June 23, 2022
  • June 23, 2022

What if your health insurance plan had no deductible?

By on December 13, 2021 0

Chris Gay (Courtesy: Evry Health)

Medicare deductibles are rising, but a local startup is shaking up the insurance industry with plans that don’t have deductibles and co-payments. Evry Health uses automation and a mobile experience first to eliminate out-of-pocket costs for networked care.

Deductibles, or the amount one has to pay for services before insurance takes effect, have jumped 68.4% since 2011, from $ 991 to $ 1,669, according to the Kaiser Family Foundation. . In 2021, 85% of all workers have a deductible in their plan, up from 74% ten years ago. For businesses with less than 200 employees, the average deductible is $ 2,379, compared to $ 1,397 for large businesses.

Franchises aren’t the only piece of the puzzle that are getting more expensive. A recent loan tree To analyse found that Texas will experience 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, which is 19 times higher than the national average.

As health insurance costs continue to rise for employers, Dallas-based Evry Health, which will officially open in 2022, says it can save most employers 20% . So how are they going to do it?

First, the purpose of these diets is to get members to see the doctor early in the process. If someone has a knee problem but hasn’t met their deductible, they may be hesitant to pay for a $ 600 MRI or see a specialist who demands a co-payment. But without treatment, a knee injury that requires a bit of physical therapy becomes expensive knee replacement surgery. By eliminating co-payments and deductibles, the plans remove a barrier to care, allowing providers to spot problems earlier and lower costs (and insurance payments) down the line.

Then, Evry embraces automation wherever possible. As a result, the business will have another insurer’s workforce of the same size, eliminating back office administration, claims resolution, and other technology-utilizing positions.

Finally, the company is building a tight network of physicians who embrace value-based care, focusing on patient outcomes rather than fee-for-service care. “Quality care, lots of automation, and a consistent plan design can deliver 20% cost savings while delivering better or better health care,” said Chris Gay, Founder and CEO of Evry Health.

Evry, founded in 2017, focuses on mid-sized 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 said they wanted to focus their innovation on this area 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 kick off next month, and Gay and other executives have met with employers and brokers to spread the word about what makes Evry different. The mobile first experience wants to put the needs in the hands of its members, guiding everything from telehealth to pharmacy and providers. The plans will also give midsize employers access to a wellness plan that is generally only available to large employers. “This is very relevant for employers with millennial workforces,” Gay says. “Everything is shifting to mobile, and we are ahead of this trend. “

Gay is no stranger to the added value of insurance plans. He has a startup background in the fintech world and co-founded an auto insurance company called MileMeter, the first to create auto insurance per kilometer, where less driving led to lower insurance costs. “I’m proud of it because it particularly benefited people who were overcharged,” Gay said. “Above all [for] women or people in a situation of poverty, this reduced the premiums by 50%.

Gay partnered with co-founder and CFO Mark Jamilkowski, who has 30 years of healthcare management experience. He was previously Managing Director of KPMG. Jay Startz is the COO with 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 assistant professor in the College of Medicine at the University of Kentucky.

But despite the emphasis on technology and automation, Gay insists regime members will be able to talk to human beings when needed. This was a priority at MileMeter, where Gay says he received positive reviews for customers being quickly connected to an employee when they called for help.

For Gay, the transition to healthcare began with personal pain and experience. “I have had friends and family with horribly tragic interactions with the health care system, and they passed away long before they should have,” Gay says. “At one point, I decided to go and sort it out. If not now when? “