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The definition of insurance, and what that means for the people who have it, can mean very different things depending on where you are. Of course, in all places, and no matter the system, there are be good things and bad things about how it works.
Take Spain, for example, a system where there's a public health system that every citizen pays for through their taxes, as well as a private health insurance market that people can buy into in order to expedite care. It's also one where wait times are often long, so there is also a private health system that offers patients additional services.
One of those private health insurance companies is Elma Care, which is looking to shake up the system by giving patients a digital-first experience.
The Spanish healthcare system
To understand what makes Elma different, it's important to understand how the Spanish healthcare system works, and where it is currently lacking.
"The Spanish health system is completely different from the American one. Here, all the Spanish people have free universal care from the public health system. Even if you come from the States and you get sick, you go to the hospital, to the public health system, and you will get care for free. You won’t have to pay anything," Miguel Ángel Antón, CEO of Elma Care, explained to me in an interview.
The problem with the public insurance, he said, is that the system is only really worthwhile if a patient has something urgent that needs to be taken care of; if that person needs non-urgent surgery, for example, it can take one to two years to have it done. And if their illness isn't serious, they will need private insurance to see a doctor in a timely manner.
Private insurance companies are able to reduce wait times, Antón explained, because public and private insurance companies actually run their own hospitals separate from each other; that is not to say that there are not some that take both, but generally they operate independently from each other. Since most people in Spain only have public insurance, roughly 10 million of the 46 million people who live in the country, the wait times are much shorter at private hospitals.
Even with the private insurance, there are still issues that need to be addressed said Antón.
"Typically, the incumbent private insurer's main value proposition is direct access to a specialist with no waiting list. The problem is that they removed the primary care service, so people are walking into the specialist or the ER, into the hospitals, with no knowledge because it’s quite clear that if you have something on your skin then you go to see the dermatologist, but if you have a pain in your liver, you don’t know who to visit," he told me.
"So, people are moving like a chicken without a head into the system because these people removed the primary care service that is typically the gatekeeper in the system. 'You came here, I made this triage for you,' and then you walk into wherever you have to go."
What Elma wants to do is the private insurance company that also provides users with that primary care option. And it does it by offering patients a digital-first experience.
Elma Care's value proposition
Elma calls itself, "a personal digital health insurance, simple and for a new generation." The company has built is a primary care center in the cloud, complete with its own doctors, nurses and concierge team. It offers patients an app where they can get their prescription, view their medical history and book a visit from a medical center. It also allows 24/7 access to its medical team.
When patients are sick they can go to the Elma app and consult with a doctor, who will decide if the patient can be treated without coming in for a physical exam. If the doctor does feel that the patient requires a lab test, Elma will book the test for the patient who can then go to the company's physical network, which consists of 23,000 specialists all around Spain and an agreement with more than 2,000 centers. Once the test is done, the patient can come back to the platform where everything will have been recorded and Elma's doctors will guide them from there.
"We help people to navigate the system, and we also cut visits that are unneeded. All the processes that we have to do as an insurance company, like authorization, reimbursement, payments and so on, all these processes are digitized so people can get everything through their app," explained Antón.
For Elma's cheapest plan, which start at €17 per month, patients get digital medical care, access to general practitioners and specialists, diagnostic tests and they have to pay co-payment. For its most expensive plan, which starts at €32 per month, patients get access travel medical insurance and dental insurance, plus their first 10 visits and medical tests per year are free.
While the company has six doctors on its platform, the fact that it's digital-first is what sets it apart from the other private insurance companies in Spain who are trying to catch up.
"All the private insurance companies are trying to develop tools like these, but the biggest problem they have it the legacy. The legacy with them are the customers, they are used to doing things in one way and so switching the way people interact with you is really complex. The reality here in Spain is that there has never been interaction between the insurer and insurees," said Antón.
That lack of engagement between the two sides leads to a high turn over rate, which is typically 20 percent; if someone has a bad experience, they can just go get insurance from another company.
"So, in terms of an incumbent insurer, I don't feel we have any competitors. For sure they will develop tools, but we don't feel that they're competitors," he said.
So far, Elma has 6,000 members visiting its primary care centers, many of whom are Millennial women, though the service is popular with people between the ages of 30 and 50, and they typically use the app three to four times every six months.
The most striking result, Antón told me, is that 90 percent of the time, when people come to the Elma app, their problem is solved with them ever needing to go see a doctor in person.
"People really need a tool like this. Now, we need to be famous and put it in everyone's pockets, but people need convenience about their health, and people are willing to find a tool that helps them not only in a reactive way, much more in a proactive way, and this is where we are moving ahead."
Last month, Elma raised a €3 million Series A funding round led by Mangrove Capital Partners, along with Antai Venture Builder, Arroba Capital, and Joyance Capital Partners, following a €1 million seed round it raised last year.
The funding will be used to help the company grow, Antón said, and to build out Elma's brand. It will also go toward building out the product, which means expanding the team from 14 people to 20.
Going forward there are a number of features the company would like to build into the platform, including a step tracker that will allow it to link the price of the insurance premium to the patient's lifestyle.
"If you have a healthy lifestyle, you don’t smoke, you do sports, you don't drink alcohol, you have a healthy life, you should pay less than if you are overweight, you don’t move yourself, you smoke. So, in terms of that, we want to fair with people, so this one of our main goals in terms of product," said Antón.
The company also plans to build out features for detecting skin cancer, where the patient can take a picture of a mole and the company's algorithms will be able to diagnose them, as well as features for period tracking and mammograms.
What Elma really wants to do, though, is become an integral part of a patient's healthcare journey over the course of their life, where it will actually be able to remember what tests each patients need and when.
"We want to help people for the future. When you get to be 40 you’re going to need to go for some tests, so we want to have good onboarding and remember what tests and proofs you have to do every year depending on how old are you and your past. We are going to track you through all your life with the tests have to do. We will remind you and we will book for you, so these kinds of preventions and promoting healthy lifestyle, this is the thing that want to do in order to get people more healthy," said Antón.
Ultimately, what that really means is putting the patient into the center of the health system so that the health system works for them, not the other way around.
"Traditionally this industry is asset-centric, and this something that motivates us. I’ve been working in the digital space for 20 years, always making spaces user-centric. This really is our goal, to put people in the center of the system, and make everything flow around them. Now, it’s the people who are moving around the assets, and the main goal is put them in the center of the system, and provide the tools to give them have a healthier life."
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Elma is a digital health insurance. At Elma, we believe that health has much more to do with staying healthy than with healing illness. This is why we set out to build an insurance company that delivers tools and services to help our members remain healthy, while covering us when ill.