#StartupsEverywhere: Beth Ann Lopez, Founder & CEO, Outfox Health
This profile is part of #StartupsEverywhere, an ongoing series highlighting startup leaders in ecosystems across the country. This interview has been edited for length, content, and clarity.
Outfoxing ambiguity and putting patients first
It’s no secret that accessing prices for medical treatments in the United States can be murky and unclear. Beth Ann Lopez–through her company, Outfox Health–is using AI to make sense of massive raw data files empowering patients to compare and contrast the costs of hospital procedures with their insurance. We sat down with Beth to talk about her company, her experience as a startup founder in America and Vietnam, and AI regulations.
Tell us about your background. What led you to Outfox Health?
When I started my career, I wanted to go to medical school. Instead, I joined the Peace Corps to work at a clinic in a rural area of Cambodia for two years. During that time, I saw that the barriers to medical care went far beyond the presence of a doctor. The clinic was supposed to be open 24/7, in reality, it was open two hours a day because all the doctors would leave for their private practices. You couldn’t blame them either–working full-time in a public clinic only netted doctors $250 a month–it was unsustainable. Experiencing this and other barriers to care in Cambodia convinced me to switch my career to public health.
I started my first company based out of Vietnam, a marketplace of Vietnamese doctors. The platform grew quickly and we ended up selling to a local healthcare company. I noticed that the most commonly used feature on the entire platform was always our customer service. People wanted to get personalized guidance on what particular type of healthcare or doctor they needed. Choosing the right doctor requires a lot of baseline knowledge. When patients get sick, they get stuck in a system that was not designed for them. I created Outfox Health to level the playing field between American patients and our healthcare system.
What is the work you all are doing at Outfox Health? Who are your users/customers?
Going to the wrong hospital for a procedure can bankrupt a patient. We create custom AI copilots that integrate with a patient’s health insurance to provide transparent costs to them. Our AI pulls data from the prices listed by insurance and hospitals. We’re able to do this thanks to a hospital price transparency rule from 2020 that requires every American hospital and insurance company to disclose their full price lists. However, these lists are not easily accessible to the average person, as they contain multiple terabytes of raw data.
Outfox takes this raw data and makes it understandable for the patients. We can show you the negotiated rate at all of the nearby hospitals for expensive, sometimes life-saving procedures like chest X-rays and CAT scans.
Our software is a win-win for the patients and their insurance providers. About 60 percent of Americans are getting their health insurance through their employer. A lot of that insurance is self-funded—meaning the employer pays each time an employee files a claim—so when an employee finds a location offering a $400 CAT scan instead of a $10,000 one, it benefits everyone.
What do you think about the proposed broad regulations imposed on the complex ecosystem of innovators and businesses developing AI?
Broad regulations on AI won’t allow for nuanced solutions, within healthcare, there are low-risk and high-risk applications. Understanding the prices offered under one’s insurance is much more straightforward than determining the dosage of a fentanyl drip for an ER patient.
AI has the potential to help cut down on the administrative bloat. There’s no reason to have call centers that still rely on fax machines to be at the center of medical billing anymore. Requests for prices and coverage on treatments should be automated.
How has your experience in the American startup ecosystem compared to your experience starting a company in Vietnam?
Vietnam is a wonderful country; it’s an emerging market with a lot of tech talent, and consumers don’t have a lot of discretionary income to spend on healthcare. The communist bureaucracy there, however, slows down a lot of innovation. It took over a year to incorporate and legally operate my company in Vietnam. Meanwhile, here in the U.S., you can incorporate it in 30 minutes. In Vietnam, I would have to file monthly reports documenting our accounting. None of this was digitized, we were a small business, and I needed help from two accountants. In contrast, here I can sign up for an accounting service and never think about it again.
I love Vietnam and Southeast Asia. It was an amazing experience. But I also like what I’m doing now, founding and running a startup based in San Francisco–I didn't realize that things could be so much easier.
Are there any local, state, or federal startup issues that you think should receive more attention from policymakers?
Healthtech innovation is being held back by the asymmetrical balance of information between insurers, providers, and patients. Policymakers should prevent information blocking in healthcare and promote transparency across the entire ecosystem—in hospitals, insurance, and among pharmacy benefit managers. Also, policymakers should ensure that the Health Insurance Portability and Accountability Act (HIPAA) is not used to shield healthcare from innovation and that information portability allows patients to access and benefit from their data.
What are your goals for Outfox Health moving forward?
The whole healthcare industry can change for the better. If patients are heard and know they have treatment options—choices that vary in both cost and quality—they can make the best decisions for their health and their finances.
When patients are more informed, hospitals and insurance companies will be forced to change their practices; ultimately, it’s the insured who pays for treatment through monthly premiums and copays. So many people are disempowered in their healthcare journeys and the goal of Outfox Health is to help them understand their rights and options.
All of the information in this profile was accurate at the date and time of publication.
Engine works to ensure that policymakers look for insight from the startup ecosystem when they are considering programs and legislation that affect entrepreneurs. Together, our voice is louder and more effective. Many of our lawmakers do not have first-hand experience with the country's thriving startup ecosystem, so it’s our job to amplify that perspective. To nominate a person, company, or organization to be featured in our #StartupsEverywhere series, email advocacy@engine.is.
