Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs - Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs
EPISODE 70, 13th November 2020
In this episode, Michael introduces Mike Poelman, the founder and president of Apta Health. Although Mike started his career as an accountant and controller, he quickly realized that he was a salesman at heart so he shifted into the TPA world working on self-funded health plans. This is where he realized that things needed to be done differently. Mike saw that lack of transparency and collusion were the biggest problems in the industry, and legacy solutions simply weren’t designed to provide employers what they needed, which is what inspired him to create a number of companies, including Apta Health.
Apta Health aggregates middle market employer groups under one umbrella so they can benefit from care coordination and cost containment solutions that are typically only available to Fortune 500 size companies. This member centric approach allows more effective customer service, higher member engagement by a team of experts/advocates to reduce provider gaps, contain costs, and improve the member journey. In fact, 88% of employees engage with a care coordinator even before a claim enters the system, which is unheard of in the industry.
The team at Apta Health has an NPS rating of over 70 for their members, employers, and providers because of their attention to the customer experience first and the TPA second. Apta Health has an exciting future ahead. They’ve recently won the 2020 Health Value Award from the Validation Institute and look forward to continuing their use of analytics and data to empower brokers and employer groups to make easy, cost-effective decisions.
Here’s a glance at what we discuss in this episode:
00:45 - Introducing Mike, the founder and president of Apta Health, who is passionate about providing self-insured solutions.
01:05 - Apta Health is a provider of care coordination and cost-containment solutions to optimize self-funded healthcare programs.
02:30 - He started as an accountant and controller but is a salesman at heart; when he first started in the industry, all he had was a phone book and phone.
04:05 - He didn’t intend to be a part of a TPA but he knew he wanted to change things by looking from an employer standpoint first.
04:40 - He started Novo Benefits, a platform where employers are empowered to get direct contacts and unbundle their programs.
05:30 - They’ve evolved into an aggregator with Apta Health; they are changing the industry and empowering employer groups.
06:50 - The key issues in the healthcare industry: transparency and collusion.
09:00 - What Apta Health does: They aggregate employer groups under one umbrella so they can benefit from large group level pricing, solutions, and engagement.
10:36 - They offer Fortune 500-level engagement to the underserved middle-market.
11:00 - The Quantum care coordination model and how it’s different: more effective disease management, better execution, and functionalities done by one pod.
12:30 - Apta is a conglomerate of solutions; they’re getting 200% better engagement
13:50 - The member journey, reduce provider gaps, drive the member experience, and get results and better engagement.
15:47 - A team of experts/nurses help guide and navigate patients through disease management to get them what they need, not just verify coverage.
17:25 - The pod team helps members find more cost-effective solutions they may not know about and create a trusting relationship with members.
21:15 - Stories of above-and-beyond service from the team that is fighting for the member.
22:35 - Deep analytics helps decide what’s best for groups, they use quality metrics, point solutions drive what needs to happen, and an easy number to reach support.
25:15 - Their PCP-centric model helped them avoid wasteful spending; the real-time intercept helps direct members and helps them avoid unnecessary tests.
28:00 - Mike shares his experience with his daughter to illustrate how a navigator can help you avoid certain costs and redundancies.
30:05 - 88% of employees are engaged with real-time intercept/ a care coordinator before claims come into the system - this is unheard of in the industry.
31:20 - They promote preventative care and have a care coordinator review paperwork and post-discharge instructions to ensure accuracy.
35:00 - On tracking the consumer experience (The Net Promoter Score): They track the member, employer, and provider and are above 70 across the board.
36:20 - On integrating with a TPA and expanding into other areas; they have something in every category now.
38:05 - The customer experience is first and the TPA is second.
38:45 - Independent analysis shows a 2.9% compounded annual growth rate (compared to the industry 8.5%).
39:25 - Rough point solutions drive book-of-business cost reductions across the board.
40:28 - Medical and Rx analytics were sent to the Validation Institute for the Health Value Awards.
41:40 - Other main point solutions of the platform: They have over a dozen that people look to, like Quantum, NavRx, second opinions, and cash pay.
44:00 - Fraud waste and abuse: They have trust accounts to get money back to employer groups.
46:35 - The fee structure: A discounted PMPM from Quantum converted to a PEPM.
47:10 - Obstacles: The employers say yes more often than the brokers; the biggest thing to overcome is the cost component.
49:05 - The future of Apta Health: Analytics, data, point-and-click things are coming to empower brokers and employer groups to make easy decisions.