In this episode of the Validation Institute podcast, we dive into the innovative strategies of APTA Health, a leader in self-funded healthcare benefits management. Tom Busler, National Vice President of Sales, discusses how APTA Health enhances healthcare transparency and care coordination for its clients. He highlights their commitment to guiding members through their healthcare journeys with a focus on quality and cost-effective solutions.
You can view the full video here:
Key Takeaways from the Discussion on APTA Health
- Guided Healthcare Approach: APTA Health champions a ‘Guided Healthcare’ strategy that supports members from the diagnosis stage through the entire healthcare purchasing process. This approach ensures that members make informed decisions, potentially improving both outcomes and cost efficiencies.
- Transparency and Independence: The company emphasizes transparency in healthcare processes, allowing members to navigate their care with more information and independence. By operating outside traditional insurance models, APTA Health places member interests at the forefront, avoiding conflicts of interest that typically arise in hospital or insurance-driven care.
- Focus on Execution and Innovation: APTA Health differentiates itself by not only developing innovative healthcare solutions but also by investing heavily in the execution and operational aspects to ensure these innovations deliver real benefits. This commitment helps avoid the common industry pitfall where great ideas fail due to poor implementation.
- Validation and Credibility: The validation by the Validation Institute serves as a testament to the effectiveness and reliability of APTA Health’s strategies. This endorsement enhances trust and confidence among potential clients and partners, promoting a broader acceptance and adoption of their programs.
Introduction
Validation Institute:
“Today I’m delighted to be joined by Tom Busler, National Vice President of Sales for APTA Health. Hello Tom, and thank you for being here today.”
Tom Busler:
“Hey, thanks a lot. We’re excited to be a part of this series with y’all.”
What is APTA Health?
Validation Institute:
“Let’s jump right in. Can you tell me what is APTA Health?
Tom Busler:
“APTA Health is a program manager for high-performance self-funded benefits programs. We really like to think of those types of strategies that enterprise-level employers—those with multiple thousands of employees—have been doing for potentially dozens of years at this point to help manage their spend and make sure that some of those same types of strategies are available to a smaller species of client. We’ve really got our start focused on the care coordination strategy. When we think of APTA Health, we’ve actually trademarked a phrase called ‘Guided Healthcare‘ which is the idea that you would be with the member not only after they’ve been diagnosed with some sort of health condition but as they enter into the purchasing equation, right as they’re being diagnosed as they’re going to that physician for the first time. We act as that sort of member interface and we’ve partnered with vendors and also invested heavily in our own strategies to figure out ways that we can really be side by side with that member again as they’re entering into the purchase of healthcare. If they’re making those decisions, we know that if you try and get involved with a member once they’ve already started down a healthcare journey path, making changes to that path can be very difficult. We also know that often, if you leave members to let the healthcare system navigate for them rather than assisting them and making thoughtful interventions, you have a series of potentially financial arrangements that are guiding them through the various stages of purchasing healthcare as opposed to what might be in their best interest for a number of other reasons, right? The quality, the total cost of care, and also looking outside of those silos that may be put around a member if they’re left to be navigated either solely by a hospital system, an insurance company, or something like that. So, the independence of having a third party who’s really looking out only for the member’s best interests and the performance features of our program allows us to navigate them in a way that they wouldn’t otherwise receive if they were in what we consider a traditional insurance arrangement.”
Differentiation of APTA Health
Validation Institute:
Well all that sounds great, so can you tell me how APTA Health different?
Tom Busler:
“How is APTA Health different? APTA Health comes back again to the notion of transparency in healthcare. A lot of the recent legislative developments within healthcare have been focused around transparency. We have now the advent of machine-readable files and the removal of gag clauses so that members can have more information at their disposal, make better decisions, and again aspire to higher levels of performance and quality within healthcare.
We feel like we’ve been implementing these principles for our entire existence, even though they’re now being mandated within the industry. APTA Health has focused on an independent, transparent model from the beginning. Everything we do is on an unbundled, self-funded model because those are the prerequisites that allow for the very best types of solutions to take hold within any given self-funded plan.
We also focus heavily on ideas and execution. As a program manager, we don’t want the failure to execute to be confused for a bad idea. There are many innovative companies out there with incredible ideas on how to fix healthcare, improve transparency, enhance performance, and bring about purchasing efficiencies. However, if they don’t invest heavily in the operational aspects that actually make those ideas work, you could have a buyer that ends up frustrated, thinking the strategy was flawed when in fact it was a failure in deployment, integration, or implementation.
APTA Health has invested extremely heavily in account management, implementation, and integration. We emphasize operational excellence so that the innovative ideas we bring to the table are realized fully, ensuring that our buyers do not regret their pursuit of innovation due to poor delivery on promises. This focus on operational excellence really differentiates us, ensuring that the benefits of our strategies are not lost in translation and that our buyers see the fruits of the ideas we brought to them.”
Ideal Clientele for APTA Health
Validation Institute:
If I’m an employer out there, who’s a good fit for this?
Tom Busler:
“Our average client is probably about a three to five hundred employee organization, typically about double that in membership if you include spouses and dependents. It’s that employer who has become frustrated with the status quo. They have been in traditional insurance arrangements, been fully insured for a while, and have a thoughtful advisor telling them about the virtues of self-funding and the additional programming that can be deployed on an unbundled chassis.
They’re ready to take that next step into a higher level of performance. We serve two different clients: the end-user, which is ABC company, and the advisor that sits in the middle. The advisor is someone we focus on heavily from a sales standpoint, ensuring they are aware of the various strategies they can deploy, moving beyond traditional self-funded or ASO arrangements, and driving towards not just the best discount but significantly better performance.
A lot of these advisors serve what we call the mid-market or transitional business—groups moving from fully insured into self-funding for the first time. We’ve also invested heavily in captive strategies and work with various major captive purveyors out in the market so that they understand our value proposition and reflect it in their stop-loss pricing.
The final distinguishing factor is that we have an entire underwriting team and department that develops new products to leverage the performance we have built in our self-funded programming. This allows us to tell a compelling story to stop-loss carriers, ensuring our clients receive extremely competitive stop-loss rates, whether through a captive or traditional stop-loss market. This investment ensures that smaller buyers who know the right thing to do have the ability to reach for that performance, deploy it effectively, and enjoy it for many years to come.”
The Importance of Validation by Validation Institute
Validation Institute:
Why was it important for APTA Health to pursue a validation?
Tom Busler:
“ In fact, if you look, we try to keep fairly tidy signature blocks, but one of the few things that we include in almost all of our personnel’s signature blocks is the Validation Institute logo and stamp of approval. We’ve embraced validation as one of the core tenets of our program. When we go out and talk about how our program works, we highlight the stop-loss validation and the independent validation we’ve received from the Validation Institute.
These validations serve as a kind of Good Housekeeping seal of approval. We have salespeople who can tell an incredible story about all the functional areas of our programs, how we build point solutions into a Guided Healthcare program that interacts with the member in real time, performing all these incredible functions. At the end of the day, though, we’re salespeople; we have a vested interest in the outcome. But when we have the Validation Institute, which uses impartial empirical guidelines to evaluate programs, it adds credibility.
This is crucial for skeptical advisors or buyers who, perhaps having been disappointed in the past, now have more faith in the veracity of what we’re presenting. It encourages them to step into what might be unknown territory because the biggest barrier to adopting new performance-oriented solutions is often fear of the unknown. With the Validation Institute‘s backing, we can demonstrate that the incredible performance we espouse is real and leads to sustainable results in healthcare. This validation allows us to convert skeptics into believers, helping them take the plunge into advanced healthcare strategies and never look back.”
Conclusion and Invitation to Learn More
Validation Institute:
“All right, well not many companies pass validation and go through that rigorous process and are able to prove out their outcomes and savings, and you obviously have. It’s a great thing, and you do some great work. Thank you very much, thank you for being here Tom and sharing your insights today. It’s been a pleasure having you here.”
Tom Busler:
“Yeah, it’s been a real pleasure to not only be on this podcast with you but also now in multiple years of validation with the Validation Institute. It’s been a pleasure to have your organization recognize ours for what we’ve been doing, and we look forward to working with you for many more years to come.”
CEO of Validation Institute:
“Great, and for everyone out there who wants to learn more, I encourage you to visit validationinstitute.com and download the APTA Health Report. Thank you very much and have a great day.”
