In the fragmented world of healthcare, Advanced Primary Care Plus (APC+) providers and self-funded employer health plans have long operated in silos. APC+ providers often use subscription-based models, avoiding the traditional claims submission process, while self-funded employers rely on TPAs (Third Party Administrators) or carriers to efficiently process health plan charges through claims. This disconnect has historically created a significant barrier, preventing large employers from leveraging the benefits of APC+ for their employees and families.
Recognizing this gap, Apaly developed a groundbreaking technology platform that bridges these two worlds, enabling them to work together seamlessly. By acting as a translator between APC+ providers and self-funded employer health plans, Apaly ensures that each can operate in its preferred fashion without additional administrative or operational burden.
A Seamless Translation for Two Worlds
Dr. Jerry Beinhauer, Apaly’s CEO and Founder, explains the innovation succinctly:
“Apaly is sort of a Google Translate between APC providers and self-funded employer health plans. We enable each to operate in their own fashion, with no additional administrative or operational burden. Apaly serves to translate their different approaches and languages between them.”
This technological breakthrough has removed a massive hurdle, allowing regional and national employers to finally integrate APC+ into their health plans. Employers can now offer their employees and families access to APC+ while retaining the efficiency and data insights provided by traditional claims processes.
Solving the Data Analytics Challenge
One of the major challenges for self-funded employers is that a significant portion of their data analytics relies on claims data. Without claims data, they’re essentially flying blind, with no navigation. This data is vital not only for managing costs but also for identifying which plan members could benefit from specific health programs.
For example, one of Apaly’s employer clients—a Fortune 100 company with over 50,000 plan members across the United States—offers a diabetes management and support program. The program is available to any plan member with diabetes. However, identifying which employees have diabetes requires claims data, such as those containing the ICD10 code for the condition. Without such data, the employer has no way of directing these members to the support program.
Apaly’s APC+ program solves this problem by converting APC+ provider invoices into claims. This process captures valuable data, allowing employers to:
- Maintain their analytics capabilities.
- Identify members who could benefit from specific point solutions.
- Deliver better, more personalized care to their plan members.
A Client Success Story
For many large employers, the inability to capture claims data has been a dealbreaker for integrating APC+ into their health plans. However, Apaly’s innovative approach has turned skeptics into advocates. One HR executive from a Fortune 100 employer shared:
“Being able to pay for APC through claims and capture the data that otherwise is non-existent has been a game-changer. It allowed us to work collaboratively to deliver better care to our plan members and helped us overcome our inability to leverage APC altogether. Apaly’s platform has made advanced primary care accessible and actionable for our entire organization.”
Transforming Healthcare Delivery
By solving the data disconnect and enabling seamless collaboration, Apaly’s platform has made it possible for self-funded employers to embrace APC+ without sacrificing the operational efficiencies and insights they rely on.
Dr. Beinhauer sums it up best:
“This is the way healthcare used to be, and should be. There was a direct relationship between the patient and their provider. There were no layers and layers of middlemen in between. This approach enables providers to get to know their patients on a very personal level and deliver care at the highest degree possible. It’s like having a doctor in your family.”
Apaly’s approach is not just bridging the chasm between APC+ providers and self-funded employers—it’s reshaping the healthcare landscape to prioritize collaboration, data-driven care, and ultimately, better outcomes for everyone involved.
