Apta Healthcare Blog

A Healthcare Plan for Platinum Patients

In a recent feature series, The Atlantic magazine highlighted “Platinum Patients,” as the most expensive 5 percent of healthcare consumers. The healthcare bills of the Americans featured in this article equal those of the other 95 percent of consumers combined. Who are these people and why do they account for such a hefty portion of healthcare spend?

The article explains that, “America’s lopsided medical expenditures are an indication not of inefficiency, but of a willingness to spend. When a person’s health is on the line, the numbers suggest there’s almost nothing they wouldn’t pay.”

The Atlantic recognizes that our national healthcare affordability dilemma is attributable not to mere purchasing efficiency questions, or unit costs, or even failures on the ever-vague "wellness" front. It is primarily a function of fear-driven behavior in the search for answers. When we face an uncertain diagnosis, or the vicarious pain of a sick child or spouse, questions of "who and how will we pay for this?" are pended until the road to recovery is discovered.

A willingness to spend on healthcare

It's been said that the only person capable of better research than an expert CIA Analyst is a mother with a sick child. When a person is forced into an unplanned, unwanted, unintended healthcare purchasing journey, the path is often rife with physical, emotional, and financial danger. The primary method of coping with that danger is to thrash about with an insurance card in-hand, swiping without question at the till of every specialist, imaging facility, and hospital we can find. Searching for answers until we’re satisfied that a cure is delivered, a salve applied in the form of explanations of benefits (EOBs) and hundred-dollar bills.

The article concludes with this thought regarding our national affordability crisis: "No solution adds up without addressing [these 'Platinum Patients'] first." With so much of the outcome invested in so few, I would agree.

Bending the healthcare trend

After more than a decade of delivering bad news to clients in the form of rate increases, utilization spikes, and diminished plan benefits, I knew I needed to search for a way to be part of the solution, rather than a mere herald for the sweeping tide of healthcare trend's seemingly inexorable creep. In Apta, I believe we’ve found a way to help.

At Apta, we believe that efficient, patient-focused, employer-sponsored healthcare is possible through the power of care coordination and navigation. Our partner, Quantum Health, is a pioneer in this burgeoning field, and has well over a decade of experience in demonstrating independent, actuarially verified results for millions of members. The premise of our program is that the "Platinum Patient" wants and needs a few things to have an optimal outcome, both physically and financially:


  1. Sanctuary from the cold, impersonal world of healthcare providers and insurance;
  2. Expertise in understanding their options, their condition, and how they can be healed;
  3. Consistency... someone who will stick by their side until the journey is complete;
  4. A Warrior Advocate who will fiercely represent their interests above those of both the provider and the insurance apparatus; and
  5. Friendship...an empathetic, patient voice of caring committed to earning their trust.

When a "Platinum Patient" finds those five things they stop thrashing, stop swiping, and start healing.

Apta Heath generates deep engagement with over 95 percent of members experiencing $10,000 or more in claims (aka, "Platinum Patients"), generating real returns for employers and a world-class experience for members. The impact is seen in both a decrease in claims and undesirable utilization (e.g. inpatient services, ER visits, imaging spend, brand Rx usage, etc), while driving primary care and preventive services, as well as member engagement and satisfaction, through the roof. These results are reflected in both reinsurance pricing and total program cost.

Contact us to learn more about how Apta Health can provide a solution for “Platinum Patients” and how our program is bending the healthcare spending trend.

The Consumer's Journey: Trott On Trends in Healthcare

Topics: Employee Benefits, Insider

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