Apta Healthcare Blog

Platinum Patients: Insurance Cards 101

Healthcare overspending is rooted in the fundamental misunderstanding that more doctor visits results in better health.

Platinum Patients are outliers that make up a mere 5 percent of the population, but spend the same amount on healthcare as the remaining 95 percent combined. This means, if there was a cake offered to 100 people, 5 people would eat as much cake as 95 people.

Okay, so Platinum Patients must be the sickest 5 percent of the population and require a significant amount of care, right? Well, not necessarily.

According to a report from the Atlantic, Platinum Patients are not sicker or older than the rest of the population. In general, Platinum Patients are people with at least one serious illness (cancer, heart disease, stroke, etc.) that have health coverage. Here in lies the root of overspending: people are faced with health issues, have coverage, and race to their deductible to maximize care. Yet, they are not getting any better because spending within this 5 percent margin remains.

You can’t blame Platinum Patients for writing a blank check to improve their health. Afterall, can you really put a price on livelihood? But, the astronomical expenses coming from this small margin of the population are not only failing to make Platinum Patients healthier, but also making employers sick when it comes time to pay the healthcare provider.

Quality over quantity

Healthcare overspending is rooted in the fundamental misunderstanding that more doctor visits results in better health — Platinum Patients view their insurance card as a platinum credit card. If employers are ever going to uncover real healthcare savings, they need to break away from the norm and establish a renewed outlook on healthcare that promotes quality over quantity.

This means several things: pairing patients with the right specialist, avoiding unnecessary tests, optimizing spending through educational programs, etc. A study from the Institute of Medicine found that one-third of all healthcare spending — $750 billion — went to unnecessary services that did nothing to help patients.

Basically, members need a way to get it right the first time, and improve healthcare utilization. This might seem overly idealistic — after all, even the most proficient Google user is beholden to the reductive nature of a cursory search. So, to address the fundamental knowledge gap that exists in the healthcare industry, something has to change.

A new approach to healthcare

The Apta Health approach to healthcare is an escape from the industry standard of patient exploitation and ineffectual overspending. By curating leading healthcare savings options into an affordable mid-market solution, Apta Health is bending the trend of excessive healthcare costs.

At the heart of Apta Health is Care Coordination and Navigation: an industry-leading support system designed to guide patients through the fragmented healthcare system and prevent unnecessary costs. Thanks to this innovative approach to healthcare, 95 percent of Platinum Patients (those that spend more than $10,000 in medical bills annually) engage with Care Coordination. Under Apta Health’s model, employees will engage with their health coverage 100 days sooner than with a traditional, full-coverage provider.

What does improved member engagement amount to? Improved member engagement stemming from Care Coordination has vast reaching, positive impacts including:

  • Decrease in claims — Members educated about the healthcare systems are significantly less likely to schedule unnecessary or redundant doctor visits, and employers have seen claims cost reductions in the hundreds of thousands of dollars after partnering with Apta Health.
  • Improved utilization — Expensive medical visits such as inpatient services, ER visits, brand Rx usage, etc. are reduced in favor of cost-effective, preventative options.
  • Best of all: member satisfaction — Apta Health offers a rare win/win within the healthcare industry. Employers experience significant savings thanks to improved member engagement, while members benefit from industry-leading educational and support resources.

Contact Apta Health to learn more about how to improve healthcare utilization for Platinum Patients, and all employees for that matter, through self-funding and Care Coordination. Apta Health offers an alternative to the full-coverage model plagued by overspending, and allows employers to manage their care delivery process, eliminate waste, reduce overhead and avoid extra costs typically associated with employee health benefits.

The Consumer's Journey: Trott On Trends in Healthcare

Topics: Self Funded Insurance, Care Coordination

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