From Complexity to Clarity: Making Diagnostic Imaging as Easy as Booking an Uber

This episode features an interview with Elan Adler, the founder and CEO of OneImaging, a nationwide diagnostic imaging network dedicated to making medical imaging faster, more affordable, and more transparent. Adler, leveraging his background in radiology operations and technology sales, explains that the company was founded to address the common problem faced by patients who lack fundamental information—such as the lowest cost, insurance coverage compatibility, appointment availability, and quality of service—when referred for an exam like an MRI or CT.

The current system is complex, often resulting in patients having "no clue what the price is" until they receive a bill, and appointments are frequently booked without prior authorization approval, contributing to a high same-day cancellation rate of 25% in the market. OneImaging disrupts this by transforming the patient experience into a simple consumer interaction, likened to booking an Uber or Airbnb, complete with price transparency and choice. The company focuses on leveraging technology to automate processes, including reaching out to members via text during the prior authorization process to guide them directly to booking.

For employers, OneImaging is an attractive solution because medical imaging is the second most used service in healthcare by volume (after prescription drugs) and represents 8% to 18% of a commercial health insurance plan's total spend. The company's financial model guarantees a one-to-one return on investment, ensuring that employers cannot lose money by implementing the solution, which can translate to tens of millions of dollars in savings (EBITDA) for large companies. By streamlining the process, OneImaging has significantly improved patient adherence, raising the T30 completion rate (exams completed within 30 days) from 45-50% up to 80%, thereby improving clinical outcomes. Looking ahead, OneImaging is deploying newly raised capital to focus heavily on product enhancements, such as creating a centralized repository for all patient images and establishing on-site imaging centers for large corporate clients. The CEO attributes the company's competitive durability to its "tech company first" approach and the network effects inherent in its two-sided marketplace.

Key Takeaways

OneImaging targets a crucial area of corporate overhead: Health insurance plan spending is the second largest line item of overhead for a company after salary and wages. Medical imaging services, which constitute 8% to 18% of a commercial health insurance plan's total spend, offer a high-leverage opportunity for reduction. CFOs should recognize this overlooked area, which can translate to tens of millions of dollars in direct savings (EBITDA) for larger companies.

The business model eliminates financial risk for the employer: OneImaging generally does not make money unless they save the client money. For budget predictability, the solution can be purchased as a subscription with a guarantee of at least a one-to-one return on investment, making it "impossible" for a client to lose money. The target is to create a 2.7% to 3% reduction in the entire healthcare spend.

A "tech company first" mindset, even in healthcare, is crucial for efficiency and competitive durability. OneImaging actively invests in product and engineering to automate processes that typically rely on faxes and manual effort. This automation is essential to eliminate pain points like the massive information loss during prior authorization and the 25% same-day cancellation rate prevalent in the market.

The focus on product experience directly improves adherence and health outcomes, which minimizes costly downstream complications. By simplifying the process to be like booking an Uber or Airbnb, OneImaging has dramatically increased the T30 completion rate (exams completed within 30 days) from 45-50% up to 80%. Higher adherence ensures employees receive timely diagnoses and follow prescribed care pathways, reducing future high-cost events.

Finally, long-term durability is achieved by integrating solutions that create network effects and a natural moat. By doing the "hard work up front" on technical integrations, the company makes the product more seamless and automated, increasing utilization and ensuring that new entrants would offer a product "so far below in quality from a price perspective" that it is not worth the effort.

Chapter Summary

(00:01:03) The interview begins by introducing Elan Adler, founder and CEO of OneImaging, a nationwide diagnostic imaging network aiming to make medical imaging faster, more affordable, and more transparent. Adler, drawing on his experience in r