Direct Contracting on a National Scale
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Self-funded employers operate their own health insurance plans to provide coverage for their employees and families. The employer is the actual insurer.
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.
The best alternative to leasing a network is direct contracting.
However, it's been impossible to scale –until we created Apaly Health.
Apaly Health enables many-to-many direct contracting relationships between self-funded employers and providers, on a national scale. Employers and providers can sign up, enter their own contract rates, and instantly deliver or receive healthcare services.
We are bringing direct contracting mainstream by turning the employer-provider relationship into an active mechanism to support quality and collaboration.
Our platform automates claim processing and reduces administrative costs and payment times.
Providers and employers enter the rates they're willing to accept or pay, and Apaly's price matching algorithm does the rest.
We purposely designed Apaly Health to feel a lot like a traditional network to employers, employees, and providers so that there is zero disruption for anyone.
Providers are incentivized to deliver a higher level of care with direct accountability through a collaborative relationship with the employer.
It's simple.
Create your account, input the employer's health plan information, and we'll do the work to make sure your employees' providers are available on the platform.
We'll guide you.
Before you commit to any contracts, Apaly displays the in-network coverage you should achieve based on the rates entered. You decide what makes sense.
Receive care & save.
After contracting, plan members can visit any participating provider who is price-matched, regardless of location. The contract rate will always apply, with no balance billing.
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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.
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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 platform I see 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’s blockchain technology platform is 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, is instantly available to deliver or receive healthcare services with everyone else on the platform. It’s like crowdsourcing the provider network to benefit everyone.
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.
“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.”
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