BlogEmployers/Partners
No PCP = higher healthcare costs
In major U.S. cities, employees wait over 26 days just to see a primary care doctor. Without that relationship, small problems become ER visits, specialist referrals, and catastrophic claims, and employers pay rising premiums regardless of how their plan actually performed. Apaly APC+ fixes this.
- 26 daysAvg PCP wait time in major U.S. cities
- 1 in 3Americans has no primary care doctor
- 20–30%Average total cost of care savings with APC+
- 5,600+APC+ provider locations nationwide
1 in 3 Americans has no primary care doctor. Your plan pays the price.
Without a primary care relationship, employees default to the ER for conditions that cost 10x more to treat there than in a primary care office. Chronic conditions go unmanaged until they become catastrophic claims, and self-funded employers pay 100% of the downstream cost.
Average PCP wait time by city
Source: Merritt Hawkins / MGMA survey data. Average days to get a new patient PCP appointment.
What happens without a PCP
| Trigger | Downstream Cost |
|---|---|
| Symptom ignored or treated at ER | 3–5x more than primary care |
| Unmanaged hypertension → cardiac event | $500K+ claim |
| Avoidable inpatient admission | $18,400 avg cost |
| Late-stage cancer detection (no screening) | Stop-loss trigger |
| Specialist referral w/ no care coordination | Duplicate / excess spend |
66%
of total plan medical spend
The Insight
The top 10% of claimants generate the majority of total plan medical spend. Most of those claims are downstream consequences of conditions a primary care doctor would have intercepted years earlier.
Get Better PCP AccessHealthcare working the way it always should have.
APC+ is a subscription-based primary care benefit billed through your health plan. Every employee gets a personal doctor (accessible same day, 24/7) with 30–60 minute visits and zero copay. It’s the foundation of a smarter health plan, not a point solution sitting outside it.
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Lower total cost of care
20 to 30% reduction. Problems caught early, chronic conditions managed, fewer ER visits.
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Simple to implement
Runs on your existing plan. No redesign, no carrier change, live in under 2 months.
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On-benefit billing
Billed as a claim through your TPA. Your stop-loss carrier and actuary see everything.
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Compliant by design
HDHP/HSA, ERISA fiduciary, IRS, SOC II, and HIPAA. Apaly is software, not a risk-bearing vendor.
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Whole-person care
Physical and mental health together. Better outcomes, lower total cost.
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Nationwide coverage
5,600+ locations in all 50 states. A provider near every employee.
No lengthy contracts
No multi-year commitments, no complicated terms. Billing starts only when a member uses the benefit.
Pair with ApalyRx
Employers overpay on pharmacy by 40 to 60%. ApalyRx fixes that, integrated with APC+.
Not all APC+ solutions are the same.
Most are missing what matters most.
| Feature | Hint Health | Aligned Marketplace | Apaly APC+ |
|---|---|---|---|
| Not a network (direct contracts) | |||
| Bills through health plan claims | |||
| 5,600+ provider locations nationwide | |||
| HDHP/HSA fully compliant | Partial | Partial | |
| Performance guarantee | |||
| Stop-loss carrier visibility | |||
| Integrated pharmacy benefit | |||
| Founded by a physician | |||
| Centralized referral coordination | Limited | ||
| Mid-market friendly (500+ lives) | Partial | Partial |
We don’t just manage the sick. We stop the healthy from becoming sick.
Apaly APC+ addresses all four population risk quadrants, not just the ones already generating claims. This is the clinical logic that drives multi-year compounding ROI.
Quadrant 1
High Risk · High Cost
Active chronic conditions, recent ER/inpatient utilization, multiple comorbidities. Currently generating claims.
APC+ Action
Dedicated longitudinal care management. Medication optimization. Reduce recurrence, manage trajectory. Target: prevent the next stop-loss event.
Quadrant 2
High Risk · Low Cost
Unmanaged hypertension, pre-diabetes, obesity, behavioral health diagnoses. Silent now. Catastrophic within 2–5 years.
APC+ Action
This is where APC+ creates the most durable ROI. Proactive screening, care gap closure, and medication management intercept trajectories before they become $200K claims.
Quadrant 3
Low Risk · Low Cost
Generally healthy, infrequent utilizers. No established PCP relationship; the group most likely to use the ER inappropriately.
APC+ Action
Annual physicals, preventive screenings, wellness programs. Establish relationship before a crisis, drive appropriate care channel utilization.
Quadrant 4
Low Risk · Rising Cost
Trending members with increasing ER use, new diagnoses, and lifestyle-driven deterioration. The group slipping toward Quadrant 1.
APC+ Action
Early intervention through established doctor relationship. Lifestyle modification, MSK management, behavioral health integration, referral to employer point solutions.
“The office worker with unmanaged hypertension doesn’t appear as a high-cost claimant for years. Then they have a heart attack.”
APC+ Case Study · 4-Year Analysis
Talk With Us4 years. 4,000 lives. $16.8M in savings.
A 4-year claims-based analysis of a 4,000-life population delivered a 36% reduction against actuarial trend. Validated by Milliman methodology.
- 35%ER visit reduction (Year 4 vs. baseline)
- 29%Inpatient admission reduction
- 14%Medical PMPY reduction vs. baseline
- 70%Reduction in specialist referrals
- 50%Stop-loss trigger frequency reduction
- 80+Member NPS score
Claims-based analysis of 207,000 eligible lives. Methodology validated by Milliman.
Do the math: a $4M plan saves about $600K
Adjust the sliders to estimate your company's ROI with Apaly APC+.
505,000
$3,000$25,000
Estimates based on industry benchmark data. Request a custom analysis for your specific claims profile.
Current Annual Plan Cost
$4,000,000
Projected Annual Savings (15%)
$600,000
Estimated Year 1 ROI
2.0x
Want to see what your custom savings could look like?
Get My Custom Savings ReportGet custom savings reportFour steps from activation to savings.
Employer activates APC+
Enable Apaly APC+ through your existing self-funded health plan at any time of year without any plan redesign or disruption. Works alongside your current carrier.
We connect to your TPA
Apaly integrates directly with your TPA so APC+ visits are billed as claims, with no separate billing system and no new infrastructure. Implementation takes less than 2 months.
Members sign up and engage
Apaly handles all member communications and enrollment support to drive sign-ups. Billing only begins once a visit takes place and a doctor-patient relationship is established, so you only pay for members who are actively using the benefit.
Costs fall, outcomes improve
ER visits drop. Specialist referrals decline. Total cost of care decreases 20–30%. The health plan finally performs the way it should: employers save money, members save money, and everyone experiences what it’s like to have a doctor in the family.
Apaly is a SaaS platform, not a network. Apaly facilitates direct contracts between employers and APC+ providers, eliminating the legal and compliance risk of unlicensed risk-bearing vendor networks.
Cut prescription costs too, with ApalyRx.
Most employers overpay on pharmacy by 40–60%. Your employees' doctors are already managing their care. ApalyRx makes sure their prescriptions are managed just as well, by eliminating the middleman with transparent, cost-plus prescription pricing.
The best benefit you can offer is one they will actually use.
Dr. Afolalu was attentive, kind, and extremely thorough during my appointment. She ensured I knew how to reach her outside of any appointments, what my follow ups were and answered all of my questions.
DianaProvider Selected: NorthShore Direct Primary CareI definitely see the added value. Being able to discuss several issues with my provider and feel that they are genuinely listening and thinking of ways to help. I enjoyed feeling of value.
Joseph W.Provider Selected: Cascade Direct Primary CareIt's great that the doctor is able to spend more time with me and really listens and asks questions. I feel valued and that she understands what is going on and explains things well for me.
GeraldProvider Selected: 4 Elements Direct Primary Care & Wellness SpaceDr. Charity Durham and APC+ restores my faith in medical professionals. As a family of 5 with some having medical challenges, I had become completely jaded with healthcare. The concept of APC+ is incredible, and Dr. Durham and Aevita Medical have been incredible.
Joseph P.Provider Selected: Aevita MedicalComplete Care DPC goes above and beyond to support her patients and I have had an amazing experience so far. She is very responsive, looks at root causes of issues (not just masking symptoms) and spends the time needed with you to understand where you are, what your goals/focus areas are and how to best support your health.
AlexaProvider Selected: Complete Care DPCIt had been over a decade since I visited a primary care provider because of horrible past experiences. I'm so blessed to have found Director Priscilla Bullen at Sunshine Health! She took the time to get to know my health history as well as who I am. She listens and then uses her wealth of knowledge and expertise to address my wellbeing as a whole!
FeliciaProvider Selected: Sunshine Health DPCDr. Lake and everyone at Lake Internal Medicine and Pediatrics are amazing. They are great with children, accommodating to hectic schedules, and are really thorough.
MichaelProvider Selected: Lake Internal Medicine and PediatricsIt has been 15 years since I had a Doctor who made me feel ‘heard’. Wonderful experience, from the office to the staff to the doctor.
JuliaProvider Selected: One MedicalIt's honestly a really great service. I feel that it is underutilized by colleagues and those that I work with don't know the benefits of it. I am very happy with the APC+ program and plan to continue using it. I think it is one of the best benefits my employer offers.
BrennanProvider Selected: One Medical
Frequently Asked Questions
We are happy to show your projected ROI to demonstrate measurable savings and clear financial benefits, and you can take advantage of our cost savings guarantee.
No, there’s no legal risk because Apaly is not a provider network. We are a technology platform that creates direct contracts between providers and self-funded employer health plans. Unlike other vendors in the industry, we are the ONLY APC+ solution that is NOT creating and operating a network, and we don’t take on risk or operate in any way that requires network licensure. We don’t put you at risk.
Implementation is straightforward, with setup completed in just a few days.
