Self-funded employers operate their own health insurance plans to provide coverage for their employees and families. The employer is the actual insurer. Over 100 MILLION people are covered under these types of plans.
Self-funded plans need providers to deliver care to their employees. Because most employers are not in the health insurance business, they typically lease a provider network from a third-party. In this model, there is no direct relationship between the employer and the provider.
A firewall exists between employers and providers, leaving no path for constructive collaboration to increase efficiency and lower costs
Employers have no say in provider network participation or the ability to interact directly with providers
Network vendors stand in the middle and often hide behind non-audit provisions in their contracts with both providers and employers
Employers are reducing healthcare costs by 20-30% by self-funding. The problem is that there is only one option for contracting with a large group of providers–leasing the network from an insurance company.
The provider network is the most important piece of a healthcare plan. Leasing one not only turns it into an afterthought, but introduces additional problems.
Employers are left with no control over the quality of providers in the network.
Employers who rely on leased provider networks often pay over 20% more than those who don’t
If you have an employee working in a different city, you often need to lease a second network from a different insurance provider.
Providers are incentivized to provide a higher level of care and employees receive much greater coverage.
Direct contracting can eliminate the need to lease a provider network.
However, scalability has been an issue –until we created Apaly Health.
We are not a provider network vendor.
We help to eliminate the need for a provider network.
Our software enables hospitals, doctor groups, all types of healthcare providers, and self-funded employers to connect and directly contract with each other.
We streamlined the process of making sure that agreed upon contracted rates are followed. This helps employers pay less, while providers make more and get paid quicker.
We are not in the healthcare contract negotiation / pricing business, but we created the software tool that enables providers and self-funded employers do this with ease.
We wanted to make sure that the HR folks weren't bombarded by employee distress calls, so we designed the software to support an experience that feels similar (only much, much better).
Hospitals and doctors are able to leverage the Apaly Health software to support their direct to employer initiatives. We are excited that our creation can help bring communities together this way.
Connecting is key.
Create your account & self-funded employer profile, and then enter the hospitals, doctors, and other healthcare providers with whom you want to connect & contract.
Our tool makes it easy.
There are several different types of contracts that you can choose from, each with different rate types. The software will help you decide what rate makes sense for you.
Receive care & save.
Your employees and families can visit any hospitals or doctors who are connected & contracted. The agreed upon contract rate will always apply - NO balance billing.
Lowering costs, enhancing quality, and improving the health and wellbeing of employees are goals for all self-funded employers. Apaly Health is an innovative, cutting edge solution that manages to balance these sometimes conflicting priorities.
Innovation is a daily topic in healthcare, but very few are focused on the core issue of healthcare, provider networks. Similar to the hotel industry, there are many locations to receive services but they fall under a handful of controllers, the large insurance companies. Disintermediating this design, similar to VRBO or Airbnb in the hospitality industry, has the ability to return healthcare to a free market design resulting in lower cost and better outcomes. Apaly Health is the only solution I have seen with a turn-key solution to enact the disruption needed to make this a reality.
Direct contracting is the wave of the future, and direct contracting with providers has been shown to save employers sometimes 75% or more. Apaly Health scales direct contracting to a national level, and can extend this value to the masses allowing the disintermediation of the middlemen in our current, archaic healthcare system. Apaly Health should be an essential cost containment / risk mitigation component in any health plan that utilizes high-performance healthcare solutions like our FairCo$t Health Plan.
Apaly Health makes direct contracting scalable by enabling many-to-many relationships between employers and providers. Every provider or employer that signs up, can deliver or receive healthcare services with everyone else on the platform. It’s like crowdsourcing provider access to benefit everyone.
“Apaly Health has created a simple and seamless solution that allows physicians (and other providers) to directly contract with self-funded employers, without any operational or practice work flow changes. It’s designed to feel just like any other payer relationship, except we get to set our own payment rates and get paid faster.”
Given the on-going shift towards self-funded employer health plans in the U.S., Apaly Health’s decentralized provider contracting platform seems to be a logical use case of blockchain technology. Disintermediating high cost gatekeepers through direct, peer-to-peer contracting between employers and providers is an ideal use case of the self-sovereign trust mechanism of blockchain technology.