Have a Great Product? Don't Be Afraid to Dismantle It to Build a Better One.

The founders of VisitPay explain their step-by-step process for doing the impossible: making your healthcare bills make sense!
Have a Great Product? Don't Be Afraid to Dismantle It to Build a Better One.
Image credit: VisitPay

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In this ongoing series, we are sharing advice, tips and insights from real entrepreneurs who are out there doing business battle on a daily basis. (Answers have been edited and condensed for clarity.)

What is your business and how long have you been running it?

My name is Vincent Martino. In 2010, Kent Ivanoff and I co-founded VisitPay, a company that transforms the patient billing experience for U.S. healthcare providers. Through our machine learning-based approach, we personalize the billing experience for the patient, providing them custom payment options, resulting in significantly higher patient satisfaction and more revenue for our health provider clients.

What problem are you solving for?

Today medical billing is a lose-lose situation for patients and health providers. For patients, the process is often confusing, paper-based and time-consuming. It’s a source of real frustration and stress in households across the country. Consequently, providers are getting paid a small amount of what they are owed. Given most U.S. healthcare systems are not-for-profit organizations, a lower margin translates directly into lower investment in new healthcare services for communities. Today patients are responsible for more of their healthcare costs than ever before, creating a real problem at a significant scale in just about every city in the U.S. 

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Was there a particular moment that led you to launch this idea? 

My co-founder and I were formerly executives with Capital One Financial. In the summer of 2009, as the Affordable Care Act moved through Congress, we believed the patient portion of medical bills would grow dramatically as a result of the forthcoming legislation. Our hypothesis was that patients would need to have more and longer-term options to pay their bills, and providers would need the tools to both customize the billing experience for patients and manage a much larger receivables portfolio. We believed that the best practices of consumer finance, which we knew from our Capital One days, would drive the ultimate solution, but we also knew that healthcare billing was complex and we couldn't just "bolt on" these best practices. We needed a partner and test lab where we could truly integrate consumer finance best practices with healthcare billing processes. 

Describe the process of getting your first customer.

We felt it was very important to find a customer — which I would call a partner — that would work with us and provide an environment where we could immerse ourselves in healthcare billing. We pitched our idea to several large health systems, and fortunately, a large health system in our backyard of Boise, Idaho, signed as our first customer. This system had a very visionary CFO — he was also very pragmatic and knew that while we were experts in consumer finance, we needed to learn the healthcare space from the inside out. I think the key is we were both willing to make sacrifices in our first deal. While we wanted to build scalable software and didn't want to be "consultants," we were willing to provide some services in order to gain access to the health system's billing practices and teams. This CFO gave us a lot of room to learn his systems and invested time with us (both him personally and his teams) as we formed the initial concept of our solution

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Can you describe the process of developing and iterating on your concept?

Since first designing the VisitPay solution, we’ve taken a Human-Centered Design (HCD) approach to building the product. We engaged directly with patients in multiple settings to understand their needs and also to understand the "breakpoints" in the billing process. Once we built our first solution and understood its strengths and weaknesses, we were very willing to keep the parts that did work, throw away the ones that didn't and build new products based on our insights. While the first product was really good — it drove a 70% increase in patient satisfaction and a 30% increase in patient payments — we were never satisfied with good as we gained insights from consumers on how to make it even better. Said a different way, we weren't wed to the past and weren't afraid to dismantle our old product to build a new one. In the first four years of deploying our solution, we completely rewrote the solution two times, and each new version brought higher satisfaction and payments. For our newer clients who onboard with our current version, we have seen payment rates increase by as much as 110% and patient satisfaction triple over industry norms.

What benefits does being headquartered in a city like Boise bring?

Boise isn’t the first city that comes to mind when people think of startups. But Boise, and Idaho in general, is growing very quickly. People move here primarily for quality-of-life reasons: Housing is affordable, commute times are reasonable, the community is generally safe and friendly and there’s incredible year-round outdoor recreation right on our doorstep. As a rule, people who live in Boise love living here. From an employment perspective, that means we tend to have a pretty happy workforce who like being part of their community and are committed to helping grow the company. While the startup ecosystem here is expanding, we have very strong employee loyalty with low staff turnover. And we haven’t found it hard to attract really smart people to relocate here from traditional tech hubs like Seattle, Austin and the Bay Area. Among the leadership team at VisitPay, there’s also a determination to build a company of national importance from the relative obscurity of a state like Idaho: to bust the myth that you need to be on the East or West Coast to succeed in a venture-funded tech growth company.

How do you keep in-house staffers and remote workers on the same page?

We’re hugely into process discipline. Like many technology companies, we use agile development methods in two-week sprints. Our health provider clients are often surprised how fast we can turn around system updates and configurations compared with the legacy technologies many of them use. Just about our whole company works in some form of agile methodology, whatever department they’re in. We complement process discipline with a small set of core technologies like Slack, Jira/Confluence and Zoom that everyone uses to stay on the same page whether they are in Boise or not. Consistency of technology and process helps keep the working environment frictionless wherever we are.

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Can you talk about any aspects of your corporate culture that have aided you in finding success?

One of the most important aspects of our culture that we’ve managed to keep intact from the beginning is a learning mentality. We always want to learn and to do better, and we always turn to data to help us understand. We’re not afraid to shift course if the data backs it up, and we’re not afraid to make mistakes if it means we find our way to a better place. It means that we’re a genuinely failure-tolerant place to work, unlike other work environments I’ve experienced. As a result, we’ve created an egalitarian culture where I think any of our employees feel empowered to bring new ideas forward. And it means we don’t get stuck based on past decisions we’ve made. 

We’ve also learned that you can only see so far ahead, and to be OK with that. People equate being an entrepreneur with having some searing far-sightedness where the future is suddenly anticipated and understood in a very complete way. We knew we found a big problem space, and we knew we had the skills (and could get the data) to do something about it. But anyone who claims they predicted exactly how the journey would work out is unlikely to be telling the whole truth. It’s obviously important to look ahead and debate what the future might be, but it’s no substitute for putting one foot in front of the other and building your way there. Make a call, move, understand what happened, learn. And then do it all over again, and again.

Having done this a couple of times now, any words of advice for people out there with a great software or platform idea? What do you wish you knew before you started on your first venture?

I see these two questions as going hand in hand. Raising capital is really important, and particularly in software ventures. How you go about building the solution will dictate how much capital you need and will burn through. There are some companies that have an immediate sonic boom in terms of revenue, but those companies are few and far between. So my advice, especially in your early days, is to search continually for and build the minimally viable solution that you think answers the market need, get it out there, test it with real customers, and then only change it after some learning cycles. I've been part of three software startups, and in all three, we overbuilt software — we threw away a lot of code that was either never used or just didn't fit the market need, or that we just built too quickly without enough learning. It's easy to say but hard to do — keep focusing on the market need, build the minimal features to answer it, learn from it, then build more from there. 

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