Our Approach

Care Coordination

Traditional health insurance programs are confusing and fragmented. In the current fee-for-service model, doctors get paid for each appointment — not necessarily for the quality of care they provide. The current member engagement rate across the country is a mere 2-7%, meaning that most members rarely interact with their healthcare insurance company unless it’s to ask about a claim balance — which typically doesn’t even surface until 60 days after the fact.

Care coordination from Apta Health offers employers and members a more compassionate healthcare experience, proactively managing member needs with industry-leading customer service, a straightforward and engaging plan design, and patient advocacy in real time. By combining world-class care coordination with a comprehensive self-funded solution, Apta Health reduces costs, creates stability, and provides a healthcare plan that truly cares for its members.

 

Essential Elements of Care Coordination

Care coordination is a much more proactive model that drives unnecessary medical events and costs out of the system, saving time and money for both the employee and the employer.

Care Coordinators
With Apta Health, all phone calls go through a trained and dedicated care coordinator. By having a single number to call, patients easily receive guidance and answers they need. In fact, 60% of Apta Health members engage with care coordinators on a regular basis. For patients with healthcare costs greater than $10,000, engagement rises to 95%.

Because of this heightened engagement, care coordinators intercept redundant, delayed, and questionable treatment in real-time. We call it Real-Time Intercept®. Then, they work together with patients and their families to help them receive the best customized care available.

With backgrounds in hospitality, and working side-by-side with a team of nurses, case managers, utilization management experts, health coaches, and disease management specialists, all available in real-time, care coordinators — or as we like to call them, “healthcare warriors” — oversee all aspects of patient advocacy and benefits delivery, including conversations with patients to:
  • Discuss claims
  • Get referrals
  • Ask about prescriptions
  • Make treatment decisions based on estimated costs
  • Quote benefits
  • Advocate for claims resolution
  • Confirm members are using in-network or top tier providers
  • Learn about wellness incentives
  • Ask about lifestyle programs
Telemedicine
Through cutting edge technology members can use their computer, tablet, or smartphone to video conference with a certified physician within minutes, enabling patients to see a doctor without leaving their home.

Transparent Pricing
Network pricing varies by up to 500% and can be confusing for members. Our transparency tool makes it easy for members to both know the Fair Price for medical procedures and find the nearest healthcare providers that offer the best services at fair prices — all in just a few clicks.

Biometrics/Wellness
Biometrics can be integrated with Care Coordination providing the necessary accountability to drive desired employee healthcare results.

Prescription Benefit Manager
Apta Health’s robust RX program follows market trends and offers innovative solutions to reduce wasteful spending. On average, clients save 5-10% off drug spend in the first year.

With this proactive approach to care coordination, our team of industry experts guides employers and their health plan members through complex healthcare processes and into the future of healthcare.

Technology at Your Fingertips
Take control of your healthcare journey with on-the-go apps. Your entire population can have access to their Care Coordinator anytime with mobile access to key features from our exclusive health plan website.

The My Care Coordinators app that lets you:
  • Find in-network providers
  • Access your ID card
  • Check claims information
  • Schedule a call with a Care Coordinator
  • Track wellness requirements (if applicable)
  • And so much more!


 

Copyright © 2017 Apta Health. All rights reserved.