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Building a Network of Care

March 6, 2009
San Francisco Business Times

SAN FRANCISCO—Bruce Bronzan and Afshin Khosravi got together in 2000 to pursue a common goal — helping people make sense of the myriad government-sponsored programs geared toward aging and long-term medical care.

The project had been something of a passion for the pair — Bronzan was a former state legislator who had become interested in health issues and Khosravi had been building web sites for nonprofit organizations — but as they started Trilogy Integrated Resources in 2001, it became personal. Bronzan’s mother was diagnosed with Alzheimer’s and Khosravi’s father had a fall and became paraplegic.

“When it hit personally, it made it different. Now we were trying to figure out how to make these things work for our own families,” Bronzan said.

Together with Alameda County, which had gotten a $2.5 million grant from the State of California, the pair made a web portal collecting information on the more than 1,000 agencies with more than 100 different funding streams in one place.

Fast-forward eight years and now the pair’s San Rafael-based company runs web sites for more than 400 counties in 30 states through their web portal, Trilogy IR has expanded to cover mental/behavioral health, children and families, developmental disabilities, domestic violence, public health and probation services, in addition to the aging and long-term care. The company has 28 employees.

The sites allow patients to look up exactly what services they qualify for and find the contact information and addresses for the doctors and case managers they would need to reach. Patients can also look up medication to see the conditions they target as well as the side effects, store their own medical records electronically and contact legislators or other government officials to lobby for more coverage.

The company’s growth has translated to its finances. Trilogy IR’s revenue grew 76 percent from 2006 to 2008 to $5.8 million, and the founders say they’ve been profitable for nearly all of Trilogy IR’s existence.

The company charges counties a setup fee and then a monthly fee. The fees are calculated based on the county’s population — a setup fee can start as low as $5,000 and rise to as much as $100,000 (for Los Angeles County, the country’s most populous). The monthly fees range from $500 to $10,000, again depending on population.

But Bronzan and Khosravi consider the sites a huge bargain since they provide services that would cost much more time and money if the counties were to go it alone.

‘Incredible resource’

Plus, the counties are not hosting the sites, nor are they maintaining them, which means they don’t have to incur the server and IT maintenance fees.

Mark Refowitz, behavioral health director for Orange County, was the mental health director for San Diego County when it was the pilot county for Trilogy IR’s first mental/behavioral health site. He now uses the sites in Orange County and says that Trilogy provides a necessary service at a modest price.

“For such low cost it’s an incredible resource that you can provide to your community. It’s the one place where you can find everything,” he said.

Refowitz said that even in a time of deficits and layoffs, he will keep the service because it’s become important, not just for the patients, but also for the doctors and case managers.

“My medical director, who’s also an emergency room psychiatrist, talks to me all the time about when he’s sitting with a family in a crisis situation he’ll pull up the site and give them a listing of program choices,” he said. “Originally we thought it was just going to be clients.”

But that’s one of the big challenges facing TrilogyIR. It’s going to be tough to continue to grow while counties have no money to spend. But some of the company’s current moves might help insulate it from the economy. The company is launching a site for veterans, particularly veterans coming back from Iraq and Afghanistan. Bronzan said that the move is gaining national attention, and it has another benefit since veterans programs have different sources of funding than other medical programs.

Question of outside investors

But the attention is bringing up another problem for TrilogyIR — whether to take on outside investors. Bronzan said that if enough counties express interest in launching a networkofcare site, the company may not be able to scale up quickly enough without quick access to cash.

The company was funded originally by the two founders, and they were able to launch their first site because of the grant Alameda County got from the state. The founders have until now eschewed venture capital or other outside investment because they wanted to make sure their vision for the company was not tainted — they take no advertising, for example. But now that they are in a more stable financial condition, the founders said they would consider outside investment if it becomes absolutely necessary.

But until then, TrilogyIR continues to grow. They’ve added three employees over the past three months, and they plan to add six more in 2009.