Exploring Medical Cost-Sharing and Next-Gen Healthcare Solutions with Health Admins
Transforming Healthcare: A Look into Medical Cost Sharing and Next-Gen Solutions
In episode 9 of Next-Gen Healthcare, we explored the future of healthcare with a focus on medical cost-sharing. Our guest, Andy Swanson, Chief Revenue Officer at Health Admins, shared insights on the evolving landscape of healthcare and how his company is paving the way for a more accessible, affordable, and transparent system. Here’s a breakdown of the conversation and the unique approaches Health Admins is implementing to make healthcare more affordable.
Listen to episode 09: Achieving Affordable Healthcare and Tech Innovations
The Birth of Medical Cost-Sharing and Health Admins
The origins of medical cost sharing trace back to the mid-1990s, when Dr. Tony Dale, after a surprisingly costly medical procedure, set out to find a way to make healthcare more affordable for consumers. This led to the formation of the Karis Group, which amassed a database of medical pricing across insurance, retail, and Medicare pricing over the next two decades. Building on that foundation, Dr. Dale launched Sedera in 2014 to offer consumers a community-based alternative to traditional insurance.
In recent years, Health Admins has grown rapidly through acquisitions to expand their offerings. Point Health, a health tech startup, joined forces with Karis and Sedera, bringing advanced negotiation tools and mobile accessibility for consumers. As the healthcare landscape continues to evolve, Health Admins has emerged as a leader in the cost-sharing space, acquiring Sedera and the American Provider Community, strengthening its focus on transparency and affordability.
Andy Swanson’s Personal Connection to Healthcare Reform
Swanson’s passion for healthcare reform stems from his own experience overcoming a traumatic brain injury in his early 20s, which left him temporarily deaf and reliant on the deaf and hard-of-hearing community. During his recovery, Swanson realized the critical need for better healthcare support, including accessible interpretation services. After regaining his hearing, he dedicated his career to making a difference, working to ensure major hospitals across North America offer video remote interpreting services.
His journey ultimately led him to Health Admins, where he’s driven by the opportunity to reshape healthcare experiences for others. He credits Dr. Dale for being a significant influence, particularly in managing the financial challenges associated with healthcare.
Health Admins’ Vision and Mission
Health Admins is committed to setting new standards in healthcare with a focus on accessibility, transparency, and cost control. According to Swanson, Health Admins’ vision centers on leveraging technology to expand cost-containment efforts, and they have made strategic acquisitions to support this. For example, Point Health’s technology enhances the cost-containment strategy by giving members the tools to make informed decisions on the best pricing and providers. The American Provider Community acquisition brought a network of providers committed to transparent pricing, reinforcing Health Admins’ mission of affordability.
Sedera’s Unique Model: Empowering Patient Choice
Unlike traditional insurance, Sedera’s model allows members to choose any provider, bypassing network restrictions that typically define out-of-pocket costs. Instead, members cover an initial “unshareable amount,” and then the community helps covers additional costs. This model gives members control over their healthcare experience, which has proven to be attractive to businesses and families alike. As Swanson points out, this approach enables employees and their families to engage with healthcare in a personalized way, often at a fraction of traditional insurance costs.
Overcoming Employer Reluctance to Adopt Cost-Sharing Models
While medical cost sharing can lead to significant savings, some employers remain hesitant to adopt it as an alternative to traditional insurance. Swanson believes this resistance often stems from a lack of understanding. Once employers learn about the cost-sharing model and its benefits, many see the potential to provide affordable healthcare options, especially for healthy workforces seeking lower-cost coverage.
Swanson emphasized that companies open to offering alternatives—like Health Admins’ virtual healthcare and Sedera’s medical cost-sharing model—often experience not only cost savings but also higher employee satisfaction, as employees gain flexibility and control over their healthcare choices.
Adapting Healthcare for a Younger Generation
Today’s younger workforce often neglects healthcare due to perceived invincibility or simply the absence of major health concerns. However, Swanson believes that medical cost-sharing options appeal to younger employees by providing affordable “safety nets” without the hefty premiums associated with traditional insurance. Cost-sharing acts as a “parachute” in case of unexpected health issues, a message that resonates with many young professionals as they consider more economical, yet reliable, healthcare options.
The Future of Personalized Healthcare with Direct Primary Care (DPC)
A transformative element of next-generation healthcare is the growing role of direct primary care (DPC), a model in which doctors don’t accept insurance, and patients pay a membership fee for dedicated, personalized care. Swanson envisions a future where DPC is a primary method for receiving healthcare, noting its advantages of better doctor-patient relationships and increased focus on individual health. By building partnerships with DPC networks, Health Admins hopes to foster a more proactive and accessible healthcare system.
A Collaborative Future for Healthcare Transformation
In closing, Swanson emphasized the importance of collaboration across the healthcare industry to make transformative changes a reality. Health Admins continues to bring together passionate individuals and organizations to support its mission of affordability, transparency, and patient choice. As Swanson said, “It’s about finding the right partners, advocating for change, and being a part of something bigger.”
Through this work, Health Admins and Sedera aim to redefine the healthcare experience, bringing next-generation healthcare solutions to individuals, families, and employers across North America.
