We have a vision of fixing healthcare through an innovative company ecosystem that separates product innovation and healthcare risk financing.
We know healthcare in the U.S. is broken. Over the last 15 years, health insurance costs have increased more than 200% while our personal income is up only 57%. Six out of ten adults in the country have a chronic disease, with four in ten having two or more chronic conditions. All of the leading causes of death and disability – heart disease, cancer, chronic lung disease, stroke, Alzheimer’s disease, diabetes and chronic kidney disease – can be prevented or managed.
We believe our company ecosystem specialization creates better focus on providing sustainable and innovative solutions for employers and their employees by curating health benefits packages that are optimized for both quality and cost, as well as enabling a self-insured financing platform that puts financial controls in front of employers.
Exponential change is coming to health care for employers. New business models are emerging that focus on consumer-centric care to drive improvements in the well-being of employees and dependents (“Members”). Members today interact with the health system only when they are sick or injured. Hospital care makes up about one-third of all current spending and chronic illnesses are tied to over 80% of hospital admissions.
The future of health will revolve around Member engagement, prevention and personalized, timely, affordable and high value care when needed. More health spend will be devoted to sustaining well-being and preventing illness while less will be tied to assessing conditions and treating illness. This shift will result in fewer and less severe diseases and a reduction in health care spending. In addition, new technology including sensors, wearable devices and health education and tracking apps will allow Members to assess and manage their health in real time.
PROBLEMS WORTH SOLVING
Health care for employers, particularly small and mid-sized firms, is plagued by several key problems.
Many small employers cannot afford to provide health benefits to their employees. When health benefit plans are offered, escalating health care premium costs reduce company profits. And increases in employee annual deductibles and co-pays are discouraging work forces from seeking appropriate care. Moreover, in the last 10 years, average family premiums have increased 55%, twice as fast as workers’ earnings (26%) and three times as fast as inflation (17%).
Health care quality has become a bigger issue than ever before, now the third leading cause of death in America. Inaccurate diagnoses, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices and/or providers who lack adequate training and expertise result in needless suffering, disability and death.
The market need for a solution to these problems is huge. There are 30,200,000 small businesses in the U.S., representing 99% of all employers and totaling 58,900,000 employees or 47% of all employees in the country.
Employers who do provide health benefit plans are forced to offer plans that are very expensive and/or provide minimal health coverage. As a result, a substantial number of employees don’t enroll in those plans. Or the employees sign up for coverage but can’t afford to add the rest of the family because the expense is too high.
ComplexityMembers are ineffective at navigating through the maze of services, providers and prices, leading to misuse of provider
services and excessive costs. Most don’t have the tools, knowledge and coaching to shop for high quality, less expensive services.
Create high quality, self-insured health benefits solutions for employers that are markedly less expensive than the competition. Prevention and personalized advocacy for every Member helps guide them away from unnecessary procedures and expensive providers to lower cost, higher quality care.
- A smart phone and tablet application that gives Members immediate access to plan benefits and service firms
- Self-insured stand-alone benefit plan for smaller employers
- Preventive services and primary care physician (“PCP”) visits covered at no cost to Members
- Captive Insurance to ensure the integrity and availability of aggregate paid in claims funds
- 24/7 Member access to experienced advocacy coaches for:
- Assistance with PCP selection and scheduling PCP/other provider visits;
- Understanding treatment options, provider choices and how to navigate the health care system;
- Providing behavioral health support, affecting nearly 1 in 5 Americans;
- Using Healthcare Bluebook online price/quality tools to find high value providers
- Coverage of telehealth at no Member expense for online, non-emergency medical consultations that don’t require visits to hospital emergency rooms, urgent care centers or physician offices
- Easy Member access to nurse care managers for timely and cost-effective treatment of complex, costly and/or high technology services
- Transparent pharmacy benefits with significantly reduced cost for Members
- Pricing for health benefits is expected to be below competing insurers and third-party administrators