost up to a certain amount, but beyond that Garnish Health pays for the rest.
Wedo not require any religious affiliation to join, and don’t deny coverage for pre-existing conditions. It is all based on risk that we’re able to derive from big data.
When somebody in the Garnish network wants to submit a claim to be reimbursed for their costs, they submit that in a redacted format that the app allows to then be reimbursed by the whole crowd of the 10% members.
This helps to prioritize these as costs and protect the network against fraud. We’re leveraging the wisdom of crowds to make sure that we’re not paying anything that would be fraudulent or frivolous.
MTDHN: How much does it cost to belong and what are the criteria?
GD: You must be 18 or older and declare any dependents. The peers’ financing depends on how much of an annual sharing you need. So, you could use it as gap insurance if you already have a policy, but say you need to cover an extra $20,000 a year. There’s pricing for that based on number of dependents.
MTDHN: Are all pre-existing conditions covered?
GD: There’s still work to be done because we don’t have a claims adjudication process to determine if something is pre-existing or not.
It is mostly going to be based on frequency of the therapy. So, if you need a regular schedule, service of dialysis, for example, then the network decides how many would be too many for the network to sustain.
Our membership rules provide some guidelines, but ultimately the members determine if they want to pay for something or not.
Like a GoFundMe campaign, you can post any kind of expense, but it depends on whether or not people want to help you afford that cost. That’s where Garnish is different from a health-cost sharing ministry.
MTDHN: How many members do you anticipate?
GD: We will not be able to launch until we have at least 5,000 members.
We are just in the starting point right now and pre-enrolling members. Once we reach a certain number of enrollments, we will launch officially.
MTDHN: Are there certain sections or areas of the country that are more amenable to this?
GD: Some states impose a penalty if you do not have health insurance. So, if you are using it as an alternative to insurance, as opposed to gap insurance, then you’re going to want to look at your state rules.
MTDHN: Who are your co-founders?
GD: My technical co-founder is Stetson Lewis who is our chief technology officer and former instructor at Johns Hopkins, Whiting School of Engineering. My other co-founder is a finance executive with an insurance company, so I cannot share his name.
MTDHN: Your members must be anxious to get started.
GD: Yes. We hear a lot of stories of people who have medically fragile children, and their insurance is a high deductible plan that doesn’t cover everything.
As a reciprocating donation platform that guarantees a certain amount gets paid off based on the number of members, we appeal to people who would otherwise go to GoFundMe with the hope that they get featured on the local news or in social media.
Sadly, 90% of the medical campaigns on GoFundMe fail to reach their goals. Our platform improves on this.
MTDHN: Does it cover pharmaceuticals?
GD: Right now, we are not providing for pharmaceutical. That may be the only significant limitation that we would impose as a programmatic rule, but that may change as the network matures and we test the sort of solvency model network.
We are saying that dental and some vision is covered.
MTDHN: Do members have to use a certain network of providers or can they go wherever they feel they get the best deal?
GD: That’s the beauty of it — they can go to any provider they choose. The other thing we’re really excited about is how the cost analysis over time will educate the network and power them to know what the value of their healthcare is or should be.
When patients are told a cash price for service at one location, they can compare it to another location and gain an understanding of what the price should be, which gives them some ability to negotiate.
MTDHN: So, you encourage them to shop around?
GD: Exactly.
MTDHN: Do you give them any guidance about going to an outpatient center versus a hospital center?
GD: It won’t be in the app at the start, but that will be one of the first two tools that we will develop based on the intelligence we gather from our members.
MTDHN: It sounds like a great alternative for people who really need that kind of coverage and cannot get it. Is there anything else about the model you want to share?
GD: One aspect that is compelling is that we can reduce the overhead using these programmatic rules for enrollment that are objective and not subjective.
Basically, we’re only retaining 2% of what’s being put into the network for administrative costs, which is the same as Medicare in terms of how much of taxpayer money actually goes to afford the medical bill.
With traditional insurance, it’s at best 80%. By optimizing our system and algorithm, we can approach what would otherwise be the same cost efficiency of Medicare.
MTDHN: Do you encourage employers to tell their workforces about this?
GD: As a gap insurance product, yes, we will do that. We are looking to start building those relationships and then also for when they lay off employees and refer them to the COBRA plan. We are hoping to be an option for those people facing unemployment and can’t afford COBRA.