Despite the numerous advancements in the field of healthcare technology, most Americans are unable to experience the benefits of this progress in the U.S. healthcare system. More than 50 percent Americans think that the healthcare system in the United States of America has major problems, while 81 percent are dissatisfied with the total cost of healthcare in this country.

Total healthcare costs, including all private and public spending, are expected to rise from $4.7 trillion in 2023 to $7.2 trillion by 2031, growing by an average of 5.5 percent per year, according to the Centers for Medicare and Medicaid Services. However, approximately 25% of total healthcare spending is considered waste and a JAMA (Journal of the American Medical Association) Network report highlights how implementation of effective measures can help to eliminate such wasteful expenditure in the complex quagmire of the healthcare industry.

Innovative Plan Designs to Bridge Gaps in the Health Insurance Industry

Failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, and fraud and abuse, have been identified as some of the contributing factors leading to wasteful expenditure in healthcare. To fix these gaps at least in the private sector, Envita Medical Centers, a Center of Excellence for Precision Oncology has launched Envita Health™, and their plan designs can be overlaid onto existing insurance plans or used to replace them.

Envita Health™ Combines Advanced Technology with Clinical Prowess to Fix the Health Insurance Quagmire in Multiple Ways. The Following List Highlights the Top 9 of These:

1.     Clinician Designed Plans

As an MSO (Managed Service Organization), Envita Health™ offers customized solutions, which go beyond the scope of other standard private insurance plans. Unlike other standard insurance plans, Envita Health™ plans are developed by clinicians themselves, who have been treating patients with late-stage cancers and other chronic diseases for over 25 years by utilizing advanced precision technology. With a clinical eye at the heart of these plans, Envita Health™ holds the potential of transforming outcomes in a more cost-effective delivery system.

2.     Precision Algorithms Backed by Technology

Effective utilization of advanced technology has helped to capitalize on this vast clinical experience, which has been crucial for the development of Envita’s precision algorithms. These algorithms play a critical role in relaying the benefits of the latest healthcare technologies to more patients. The Envita Health™ plans demonstrate how the powerful combination of clinical experience and robust technology can be utilized to widen the toolkit of options for patients, while reducing overall healthcare costs.

3.     Specialized Training to Fix the Causes of Healthcare Waste and Improve Outcomes

Every healthcare provider at Envita, irrespective of their specialization, has been trained in the innovative personalized precision medicine approach, which enables elimination of certain wasteful expenditures, like overtreatment or low-value care. The strength of this intensive training shines through the Envita Health™ plans, which have been smartly designed to work towards removing wasteful expenditure from the healthcare system. Eliminating such healthcare waste helps in reducing the high costs for payers, while improving patient outcomes. For example, if a patient has to undergo a knee surgery, then typical standard private insurance may redirect patients to a COE, which helps to reduce long-term costs, but with Envita Health™ plans, designed by doctors trained in conventional and integrative personalized medicine, patients may bypass the need for surgery as they get access to advanced regenerative medicine. Such innovative initiatives not only help patients recover fast, but also reduce the overall healthcare costs for all stakeholders, including employers, and employees and their dependents, who are the plan members.

4.     Enhances Connectivity and Improves Decision-Making

With the help of advanced technology, the Envita team has developed precision algorithms, which have been utilized to build proprietary codes that allow the team to provide coverage for integrative and personalized medicine. These proprietary billing codes have created a favorable ecosystem for enhancing smooth and secure connectivity of health information in real time, facilitating proactive interceptions throughout the patient’s healthcare journey. For instance, if an Envita Health™ plan member is recommended a knee surgery, then its infrastructure has been designed to identify such codes for which patients can have access to more cost-effective alternatives. With the use of advanced information technology infrastructure, the Envita team ensures that plan members are aware of and have coverage for the recommended alterative options, thus improving the process of decision-making for patients and their families.

5.     Gamechanger in Chronic and Life-threatening Conditions

Widening the toolkit of options proves especially beneficial for patients with chronic conditions and life-threatening diseases, like cancer. Envita’s advanced precision oncology approach has helped many late-stage cancer patients who were left with limited options in standard insurance-based oncology programs. These successful recoveries are a result of cost-efficient, integrative precision treatments, as a 3rd party actuarial response data highlighted that Envita’s costs are 50% less than standard oncology*. Cancer is now the top driver of employer healthcare costs, and taking advantage of precision oncology protocols can not only help save and extend lives, but also reduce costs for the payers.

6.     Offers Fair Pricing

Utilizing precision technology also helps address wasteful expenditure due to pricing failure, which translates to inconsistent pricing of care in the U.S. healthcare sector. On an average Envita’s fees were 141 percent of Medicare rates while a JAMA (Journal of the American Medical Association) Oncology report showed that hospitals can sometimes bill upwards of 10 times or 1000 percent of Medicare reimbursement for radiation therapy alone. With Envita Health™ all providers, facilities, and hospitals are accepted, and guaranteed to never exceed 200 percent of Medicare.

7.     Reduces Pharmacy Costs

These proactive services offering a true 2nd opinion to patients permeates into their pharmacy program as well, which also helps to plug the hole of healthcare waste caused due to expensive drugs. According to a latest Commonwealth Fund report, prescription drugs are one of the factors associated with excess spending in the U.S. healthcare system. Switching branded to generic medications has become a common cost-containment measure, but Envita Health™ takes it to the next level by offering a pharmacogenomic program. This program may help determine drug-free options for areas of disease where medication reduction is crucial for enhancing overall health.

8.     Revolutionary Preventive Programs

Envita Health™ breaks away from the reactive approach of Medicine 2.0, which focuses on diagnosing and treating illnesses, to function on the principles of Medicine 3.0. This paradigm shift in medicine is aimed at utilizing the latest technologies to personalize treatments for early intervention, disease prevention, and overall holistic recovery.  With Envita Health™, plan members not only get access to regular diagnosis and treatment like any other standard insurance-based care, but they can also utilize the perks of the latest healthcare technology for advanced screening programs. For example, a simple blood draw to screen for 52 different types of cancers, and numerous such tests in different specialties, which are designed to screen for the earliest signs of disease onset. Early identification of diseases leads to proactive and timely medical intervention, which is crucial for improving outcomes and reducing overall healthcare costs.

9.     Open Network Access Helps Tackle Wasteful Expenditure

Envita Health™ also uses revolutionary technology to remove the HMO and PPO restrictions, offering access to 1.1 to 1.4 million practitioners, hospitals, and ancillary providers nationwide. This open network access reduces the chances of healthcare waste caused due to failure of care coordination and fraud and abuse, which includes misrepresentation of the types of services rendered to a patient or seeking improper reimbursement.

Call Us Today

Backed by a top insurance carrier, Envita Health™ stands for honesty, transparency, and value, leaving no room for fraud and abuse in any step of implementation and processing of their plan designs. By providing coverage for cutting-edge precision technology in both conventional and integrative medicine, Envita Health™ aims to steer through this complex quagmire, while remaining focused on the goal of improving outcomes and reducing costs. For any queries related to your health insurance plan, please feel free to call us at 877-214-8660. May God bless you on your healthcare journey!

*Data is based on our analysis of records for 87 out of 129 patients that participated in Envita’s treatment program in 2020. 42 patients were removed from the cohort due to the patient’s inability to start or complete Envita’s prescribed treatment for a variety of reasons, including but not limited to, advanced disease state, disease progression, or inability to travel.