Apaly Health Launches Direct Contracting Solution

“Will my doctor accept our insurance” ….………… “Yes, unless he’s an idiot.” 

The article below outlines a strategy that makes sense – allow providers to name their price.

Any plan can adopt this strategy independently as a few of our clients have, and with good success – Each provider names their price (% of MC) and the plan assigns appropriate patient responsibility to the selected pricing level.

For example, 100% MC = $0 copay, 125%MC = $20 copay, 150%MC = $50 copay, 200%MC = $100 copay.

Or the plan can pay a % applied to each level: 100% MC = 100%, 125% MC = 80%, 150% MC = 65%. or some other appropriate coinsurance factor.

A RBP plan should have no problem in getting every doctor on the planet signed up.

The common question “Will my doctor accept our insurance” can be answered “Yes, unless he’s an idiot. Between you and the plan your doctor will be paid whatever the doctor charges. But remember, the more he charges the more you pay” (Plan’s portion remains approximately the same).

North Carolina, whose attempt to move the state plan to RBP failed, should have employed this strategy. It can be applied to hospitals too.

Goodbye Balance Billing. (Balance billing only occurs when you don’t ask the price)


“Providers and employers enter the rates they’re willing to accept or pay, and Apaly’s price matching algorithm does the rest.”

Apaly Health Launches Direct Contracting Platform for Self-Funded Employers

MyHealthGuide Source: Apaly Health via PRNewswire, 11/4/2019

TAMPA, FL — Apaly Health, the platform that enables employers and providers to direct contract at scale, is excited to announce national support for direct contracting between employers and healthcare providers.

The Apaly Health platform enables many-to-many direct contracting between self-funded employers and providers, on a national scale. Each can sign up, enter their own contract rates, and instantly deliver or receive healthcare services. It’s that simple.

“Direct contracting is increasingly seen as a cost-effective way for employers with self-funded health plans to manage cost on their provider networks and, until now, has generally only been available to large, multinational corporations,” said Dr. Jerry Beinhauer, founder and CEO of Apaly Health. “Employers now have an alternative to the leased provider network that enables them to source better care at lower prices.”

Apaly is able to realize these cost savings by automating the various tasks currently done by various intermediaries. These middlemen add bloat and hundreds of billions in unnecessary cost each year. One recent study showed that it now costs more than $20,000 to insure a family on an employer funded health plan.

“Self-funded employers who directly contract with providers can significantly reduce their healthcare spend, along with the added benefit of being able to drive quality and control at the network level,” Dr. Beinhauer added.

Providers that join the Apaly Health network only need to sign up once, making them available to all employers on the platform — nationally, eliminating the need to establish individual direct contracting relationships. On average, they can also expect higher reimbursement rates and get paid faster.

“Apaly Health has created a simple and seamless solution that allows providers to directly contract with self-funded employers without any operational or practice work-flow changes,” said Dr. Chris Pittman, Medical Director and CEO, Vein911® Vein Treatment Centers. “It’s designed to feel just like any other payer relationship, except we set our own payment rates and get paid faster.”

As part of a pilot program, employers and providers have been signing up and contracting in states including Alaska, California and Washington. This national launch comes after the success of that effort.

About Apaly Health

Apaly Health was founded in 2018 by Dr. Jerry Beinhauer as a decentralized healthcare-specific ecosystem that uses cutting edge blockchain technology to enable patients, payers, providers and other participants to directly interact, contract and transact. Contact Ryan Gorman, Executive Vice President, Corporate Communications, at 813-938-6626, ryan@apaly.com and visit www.apaly.com.