Elevating
Care.
Reducing
Cost.
A comprehensive proposal for Virtuosa PLLC
Executive Summary
For years, Virtuosa PLLC has provided employees with generous benefits through a traditional, level-funded plan with Aetna. 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, Virtuosa PLLC is projected to realize $84,334 in direct premium savings. In addition, our integrated health management programs are projected to reduce claims by $53,500, creating a total potential value of $137,834 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 offer expert guidance.
Improving Health to Reduce Costs
Our model is designed to address the root causes 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
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. This is how we deliver better care and lower costs.
Care Coordination System
1. Intelligent Pre-Certification
Our pre-authorization service, powered by an advanced AI engine and reviewed by clinicians, dramatically accelerates approvals. This eliminates frustrating delays and creates critical early data for our care team.
2. Proactive Clinical Outreach
The moment a procedure is approved, that data triggers an immediate outreach from the member’s dedicated health coach. They don’t wait for a call; they reach out proactively to begin coordinating care and support.
3. High-Value Care Guidance
Our health coaches use our proprietary care guidance platform to direct members to the best in-network providers, schedule appointments, and arrange follow-up care. This ensures a better experience, improved outcomes, and lower costs for the plan.
Every administrative step becomes a proactive care opportunity. It’s not just about speed; it’s about intelligence. By converting routine processes into trigger points for outreach and guidance, we ensure better care, a better member 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 care journey is powered by these foundational services, designed to provide comprehensive support across all aspects of health.
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. 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 Digital Hub that simplifies benefits management and enhances the human support provided by our care teams.
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
A health plan is only as good as an employee’s ability to understand and use it. Health365+ lifts the burden of benefits education from your HR team by providing direct, expert support to your employees.
Guided Enrollment with Licensed Coaches
During open enrollment, Health365+ provides your employees with direct access to salaried, licensed benefit coaches to walk them through their options and complete enrollment.
"BenefitBites" On-Demand Education
We make complex benefits simple with our library of short, interactive micro-learning courses sent directly to employees to teach them how to use their health plan effectively.
Voices of Our Members
Here’s what employees using the Health365+ model have to say about their experience.
"With my old plan, I felt like just a number... The first time I called Health365+, I spoke to a real person who knew my name and solved my issue in minutes. The difference is night and day."
"Managing my diabetes used to be a constant struggle. With Health365+, they sent me a free glucometer that syncs with their app, and my health coach checks in regularly. I feel more in control of my health than ever before."
"I was so stressed when my daughter got sick, but our Health Coach was incredible. She helped us find a top-rated pediatrician in our network and even scheduled the appointment for us. It was a huge weight off my shoulders."
A Strategic, Apples-to-Apples Comparison
To provide the clearest possible financial picture, we have analyzed each of your current plans separately. For each group of enrolled employees, we present multiple strategic alternatives. 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 Level-Funded Plan (Aetna) | The Health365+ Model |
|---|---|---|
| Access to Claims Data | A "black box" where data is owned and hidden by the insurer. | Full transparency – you own your plan’s data and can see exactly where every dollar is going. |
| Unused Claim Dollars | Forfeited to the carrier as profit. Even carriers that offer a “surplus” via level-funding often return only part of the unused funds (e.g., 50%) and keep the rest. | 100% Retained. Every dollar in the claims fund that isn’t used for care stays with Virtuosa PLLC. |
| Plan Design & Flexibility | "One-size-fits-all" off-the-shelf plans. Limited ability to tailor to your workforce. | Custom-designed by you, for you. Flexible plan designs to meet your team’s specific needs. |
| Financial Control & ROI | Unpredictable annual increases, with no control over the underlying cost drivers. | Strategic cost management – by improving member health, we deliver lower costs and measurable ROI over time. |
Comparison for AFA OAAS 1500 70% CY V23 Enrollees (5 EE, 1 EE+CH)
| Benefit | Current: Aetna OAAS 1500 | Strategy 1: Better Alternative (Silver H302) | Strategy 2: Max Savings (Bronze H405 + PPO GAP) |
|---|---|---|---|
| Deductible | $1,500 / $3,000 | $3,000 / $6,000 | $6,000 / $12,000 (Member pays $0) |
| OOP Max | $6,500 / $13,000 | $6,000 / $12,000 | $7,000 / $14,000 (Max exposure $1k/$2k) |
| Coinsurance | 30% | 20% | 30% |
| PCP / Specialist | $40 / $80 | $35 / $55 | $50 / $120 |
| Emergency Room | $300 + 30% | $500 | $500 + 30% |
| Rx Tier 1/2/3 | $10 / $50 / $80 | $10 / $35 / $75 | $10 / $35 / $75 |
Comparison for AFA OAAS 7350 80% CY V23 Enrollees (3 EE)
| Benefit | Current: Aetna OAAS 7350 | Strategy 1: Better Alternative (Bronze H405) | Strategy 2: Max Savings (Bronze H405 + PPO GAP) |
|---|---|---|---|
| Deductible | $7,350 / $14,700 | $6,000 / $12,000 | $6,000 / $12,000 (Member pays $0) |
| OOP Max | $8,750 / $17,500 | $7,000 / $14,000 | $7,000 / $14,000 (Max exposure $1k/$2k) |
| Coinsurance | 20% | 30% | 30% |
| PCP / Specialist | $45 / $90 | $50 / $120 | $50 / $120 |
| Emergency Room | $300 + 20% | $500 + 30% | $500 + 30% |
| Rx Tier 1/2/3 | $10 / $50 / $100 | $10 / $35 / $75 | $10 / $35 / $75 |
Comparison for AFA OAAS 2750 HSA 100% TE CY V23 Enrollees (1 EE+CH)
| Benefit | Current: Aetna OAAS 2750 HSA | Strategy 1: Better Alternative (Silver H303) | Strategy 2: Max Savings (Bronze H404 + HSA GAP) |
|---|---|---|---|
| Deductible | $2,750 / $5,500 | $3,300 / $6,600 | $6,000 / $12,000 (Member pays first $1.65k/$3.3k) |
| OOP Max | $7,500 / $15,000 | $6,400 / $12,800 | $6,000 / $12,000 (Max exposure $1.65k/$3.3k) |
| Coinsurance | 0% | 20% | 30% |
| PCP / Specialist | $25 / $75 | 20% after Ded | 30% after Ded |
| Emergency Room | $250 + 0% | 20% after Ded | 30% after Ded |
| Rx | Tier 1&2 apply to Ded | All Tiers apply to Ded | All Tiers apply to Ded |
Detailed Rate & Savings Analysis
Savings for AFA OAAS 1500 70% Enrollees
| Cost Analysis | Current Renewal Cost | "Better Alternative" (Silver H302) | "Max Savings" GAP (Bronze H405) |
|---|---|---|---|
| Monthly Cost | $5,038.39 | $4,824.21 | $4,221.02 |
| Annual Cost | $60,460.68 | $57,890.52 | $50,652.24 |
| Annual Savings | — | $2,570.16 | $9,808.44 |
Savings for AFA OAAS 7350 80% Enrollees
| Cost Analysis | Current Renewal Cost | "Better Alternative" (Bronze H405) | "Max Savings" GAP (Bronze H405) |
|---|---|---|---|
| Monthly Cost | $1,851.33 | $1,840.44 | $1,893.18 |
| Annual Cost | $22,215.96 | $22,085.28 | $22,718.16 |
| Annual Savings | — | $130.68 | -$502.20 |
Savings for AFA OAAS 2750 HSA Enrollees
| Cost Analysis | Current Renewal Cost | "Better Alternative" (Silver H303) | "Max Savings" GAP (Bronze H404) |
|---|---|---|---|
| Monthly Cost | $1,299.74 | $1,271.91 | $1,120.11 |
| Annual Cost | $15,596.88 | $15,262.92 | $13,441.32 |
| Annual Savings | — | $333.96 | $2,155.56 |
Grand Total Savings Summary
| Strategy | Total Renewal Annual Cost | Proposed Annual Cost | Total Annual Savings |
|---|---|---|---|
| Better Alternative | $98,273.52 | $95,238.72 | $3,034.80 |
| "Max Savings" GAP | $98,273.52 | $86,811.72 | $11,461.80 |
Total Value & Savings Projection
The projection below provides a transparent, year-by-year outlook on the total financial value of partnering with Health365+. It assumes a standard 10% annual trend for your current plan vs. a managed 2.5% trend for the Health365+ plan, plus projected claims savings from our care programs.
A 5-Year Financial Outlook ("Max Savings" GAP Strategy)
| Year | Trended Current Cost | Trended H365+ Cost | Annual Premium Savings | Projected Program Savings | Total Annual Value |
|---|---|---|---|---|---|
| 1 | $98,274 | $86,812 | $11,462 | $10,186 | $21,647 |
| 2 | $108,101 | $88,982 | $19,119 | $10,441 | $29,559 |
| 3 | $118,911 | $91,207 | $27,705 | $10,702 | $38,406 |
| 4 | $130,802 | $93,487 | $37,315 | $10,969 | $48,285 |
| 5 | $143,882 | $95,824 | $48,058 | $11,243 | $59,301 |
| Total | $143,659 | $53,540 | $197,199 |
A Stronger, Smarter Network
The proposed HealthSmart Preferred (HPN Texas) network provides excellent access to top-tier local care for your members in the San Antonio area. Our analysis confirms that all major local hospital systems are in-network, ensuring continuity of care and broad provider choice. For any providers not included in this primary network, the plan is wrapped with the PHCS network, one of the largest in the nation, providing an extensive safety net for care across the country.
San Antonio Hospital Access
| Hospital System | Current Aetna Network | Proposed Health365+ Network |
|---|---|---|
| Methodist Hospital System (HCA) | ✓ Yes | ✓ Yes |
| Baptist Health System (Tenet) | ✓ Yes | ✓ Yes |
| Christus Santa Rosa Health System | ✓ Yes | ✓ Yes |
| University Health System | ✓ Yes | ✓ Yes |
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. This means you can dramatically lower premium costs with a high-deductible plan, while your employees still enjoy first-dollar coverage on big-ticket medical needs.
Aligning GAP with Your Plan Types
This proposal matches your employees’ current plan types with the appropriate GAP plan. If employees are on an HSA-eligible plan currently, we propose a Bronze HSA plan wrapped with an HSA-compatible GAP plan. If they are on a traditional PPO plan, we propose a Bronze PPO plan wrapped with a PPO GAP plan. This ensures the strategy aligns with your employees’ current account structure.
Crucially, the HSA GAP plan is designed to comply with federal regulations. This means it only begins to pay for services after a member has personally met the federal minimum required deductible for an HSA-qualified plan (For 2025: $1,650 individual / $3,300 family). After the member satisfies this portion, the GAP plan covers the remainder of the plan’s deductible.
How the GAP Works: Real-World Example
Scenario: $20,000 Inpatient Surgery
Comparing Current Gold PPO vs. "Max Savings" GAP Strategy
Current Gold PPO Plan
Proposed Bronze + PPO GAP
In this scenario, the employee saves $5,500 on a major medical event.
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
Select Your Strategy
Please select your preferred overall strategy below to move forward. You can choose to apply one strategy across the board, or mix-and-match based on the needs of your different employee groups. Clicking "Submit Strategy Selection" will generate a pre-filled email to notify us of your choice.
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