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David Pinkert has been an executive and entrepreneur in the healthcare industry for over 30 years. Currently, Dave serves as President and Chief Commercial Officer at Hint Health. Hint provides software and network management services to 4,000 providers in the high-growth direct primary care segment. Prior to joining Hint Health, Dave was President and co-founder of Friday Health Plans, a private, high-growth health insurer focused on the ACA marketplace. Founded in 2015, Friday Health Plans grew to serve customers in seven states, with over $2B in revenue and 400,000 customers in 2022. Before co-founding Friday Health Plans, he was one of the first employees of TriZetto, the largest provider of software and services for the managed care industry. At TriZetto, Dave led multiple business units over a 15-year period, including product launches and multiple turnarounds. Before TriZetto, Dave worked at Oxford Health Plans, developing innovative value-based networks. He has also worked in financial services and health policy. He lives in Colorado with his wife, who is a physician, and they play in the mountains whenever they can.
How did a history major from Virginia go on to build a health plan in Colorado?
David Pinkert (Hint Health): I was fortunate to have an early career experience working at Oxford Health Plans in the 1990s. If you're not familiar with them, it was a very rare health insurer that was focused on product and service innovation. It was run by extraordinary founders and filled with hardworking, optimistic young people. Our clients, providers, and brokers loved us, and it made me believe that "innovative health plan" was not an oxymoron.
Then, for the next 15 years, I led product at TriZetto, which over time became the largest provider of software and IT services to the US health insurance industry. By the time I left, 75% of US health insurers were our customers and the other 25% were our prospects. We were very successful in building that business.
In that time, I got to know almost all of the US health insurers very closely, and it was a disappointing experience for me. It got to the point that every time TriZetto won a large software deal, I began to dread what would happen next—how the culture of US health insurers killed innovation and how our clients would take technology designed to improve healthcare and find a way to implement it to make healthcare even worse!
A close friend was watching me mope as the team celebrated another win and asked me what my problem was. When I shared my concerns with him, he challenged me to do better. I wrote a one-page business plan for Friday Health Plans that night. We both quit our jobs and founded the company together.
What did you get right at Friday? If you were going to build it again, what would you change?
David Pinkert (Hint Health): Considering that Friday Health Plans was ultimately not successful, we still got many things right. At our peak, we were live in seven states with 400,000 members in the ACA exchange marketplaces, $2B in annual premium revenue, and 800 employees. Just a few examples of things that we nailed:
- Network designs: We were very thoughtful about how consumers might choose health insurers differently than employers. For example, employers had to choose networks based on broad geographic coverage and avoiding major disruptions to their employees’ physician relationships. This is almost impossible to do as an employer, especially if you actually want to save money on healthcare. For a family, this is much easier. The vast majority of families are going to check if their PCP or OB/Gyn is in-network, if their kids' pediatrician is in-network, and if their mental health therapist is in-network. If you can say yes to most of those questions, then the network is great for a family. Most families don't care which transplant surgeon is in the network, and most families would not spend their own money to ensure that the local academic medical center was in-network. By aggressively recruiting the widest possible network for PCPs, peds, OB/Gyns, and mental health therapists, we were able to optimize cost efficiency and market appeal at the same time.
- Product designs: The most "affordable" ACA-compliant products were subpar because they included very high deductibles, which was unappealing to consumers and created barriers to affordable healthcare. Our products all had three common features, regardless of metal level or deductible. Every product included free unlimited primary care, free unlimited generic meds, and free unlimited mental health therapy visits. We found that in most of our markets, this design allowed 65%-80% of our customers to have no out-of-pocket healthcare expenses every year. And because these services are very cost-effective, our medical costs were very low. This simple product design was also very easy to communicate and understand. We were often known in markets as "the free primary care people." I liked that.
- Customer experience: Most importantly, we knew from experience that the US health insurance industry was hard-wired for lousy customer service. While that might not matter much in an employer-funded world, in an exchange-based world, that would matter dramatically. If our customers had even one subpar experience with us, they could leave as soon as the next open enrollment. So we invested heavily in building our proprietary service centers. We focused on a culture of empathy, and we insisted that virtually every new employee to the company was trained in our call center culture. While network designs and product designs could theoretically be copied by the legacy insurers, we knew that they could spend a generation chasing our consumer experience and would never catch us.
That said, a few important things didn't work. Unlike starting technology businesses, starting a health insurer is very capital-intensive. We started Friday Health Plans with our own money, investments from a couple of like-minded industry angels, and a belief that we would eventually find enough capital to be successful. While we were ultimately successful in bringing on institutional investors, we were always straining to raise enough cash to continue operating and growing the business. We also got caught up in the tricky business of risk adjustment. While we had been successful in managing the risk adjustment process in the early days of the business, our rapid expansion led us to perform very poorly in our expansion states, basically wiping out the capital we had raised.
Many Americans are angry at their health insurance companies. Do you think that's fair? What misconceptions about health insurance companies would you like to clear up?
David Pinkert (Hint Health): I think Americans aren't angry enough at their health insurers. We've been stuck with health insurers that effectively (and at times intentionally) block access to low-cost, high-quality healthcare. They've been protected from meaningful competition by increasing regulation and industry consolidation. Why we allow the BCBS plans to operate as a non-profit cartel is beyond me. Employers, while trying to do the right thing for their employees, have been put in an untenable position. For the money we spend as a society on healthcare, we should be massively disappointed in what we get back from the health insurance industry. Of course, if I thought the health insurers were doing a good job, I would never have started a competitive health insurer!
What are you most excited about working on at Hint?
David Pinkert (Hint Health): I'm so excited to be part of the Hint team for so many reasons. I'm extremely motivated to solve hard problems in healthcare, and Hint very much aligns with this for me. Hint is helping make high-quality, affordable primary care accessible to all. Hint is helping primary care providers get control of their practices and care for their patients the way they imagined when they signed up for this challenging career. If we're successful in helping more people access primary care through more direct models, we will have made a huge positive difference in the US healthcare system. Furthermore, the Hint team is amazing. It's very rare to find such an innovative, hardworking, and committed team. I'm so deeply grateful for the opportunity, and I hope I can help Hint as we scale up and tackle bigger and more complex challenges.
Who else in healthcare inspires you, and why?
David Pinkert (Hint Health): I'm inspired by the innovators. Every time I see someone who has identified a broken piece of the system and has committed to fixing it, I find a little more conviction that we're on the right path, that in my lifetime, we will have a much better healthcare system than we have today. And I'm inspired by those who are committed to caring for others. I'm married to a physician, and I see every day what that commitment means. What really matters is the interaction and relationship between healthcare providers and their patients. If you're working in the US healthcare system, don't forget that providers and patients are the only thing that really matters. If you're not making life better for them, then you're in the wrong business.
