Understood Care

What do they actually do

Understood Care provides human-led healthcare personal assistants for people on Medicare. A named assistant helps members schedule appointments, understand and use their benefits, handle prior authorizations, manage medication refills, and sort out confusing medical bills and claims.

Members (or their caregivers) typically interact by phone and text, with a simple intake and ongoing check-ins. The focus is practical coordination: calling providers, confirming coverage with insurers, setting reminders, and closing the loop on follow-ups so care happens on time without paperwork bottlenecks.

On the business side, they likely work directly with beneficiaries and caregivers today while pursuing partnerships with Medicare Advantage plans and primary care groups to scale the service.

Who are their target customer(s)

• Medicare beneficiary managing multiple chronic conditions: Struggles to coordinate appointments, prior authorizations, refills, and billing issues across multiple providers and insurers, which leads to delays or missed care.
• Family caregiver (spouse or adult child): Spends hours on calls and paperwork while juggling work and family responsibilities; worries about missing benefits, deadlines, and follow-ups.
• Medicare Advantage plan operator (care management/member experience): Needs to reduce avoidable ER use and improve member retention/experience but lacks capacity and turnkey workflows for one-on-one navigation at scale.
• Primary care practice or clinic with limited staff: Front desk and clinicians are overwhelmed by benefits questions, scheduling, and prior auth tasks, leading to no-shows and less time for clinical care.
• Post-discharge and care-management teams (home health, transitional care): Struggle to reach patients consistently, reconcile medications, and set up follow-ups across providers and payers, risking readmissions.

How would they acquire their first 10, 50, and 100 customers

• First 10: Manually onboard a handful of beneficiaries and caregivers from the founders’ network and nearby clinics/hospitals to validate intake, permissions, and end‑to‑end coordination on real cases.
• First 50: Repeat a simple referral playbook with local PCPs, discharge planners, home health agencies, pharmacies, and senior centers; add a staffed phone line, light paid tests, testimonials, and a short case study to open early plan conversations.
• First 100: Convert the first payer pilot to a paid contract, expand provider partnerships across affiliated networks, introduce basic integrations and reporting, and run targeted outbound to regional MA operators using documented ROI from pilots.

What is the rough total addressable market

Top-down context:

Medicare Advantage membership is in the tens of millions; even single‑digit penetration for a navigation service can translate into hundreds of millions in annual contract value.

Bottom-up calculation:

Example: 3.0M MA members enrolled × $10 PMPM × 12 months ≈ $360M/year; a conservative low end (1.25M × $5 × 12) is ~$75M/year, while higher penetration and pricing can reach into the multi‑billion range.

Assumptions:

• MA enrollment ~25–35M members; replace with current CMS figures for precision.
• Targetable segment needing navigation ~5–20% of MA members (higher with multimorbidity/recent hospitalization).
• PMPM pricing for human‑led navigation ~$5–$25 depending on scope and service level.

Who are some of their notable competitors

• Accolade: Large care navigation and health advocate provider for employers and health plans; overlaps on scheduling, benefits questions, and member coordination budgets.
• Included Health: Clinical navigation and second-opinion services with virtual care; competes for complex-care guidance programs sold to plans and employers.
• Wellthy: Human concierge for complex care and caregiving logistics; partners with payers/employers and directly substitutes for outsourced navigation support.
• Signify Health: Runs large MA programs (in-home assessments, care gap closure, care management); competes for MA spend and member outreach/follow-up workflows.
• CareBridge: Coordinates across payers, providers, caregivers, and community services; overlaps on navigation and social-needs referrals for vulnerable populations.