Health insurance deductibles are rising, but a local startup is shaking up the insurance industry with plans that have no deductibles and copays. Evry Health uses automation and a mobile-first experience to remove out-of-pocket fees for in-network care.
According to the Kaiser Family Foundation, deductibles, or the amount one must pay out of pocket for services before insurance takes effect, have jumped 68.4% since 2011, from $991 to $1,669. In 2021, 85% of all workers have a deductible in their plan, compared to 74% ten years ago. For companies with less than 200 employees, the average deductible is $2,379, compared to $1,397 for large companies.
Franchises aren’t the only piece of the puzzle that’s getting more expensive. A recent loan tree To analyse found that Texas will see the fifth highest increase in health insurance premiums in 2022. Texas health insurance premiums are expected to increase 12.97% in 2022 compared to 2021, 19 times higher than the average national.
As health insurance costs continue to rise for employers, Dallas-based Evry Health, which will officially open in 2022, says it can provide 20% savings for most employers. So how are they going to do it?
First, the purpose of these plans is to get members to see the doctor early in the process. If someone has a knee problem but hasn’t paid their deductible, they may be hesitant to pay for a $600 MRI or see a specialist who requires a co-pay. But without treatment, a knee injury that requires a bit of physical therapy becomes expensive knee replacement surgery. By eliminating copayments and deductibles, the plans remove a barrier to care, allowing providers to detect problems earlier and reduce costs (and insurance payments) downstream.
Next, Evry adopts automation wherever possible. As a result, the business will have the staff footprint of another insurer of the same size, eliminating back-office administration, claims adjudication and other positions using technology.
Finally, the company is building a close network of physicians who embrace value-based care, focusing on patient outcomes rather than fee-for-service care. “Quality-based care, high automation, and consistent plan design can deliver 20% savings while providing better or better healthcare,” says Chris Gay, Founder and CEO of Evry Health.
Evry, founded in 2017, focuses on mid-size employers with 100 to 2,000 employees in Dallas, Denton, Collin, Rockwall and Tarrant counties. Because about half of Americans get their health insurance from their employer, Gay says they wanted to focus their innovation on this sector and build slowly. Its network includes the Medical City Healthcare Network, which recently ranked ten hospitals in the Leapfrog Group Hospital Rankings for Quality and Value, endorsed and led by the Dallas Business Group of Health.
The plans will be launched next month, and Gay and other leaders have met with employers and brokers to spread the word about what makes Evry different. The mobile-first experience wants to put needs in the hands of its members, guiding everything from telehealth to pharmacy and providers. The plans will also give mid-sized employers access to a wellness plan that is usually only available to large employers. “It’s very relevant for employers with a millennial workforce,” Gay says. “Everything is going mobile, and we are ahead of that trend.”
Gay is no stranger to bringing value to insurance plans. He has start-up experience in the fintech world and co-founded an auto insurance company called Mileage, the first to create per-mile car insurance, where less driving leads to lower insurance costs. “I’m proud of it because it particularly benefited people who were overworked,” says Gay. “Above all [for] women or people living in poverty, this reduced the premiums by 50%. »
Gay partnered with co-founder and chief financial officer Mark Jamilkowski, who has 30 years of healthcare management experience. He was previously CEO of KPMG. Jay Startz is the COO with an entrepreneurial background in fintech and healthcare who founded MassCatalyst, a back-office solution for private equity firms to streamline private placements. The chief medical officer is Dr. Mamata Majmundar, former medical director of Aetna and adjunct professor at the University of Kentucky College of Medicine.
But despite the focus on technology and automation, Gay insists regime members will be able to talk to human beings when needed. It was a goal at MileMeter, where Gay says he received positive reviews for customers being quickly connected to an employee when calling for help.
For Gay, the transition to health care began with personal pain and experience. “I’ve had friends and family with horribly tragic interactions with the healthcare system, and they died long before they should have,” Gay says. “At some point I decided, let’s fix this. If not now when?”