Startup Physicians

Rethinking Risk: What Startups Miss Without Physicians at the Table with Isaac Edrah

• Alison Curfman, M.D. • Season 1 • Episode 22

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What happens when clinical expertise meets data-driven financial modeling? In this episode, Dr. Alison Curfman sits down with Isaac Edrah, a healthcare actuary and founder of Paramean Solutions, to explore how physician insight can dramatically shape — and de-risk — value-based care models.

Isaac shares stories from the field, including one orthopedic collaboration that uncovered billions in potential savings. Together, they unpack the hidden leverage physicians offer in startup and venture settings — especially when financial risk and clinical pathways collide.

Physicians don’t need to become data experts to make a difference. They need to understand their own value — and learn how to partner with teams like Isaac’s to drive smarter, faster, and more scalable innovation.

Episode Highlights:

[00:00] - Introduction to Actuarial Insights in Healthcare
[02:50] - The Role of Actuaries in Healthcare
[06:06] - Collaboration Between Clinicians and Actuaries
[09:00] - Real-World Examples of Clinical Models
[12:12] - The Importance of Clinical Expertise
[14:59] - Value Creation in Healthcare Startups
[17:53] - Bridging the Gap Between Data and Clinical Practice
[20:59] - Encouraging Physician Involvement in Startups
[24:03] - Challenges in Collaborating with Physicians
[27:10] - Conclusion and Call to Action

Alison Curfman:

One of the things I teach people when they're trying to figure out, like, how do I deliver value to startups? How do I have anything valuable to offer? I kind of put it in three categories. You can either help them a company, increase their revenue, decrease their risk, or decrease their costs. Those are the three ways to add value. Welcome to Startup Physicians. Please Like and follow our show to join our community of physicians who are reimagining healthcare delivery. Hi everyone. Welcome back to Startup Physicians. I'm your host, Dr. Alison Curfman, and I am here with my colleague Isaac Edrah today. He and I met through a colleague, a friend, and I've always been really interested in the sort of work that he does, and so I've had a lot of physicians on this podcast to talk about their journey, and one of my visions was to really bring in other people from industry and from the venture side of things to come in and really share their thoughts on the value of physician contribution to this space. And Isaac and I had a very, very long and dynamic talk about all of the work that he does. And was I was really excited to hear about his perspective when he and I first met. So Isaac is an actuary by training, and some of you may not know what that is, and so he's going to tell you all about what an actuary is in the firm that he started, and then I'd love to just share more with you guys about how valuable your perspective is. So Isaac, thank you so much for joining me today. Thanks for having me, Alison. So can you start by telling us just a little bit about your career background and the type of work that you

Isaac Edrah:

do, sure so like you say, I'm an actuary by trade, and I'll say a little bit about that actuaries. Whenever you hear the word actuary, you should understand the word risk. You bring an actuary when there is a risk to be quantified. And I spent my entire career in healthcare. So having worked for a health insurance company for several years, moved into a consulting firm where I also was doing kind of the same work as an actuary in combined with some strategy around for hospitals and insurance companies. And then the last several years, work a lot in the startup space, including the new company that I founded about three years ago. But back to what we do as actuaries, is especially in the healthcare field, there's a lot of contracts that go around in healthcare, and many of these contracts have a performance based approach. Many of them include the level of risk across the different parties. This is where actuaries come in play to have folks understand the risk better, understand, measure those risks better, and sometimes even protect those risks better. Yeah,

Alison Curfman:

well, and so I actually, when I first got involved with building a value based company, I I didn't know what an actuary was. I knew that people, there were people out there that measured risk, but I got the experience to work with a healthcare economics team when we were building our clinical model and and also work with actuaries. And the more that I've learned about the work that actuaries do, the more I've been so impressed that it's such a detailed and interesting field, and I think this is like several layers deeper in complexity for physicians wanting to work on clinical models. So this is one thing that I really teach people how to do, is how to translate their clinical skills into working with venture working with startups, and particularly around assessing clinical models. And so people may have the opportunity to work with a company who has a fairly simple clinical model. Maybe it's, you know, a direct to consumer product that they're just being asked to weigh in on, like, oh, is this what patients need? Is this what physicians need? When you get into actual contracts that involve payers, that involve health systems, that involve value based care, it adds a lot of complexity, but I think that what's been so amazing is to watch this, you know, collaborative work between someone like you and someone like me, and seeing how both of those things are so deeply needed to get the model right.

Isaac Edrah:

Yes, it's a it's critical that both. Of such teams work together, and I've been doing a lot of work with health system, hospital and in a body based care community for at least the less the last 10 years, and more and more we've been what has been my conclusion is that you have to never forget that we are dealing with clinical care at the end of it all right, so if any of our data that we're looking at, any of our understanding of financial, race, corporations, if it's not all embedded into the care model or the care delivery approaches, then we all are looking at the wrong thing. And many months, many years later, the results will speak to themselves, because at the core of it, this is all about care, and the folks that are delivering the care are leading the delivery of the care at this position. So we, we at Param and myself personally, have spent, we spent quite a bit of time working with various chief medical officers and their teams whenever we are brought in to understand care model, like you said, or to even understand how we can work with a different, different organization. It's very, very critical that we understand, you know, the care delivery approaches that are part of it and that inform the data we're going to look at that even informs the type of work we're going to do. Yeah,

Alison Curfman:

and I think that one of the things we take for granted as clinicians is that we kind of assume that a lot of the things that we know are just common knowledge like it's very hard for physicians to understand that so much of what they live in their day to day experience with patients is valuable knowledge that people are looking for, that companies need to know, because we All have seen what happens when a company actually doesn't have a solid clinical model. Maybe they have, like, a an idea and an initial approach, but they haven't really deeply figured out, like all the stakeholders, how it's going to affect all these different very complex layers of care, because healthcare is really complicated, and sometimes it can take a couple years for that to pan out. But in general, if a company doesn't have a strong clinical model, it will be very costly. In the end,

Isaac Edrah:

it will be. It definitely will be. And actually, I will give you a quick story. About a couple years ago, I, myself and my team were working very closely with an organization focused on a better care for muscular kettle delivery, as in, you know, surgeries, spine surgery, back surgeries, and all of this. And this is a very critical part of our healthcare system, about about 10 to 12% of cost of care for Medicare population they everybody age is 65 each to older, about 12% of the amount spent in cost of care for them is part of those constituents. And it's not just the cost, but also the quality of some of those. Care is not necessarily the right way or delivered the right way, and we wanted to understand this better. But beyond that, we wanted to understand what value such a thing will bring to the different stakeholders in healthcare, anywhere from the from the insurance companies to the drug companies and to the hospitals. And we went about it from a very financial perspective, took several months building some very nice projection models, and somehow along the way, it just never made sense. The numbers never added up so and then finally, one of the one of the board advisors for that company said, Hey, I had this orthopedic surgeon, and this guy is very smart, and he knows he's been in this field for forever. Let, let's bring that person in. And we he started asking questions, have you considered this? Because this is the pathway of this patient, and oh, we have, not. We've looked at it, did I very broadly? Yeah, because we don't even know that it's such a pathway happens right a several months later, because we, you know, this kind of worked in quite, quite a bit of time, with the guidance of that person, about that clinician, and a few other folks that you brought on board to help us, we had a very different pathway. And the value proposition, financially across the board, became very different if we're going to look at, you know, spinal surgeries, versus if we're going to look at Back Pain, or when there are there is the need for therapies to be involved, a PT to be involved. All of those pieces became so much clearer, and our data becomes so much more accurate. Rate, then we were able to find value across the whole value chain for every stakeholder by the time we were done. I mean savings, potential savings in the market were north of several, several billions of dollars right, and billions, billions right. And you were looking at a broader Medicare population, and this is the kind of things that sometimes physicians assume that we know and we have no clue. Many of us have zero clues, right?

Alison Curfman:

Yeah, right. Well, and we were talking about this before we started recording, but you know, some of what I did in the early days with Imagine, was working on our out selection algorithm of basically which types of patients we were going to take care of, and I was working with a team like yours, and we were going through like, all these categories, because it's all based on claims data. And it was like, Okay, well, let's look at inpatient spend. Let's look at outpatient spend. How can we break this down? Let's look at diagnosis spend. Let's group these diagnoses by different I don't know groups. And then I would go through and I would see stuff that it's, I don't consider myself a genius, but I do have, like, clinical experience, so I would see stuff, and I'd be like, Huh? Those like, don't go together. Those are very, very different when you look at their like, longer term pathways. So, like an example, we had transplant patients all in one category, but we're trying to map this as like, what sort of pathways and needs and and level of resources different categories of patients need. Well, there were cardiac transplant patients in that group, and then there were, like, corneal transplant patients in that group. And so those are very different. Like, once you get corneal transplant, it's like, there's not really any long term

Unknown:

interventions or risks compared to the cardiac transplant group. And so just going through, like, those were things that, just like, immediately stopped. Stood out to me. I was like, Oh no, those aren't the same type of patient. And when you're just someone that's just doing codes and like going off of codes and grouping them different ways, it's like it was that combination of, you know, my understanding of clinical conditions and the actuary and healthcare economics team understanding of, like, the deep analysis of this sort of very, very complex data that helped us to get the answer right, right and and in and I, on top of, you know, to add to that, I I'm so excited every time we get to partner with physicians these days, it's just and as A matter of fact, every time we start an engagement with any new any new hospital or, you know, physician, physician enabling practice, or anything like that, we do want to always talk to their care delivery team. As a matter of fact, at paramine, we've started building a clinician advisory group, which Alison you will be, we will love to have you. Would love to work together with you on this

Isaac Edrah:

will be guiding us internally, actually, on how we build several models to deliver the right financial risk advisory to our customers. Because we look at we look at different type of care every day. We look at cancer type of care. We look at diabetic type of care. We look at, you know, all different ways, and many of them correlate somewhere, but several of them also very different. We need the expertise of physician to be able to understand the data that we have to do the right way so we can deliver the value to our customers. So it's become that important that we even eternally had to have a group of people a physician that have to help us.

Alison Curfman:

Yeah, and it, I mean, I think it's just so mind blowing your example of like, oh, all of a sudden we got this ortho guy in here, and we worked through the model more and realized that there were billions of dollars of savings that we could be trying to capture, like B billions with a B, that's a big number and and so it's like, what is that expertise worth? Because a lot of doctors feel like, Oh, well, I wouldn't have anything to tell them, and I wouldn't, I wouldn't know anything. But one of the things that I also shared was, again, one of the most important things that I was able to contribute while working at, you know, a private equity firm with a healthcare econ team, was my patient journeys. And you just said something about pathways in spinal surgery. But these are things that we know from treating 1000s of patients. So like when I was trying to design solutions for complex kids, like I have taken care of 1000s, hundreds, 1000s of of complex kids in my career, through, you know, both the company that I started in, just through my day to day work like I, I know these. Moms. I know their journeys. I know their struggles. I know what makes them end up in the hospital. I know what, how the system fails them, because I live it. I work in an ER, and I see them. And it's like those insights that you can't pull out of claims

Isaac Edrah:

data. No you cannot. And as a matter of fact, one of the pieces that I also tell many companies we work with them is internally here, we have access to almost all data from Medicare, Medicaid, and most of data for commercial patients. And we can do we can boil the ocean ocean, and it's going to take us months to do this right. Or you we can bring in your clinicians that can help us get a little more focused, so we all don't waste, you know, a lot of money, or, they, know, a lot of time doing this. So again, this is even an area where, you know, physicians don't have to become the if they want to depend, obviously, but they don't have to become, all of a sudden, the data guy they don't, or the financial guys. But when we bring a problem from it, from a clinical lens, their input allows us to go from here to here and where we can start thinking about a problem. And that's even more important than a lot of

Alison Curfman:

things. Yeah. And so one of the things I teach people when they're trying to figure out, like, how do I deliver value to startups? How do I have anything valuable to offer. I kind of put it in three categories. You can either help them, a company, increase their revenue, decrease their risk, or decrease their costs. Those are the three ways to add value. Obviously, your entire world is decreasing risk. So if people are going into multi billion dollar contracts like they really want to make sure they're not, you know, getting into terms that will cost them hundreds of millions of dollars, like there, it is very worthwhile to invest in Actuarial services when you're talking about contracts of this size and this complexity, but When it comes to decreasing cost or increasing revenue. Like, I can think of ways that probably that orthopedic example was either like, oh, well, we miss all of this because we don't do this, or we don't have a good way to capture, you know, home follow up and there, you know, it ends up to increase costs or whatever. But then you're also talking on a very, very practical standpoint that someone is investing in Actuarial services, and that is expensive, especially if it's going to be a multi, multi month process, and you're looking at like, millions of data points, and having someone there to help guide you and target the analysis saves them a ton of money like that is they're already investing in decreasing their risk, right? So they already are like, Oh my God, we got to get an actuary in here. We have to make sure we're covered before we sign these big contracts. But the actual process of the actuarial analysis can be much more focused and much

Unknown:

less expensive, and in less time when you have the right people helping focus that work. I agree with that completely. Like I say, we we so much that we have to do it internally to have a team. So one thing I do want to do, though, is definitely, you know, reach out to the community that you know that is working with you, or the that is following this podcast, we will be, we will be talking to Alison about many you know, who she can recommend from from the group to help us as well. Because it's going to be a you know, we will need our clients, our customers need it, and we internally, need many physicians that can help us do this. Work together, and it's, you know, and we also work so closely with many startups and even health systems and and provided practices and accountable care organizations that would that would need physicians that you know that really can guide them. This is like why I got so excited when I talked to you. There were several reasons. One, this is like, my favorite type of work to do. It was one of my favorite things to do, and when building a company, and I felt like I felt so valued. I felt like my my input, like, literally led to, like, millions of dollars of savings. I was like, wow. Like, I I actually know some stuff. This is so cool. And I personally like to get into the like, I love a good spreadsheet. I love to get into, like, the really details and work with a thought partner like you. So I personally, I was like, Oh, I love doing this sort of work, because I like to think about really complex problems and work with other smart people to try and come up with, like, new ways to fix them. But two, I want to create so many pathways for other physicians who have, they don't have friends that are actuaries, and they don't, you know, have a lot of contacts in the BC space. And so a lot of times I have people start by doing searches in their own specialty, just to start getting a lay of the land, of like, who's doing what? Like, I'm a I've had people come to me and be like, Oh.

Alison Curfman:

Oh, well, I don't know if there's much going on in my field, because they haven't even done a Google search. And it's like, I've had people say, like, Oh, I'm an ophthalmologist. It's such a tiny body part. And I'm like, Okay, well, I just found 10 venture firms that they only focus on eyeballs stuff. Like, there's stuff going on out there. Same with I had someone ask me recently like, Oh, what about palliative care, I don't know if there's anything, oh, my god, palliative care. Like, yes, there's huge value in end of life and palliative care and like, creating a really phenomenal experience for anyone I know who's ever been involved in any sort of palliative care has had, like, just the most phenomenal team and bringing that sort of perspective to the masses to solve a really expensive and challenging and just morally challenging problem, I was like, Absolutely, like, please, please, please come into the space, because we need more palliative voices help us determine some of these things. So, you know, there's all these people who like, well, I don't really know that my specialty could be represented and and so I have them start by looking doing searches in their own kind of specialized field. And maybe they'll find like individual companies that they could reach out to or connect with just to learn more. But then this other perspective I take is to also connect with actual firms that are almost like a like a hub and spokes model of like, okay, if I can make a connection with a venture firm whose vision and mission really aligns with the sort of work I do, and I create relationships there. Now I'm connected to potentially, a whole lot of portfolio companies that I can learn about and maybe contribute to. And so when I talked to you, and I was like, Okay, you personally need physicians to help you with all these different, you know, problems that are coming in of all these different flavors, like one day, maybe you need an orthopedic doctor to come in and help you identify billions of dollars. And then other days, you might need a pediatrician. So that's exciting. But then also working with companies like yours that have so many connections across the healthcare field, I just think it's such an amazing way to get exposure to new ideas, new concepts, new people, solving problems. And so, yes, I will find you some physician advisors. All

Isaac Edrah:

right, I, I would say again to like so I, I need my idea one and one had a lot of physicians. That's part of our cohort. And one of the Yeah, one of the things that many of them today very good friends, one of the things I loved about physicians, and I didn't know that before, when they were just my doctors, because, you know, I go to my doctor, he tell me do this, and I sometimes do it, sometimes I don't. But working with them closely, I realized that they're just problem solvers in general, physicians, just like they follow the path of just critically solving a problem, and as actuaries, that's literally what we do. So a lot of the time when we start working with physicians, and there was this problem, this this new company is trying to solve, you know, we go deep, and physicians also really go deep. It's just that we look at two different lenses, and together, we actually find the solution very, very closely. So I am very excited about the opportunity to, you know, to work together and work with many of the folks that you know, you have on the panels here.

Alison Curfman:

Do you ever see so I agree with you that physicians are problem solvers. We're critical thinkers. There's all these things that we do in our day to day Doctor world that actually are very translatable skills to solving other types of problems. What do you see as drawbacks or barriers to working with physicians? Sometimes, because I also sometimes Train, train certain behaviors out of people. But what do you see that can be a problem?

Isaac Edrah:

Okay, I hope, hopefully, if my physicians friends hear this, they won't resent me too much, because they already know I have those, those thoughts. But number one, they believe physicians really believe they're always right. Okay, so that is, that is, you know, I'm not sure what happened in medical school, but it's clearly hubris. I get it. I totally get it. To be able to save somebody's life, you have to believe that you know what you're doing right. And most of them really do know 99% of time when it comes to it, but there is a 1% here where sometimes the data tells a different story, and we have to find a common ground. So I think usually that's where it takes us some time to get to that middle ground with our physician partners. So but again, it's, it comes from, it comes from just the training different side, right? Yeah,

Alison Curfman:

that's one. I do think you're right that, like, sometimes we think we know something, but the data does tell a different story. So, like, I there's a certain condition that I was like, Oh, for sure. This is probably a ton of spend. In pediatrics. Like, I have no doubt, like, because I see it all the time. I see a lot of patients with this all the time. It's probably causing a lot of spend, if you like, go, like, we got into it, and we're like, because I was like, Oh, we're going to build program for this. We're going to put, you know, pathways and workflows and targeting all this in our in our initial model. And it's kind of like, huh, like, there's actually not a lot of like, spend there. I like, don't know why. I can't figure it out. Because I feel like, Oh no, no. My clinical experience, like, this is a big problem, but the data tells a different story. And it's like, okay, well, we're not going to invest in that pathway right now. Maybe someday we'll figure out why I'm seeing this disconnect. But maybe we need to pivot. Maybe we need to do something else and find a problem that, or there's another area of spend that like is like this massive area of spend, but maybe our particular model does not address that spend. It does not like, for example, one of the things we dealt with was, you know, neonatology kids that are born and end up spending, like, a really long time in the NICU,

Unknown:

we, as a home based medical group, don't affect NICU spend because they haven't even gone home yet. We do our interventions in the home. So maybe that falls outside of the model. Or maybe there's something else that's like a really, maybe someone else needs to start a whole nother company on that. And actually, I'm working with some people who are but I think that being humble and working with teams and recognizing other people's expertise and value is so important, and I appreciate that perspective from someone with a really, really expert skill set, to be able to be like, hey, doctors, like, sometimes you're wrong. And like, you need to be able to be like, Oh, okay. Like, tell me how I'm wrong. Yeah, no, I that's, that's and again, it goes, it goes in all professions, you know, sometimes people think that actually think that they're always right, because we say data never lies. But again, it depends on how you look at the data right. So that's that's kind of where it goes. And the final thing I would say is, my experience is, as you know, from physician, from working with physician, is sometimes a little hard to translate from you are focused on one patient, when you are in practice, when you go in population health or trying to solve a broader problem, you have to think very broad about the population, right? That means, like you say, some of the cases that you believe you see often that could be a problem may not be that big of a problem, population wise,

Isaac Edrah:

right? So, and that's where, for me, the concept of pathways become very, very critical. Because if one were to look at pathways from a view, sometime of somebody who seen one patient, almost every single patient is different, and the experience is different. So we can get on the path to have so many pathways, but when you look at broader, then it gets a lot less. And And again, some you, you I want to when I go to my doctor, then he only thinks about my pathway as me. Yeah, right, so. But when, when I'm working behind the screens, and I have to think about a broader Medicare population, we need to start thinking about, you know, sometimes we have to, we have to let away, get rid of the outliers, and focus on the bigger picture. And that part of the job. I think this is also an area that I think we work well with physicians to do together, but it's an area that I do think that, you know, it's not a very straightforward movement

Unknown:

for them. Yeah,

Alison Curfman:

yeah. I think yes, when you're looking at a broad population, especially 10s of 1000s or hundreds of 1000s of patients. You're looking for common denominators, you're looking for common pathways, and like how to group things. And so it's a totally different way of thinking. I think a lot of people haven't had experience doing this, but could be really good at it. And so just as we wrap up, I want to encourage people your knowledge is super helpful. Maybe you could save them billions of dollars. That's a really big number.

Unknown:

There are a lot of people out there, like Isaac, who are building companies that truly value physician input. So I'm happy to be involved as an advisor and to help find more people of different specialties to help help your company and help the companies that you serve. His company is called Paramean Solutions, and you can contact him on LinkedIn. You can also reach out to me if you're interested in being considered to, you know, work with this company, because I think that it would be really cool if our groups can come together and and work together. But thank you so much for coming on today. Isaac, I really enjoyed this conversation. Thank you so much. Alison, it's been a pleasure. Thank you for listening to Startup Physicians. Don't forget to like, follow and share.

Alison Curfman:

You.