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The Future of Healthcare is Digital — and It’s Being Fast-Tracked by COVID

The Future of Healthcare is Digital — and It’s Being Fast-Tracked by COVID 1200 600 Apostrophe Health

Virtual health care is meeting critical needs now, and will be essential to patient care during the national recovery and beyond.

There’s a constant hum around all the ways the healthcare industry needs to improve and shift. COVID-19 has been the catalyst needed to accelerate that change overnight. There’s no more waiting. The time to accept and embrace innovation is here.

Digital health care services, like telemedicine and virtual primary care, were thrust onto the frontlines of the pandemic battle. What has seen slow adoption in recent years is now gilded as essential, and will continue to play a critical role in the recovery of our overtaxed health systems.

“The social and medical practices that are happening in response to COVID-19 will remain in place when the crisis eventually subsides,” reported Eric Topol, MD, a highly regarded cardiologist and medical author. “Telemedicine will play the role of the first consultation, akin to the house-call of yore,” for a long time to come.

It will be impossible to return to normal once this has all resolved. Who would want to? The healthcare system is broken and hasn’t worked for far too long. The deficits have never been more conspicuous:

  • Trillions of dollars in overspending and unnecessary treatment
  • Out of control health care costs that increase annually, while benefits get worse
  • Complicated access to the right kind of care when it’s needed
  • A system designed to put the interests of legacy insurance companies first, not patients 

If it all seems too expensive now, wait until next year when we see the true economic fallout of the pandemic. In 2021, some are projecting as much as a 40% spike in premiums from legacy health insurance carriers. That’s a dire warning from California’s Affordable Care Act marketplace that also cautioned:

  • Increased out-of-pocket expenses for employees
  • Employers drop or reduce coverage
  • Employers shift more of the cost-share burden to employees

For as much as this is breaking our norms, finances and even spirits in the moment, employers who can embrace drastic change now are primed to fare far better on the other side.

Most companies admit that their health plan does not maximize value nor deliver truly modern benefits, per a 2019-2020 Benefit Trends Survey from via Willis Towers Watson. This is your chance to take decisive action with your company’s benefits plan and budget. 

The telehealth and virtual health care services popularized in this moment will be the saving grace of the entire industry when it’s time to repair itself. Hospitals, health systems and private practice providers will face a period of recovery.

Digital health services, as we describe below, will be:

  • Called upon to bridge the gap
  • More cost-effective, efficient and accessible
  • The new standard

TELEMEDICINE AND TELEHEALTH

“Out of every crisis, a new opportunity arises. For telehealth, it may be an opportunity whose time has finally come,” wrote Paddy Padmanabhan, author of The Big Unlock Harnessing Data and Growing Digital Health Businesses in a Value-based Care era. 

Adoption rates for telemedicine have been about 2% nationally, but Padmanabhan cited increases of 500% since coronavirus arrived.

Now that everyone’s gotten a crash course in this alternative to urgent care, we expect to see engagement continue to replace costly in-person visits.

Employers should champion this. One case study cited a company saved $6 for every $1 spent on telemedicine.

VIRTUAL PRIMARY CARE

Where telemedicine is a virtual replacement for urgent care, VPC virtually replaces the primary care office. The low or zero-dollar copays eliminate the barrier to entry, and reduce costs for employers and employees alike. For annual physicals, chronic care and disease management and self-care combined, VPC poses “an economic value of approximately $10 billion annually across the U.S. health system over the next few years.”

The on-demand availability by instant chat, video, or telephone eliminates days of waiting for appointments. Patients can see a doctor right now about any little or big concern they have. These physicians can diagnose and manage about 95% of conditions seen in-office, and can diagnose and treat about 70% of primary care health concerns (without an in-person referral).

We expect patient consumers to become much more familiar and comfortable with this method of care and standardize it going forward.

VIRTUAL PHYSICAL THERAPY

SHRM calls tele-rehab the sweet spot of telemedicine, and lauds it as a lower-cost, higher-satisfaction alternative to in-person physical therapy. Through technology as simple as Skype and as novel as 3D motion-capture, therapists can work with patients remotely and achieve positive results. 

A 2020 large employer healthcare survey found that 85% of employers ranked musculoskeletal issues as a top-three condition with the biggest impact on their costs. And a 2019 study by orthopaedic surgeons found that post-surgical tele-rehab services saved a minimum of $1,000 per patient.

VIRTUAL BEHAVIORAL HEALTH

Another sweet spot in telemedicine is virtual behavioral or mental health services. Patients use video conferencing tools from their own couch to speak with an on-demand therapist or to establish recurring therapy. Studies have found it to be just as effective as face-to-face meetings with lower attrition rates. 

Especially amongst millennials (now in their early 20s to late 30s), instances of anxiety, depression and other mental health issues have never been so high. As Americans cope with the current quarantine, and in time grapple with the emotional and economic ramifications, remote access to mental health may become the rule, not the exception.

Teletherapy apps, like that of our partner MeMD, have completely disrupted a decades-old practice in the best way. Virtual behavioral health will continue to improve access to and reduce the stigma of this necessary healthcare service.

ASK THE TOUGH QUESTIONS TO GET AHEAD

How much access do you and your employees have right now to this modern suite of healthcare services? Do you have any idea how much it would cost if you did?

Rising healthcare costs are one of the greatest challenges facing 80% of employers in the next 36 months. The yet-to-be-seen ramifications of COVID-19 can’t ease those concerns.

Ask your advisor: How much will my premiums increase, and benefits value decrease, in 2021?

Are you comfortable with the answer?

You can stand by and wait to see what’s going to happen to you later this year or next. Or, you can decide it’s time for your company to take control of the cost, experience and quality of your health benefits plan and demand better benefits for less money.

Apostrophe is already way ahead of that curve for plan sponsors. Our Intelligent Health Benefits:

  • Simplify and improve the member experience with white glove Member Care
  • Provide a curated suite of virtual health care solutions 
  • Collaborate with a robust roster of partners to provide telehealth and flexible payment options
  • Advocate on behalf of our members for low- and $0 treatment options with high-quality providers
  • Make price transparency the standard ahead of a federal mandate


This pandemic will impact all of us in ways we still can’t know for sure. It will not, however, eliminate your ability to transform the most expensive line in your ledger.

COVID-19 Exposes the Breaking Point in America’s Dysfunctional Healthcare System

COVID-19 Exposes the Breaking Point in America’s Dysfunctional Healthcare System 2083 1041 Apostrophe Health

The coronavirus pandemic poses a financial threat to American families, one the legacy insurance industry designed and will benefit from.

Half of American households don’t have as much as $4,500 in their bank accounts. Which is why “most Americans are a bad stubbed toe away from financial ruin,” according to David Chase, co-founder of Health Rosetta.

Or, just one case of coronavirus. High deductibles, excessive copays and surprise billing can devastate a family financially, especially in the face of an unexpected illness.

The coronavirus pandemic (officially known as COVID-19) is exposing just how fundamentally broken the American healthcare system really is. Under the most expensive healthcare system in the world, a family with little discretionary funds would be hit hard by the $3,270 bill for coronavirus treatment a Miami man received last week.  

While the CDC is not billing for testing (that’s right, you won’t be charged for COVID-19 lab tests), related treatment expenses from hospital stays and medications won’t necessarily get the same free pass.

On March 11, President Trump said “leaders of [the] health insurance industry…have agreed to waive all co-payments for coronavirus treatments, extend insurance coverage to these treatments and to prevent surprise medical billing.”

However, that same night, a spokesperson for the major insurance lobby America’s Health Insurance Plans’ made an important clarification to Politico. They will only waive co-pays “For testing. Not for treatment.” This rare sign of decency from traditional carriers won’t play out exactly as the president described. AHIP said even less in their public statement, and didn’t address cost at all.

The decades-long effect of outrageous billing schemes from these legacy insurance companies has dangerous effects, which includes avoidance of care when people need it most.

No one should avoid testing or treatment, for coronavirus or any other ailment or disease, because they fear the unknown and potential financial setback from medical bills.

This is the problem with America’s broken healthcare system

NOW IS THE TIME FOR INTELLIGENT HEALTH BENEFITS

Most insured Americans are flying blind at each doctor, hospital or ER visit. There aren’t published rates, there’s not much clarity around who’s in network, and you’re at the mercy of the provider to run any lab or scan they see fit. It gets unnecessarily expensive very quickly. 

There’s enough panic around the outbreak without igniting fear over bankruptcy and financial ruin because someone in your family gets sick.  

Apostrophe’s direct-purchase model does away with the waste and helps self-insured employers control costs for better benefits for their team. We’re committed to:

  • Simplify the experience and billing process
  • Be transparent so members know what they’re spending and saving
  • Show our members love during the most routine or life-changing circumstances

This is how Apostrophe humanizes care for our members every day, especially now.

TELEMEDICINE AND VIRTUAL PRIMARY CARE

The CDC recommends avoiding crowds, limiting contact with those who are sick, and staying home as much as possible during the COVID-19 pandemic. They also recommend calling your doctor if you’re developing symptoms. This is exactly what telemedicine and VPC were designed for.

Apostrophe members get direct access to quality physician care without entering infected environments, protecting themselves and everyone else.

Using our 24/7 telemed partner MeMD or virtual primary care partner Sherpaa is especially beneficial for members in at-risk populations or with compromised immune systems. Avoid the waiting rooms altogether — they can assess symptoms, order lab work and call in prescriptions online or by phone.

PRESCRIPTIONS DELIVERED TO YOUR HOME

Groups using our pharmacy benefits have the advantage of having medications delivered to their door. Skip the lines — and potential crowds — at the corner drugstore.

NO NETWORK CONFUSION

Our members can see any provider who’s willing to accept Apostrophe. There are no confusing network rules and no out-of-network penalties.

WHITE GLOVE MEMBER CARE

If our members are feeling uncertain about the coronavirus situation, or have questions about COVID-19 treatment costs, they can always contact our market-leading Member Care team. Member Care will:

  • Help to navigate a bill and avoid overpaying
  • Explain what is covered under their health plan
  • Make sure they maximize their virtual care benefits 

We’ve known for a long time that the state of healthcare in America is at a breaking point, and the COVID-19 pandemic may push it to the limits. 

Especially during a global pandemic, we’re committed to putting our members first. We’d like to see the entire industry make necessary moves to do the same. 

Current Apostrophe Health members, Call Member Care at the number on your card for coverage questions.
Current and prospective self-insured employers, please visit our COVID-19 page for more information.

A Broken Leg, A Broken Healthcare System And A New Approach

A Broken Leg, A Broken Healthcare System And A New Approach 2500 1478 Apostrophe Health
Healthcare benefits advisor Matt Cole knows the industry inside and out, but he hadn’t personally experienced the system beyond a few minor treatments, the birth of his child and the standard wellness visit. That all changed when an unexpected and unsatisfying 4-day stay at the hospital made him wonder: How could this have gone differently?

From Soccer Game to Emergency Room

The day started as most do. I was up at 5 a.m. for a quick workout and then off to the races with meetings, emails and other appointments. It was a Thursday, which meant I would be meeting friends in the Detroit area for a game of soccer — and hopefully a delicious beer afterward.

On the field, everyone was enjoying themselves until a single play changed everything. Trying to telegraph a pass from the other team, I ended up tangled with another player who lost his footing. My leg was extended in an awkward position as I helped break his fall and everyone heard the snap. I thought maybe I just sprained an ankle, but it seemed everyone around me knew the injury was much more severe.

Fortunately, a friend was able to drive me to an emergency room near home. When we arrived, the staff placed me in a wheelchair. I spoke to a woman at the front desk and another took my insurance information. Then I sat for about 45 minutes before receiving medical attention.

As you can imagine, I was in some severe pain by this time, with what I would later find out was a broken tibia and fibula.

Treatment and Care Are Two Different Things

Finally, after a long wait, I was seen by the ER physician to determine if any time-sensitive issues needed to be treated right away. He gave the all-clear and I was sent to x-ray and admitted to the ER.

Let’s consider how long that process took: The injury had occurred around 5 p.m. on Thursday. Friday morning was fast approaching as I sat in a bed in the ER. Why the delay? The medical staff was waiting for the orthopedic specialists to review my records and determine the treatment course.

Late in the evening, I was told I was being discharged. I was relieved until the medical staff came in again to let me know that the orthopedic specialist finally had a chance to review my x-rays and determined that I would spend the night after all: My leg needed to be reset, and I had to be prepped for surgery the next day.

I was thrown off by the 180-degree change as much as the opioids and other pain meds I was given. On that note, much of my time spent in the hospital is a bit blurry. From what I can recall, here are some frustrating events that came up during my stay and treatment:

      • I had little say in my treatment plan. I recall several times asking to speak to medical staff on options, outcomes and best practices. I essentially was left with minimal explanation.
      • I wasn’t given multiple treatment options. Surgery was presented as the only course of treatment, and I wasn’t given any alternative options.
      • I didn’t know the recovery rate of my injury. Likewise, I wasn’t informed of any of the long-term side effects of such a traumatic injury.
    • Ididn’t have any information about my surgeon. Despite my med-induced fog, I was able to do some quick research about him and was relieved that he had extensive experience with the procedure.

I was getting the correct treatment (I could only assume) from a qualified expert (from what I could tell based on hasty research). Going in for surgery is scary enough. Getting emergency surgery without enough information, patient advocacy or presence of mind? That’s terrifying.

Based on that experience, I’d say I received treatment — but I can’t say I received quality care.

The Damage: Someone Could Have Bought a Mercedes Benz S-Class

I remember trying to go home Saturday evening because I was tired of being in the hospital. I felt okay enough to leave, but soon realized my pain levels were so low because of the nerve block the doctors gave me. Once that wore off, I was uncomfortable again. After a quick phone call with my wife, I decided to stay until Sunday.

In total, I entered the ER on Thursday, May 31 and was discharged Sunday, June 3. I was confident that my $7,000 out-of-pocket maximum was going to be met. The grand total for my 2018 medical expenses was $91,000!

Before this injury, I had seen the doctor for my annual wellness visit. That’s it. In less than 4 days, I accumulated tens of thousands of dollars in medical expenses.

When did treatment for a broken leg get this expensive? How is the average person supposed to recover both physically and financially from an injury that sets them back 6-12 months and over $7,000?

I am fortunate to have an employer who supported me throughout my recovery and someone who offers their employees great healthcare by today’s standards, but when this situation arose, it was a rude awakening to the flaws we have developed in our system.

The Aftermath: Dealing With Billing

The bills started to roll in before I made it home from the hospital. I knew they were going to be big, but I underestimated the number of invoices and their complexity. Surgery bills, anesthesiologist bills, bills from physician practices, bills from doctors that I never met and, if I did, do not remember.

All in all, I had about 10 different bills sent to me in the mail for my three-and-a-half-day treatment.

For the first few weeks, I let the bills stack on the counter. I wasn’t ready to try and make sense of the madness. Plus, I wanted to make sure my insurance carrier, BCBSM, had a chance to review the invoices and guide me, as a member, on what to pay.

Easy enough, right? Not exactly. I had over 20 listed claims in my member portal on my carrier’s website for the time I was in the hospital. The claims had various doctor names, physician practice names and listings, even though my whole stay was at the same place.

As I tried to sort through this confusing mess, I kept coming back to the same questions:

  1. How could this be so difficult?
  2. Why would I be left to sort this mess out?
  3. How hard could it possibly be to get a single bill from the hospital that performed the services with my insurance carrier’s stamp of approval?

What Could Have Gone Better? Lots, Apparently.

Dissatisfied with the care I received and the exorbitant cost of my emergency care, I decided to get in touch with my friends at Apostrophe to play a little game — kind of like those old Choose Your Own Adventure books. How would this have been different if Apostrophe was handling things?

Apostrophe’s Intelligent Health Benefits deliver excellent health plans at a fair price for self-insured employers. They developed their platform and exceptional member care services to eliminate legacy insurance carriers like my own.

Apostrophe prides themselves as the health plan that’s fixing America. We decided to audit my bill and overall experience together, and what they found was eye-opening.

Solving Problems with Simplicity, Transparency and Love.

Nothing’s going to make a broken leg painless, but Apostrophe’s Intelligent Health Benefits could have helped with some of the headaches Matt encountered along the way. Here are a few ways Apostrophe’s Member Care team could have made Matt’s experience go much more smoothly.

1. Guided decision-making for critical care

Problem: Matt had little say in his treatment plan and wasn’t given any multiple solutions.

Solution: Matt could have called Apostrophe’s member care team — yes, from his hospital bed — for a second opinion from a medical expert. He also could have consulted with our member care specialists to learn more about his doctors and surgeons. We have access to industry-leading databases about providers across the country and use these resources to recommend quality care for our members.

2. Negotiated rates for lower total costs

Problem: Matt’s hospital stay and surgery ended up costing $91,000 — the longer he stayed, the longer his bill grew.  

Solution: Apostrophe links provider payments to the Medicare pricing schedule so that costs are transparent to members and tied to a hospital’s actual costs — rather than the billed amount, which is set by the hospital. Medicare pays about $13,000 for an inpatient stay for a fractured tibia, which would have been Apostrophe’s starting point for the cost of the treatment.

3. Eliminated unknowns with transparent pricing

Problem: Matt didn’t know his total medical expenses until he got home from the hospital, and was amazed by how many costs had accumulated in just four days.

Solution: Apostrophe pays hospitals based on a multiple of Medicare, so charges are based on your diagnosis, not a list of itemized charges. This means the hospital gets paid the same amount regardless of how long you stay or what services you receive during your stay.

4. Simplified, easy-to-understand billing and flexible payments

Problem: The hospital bills kept stacking up, and Matt couldn’t get a straight answer from his insurance company about what he owed and what he didn’t.

Solution: Apostrophe provides single, fully-audited bills for members on a monthly basis. No one needs to get piles of bills to sort through and reconcile, especially after a major medical treatment. Members can also take advantage of single payment plans for all medical bills. Pay bills down over a period of time that works for you and your budget.

Another option: Apostrophe’s Member Care team could have directed Matt to a vetted surgery center with a much lower price before he was admitted to the hospital. All it takes is one call to Member Care find high-quality care at a fair price.

If you’re ready for a change,

let’s talk.

You have so much more control over your health plan than you might realize. There are better options out there for you. Let’s find them.

info@apostrophe.health

www.apostrophe.health