HealthMe reduces specialty care costs by powering direct-pay contracts end to end, helping self-funded plans move care faster and giving advisors the infrastructure to make direct contracting work.
In this 3x3x3 Challenge, David Comiskey with HealthME answers 3 questions, using 3 slides, in under 3 minutes.
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FULL TRANSCRIPT:
What is HealthMe?
Well, when it comes to specialty care, everyone knows that orthopedics, musculoskeletal care, and other surgical specialties drives for the highest claims for self-insured employers. There's a lot of talk about addressing these, but really pulling direct contracts together to address these high cost specialties can really feel like pulling teeth. HealthMe is the operating system for direct-pay specialty care. We're not another transparency marketplace or point solution, but the actual infrastructure for administering and executing direct contract care. From referral management, through payment and claims adjudication. We're physician-founded, Dr. Mike Havig, a practicing orthopedic surgeon, built HealthMe in his own practice. And today, HealthMe is used by thousands of physicians across the country as their operating system for direct contracted direct-pay specialty care.
How is HealthMe different?
There are many in this space who can show you a bundled price or show you some sort of direct contract and maybe even show you some dots on the map of where those direct contracts exist. The difference is actually what happens after the referral. Most direct contracts fail at the practice's front desk. The proverbial, "We don't take that plan," or the referral goes unanswered. And every episode and every direct contract can feel like you're reinventing the wheel. HealthMe is different because the medical groups on HealthMe use our platform to run their self-pay business, all day, every day. So when a member's referral comes through, it lands on a scheduler's desk at the practice who already knows us, who knows how to coordinate referrals, who knows how to make appointments for direct contracts. Appointments happen in days, and not weeks. So take for instance, a total knee replacement at a hospital like being shown on the slide. Hospitals, that episode of care, and this is from real claims analysis we did recently was $86,000 for that total knee. A HealthMe direct contract was $26,000. And the care happened three weeks faster than a hospital would've been able to deliver it.
Who is a good fit for HealthMe?
Really anyone who's trying to make direct contracts actually work for employer plans. Benefit advisors who are building unbundled self-funded plans, plan sponsors, TPAs, care navigation teams. HealthMe becomes your direct contract network and the technology layer, the plumbing that administers all of it. From referral management, payment, claims adjudication, end to end. And it's proven. What we're showing here is a self-funded school district who nine months live on our platform, generated 316 referrals and saved almost over $1 million back to the plan.
