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Apaly Health: A new approach to better employee health

According to the Kaiser Family Foundation, approximately 100 million lives in the United States are covered under self-funded employer healthcare plans

Photo by RDNE Stock project on Pexels
Photo by RDNE Stock project on Pexels

Opinions expressed by Digital Journal contributors are their own.

According to the Kaiser Family Foundation, approximately 100 million lives in the United States are covered under self-funded employer healthcare plans, and these employers spend over $1 trillion annually on healthcare for their employees and families. This makes employers the largest category of payer of healthcare services in the country, and healthcare coverage typically represents their second largest expense beyond employee salaries. By operating their own health insurance plans, these employers directly assume the financial risk. They tailor benefit design to best serve their plan member’s needs, to keep them healthy and happy, with a focus on delivering high-quality care at the best rates possible.

Human resource staff face many challenges when operating their employer health plans. In today’s world of provider shortages (which, according to the American Medical Association, is only going to get worse) and corporate consolidation of medicine (according to the Physician Advocacy Institute, over 70% of providers are now employed by larger organizations), delivering ubiquitous and equitable access to high-quality care, along with continuing to demonstrate their efforts to reduce costs and serve as the health plan’s financial fiduciary, are a couple of their major issues.

A relatively new and growing segment of the healthcare industry inherently helps address these issues. It’s called Advanced Primary Care or APC. Many primary care providers have gotten fed up with the old way of doing things. They no longer want to operate on a fee-for-service basis, which includes seeing a patient, submitting a medical billing claim and waiting to get paid from the insurance company, having to maintain a panel of over 2,500 patients, seeing over twenty patients a day to make ends meet, and only being able to spend a few minutes with each. They are making a change to the new form of primary care – APC. 

With APC, providers are paid a per-member-per-month (PMPM) subscription, limit their panel to around 800 patients, and typically spend thirty to sixty minutes with each patient. They are able to form a very close relationship with their patients, which many patients describe as “like having a doctor in the family.” The APC model addresses the care access challenges faced by self-funded employer health plans through same-day or next-day appointments, as well as around-the-clock access to a personal provider. By spending much more time with their patients and getting to know them on a deeper level, as well as practicing at the top of their license and making fewer referrals, APC providers typically reduce ER visits by 54%, hospital admissions by 25%, and overall plan costs by over 13% (American Journal of Lifestyle Medicine 2021 report). These cost reductions, along with the fixed PMPM charge, help address the other issue for human resource staff related to demonstrating their plan fiduciary responsibilities.

Although local employers with employees and families that live within a concentrated geographical area can usually directly partner with a local APC provider, this is not possible for regional or national employers. There simply isn’t any one single APC provider that has a large enough nationwide presence on its own to enable wide-scale regional or nationwide coverage. This is one problem a software platform built by Apaly Health is helping with.

Apaly Health has built a digital direct healthcare technology platform designed to make it simple for organizations to create and operate their own Advanced Primary Care (APC) solutions to directly connect employees and families of self-funded employers with APC healthcare providers on a national scale. “The tremendous benefit delivered by APC providers continues to be appreciated,” says Founder and CEO of Apaly, Dr. Jerry Beinhauer, “We are excited to help bring APC to so many lives through our solution partners, who utilize our platform to deliver their own white-labeled APC offerings to their employer clients. We have been experiencing an ever-growing number of third-party administrators (TPAs), healthcare benefit consulting firms, associations, cooperatives, captives, stop-loss carriers, and even individual start-up organizations, who recognize the value of APC for not only their employer client’s overall health plan but most importantly for the health and wellness of their employees and families.”

The platform supports direct nationwide access to participating APC providers to mitigate this issue of limited healthcare provider accessibility effectively. Employees and their families can receive timely and comprehensive care with same-day or next-day appointments, circumventing long wait times. Moreover, facilitating these direct relationships between large employer families and APC providers plays a pivotal role in cost reduction for employer health plans.

This unique marketplace model has led to a surge in inquiries from various organizations eager to establish their presence on the platform. Rather than viewing Apaly as a competitor, companies can recognize it as an invaluable tool for expanding their reach and enhancing their service offerings.

Dr. Beinhauer explains, “The different organizations we’re onboarding create and operate their own APC offering that enables them to easily deliver this valuable benefit to their employer clients. Apaly doesn’t directly sell to employers. Our platform makes it possible for other organizations to do that. This approach ensures we remain a facilitator rather than a competitor to our solution partners who collaborate with us. In essence, we are providing a turn-key approach for organizations to integrate APC into their employer client’s health plans.”

Overall, Apaly offers employers a comprehensive solution for delivering advanced primary care services. This solution ultimately improves access, reduces costs, and enhances the quality of healthcare for employees and their families. The platform’s scalability suggests potential expansion into smaller markets, benefiting a broader range of businesses and ultimately contributing to the health and satisfaction of employees across various industries. To learn more about the platform, visit apaly.com

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Written By

Jon Stojan is a professional writer based in Wisconsin. He guides editorial teams consisting of writers across the US to help them become more skilled and diverse writers. In his free time he enjoys spending time with his wife and children.

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