Nick Soman | Decent
NICK SOMAN
Founder & CEO of Decent, a company that offers affordable healthcare by aligning incentives to improve health, reduce costs, and put members at the center of their care.
What Is Decent? Tell Us About What You Do And How You Do It.
Decent is a health insurance startup that helps small business band together to get affordable health insurance. That’s the simple elevator pitch. What we hope to accomplish is much bigger. Decent envisions a world where everyone has access to affordable and comprehensive health insurance so that they have the freedom to do the work they want to do. Over the past decade, small business owners and entrepreneurs have faced rapidly escalating healthcare coverage costs. It’s unsustainable.
Many small businesses are faced with the tough decision of foregoing health insurance all together. Decent enables small businesses and entrepreneurs to band together and self-insure, using a similar structure that large companies have been leveraging for years to drive down the cost of their premiums. We do this by grouping small businesses in similar industries and offering ACA-compliant health plans up to 40 percent lower than currently available options for small businesses. We also do this by incentivizing primary care – all of our plans include unlimited free primary care via the direct primary care (DPC) model.
Our plans have a net promoter score (NPS) of 79, vs. the industry average of 14. Most Americans hate their health insurance more than everything but TV and internet services. It’s because we pay a lot for what we get. We deserve something better. We deserve decent health insurance.
I believe that healthcare should be affordable for everyone, that compassionate primary care is at the heart of effective health systems, and that all positive change in healthcare comes from aligning with the patient.
What Is Your Background? What Led You To Starting Your Own Company, And How Did You Choose This Space?
I’m the only member of my family who is not a doctor. My parents are primary care doctors turned executives. My dad was the Chief Medical Executive of a large HMO when I was 14 and he came home and told my family over dinner, “I just don’t think my counterpart on the insurance side of our business cares about the patients.” I watched as they became less and less happy with their jobs as the influence of big insurance took over patient care.
Past that, one of the reasons I’m alive and well today is because I had good health insurance, which is why I value it so much. In 2009, while attending Harvard Business School, I became paralyzed. This was caused by Guillain-Barré Syndrome, a condition that arrests your nervous system so your body can't take signals from your brain. I was in intensive care for four months and rehab for another six. I could see, hear, and think clearly, but I couldn't feel anything or move. The experience changed my career pathway. Instead of starting my own business, like many of my friends, I chose a more traditional career route joining the Amazon Kindle team. They had great health care coverage! Eventually, I grew eager to launch something of my own. After graduating from Techstars Seattle, I founded a social app called Reveal Chat, which was sold to Napster in 2015. After that, I led growth at Gusto, a payroll and health benefits software company. It was during these years that I got my first taste of how expensive health insurance is for small business owners and self-employed individuals. While I was self-employed, at times, my family of four was paying more for health insurance than for anything else in our budget — including rent in the Bay Area. It felt wrong, and it is.
Why was something this important (health insurance) out of reach for the huge percent of America that owns a small business or works for a small business? That’s what led me to start Decent.
What Was The Inspiration Behind The Company Name?
We all deserve decent health insurance — coverage that is affordable and offers the basics of what we need. FDR's Second Bill of Rights was also a major inspiration for the name Decent.
What Have Been Both Your Favorite And Least-liked Parts Of Your Entrepreneurial Journey? What Have Been Your Most Challenging And Most Exciting Moments For You And The Company?
The best part of the journey is when you’re able to delight customers and give them something better than what they’ve had before. The most challenging part is when circumstances beyond our control prevent you from serving the people you want to serve. Decent initially launched to serve self-employed people, and we were on track to have thousands of members on the first of this year when the Texas Department of Insurance let us know that due to the unresolved status of an ongoing federal court case from 2018 that does not involve us, we needed to stop serving self-employed people without employees at the end of the year. We got a lot of letters from members who were unhappy to lose Decent coverage, which inspired my team to keep fighting and to launch successful new plans for small businesses. I wrote about this experience and included some member letters here.
What Was The Fundraising Process Like For You? Tell Us About Your Investors And What You Use The Money You’ve Raised For.
Fundraising isn’t easy, but it can be fun when you’re confident in what you’ve got. We actually raised our Series A near the start of the pandemic, which amped up the difficulty a bit. We’ve been lucky to have great investors – strong VCs including QED and Foundation Capital, who have led our rounds so far, and smart values-aligned angels. You can read more about Series A in the press release here – we had some fun with it.
Can You Tell Us About Some Of Your Numbers? How Has Growth Been Over The Last Year?
I can’t share specific numbers, but we’ve proven that we can grow the business very quickly. It’s not easy to break into the health insurance space when you have zero brand recognition. Our premiums are well below big insurance companies and people often ask, “what’s the catch?”. But we won them over. I’m enormously proud that after our first year, our members gave us a Net Promoter Score of 79 in an industry that averages 14. (The bar was low but we soared over it.)
Decent is in some uncharted territory when it comes to how much our members love their health insurance and we’re only getting started. In addition to rolling out for small businesses, we have expanded Texas-wide. We're not just gearing up to be here next year, we're thinking through how we can continue to make health insurance more and more affordable to those in Texas and beyond for the next several decades.
What Are Some Of The Regulatory Obstacles You’ve Had To Overcome In Launching And Scaling Decent?
I knew we would have many hurdles to overcome in the health insurance industry. My parents are primary care physicians and so I grew up hearing about the challenges at the dinner table. Everything (literally everything) is complicated in health insurance. Just recently we heard that Haven, the venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase that aimed to disrupt health insurance is disbanding less than three years after it launched. It’s a really tough industry to be in even for the massive companies. But the need and impact are enormous.
Decent right now is small and nimble, which is an advantage when striking new ground. Initially we launched in Austin, Texas serving self-employed individuals and then expanded last year to all of Texas including small businesses. However, due to a recent regulatory hurdle, we are no longer allowed to cover self-employed for 2021 — something that we’re working to make happen for 2022. While often it’s felt like a Texas two-step — two steps forward, one step back — I know we’re making progress by the feedback we’re getting every day from our members.
How Do You Think Your Industry Will Change Post-COVID?
Has health insurance ever been more important than in a public health pandemic? Yet, due to COVID and the economic uncertainty so many industries, so many companies will need to cut costs and possibly cut health benefits. Small businesses need more affordable options to offer healthcare benefits to employees.
There have been some silver linings too. Virtual health has never been so widely accepted, largely due to the pandemic. When we launched (a year before COVID), one of the products we offered was a virtual health plan – which allowed members to have a dedicated direct primary physician whom they connected with virtually for an extra monthly savings. This plan option is getting a lot more interest these days.
What Are Your Daily Routines? Walk Us Through Your Typical Workday Schedule.
My wife and I have two young boys at home – ages 7 and 4 – so I wake up almost every morning between 5:30 and 6:30 to the little one climbing into our bed. I get up and make sure the boys are in good shape and start work. I love my team and feel really inspired by what we have to do, so I’ll usually keep working until 6 or so when I’m on the hook to help with the boys for dinner, sometimes a quick hot tub, and bedtime. I used to work more after dinner but I’ve been trying to tone that down – I actually use an iOS app called Downtime on my phone to disable most internet apps after 8PM, which has helped. Sometimes I read or play Scrabble or have a glass of wine with my wife. I go to bed between 10 and midnight most nights.
What Are The Most Important Skills A Modern Day Entrepreneur Needs In Order To Be Successful? What Advice Do You Have For Entrepreneurs Who Are Just Starting Out?
I agree with the venture capitalist Fred Wilson that a CEO has three jobs: tell the story, hire and retain the best people, and keep enough money in the bank. I think the 3 skills that map well do all of those jobs are persuasion, empathy, and relentlessness. So my advice to entrepreneurs who are just starting out is that persuasion can be learned over time, so focus on being empathetic and relentless.
Tell Us A Story Of Something That Happened To You, Something You Heard, Or Something You Saw, That Either Made You Laugh Or Taught You An Important Lesson.
My sons are both willful. The older one gets focused on what he’s doing and he cannot be budged for anything. I was complaining to my wife about it and she just started laughing at me and I realized he gets it from me. So that made me laugh and taught me a lesson. And I’m not sure I could change if I wanted to, so now I guess I just feel proud of him.
If You Can Have A One-Hour Meeting With Someone Famous Who Is Alive, Who Would It Be And Why?
I’d like to sit down with Bill Gates. He’s thoughtful and willful, and I’d love to work through the mess of U.S. healthcare from first principles with him. I’m sure I’d learn a lot, both from what he knows and from how he thinks. (It would be our second conversation – I met him briefly years ago at 1AM in the line to Dick’s Burgers in Seattle. My friend offered to buy his burger but he told us he was all good.)
What Is Your Favorite Quote And Why Does It Resonate With You?
I want to help solve big problems for people. Improving healthcare is a worthy challenge. I agree with the Austrian poet Rainer Maria Rilke who wrote “The purpose of life is to be defeated by greater and greater things,” and the Australian race car driver Peter Brock who said “Bite off more than you can chew, and then chew like hell.”
Who Is Your Role Model?
My parents. I really admire them and it’s hard not to be biased while talking about them, but hey. They were both family practice doctors for 30 years before going into medical leadership, and my dad retired as the Chief Medical Executive of Group Health, a 600,000 member integrated delivery system in the Pacific Northwest that was acquired last year by Kaiser Permanente. Group Health had a hospital and doctor side (which my dad led) as well as an insurance side, and I grew up aware of the tensions between the sides.
What Are Your Top Three Books You Recommend?
1. The Gift, by Hafiz
2. The River Why, by David James Duncan
3. The Feeling Good Handbook, by David D. Burns
What Does Success Mean To You?
I was just talking with my wife about this. On a personal level, going into the grocery store and being able to get whatever groceries we want without thinking too much about the cost. And we’re pretty much there. Externally, I want to build a business that helps a billion people. And I’m very bullish about where we’re going at Decent, but we’re nowhere close to that yet.
