Health insurance deductibles are rising, but a local startup is upending the insurance industry with plans that don’t have deductibles and copays. Evry Health uses automation and a mobile-first experience to remove out-of-pocket costs for in-network care.
According to the Kaiser Family Foundation, deductibles, or the amount one has to pay out of pocket for services before insurance kicks in, have jumped 68.4 percent since 2011, from $991 to $1,669. In 2021, 85 percent of all workers have a deductible in their plan, up from 74 percent a decade ago. For companies with fewer than 200 employees, the average deductible is $2,379, compared to $1,397 for larger companies.
Deductibles aren’t the only piece of the puzzle getting more pricey. A recent Lending Tree analysis found that Texas will have the fifth-highest increase in health insurance premiums in 2022. Texas health insurance premiums are predicted to be up 12.97 percent in 2022 compared to 2021, which is 19 times higher than the national average.
As health insurance costs continue to go up for employers, Dallas-based Evry Health, which will be officially open for business in 2022, says it can provide 20 percent savings for most employers. So how will they do it?
Firstly, the goal of these plans is to get members in to see the physician early on in the process. If someone has a knee issue but hasn’t met their deductible, they may be hesitant to pay for a $600 MRI or see a specialist that requires a copay. But without treatment, a knee injury that needs a little physical therapy becomes an expensive knee replacement surgery. By eliminating copays and deductibles, the plans remove a barrier to care, enabling providers to catch problems further upstream and reduce costs (and insurance payouts) down the line.
Next, Evry is embracing automation wherever possible. As a result, the company will have the staffing 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 narrow network of physicians who embrace value-based care, focusing on patient outcomes rather than fee-for-service care. “Quality-based care, a lot of automation, and coherent plan design can deliver 20 percent savings while providing improved or better health care,” says Evry Health founder and CEO Chris Gay.
Evry, founded in 2017, focuses on mid-size employers with 100-2,000 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 that sector and build slowly. Its network includes the Medical City Healthcare network, which recently notched ten hospitals on the Leapfrog Group’s hospital rankings for quality and value, endorsed and led by the Dallas Business Group of Health.
The plans are launching next month, and Gay and other leaders have met with employers and brokers to get the word out about what makes Evry different. The mobile-first experience wants to put needs in the palm of its members’ hands, guiding everything from telehealth to pharmacy and providers. The plans will also give mid-size employers access to a wellness plan that is usually only accessible to larger employers. “That’s very relevant for employers with a millennial workforce,” Gay says. “Everything is shifting to mobile, and we’re ahead of that trend.”
Gay is no stranger to bringing value to insurance plans. He has startup experience in the fintech world and co-founded a car insurance company called MileMeter, the first to create per-mile car insurance, where less driving led to lower insurance costs. “I’m proud of that because it particularly benefited people that were being overcharged,” Gay says. “Especially [for] women or those in poverty, it drove down premiums 50 percent.”
Gay partnered with co-founder and Chief Financial Officer Mark Jamilkowski, who has 30 years of healthcare management experience. He was previously managing director at KPMG. Jay Startz is the chief operating officer with fintech and healthcare entrepreneurial experience who founded MassCatalyst, a back-office solution for private equity firms to streamline private placements. The chief medical officer is Dr. Mamata Majmundar, a former medical director at Aetna and an adjunct professor at the University of Kentucky College of Medicine.
But despite the focus on technology and automation, Gay insists that plan members will be able to talk to human beings when needed. It was a focus at MileMeter, where Gay says it received positive reviews for customers being quickly connected to an employee when they called for assistance.
For Gay, the shift to healthcare began with personal pain and experience. “I’ve had friends and family with horrifically tragic healthcare system interactions, and they passed long before they should have,” Gay says. “At some point, I decided, let’s go fix this. If not now, when?”