How a hugely valuable startup succeeded without inventing anything

Like a lot of publishers, Reuters will put a one-word subject heading over the title of an article to attract some attention, like placing "Technology" over an article about the pending Bright Health Group initial public offering of stock.

This didn't help. Bright Health sells health insurance, not software or gadgets. The Bloomington-based company itself said "at its core, Bright Health is a health care company" in the registration statement filed for its IPO.

Maybe the company's stock seems to trade a little like it's a Silicon Valley tech darling. Last week, Bright Health completed a disappointing offering, given its stock price expectations in its last filing. Yet it still ended the first day of trading worth more than $10 billion in the market.

The IPO was the largest in Minnesota history — and it also was was one of the most interesting. It's not clear, from reading the registration statement front to back, what exactly this company has invented that has enabled it to go from a standing start just six years ago to a market capitalization of $10 billion.

It is worth a closer look.

Bright Health's industry segment is known as "insuretech," and the companies in it like using gee-whiz language for their technology.

Competitor Oscar Health happily described its "member engagement" system as "powered by a differentiated, full-stack technology platform that will allow us to continue to innovate like a technology company and not a traditional insurer in the years ahead."

Bright Health topped it, saying it has an operating system.

"Our ability to optimize the delivery and financing of care is driven by our purpose-built, end-to-end technology platform, the Bright Health Intelligent Operating System, or BiOS," Bright said in its public offering filing. "Using robust data generated through our care partner alignment model, BiOS enables an integrated health care system of the future."

But U.S. Bancorp, C.H. Robinson and a host of other businesses invest a lot in their technology, too. Even the kids setting up their cul-de-sac lemonade stand could easily accept payments over Venmo.

As for what it charges customers for, Bright Health first offered individual health insurance policies for 2017. A year later, it launched Medicare Advantage plans.

One thing that is a little different for Bright Health is its history of acquisitions. As one analyst pointed out in a long blog post, health startups usually take the view that the health care system is so broken that there's no hope of creating something better without starting with a blank sheet of paper.

Bright Health's first acquisition was of a health care practice in Florida, then it went on to complete several more deals, including three this year. One of those was the more than $70 million purchase of Zipnosis, Inc., a Minneapolis technology startup that had developed a telehealth system used by other health care systems.

This history makes you wonder. Instead of building a revolutionary new mousetrap, did Bright Health build a more-or-less conventional mousetrap assembled out of mousetrap parts easily found on the internet?

While it might not be ingenious creation, Bright Health is still a very promising business. To understand why, you need to see the markets the way these upstarts seem to.

When people get mad about the high cost of their health insurance, it's really a misplaced anger. Health insurance is a way to manage risks and smooth out payments for things that really do cost a lot of money and seem to only get more costly — things such as prescription drugs, doctor visits and medical procedures.

What's worse, consumers rarely know what those things really cost. Told by their doctors to get a colonoscopy, too few patients will even ask about the cost.

The other big contributor to the mess is that there are different prices for the same basic procedure at different providers — and good luck shopping for a deal.

Put "lowest cost colonoscopy near me" into the Google search box, and my first result was an ad for HealthPartners. It takes the curious to a page that's all about why someone needs a colon cancer screening with a list of HealthPartners places to go for one. But there's not a word about price.

Bright Health calls its approach to this cost problem "alignment." Strip away the jargon, and what's left is a business model designed to provide enough incentives for the consumer, the health care provider and the insurer to all want the same thing: the consumer getting the care that's needed from the most efficient provider.

It can be a win for consumers because they can get a personal care plan and be more in charge of their health care, including its cost.

It can be a win for health care providers because the industry is slowly switching over to what's called value-based care, meaning payments based at least in part on how healthy a provider keeps patients, instead of just generating revenue by seeing patients and doing procedures.

If that's the trend, better to jump in now and take market share from the slow adopters.

Health insurers can win, too, including Bright Health's own health plans, because it should be easier to manage member health care costs.

Alignment is not, by the way, a stunningly original idea. The terms might not be the same for everyone trying that approach, but none of them are that different from what Group Health, the predecessor to today's HealthPartners, was talking about decades ago. Bright Health even has a competitor that calls itself Alignment Healthcare.

That suggests the opportunity here for Bright Health is really one of out-managing and out-hustling the competition, not by coming up with the most user-friendly consumer app or a clever pricing algorithm.

If you look at the background of those leading this company, there's a lot of UnitedHealth Group experience along with stints at Best Buy, Target, Cigna and a handful of entrepreneurial ventures.

A big business opportunity lies ahead for any management team that really solves this alignment problem. Investors last week voted with their money that Bright Health has the kind of management team that has a chance of doing that.