Elevating
Care.
Reducing
Cost.
A comprehensive proposal for Quality Innovation, Inc.
Executive Summary
For years, Quality Innovation, Inc. has provided employees with generous benefits through a traditional, fully-insured/level-funded plan with UnitedHealthcare. However, this model has led to a familiar cycle: significant premium growth that outpaces your actual claims experience. If you don’t take control of your health plan, you will continue to be subject to unpredictable, double-digit increases. Health365+ offers a fundamentally better model that provides immediate savings while controlling long-term costs. Over five years, Quality Innovation, Inc. is projected to realize $612,428 in direct premium savings. In addition, our integrated health management programs are projected to reduce claims by $482,531, creating a total potential value of $1,094,959 and paving the way for lower stop-loss renewals.
A Journey Reimagined
Health365+ is built on a different idea: real support should feel personal, accessible, and proactive. We're on a mission to transform health coverage from a frustrating maze into an experience that is guided, transparent, and genuinely helpful for everyone.
Our Philosophy: A Fundamentally Better Approach
A True Concierge Experience
We provide a dedicated, human-first point of contact for every member, moving beyond call centers to build real relationships and provide expert guidance.
Improving Health to Reduce Costs
Our model is designed to address the root cause of claims. By proactively engaging members to manage and improve their health, we deliver better outcomes and generate sustainable, long-term savings for your plan.
Human-Centric Technology
We leverage powerful, integrated digital tools not to replace human interaction, but to enhance it. Our apps and platforms free our care teams to focus on what matters most: your people.
Our Integrated Care Model
This is how we deliver better care and lower costs. Our model isn't a set of disconnected services; it's one intelligent system that connects technology, data, and human expertise to proactively guide members at every turn.
1. Intelligent Pre-Certification
Our pre-auth service, powered by an AI engine and reviewed by clinicians, dramatically accelerates approvals. This eliminates frustrating delays and creates critical data for our care team.
2. Proactive Clinical Outreach
The moment a procedure is approved, the data alerts the member's dedicated health coach. They don't wait for a call; they reach out immediately to begin care coordination.
3. High-Value Care Guidance
The coach guides the member to the best in-network providers, schedules appointments, and arranges follow-up care. This ensures a better experience, improved outcomes, and lower costs for the plan.
This isn't just about speed; it's about intelligence. Every administrative step is transformed into a proactive care opportunity, ensuring better care, a better experience, and lower costs.
The Coordinated Care Difference
In traditional healthcare, members are often left alone to navigate a web of disconnected providers, labs, and pharmacies. There's no central "quarterback" to manage their care. We solve this problem by acting as the single, reliable hub for all of a member's health needs.
Typical Member Journey
Fragmented, confusing, and stressful.
Member feels unwell and is unsure where to go.
Searches for an in-network provider, calling multiple offices to find and schedule an appointment.
Must coordinate between the primary care doctor, specialists, labs, and pharmacies on their own.
Spends hours on hold with the insurance carrier to understand bills and coverage issues.
Health365+ Coordinated Journey
Unified, proactive, and simple.
Member contacts their dedicated Health365+ Care Team (one call, 24/7 support).
Care Team promptly finds the right in-network provider and schedules the appointment.
Care Team handles pre-authorizations, specialist referrals, and prescription coordination behind the scenes.
Member has one point of contact for all questions. The process is simple and stress-free, with a knowledgeable advocate guiding them at every step.
Core Plan Services
The integrated journey is powered by these foundational services, designed to provide comprehensive support across all aspects of care.
Virtual Direct Primary Care (DPC)
The digital front door to our system. For a $0 copay, members get unlimited, on-demand access to a dedicated primary care team for acute issues, chronic condition management, wellness visits, and prescription renewals.
Proactive Chronic & Whole-Health Management
Using data from across the healthcare ecosystem, we identify at-risk members and engage them with a personal health coach, and a free remote monitoring device (as needed). This program is proven to save over $2,000 per engaged member per year by preventing complications and improving health behaviors.
A Conflict-Free Pharmacy Model
We fundamentally redesign pharmacy benefits to eliminate conflicts of interest. For high-cost specialty medications, our TPA works with members to leverage Manufacturer and Patient Assistance Programs. This strategy generates an average savings of 35% on your total pharmacy spend or delivers significant savings based on our national benchmarks. Any claim fund dollars remaining at year-end are returned to you, the employer.
The Health365+ Digital Hub
We empower members and administrators with a unified, intuitive technology platform that simplifies benefits and enhances the human-powered support our care teams provide.
Your Central Hub for Digital Support
Our platform provides a single point of access for all plan-related information and tools, eliminating the confusion of multiple logins and disconnected systems. It's the central hub for a member's entire health journey.
"We believe technology should simplify the healthcare journey, not complicate it. Our platform provides the clarity for transparent decisions while always keeping the member at the heart of a human-centric experience."— Joshua Parise, Chief Innovation Officer
A Better Benefits Experience
We believe that a health plan is only as good as an employee's ability to understand and use it. We lift the burden of benefits education from your HR team by providing direct, expert support to your employees.
Guided Enrollment with Licensed Coaches
We provide your employees with direct access to our team of salaried, licensed benefit coaches. During open enrollment, our coaches can walk each employee through their options and complete their benefit elections over the phone or via a co-Browse session. This hands-on approach limits costly enrollment errors, gives valuable time back to your HR department, and dramatically increases employee understanding of how to select and use the right plan for their family.
BenefitBites: On-Demand Education
We make complex benefits simple with our library of short, interactive "BenefitBites" courses. These communications are sent directly to employees via SMS or email both pre- and post-enrollment to teach them how to use their plan effectively. Each course is custom-built for your benefits package, ensuring your team gets the specific information they need, when they need it.
Three Strategic Options for Quality Innovation
We have designed three distinct plan strategies to give you maximum flexibility. This approach allows you to see the precise savings and value generated by moving a specific employee population to different plan designs, from a direct comparable match to a richer plan or a maximum savings option.
From Passive Payer to Empowered Owner
| Aspect of Your Plan | Typical Fully-Insured Plan (UnitedHealthcare) | The Health365+ Model |
|---|---|---|
| Access to Claims Data | A "black box" where data is owned and hidden by the insurer. | Full Transparency. Access your plan's data to see exactly where your dollars are going. |
| Unused Claim Dollars | Forfeited. The insurance carrier keeps all unused premium dollars as profit. | 100% Retained. You keep every dollar in your claims fund that isn't spent on care. |
| Plan Design & Flexibility | "One-size-fits-all" menu of off-the-shelf designs. | Designed by you, for you, with the flexibility to meet your workforce's specific needs. |
| Financial Control & ROI | Unpredictable annual increases with no real control over costs. | Strategic Cost Management. Finally manage the root cause of costs: member health. |
Apples-to-Apples Strategy
Matches your current benefit structure by moving each employee group to a comparable plan, resulting in significant blended savings.
$393,254 / year
- Plans: H403 (for DP7A group) & H405 (for DP7F group)
- Deductible: Varies by group
- OOP Max: Varies by group
Better Alternative Strategy
Provides a richer plan design (eDIYBS Bronze H403) for your high-deductible employees, creating a different cost mix while still offering savings.
$394,795 / year
- Plan: eDIYBS Bronze H403 (for all employees)
- Deductible: $5k / $10k
- Richer benefits than current high-deductible plan
MAX SAVINGS
GAP Strategy
The lowest premium cost with the power of our GAP protection.
$420,585 / year
- Plan Deductible: $8k / $16k
- GAP pays the deductible for major events
- Member has $0 cost for most services
- Maximum possible premium savings
Side-by-Side Plan Comparison
Comparison for UHC Plan DP7A (Low Deductible) Enrollees
| Feature | Current: UHC DP7A | Proposed: Apples-to-Apples | Proposed: GAP Strategy |
|---|---|---|---|
| Deductible (Indv/Fam) | $3,500 / $7,000 | $5,000 / $10,000 | $8,000 / $16,000 |
| Out-of-Pocket Max (Indv/Fam) | $7,000 / $14,000 | $8,700 / $17,400 | $8,700 / $17,400 |
| Effective Member Cost (w/ GAP) | N/A | N/A | $0 for major events |
Comparison for UHC DP7F (High Deductible) Enrollees
| Feature | Current: UHC DP7F | Proposed: Apples-to-Apples | Proposed: Better Alternative | Proposed: GAP Strategy |
|---|---|---|---|---|
| Deductible (Indv/Fam) | $7,000 / $14,000 | $8,000 / $16,000 | $5,000 / $10,000 | $8,000 / $16,000 |
| Out-of-Pocket Max (Indv/Fam) | $8,000 / $16,000 | $8,700 / $17,400 | $8,700 / $17,400 | $8,700 / $17,400 |
| Effective Member Cost (w/ GAP) | N/A | N/A | N/A | $0 for major events |
Detailed Rate & Savings Analysis
| Plan / Strategy | Monthly Cost | Annual Cost | Annual Savings |
|---|---|---|---|
| Current UHC Renewal - DP7A (Low Deductible) Enrollees (32 Employees) | |||
| Current UHC Renewal | $33,260 | $399,116 | — |
| Strategy 1: Apples-to-Apples | $29,898 | $358,781 | $40,335 |
| Strategy 2: GAP Strategy | $31,825 | $381,895 | $17,221 |
| Current UHC Renewal - DP7F (High Deductible) Enrollees (4 Employees) | |||
| Current UHC Renewal | $3,315 | $39,779 | — |
| Strategy 1: Apples-to-Apples | $2,873 | $34,473 | $5,306 |
| Strategy 2: Better Alternative | $3,001 | $36,014 | $3,765 |
| Strategy 3: GAP Strategy | $3,224 | $38,690 | $1,089 |
| Grand Total & Savings (All 36 Employees) | Total Annual Cost | Total Annual Savings |
|---|---|---|
| Apples-to-Apples Strategy | $393,254 | $45,641 |
| Better Alternative Strategy | $394,795 | $44,100 |
| GAP Strategy | $420,585 | $18,310 |
A Stronger, Smarter Network
A key consideration is ensuring your employees have access to the care they need. We have analyzed the proposed HPN Texas network against the major hospital systems in your primary area of Austin, TX. Our research confirms that the Health365+ network provides robust access to top-tier local facilities.
Austin, TX Hospital Access: Before & After
St. David's HealthCare
Leading Austin System
Current UHC
✓ In-Network
Health365+
✓ In-Network
Ascension Seton Healthcare
Comprehensive Care
Current UHC
✓ In-Network
Health365+
✓ In-Network
Baylor Scott & White Health
Trusted Regional Provider
Current UHC
✓ In-Network
Health365+
✓ In-Network
Our network strategy ensures minimal disruption. The proposed network includes all major hospital systems in the Austin area. For any niche specialists or ancillary facilities that might fall outside this core network, our plan is wrapped with a broad, national PPO network (MultiPlan/PHCS) to cover potential gaps and provide comprehensive nationwide access.
GAP Strategy: Financial Protection
Pairing the right high-deductible plan with a GAP supplement is a powerful strategy. The GAP plan “wraps around” the primary plan’s deductible, shielding your employees from high out-of-pocket expenses for major medical events.
How the GAP Works: Real-World Example
Scenario: $50,000 Inpatient Hospital Stay
Plan: GAP Strategy
The GAP plan covers the member's entire deductible and out-of-pocket responsibility for this event, providing superior financial protection.
GAP Rate Details
| Deductible | EE | ES | EC | EF |
|---|---|---|---|---|
| $1,000 | $16.79 | $30.22 | $29.73 | $42.82 |
| $1,500 | $25.19 | $45.33 | $44.59 | $64.23 |
| $2,000 | $33.58 | $60.45 | $59.46 | $85.64 |
| $2,500 | $41.98 | $75.56 | $74.32 | $107.05 |
| $3,000 | $50.37 | $90.67 | $89.18 | $128.46 |
| $5,000 | $59.97 | $107.93 | $106.25 | $154.12 |
| $8,000 | $87.21 | $156.95 | $154.50 | $224.10 |
Our Partnership Pledge
Choosing Health365+ is the first step in transforming your healthcare into a strategic benefit. We are not a vendor; we are an extension of your team, and our success is measured by your success.
Our Pledge to You, the Employer
- We pledge absolute transparency. You will have full access to all data and insights needed to make informed decisions.
- We pledge a proactive partnership. We will continuously analyze your population health data and bring you data-driven recommendations.
- We pledge to deliver a measurable return. By improving health and optimizing care, we are committed to lowering costs.
Our Pledge to Your Employees
- We pledge to always be a compassionate, human-first point of contact.
- We pledge to be your employees’ trusted health advocate.
- We pledge to empower every member with the tools and information they need.
Jeremy Spreitzer
Chief Executive Officer
Joshua Parise
Chief Innovation Officer
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