Sesame raises $27M to build out its direct-pay healthcare marketplace

Healthcare costs are rising, with health spending in the U.S. increasing by 9.7% in 2020 to $4.1 trillion. Meanwhile, according to the 2020 US census, 28 million Americans still do not have any type of health insurance.

The cost of care is a problem that has vexed the US healthcare system for decades but Sesame thinks it has the answer: the company, which announced a $27 million funding round this week, has built a dynamic marketplace for medical care services, allowing consumers who can't afford care to shop for either in-person or via telehealth, across categories such as mental health, GI, OB-GYN, cardiology, dermatology, urology, labs, and imaging.

"We created Sesame to address a need that has historically been unmet: bringing high-quality, accessible healthcare to people who have been priced out of receiving the care they need. We call it 'half-price, whole-quality' medical care," said David Goldhill, Sesame co-founder and CEO.

An Expedia for medical care

He likened what the company does to "an Expedia for medical care," meaning a platform where doctors and providers are able to list their services with a specific cash price for them, much like an airline would list a flight on Expedia, and then the consumer can buy what they want directly, "without the middleman/insurance company." 

"Providers can price dynamically, modifying and varying pricing to offer affordable rates at all times of day and all days of the week. This concept has not existed yet within healthcare," said Goldhill.

While those who lack insurance make up a sizeable portion of the over 150,000 patients who have used Sesame to date, just over 60% have some form of insurance, yet still cannot afford care due to being on high-deductible plans, which often prices people out of being able to get care: more than half of American workers covered by private health insurance through their employer were enrolled in high-deductible health plans in 2020, an increase of more than 33 percent in five years. 

The benefit to the patient for using Sesame is lowered healthcare costs; while healthcare prices are overall going up, Sesame saw prices on its platform drop as much as 67% in 2021. The average price paid for care in the Sesame Marketplace is less than $40, and can sometimes be as low as $25 per visit.

There's also the benefit to the physician, including that many find that "it allows them to treat patients directly at fair, transparent prices, and benefit from the use of technology to save time and money," Goldhill explained.

"From a resourcing perspective, listing on Sesame alleviates the need for time-consuming and financially-restrictive processes associated with collection on appointments for direct-pay patients. It also minimizes the labor and time-intensive process of insurance paperwork and reimbursement," he said.

There are hundreds of physicians on Sesame who have seen over 1,000 patients after joining the platform.

Sesame's new membership product

The company's new funding round, which brings its total raised to $75 million, was led by GV, with participation from new investos Virgin Group, TeleSoft Partners and FMZ Ventures, and existing investors General Catalyst, Industry Ventures, Coefficient Capital, Giant Ventures and Alumni Ventures Group.

In conjunction with the funding, it was announces that Cathy Friedman, Executive Venture Partner at GV, will join the Sesame board of directors.

"We are thrilled to welcome Cathy Friedman to our board of directors. She brings nearly 40 years of experience across highly relevant industries, including healthcare, finance and technology. In particular, Cathy has spent over 15 years on the boards of leading public and private life sciences and technology companies that improve lives and patient outcomes," said Goldhill.

"As such, Cathy has a unique view into creating companies with real impact. We’re eager to learn from each other as Sesame continues to grow."

The company plans to use the new funding to accelerate its growth, as well as to take its membership product, Sesame Plus, out of beta.

While consumers are able book appointments on Sesame on an as-needed basis, consumers can join Sesame Plus for $99 per year, or pay $10.99 per month, to get benefits that include saving $20 on all telehealth and primary care visits, saving $30 when they see a dentist or a specialist in-person, and a free lab or blood test per year.

Since launching Sesame Plus in Beta in November 2021, the company has found that members book 33 percent more appointments than non-members.

Creating true consumer-driven healthcare

Ultimately, the goal at Sesame is to help consumers who are confronted with a major healthcare crisis, something that happens on a daily basis in America, said Goldhill.

"If you have ever been through one personally, you know it’s unbelievably confusing. On top of navigating how you or your family member is feeling, you’re determining if you need pre-approval, if a provider is in-network, what you’ll pay out-of-pocket – and that’s if you’re lucky enough to have insurance. Cash pay and high deductible patients are often making tough choices between medical care and other crucial daily expenses,"

Sesame wants to make as much of the process in the direct pay market as easy as possible by creating true consumer-driven healthcare.

"On Sesame, you see simple, easy-to-understand prices that don’t change after the fact. You also see high-quality clinicians with published reviews you can browse to select the provider who best fits your needs. You can also book an appointment often the same-day, sometimes within two hours, to receive the care you need on your terms."