PER THE KAISER FAMILY FOUNDATION, AVERAGE ANNUAL PREMIUMS FOR EMPLOYER-SPONSORED FAMILY HEALTH COVERAGE REACHED $19,616 THIS YEAR, UP AN ADDITIONAL 5% FROM LAST YEAR.
Employees paid an average $5,714 out of pocket in premiums alone. This outrageous cost for insurance, is hurting both employees and employer groups.
Unfortunately, for most organizations, these costs are projected to grow exponentially, with no end in sight.
Why are healthcare costs rising so quickly? Factors such as being overcharged by providers, hidden fees, exploitive processes, and many more, prey on the checkbooks of uninformed individuals and have driven up the bottom line of employer beneﬁt packages.
It’s no secret that the health insurance model is broken. Once well-intentioned, health insurance service has degraded into a fragmented, confusing labyrinth of bureaucracy. Recent surveys suggest that only 4% of Americans understand health insurance jargon which results in wasteful spending and frustrated members.
These frustrations have most employer groups shouting, “Enough is enough!” Mid-market employers (deﬁned as organizations with under 2,000 employees) are tired of being forced to oﬀer mediocre beneﬁts at an outlandish cost.
Luckily, there is an alternative: a high performance, self-funded beneﬁt program that focuses on employee engagement and navigation.
A BROKEN SYSTEM CALLS FOR AN INNOVATIVE SOLUTION
Think about the last time you needed medical services. Who did you turn to? Maybe you defaulted to a cursory online search of symptoms, which oﬀered results ranging from common cold to the plague. Was this approach helpful?
In the traditional health insurance model, there is no central point-of-contact to help individuals navigate the disjointed, confusing world of medicine.
That’s the problem - traditional health insurance does not oﬀer policyholders any level of individualized care. This lack of personalization often leads to employers overspending on coverage. Individuals in need of care ultimately bounce from doctor to doctor and rarely arrive at a solution in a timely or cost-eﬃcient manner.
This prevalent conﬂict was the impetus for the formation of Apta Health, which was created to improve engagement between individuals and health insurance carriers, deliver better care, and generate meaningful savings.
Apta Health is the ﬁrst fully integrated, mid-market Care Coordination model. It stands as an innovative alternative to the exploitive fully-insured system by oﬀering a comprehensive care coordination solution to mid-market employers that was previously only available to Fortune 500 companies.
Over a decade of research has gone into developing a healthcare model that is customized for the mid-sized market, and all indications show a need for greater personalization when it comes to healthcare. When was the last time you called your health insurance provider and left the conversation with a better understanding than when you ﬁrst called? Most people never experience this, since traditional insurance providers don’t oﬀer a central service center to ﬁeld policyholder questions.
For this reason, members typically avoid calling their insurance carrier, which leads to engagement levels with the insurance carrier at an embarrassingly low 2-7%. Policyholders are left to fend for themselves in the confusing world of healthcare, leaving individuals no choice but to throw money at doctor visits until a solution is uncovered. Research shows that 50% of patients are confused by their own healthcare beneﬁt plans.
Apta Health has designed a better way to approach healthcare, utilizing Care Coordination.
WHAT IS CARE COORDINATION AND WHY IS IT SO IMPORTANT?
Care Coordination is changing the paradigm of health insurance. In a nutshell, it is the ﬁrst line of defense in overspending on health coverage.
Care Coordination is a more compassionate approach to healthcare. Care Coordinators are individuals who have been expertly trained to proactively manage member needs with industry-leading customer service. We call them Healthcare Warriors, because they are constantly advocating for the health of the patient.
Care Coordination oﬀer a better way. By employing a more compassionate and proactive approach to healthcare, employees eliminate unnecessary medical costs and save time and money for themselves and their employers.
All member phone calls are routed directly to their personally assigned Care Coordinators, who work alongside a team of nurses, case managers, utilization management experts, health coaches, and disease management specialists. Anything related to health coverage is handled by Care Coordination including:
Treatment decisions based on estimated costs
Claims resolution advocacy
Conﬁrmation that members are using in-network or top-tier providers
Information on wellness incentives
Learning about lifestyle programs
Care Coordination leverages the power of empathy, support, and humanity to uncover savings at every step of the healthcare process. Employees receive expert guidance while navigating complex healthcare system. As a result, 60% of Apta Health members engage with Care Coordinators regularly. This percentage increases to 95% when it comes to healthcare costs greater than $10,000. This level of engagement is the reason Care Coordination is the premier cost containment strategy on the market.
HOW CARE COORDINATION PREVENTS HEALTHCARE COSTS FROM MOUNTING BEFORE THEY OCCUR
Saving on healthcare costs begins at the individual level. With the aid of Care Coordination, Apta Health members have access to resources that lead to smart and healthy choices - and healthy members lead to lower costs for employers.
Through health education, decision navigation, and patient advocacy oﬀered by Care Coordination, members are able to make lifestyle changes and avoid catastrophic healthcare costs.
Care Coordinators also discover and prevent redundant, delayed, and questionable treatment in real time. A study from the Institute of Medicine found that one-third of all healthcare spending ($750 billion) went to unnecessary services that did nothing to help patients. Real-Time Intercept® is Apta Health’s defense against unnecessary healthcare spending through immediate and relevant patient advocacy. Care Coordinators work with patients and their families, on a case-by-case basis, to help them receive the best customized care available and reduce employer healthcare spending.
Healthcare Warriors meet members where they are. Thanks to the My Care Coordinators app, members can access Care Coordination from mobile devices. Key, cost-saving features such as ﬁnding in-network providers, accessing ID cards, checking claims information, scheduling a call with a Care Coordinator, and more can be done from the intuitive and easy-to-use mobile app.
APTA HEALTH PAYS FOR ITSELF IN LONG-TERM SAVINGS
Employers have been led to believe they have no choice when it comes to employee beneﬁt packages. But, if you’re reading this, you already know the secret fully-insured insurance providers don’t want you to know - Apta Health is ﬂipping the insurance market on its head.
By leveraging the proven cost-savings potential of Care Coordination, along with other cutting-edge strategies, employers see long-term savings. Apta Health is committed to reversing the rising trend of healthcare costs and putting money back into the employer group’s pockets.
Improved transparency is a fundamental cost-savings measure implemented by Apta Health. Employers can access a predictive modeling engine to uncover recurring employee healthcare costs. This health intelligence platform allows groups to implement data-driven solutions to meet ﬁnancial objectives and prepare for the possibility of large claims.
APTA HEALTH IS PROVEN TO SAVE YOUR COMPANY MONEY
The numbers speak for themselves. One mid-sized moving and storage company saved over $200,000 in claims in its ﬁrst year with Apta Health! Thanks to Apta Health’s compassionate approach to healthcare, this company saw a signiﬁcant increase in member engagement, resulting in healthier and happier employees.
Increased member engagement correlated to a dramatic change in major healthcare cost drivers. In the ﬁrst year partnering with Apta Health, this company saw a large increase in preventative care and preventive visits. Similarly, they saw a major decrease in wasteful spending, including unnecessary outpatient and inpatient services.
This company, and countless other clients, stand as a testament to the cost-savings of transparency and how member engagement is bolstered through Apta Health’s innovative program. In our most recent independent actuarial validation, our model produced a 5.2% cost reduction in year 1, 10.8% by year 3, and 17.5% by year 5!
WHAT ARE YOU WAITING FOR?
Every minute constrained by traditional health insurance is costing you money. Employers have been overpaying for health coverage, but the good news is — you don’t have to anymore.
Apta Health oﬀers a better solution for mid-market employers. Moving to Apta Health isn’t just the smart thing to do, it’s the right thing to do for your employees and your bottom line.