The Future of Healthcare: “We need to consider healthcare from both the clinical and non-clinical perspectives” with Jacob Sheridan, co-founder of TPA Stream

Jacob Sheridan co-founded TPA Stream in 2014 to make health benefits easier for employees and administrators. Jacob has over a decade of experience building, selling and managing entrepreneurial businesses and software. Focusing most of his time in healthcare, Jacob has developed a keen understanding of how technology can make healthcare easier for individuals, employers, brokers and third-party administrators.

Can you tell us a story about what brought you to this specific career path?

I grew up in Cleveland, learning about startup companies and angel investing and had the opportunity early in my career to work for a growing startup in the healthcare space. From there I learned about the value of integration between software systems — I discovered that sometimes the integrations were just as important as the software itself!

It was clear there was a great deal of opportunity in this area, so when a friend of mine built a piece of software to solve a problem he was having with his personal health insurance, I was instantly drawn to it and helped him turn his personalized tool into a broader business.

Can you share the most interesting story that happened to you since you began leading your company?

The first trade show I attended with my co-founders was done by taking paid time off from our current full-time jobs to attend. We knew very little about the industry at the time. After the first night’s cocktail hour, we negotiated a contract with one of the largest prospective customers at the trade show! It’s crazy how those things can happen, but as a result, we knew we were really onto something big and something that would prove critical to the industry.

Can you tell our readers a bit about why you are an authority in the healthcare field?At TPA Stream we look at healthcare differently, through a technology-focused lens. We question the status quo — just because something has always been done a certain way, is that the best way? We use our innovative bot and integration technology to solve data problems in more creative ways that allows us to move faster, automate more processes for our clients and ultimately make the healthcare payment landscape easier on everyone — including the consumer.

What makes your company stand out? Can you share a story?

We founded the company on a few core principles, which hold true today: we treat our customers better than we treat ourselves; and we build software that is fundamentally easy to use — I’ve trained a customer in just 15 minutes.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

There is so much fragmentation across all parties that operate in the health insurance space — everyone from the professionals who provide care, to the organizations who help pay for care, to the individual patient themselves. Our goal at TPA Stream is to bridge the gap that exists between these parties by shortening the time to resolve issues with claims and denials.

Our proprietary software solution is focused on consolidating data, integrating with existing systems of record, and supplementing traditional data collection with alternative methods to create greater efficiency. This approach allows organizations to innovate and grow regardless of their current technology infrastructure, and we can easily support organizations through transitions. We’ve also developed new approaches for migrating data between systems, which makes it easier than ever before for companies to evaluate new cloud-based administration platforms.

What all of this means in the broad sense, and what speaks to our larger vision at TPA Stream, is that we are contributing to transformation in the industry by applying best practices and technology solutions to its most challenging problems. Ultimately, we want to enable and empower consumers to make better healthcare decisions.

Are you working on any exciting new projects now? How do you think that will help people?

We are working on ways to solve some of the biggest challenges in the health insurance administration space, and it’s all very exciting! One example is our Consolidated Billing product which uses data from various software systems to create invoices and streamline extremely manual and time intensive processes, not only for independent third party administrators (TPAs), but also health plans and financial institutions.

We are also integrating systems that health plans, TPAs, brokers, and employers all use to manage both participants and employees, reducing processing time and manual entry errors.

What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)

There is a great saying that to “assume is to make an ass of both u and me.” It holds true in business — making assumptions can prove detrimental. Two things I wish someone had told me before I started have to do with making erroneous assumptions:

  • Don’t assume that businesses in the health insurance space act or operate logically.
  • Don’t assume that standards are used and followed.

Two other lessons have proved pivotal in my career and are certainly something I would share with someone just getting started:

  • You can’t spend enough time learning from your customers.
  • Ease of use will only be more important in the future, so whatever you’re building, make it intuitive for the end user.

Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

While there are certainly improvements our healthcare system needs to make, I think it’s important to point out that the United States tracks more variables and we have better data than other nations, which can sometimes skew the data. For example, in childhood mortality we sometimes rank lower than other countries not because we in fact have a higher childhood mortality rate, but because of the ways we track data and the detailed information we are able to access.

There are some concerns that work against our overall rankings as well, including the levels of complexity present at both the federal and state levels — this creates inadvertent silos between them. In addition, a lack of system integration and a lack of overall technical sophistication across all parties involved create disparities in our healthcare system that ultimately hurt our rankings against other countries.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

In order to see changes in healthcare costs and billing we need to be reasonable, but certainly we should expect more than the current status quo. Baby steps are an effective way to create change, and can be far more realistic than expecting a complete overhaul of the entire system.

We need to develop a plan that involves both federal and state agencies. This is one of the more complex issues within the United States, because our state governments are each unique and are responsible for a great many decisions around healthcare. We also have the federal system to comply with, and creating a solution that works for everyone must involve everyone.

Finally, we need to consider healthcare from both the clinical and non-clinical perspectives — we tend to focus on the clinical side and ignore the administrative details. It may not be as ‘sexy’ as patient-facing healthcare reform, but I would argue that backend changes will be the catalyst for true, reformative impact on our healthcare system.

Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?

One of the first things we can do is get providers and payers (insurance companies, employers and other third-party payers) better aligned with one another. Both groups should take a hard look at the current technology they are using and become familiar with what they use, whether it is still server-based and what integrations exist today.

From there, it’s easier to understand and assess new technologies which can help bridge the gap between the many varied systems in use today. Some of this technology didn’t even exist five years ago, but it can play a critical role in process improvement today.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I really love the podcast How I Built This with Guy Raz on NPR. He talks to various entrepreneurs and innovators and dives into how they created their companies and what they learned along the way. Many of the individuals he interviews run companies with household names, and it’s always an interesting peek-behind-the-curtain way to be inspired and motivated in growing my own business.

Why TPA Stream

TPA Stream is a thriving, innovative insurance technology company committed to empowering better healthcare outcomes for employers and their employees.

Learn more about TPA Stream here.

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