Aphora Health™

Aphora Health™
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Frequently Asked Questions

General

Aphora Health is a global healthcare services company created by a group of executives with decades of experience in the healthcare provider and health insurance sectors who are deeply committed to improving people’s lives. The company’s vision is to improve health equity and lower costs by bringing global healthcare to US markets.

Aphora Health brings destination healthcare directly to consumers who pay for their own healthcare and self-insured employers, along with their plan members, through its network of accredited healthcare providers, with a clinically focused, high-touch customer service model at a fraction of the typical cost.

The company’s offerings target expensive specialty medications, high-cost elective surgeries, and cosmetic/non-covered procedures, bringing accessible, high-quality services at significantly lower cost.

Millions of Americans cannot afford high-cost surgeries and expensive specialty medications when in fact they have health insurance. Many are trying to stretch their paycheck to cover housing and food and the ability to pay as much as $5,000 – $10,000 out of their pocket to meet deductibles and cost sharing is not possible. As a result, average wage workers put off getting the care that they need. Aphora Health is committed to changing this inequity in our system.

The market opportunity for medical tourism, or what we refer to as destination healthcare is growing at an astronomical pace and projected to hit $77B this year with millions of Americans seeking care outside the US annually.

At Aphora Health, we focus on two lines of business. First, our Direct-to-Consumer line, who are clients that self-pay for the healthcare services typically not covered by health insurance plans. There is some competition in the DTC market with companies like ours largely focusing on those self-pay consumers. We launched our service in the DTC market in November in select markets where there are direct flights to our premier medical facility in San José, Costa Rica. Our focus in this line of business is largely on cosmetic, non-covered health care services where there is increasing demand for lower cost, high quality services and we are excited to see interest in the Aphora offer.

Aphora will differentiate itself through the employer line of business focused on the 177M employees of self-funded employers where there is considerably less competition today in the medical tourism market. Self-funded employers fund their own health care claims expense for their employees which represents an ever-growing percentage of a company’s operating expense. These self-funded employers are looking for ways to reduce healthcare costs without sacrifice to quality, which is what Aphora Health delivers.

Available in mid-2024, our employer offering consists of three components. Our voluntary, non-covered offering allows employers to provide a lower cost option for sought-after services, such as cosmetic, medical and dental services typically not covered by the health plan. Employers can meet this growing demand without increasing the cost of their health care program. The second component of our employer offer is our Pharmacy program, which enables employees needing often lifesaving, high-cost medications access to these drugs at a fraction of the cost. Pharmacy costs represent some 24% of employer health plan spend and our program provides significant savings to the employer and employee. The third component of our employer offering is the medical/surgical component, which includes procedures in Orthopedic, Cardiovascular, Bariatric, Neurosurgical and Oncology medicine. Employers can elect one or all of these service components to benefit from the lower health plan expense and improved employee health and satisfaction benefits.

Self-funded employers today spend some $550B a year on healthcare claims and few cost containment programs can yield the savings we offer those employers. Introducing Aphora as an optional care delivery approach means employees will be less likely to put off needed healthcare services while at the same time, employers save significant dollars.

How does Aphora make healthcare more AFFORDABLE?

The healthcare cost crisis continues to build here in the U.S. Employer costs are forecast to increase another 8.5% in 2024 with family coverage expected to jump to over $24,000 per year.

Millions of Americans cannot afford to get the healthcare they need or desire with 1 in 5 having accumulated significant medical debt. Many in fact have health insurance but can’t afford the high deductibles and cost sharing that can add up to as much as $5000 – $10,000 for a surgery.

Aphora Health makes healthcare more affordable through our contracted network of high-quality international medical facilities and physicians in medically advanced and desirable destinations in the world. Costs are often less than half compared to the U.S.. Improving affordability and increasing access to care is what Aphora is all about.

How does Aphora help make sure that the international healthcare is HIGH QUALITY?

Many people do not realize that there are hospital facilities and doctors outside the U.S. with quality and outcome results equal to or better than the U.S. We have identified and assessed these facilities and have built our select network with quality health care delivery as our primary focus. All of our facilities have received and maintain accreditation through well respected accrediting bodies, such as Joint Commission International who require these facilities to meet high quality, safety and service delivery standards. And, many have affiliations with leading medical institutions in the U.S. like John’s Hopkins Medical Center. Our clinical team visits each of these facilities and maintains ongoing relationships to monitor performance to ensure only the best for Aphora Health clients.

How does Aphora make sure travel is SAFE?

The Aphora Health solution includes a hyper-focused emphasis on safety for our clients and their traveling companion. We select destinations that are safe for travelers and monitor the travel safety constantly through real-time, state-of-the-art tools and resources. Even more importantly, our Care Navigators in coordination with an experienced travel services firm develop itineraries that include escorted, door-to-door transportation as well as lodging in some of the most desirable and convenient areas where our contracted facilities are located. Aphora clients trust the experience of the Aphora team to arrange all travel needs — a key component of the Aphora difference.

What does Aphora do to help make receiving international healthcare SIMPLE?

Aphora clients enjoy the simplicity and peace of mind they receive by having our Care Navigators serve as their guide and partner throughout their care journey. We have developed a technology platform and leveraged resources that help us efficiently educate and serve our client’s needs. Our client portal allows for easy communication and is a repository for key client information. The Aphora clinically trained Care Navigators form a relationship with our clients and become their trusted resource throughout the care journey.

At Aphora, we provide a personal experience that builds relationship and instills confidence with those we serve. Our clients have an inititial consult with their Care Navigator who educates them about the Aphora clinical services available through our contracted providers and what to expect throughout the care journey. Care Navigators obtain the needed clinical and other information about their desired medical service and talk with clients about their preferred destinations to match the clinical expertise of our curated network with the desired travel experience our clients and their companions are looking for. We provide our clients with opportunity to have a virtual visit with their care provider as part of the selection process to learn and ask questions. When the client decides to move forward, we coordinate all the travel and logistics for the patient and their companion and guide them through the entire care experience. Our Care Navigators are there for our clients before, during and after the procedure as a first point of contact for anything our clients may need. 

Aphora Health offers high quality, lower cost services covering a wide array of some of the most costly health and dental services available today. Through what we call our “hub and spoke” model for provider contracting, we look for the best hospital facilities with strong outcomes and experience in international care delivery in desirable destinations as the provider “hub”, then look within that same area for other providers offering other components of the Aphora service offering, such as cosmetic and dental services, which we call the “spoke”. This approach establishes us in those key markets and allows us to leverage travel and accommodation arrangements to best serve our clients and the companions travelling with them.

With the increasing rise in healthcare costs in the U.S., expected to rise 8.5% in 2024, more than doubling the previous two years increase percentage, employers and consumers alike are seeking lower cost alternatives while still maintaining high quality care delivery. With that in mind, Aphora has developed a service offering that includes some of the highest demand and highest cost procedures to improve access and affordability.

Our offering of medical/surgical services spans some of the most common surgical procedures in Orthopedics, Cardiology, Bariatrics, Neurology, Oncology, and General Surgery. Plans of treatment for these services are arranged with highly skilled surgeons whom our clients have an opportunity to meet during the selection process. Stays for international services are longer than the U.S. to allow for adequate post-care services and recovery before traveling home.

Pharmaceutical costs are an increasing portion of health plan spend for employers representing some 24% of health plan costs, up 3% from the prior year. This reality makes the Aphora Pharmacy offering high-cost medications a highly sought after component of our program. Approximately 20 high-cost medications from the same manufacturers as those used in the U.S. are included in our offering at a fraction of the cost. Our pharmacy program will help thousands receive the much needed, and often life-saving medications in a high-quality and safe manner.

An increasing number of Americans are seeking elective services such as cosmetic procedures and dental services and Aphora includes these services in our offering. Through our direct-to-consumer program or a voluntary offering by employers, these sought after services can be obtained by high quality facilities and professional providers at 50-70% lower cost compared to the US. These services that make us feel better and look younger are often out of reach of the average person, but Aphora makes it affordable, safe, simple with outcomes on par or better than the U.S.

Some specialty services, many of which are not covered by medical plans, are also included in the Aphora offering. Services such as In-vitro Fertilization, gender affirming care and wellness medicine are also offered within our network of contracted providers making these important services more affordable.

All of the Aphora service offerings include the support of an Aphora Care Navigator who supports the client throughout their care journey and does all the coordination so the client can focus on feeling better and looking great!

Aphora Health offers high quality, lower cost services covering a wide array of some of the most costly health and dental services available today. Through what we call our “hub and spoke” model for provider contracting, we look for the best hospital facilities with strong outcomes and experience in international care delivery in desirable destinations as the provider “hub”, then look within that same area for other providers offering other components of the Aphora service offering, such as cosmetic and dental services, which we call the “spoke”. This approach establishes us in those key markets and allows us to leverage travel and accommodation arrangements to best serve our clients and the companions travelling with them.

With the increasing rise in healthcare costs in the U.S., expected to rise 8.5% in 2024, more than doubling the previous two years increase percentage, employers and consumers alike are seeking lower cost alternatives while still maintaining high quality care delivery. With that in mind, Aphora has developed a service offering that includes some of the highest demand and highest cost procedures to improve access and affordability.

Our offering of medical/surgical services spans some of the most common surgical procedures in Orthopedics, Cardiology, Bariatrics, Neurology, Oncology, and General Surgery. Plans of treatment for these services are arranged with highly skilled surgeons whom our clients have an opportunity to meet during the selection process. Stays for international services are longer than the U.S. to allow for adequate post-care services and recovery before traveling home.

Pharmaceutical costs are an increasing portion of health plan spend for employers representing some 24% of health plan costs, up 3% from the prior year. This reality makes the Aphora Pharmacy offering high-cost medications a highly sought after component of our program. Approximately 20 high-cost medications from the same manufacturers as those used in the U.S. are included in our offering at a fraction of the cost. Our pharmacy program will help thousands receive the much needed, and often life-saving medications in a high-quality and safe manner.

An increasing number of Americans are seeking elective services such as cosmetic procedures and dental services and Aphora includes these services in our offering. Through our direct-to-consumer program or a voluntary offering by employers, these sought after services can be obtained by high quality facilities and professional providers at 50-70% lower cost compared to the US. These services that make us feel better and look younger are often out of reach of the average person, but Aphora makes it affordable, safe, simple with outcomes on par or better than the U.S.

Some specialty services, many of which are not covered by medical plans, are also included in the Aphora offering. Services such as In-vitro Fertilization, gender affirming care and wellness medicine are also offered within our network of contracted providers making these important services more affordable.

All of the Aphora service offerings include the support of an Aphora Care Navigator who supports the client throughout their care journey and does all the coordination so the client can focus on feeling better and looking great!

There are several factors that contribute to lower cost of healthcare services outside the United States. First, we see that in general, the cost of living and cost of goods and services outside the U.S. is significantly lower, which translates into lower medical costs as well. As a result, we see medical staff salaries, including physicians, hospital costs and other related health care services significantly lower outside the U.S. This lower cost structure also extends to services like diagnostic testing and pharmaceuticals. We also see impacts from the profit margin demands on health care systems in the U.S. coupled with the high cost of malpractice insurance in the United States contributing to the cost gap as well. The bottom line is that an increasing number of U.S. citizens are unable to afford needed care in the U.S. and recognize the high-quality care available in other countries at a fraction of the cost.

Our primary focus is developing an international network of high-quality providers to improve access and affordability to health care services for our clients. Over time, we may extend that focus to include domestic centers of excellence in our network to provide high quality, lower cost services within the U.S., but that is not the primary focus and business model of Aphora at this time.

To date, Aphora Health investors are individuals in the healthcare, health insurance and technology markets who have a proven track record of identifying successful investment opportunities in early-stage companies like Aphora Health that end up having a big impact on unmet market needs. Individual investor names are confidential.

Employer

The specialty medications included in the Aphora program represent a very low volume of the overall medications fills within your group. Typically only 1-3% of your health plan members are taking these medications making the volume impact to your PBM very minimal. And, the Aphora savings on these medications surpass rebate opportunities you may be receiving today. 

Stop loss agreements typically require an amendment to support the introduction of an international benefit into your health benefit program. This amendment language would designate that the international benefits payable under your plan would accumulate toward your liability limits (except for any specific services or claims for which your stop loss carrier excludes from coverage) 

TBD

TBD

The Aphora program can be introduced outside your annual renewal. It is actually preferable to introduce the Voluntary program outside your normal renewal to increase focus and attention on the offering. The Medical/Surgical and Specialty Medications offering can also be offered outside your annual renewal with the appropriate program amendments in place to support the offering and Aphora can provide assistance with those activities. 

Aphora has a complete and thorough approach to implementation that requires minimal time investment for employer groups. We work in partnership with your TPA (Third Party Administrators) to ensure the necessary components are in place to facilitate the program for your health plan members that allows for you to maximize savings while ensuring a service focused experience for your health plan members. The implementation plan includes communication materials you can make available to your employees to educate them on the benefits and services of Aphora Health. 

The care pathway for the specialty medications program is dependent on several factors including the type of medication, the location, and our contract with the rendering pharmacy. Not all pharmacies offer all pathways and the travel pathway is focused on closer destinations where the travel is reasonable for a 2-3 day stay. The Aphora Care Navigator will work with the health plan member to determine the most appropriate and cost-effective pathway for the needed medication. 

While we initiate the medication fills in sufficient time to allow for safe and timely receipt, if there is a delay in shipping that causes the member not to receive their medications timely the local pharmacy is always an option for the member to use and any amounts paid in advance would be refunded. 

The Aphora Specialty Medications program includes a formulary of high-cost medications in treating inflammatory conditions, multiple sclerosis, cancer, HIV, hemophilia, hepititas and respiratory conditions. We evaluate drugs for inclusion in our formulary regularly and target drugs with a US per fill cost of $2500 or greater. 

The Aphora Care Navigator provides support before, during and after the procedure and is there to help coordinate support for any complication or follow-up care that might be needed upon your return home. Hospital stays outside the US are typically longer and allow for in-country care for issues that might arise post-surgery by the treating physician and facility. 

Many people simply cannot afford the out-of-pocket costs for health care services and delay needed care impacting not only their quality of life, but their absenteeism and productivity resulting from the medical condition. Making care more affordable through the Aphora program enables the employee to receive needed care and return to full function that actually has a positive impact on productivity and overall employee well-being. 

Health Plan Members / Individuals

The Aphora Care Navigator is at the center of ensuring the appropriate level of care continuity for the service you are receiving. They are clinically trained and can work with you, and if needed your local provider, to support your local care coordination needs from pre-treatment to post treatment. 

Yes! Upon discharge following your procedure, you will receive comprehensive discharge notes and a discharge plan designed to meet your post operative care needs. The facilities contracted with Aphora can provide detailed medical records to patients upon request. Your Aphora Care Navigator can educate and direct you through the process with each facility to enable you to directly obtain your medical records. 

Quality care and positive outcomes are job-one for Aphora. While the improved affordability of services is compelling for our clients, if that does not allow for quality care delivery and great treatment outcomes, then we and our providers partners have failed. At Aphora, we select only the best facilities with a proven track record and deep experience in the services we provide our clients. We have a team at Aphora with a clinical background that visits each of the global facilities we consider for contracting to meet the administrative and care teams that will be interacting with our clients. They validate facility accreditation, care quality and safety performance data and establish a protocol for ongoing monitoring of these results. Of equal importance is the feedback we receive from our clients throughout their care journey which we value and share with our contracted providers. 

The Aphora difference is our focus on safety, quality and simplicity for those seeking lower cost health care available outside the US. Many of us have heard about the bad experiences resulting from people doing their own research of providers outside the country and coordinating their own travel, lodging and hoping for the best. Aphora provides a fully vetted network of quality providers and the level of end-to-end support that helps ensure quality care delivery with positive clinical and safety outcomes. Our international facilities and providers have the experience and the right credentials to offer the kind of care delivery we all expect. And our Aphora Care Navigators, who themselves have clinical background, do all the legwork for you, guide you, and actually become a trusted resource for our clients every step of the way. 

The Aphora network of international providers is only comprised of facilities and practitioners that have achieved and maintain the highest levels of quality in their respective fields. All of our facilities are accredited by Joint Commission International (JCI). 

All travel arrangements are made by our Care Navigators which includes coordination of all travel documentation requirements, air, hotel and ground transportation for you and a companion. Aphora members receive a door-to-door travel escort service from licensed and reputable companies. In addition, our network is developed with a focus on travel safety and only designations that are deemed safe for international travel are selected for our members. 

The Aphora network facilities are located in many of the most desirable travel destinations in the world. Not all surgical services are available in all contracted facilities so we will match your healthcare needs and destination preferences with our network providers and present those options to you for consideration. Often, you will have more than one facility/destination from which to choose. 

Yes, surgical services appropriate for international care delivery which are covered under your employer medical health plan would be covered by an international facility contracted with Aphora. The prior authorization process would occur as usual and upon approval, international options would be presented to you for your consideration. Employer plans support the use of international care delivery for high quality, lower cost and improved affordability for its employees. 

The length of stay for surgical services received outside the US is typically longer compared to the US to allow for post operative care to be provided by the facilities and providers you selected. Often times, these healthcare facilities have a residential setting adjacent to the hospital where patients recuperate for several days post-surgery to obtain a level of recovery necessary to allow for travel back to the US. Should complications arise upon return to the US, your Care Navigator will coordinate with appropriate providers to ensure any issues are addressed appropriately. Your Aphora Care Navigator is there to assist you with any pre and post-surgical services and care needs. 

Yes, many of our network facilities provide cosmetic surgery and cosmetic dental services at more affordable rates compared to the US and our Aphora services extend to those procedures as well. 

For services covered under your employer insurance plan, Aphora members have virtually no out-of-pocket cost for surgical and travel services. Any applicable deductible, copayment, or coinsurance are waived for Aphora members receiving services not covered by their medical plan or for those that are not have medical insurance, Aphora members will pay for services received at a significantly lower cost compared to the US and those fees will include travel expenses for the member and a companion. 

Yes, detailed information about the facilities and providers is available on the Aphora website including information about the quality, safety and patient experience ratings of the facility and its staff.  

Yes, some of our patients chose to extend their stay at the selected destination and while those additional days are at the member’s expense, our travel agency partner can assist in making your travel arrangements to include that extended stay. 

No, Aphora will help coordinate with your medical facility for you to obtain your confidential medical records when needed and have them sent directly to you. 

Specialty Medications

The Aphora Specialty Medication Program significantly reduces the cost of expensive specialty medications for self-funded employers and their health plan members. 

The patient and a companion can travel to a quality, accredited facility to be seen by a board certified provider who will write the prescription to be filled at the facility next day and then return home with their 90 day supply. Alternatively, they can receive a live virtual visit with a U.S. Board Certified, U.S. educated, and U.S. trained physicians who after consultation and medical records review will prescribe the same brand name medications the patient is already receiving. A 90-day supply of the medication will be dispensed after completion of the virtual consultation. 

Aphora has three pathways to receive specialty medications. With the travel pathway, Aphora clients travel to a contracted destination to see a board- certified care provider who, following assessment, will issue the identical prescription to the original from the U.S. The Medication will be filled at an onsite pharmacy the same or next day for a 90 day supply then the client travels home. Under the home delivery pathway, the client participates in a virtual care assessment with a board-certified provider and following assessment, will issue the same prescription to the original from the U.S. The 90 day supply will be filled at the established pharmacy abroad and shipped in appropriate and temperature-controlled packaging (if required) to the clients home. In the hybrid pathway, the client may travel for 1-2 visits per year and other refills are handed through the virtual care pathway. 

Yes, absolutely safe. Aphora Health partners with internationally accredited hospitals and pharmacies to obtain the same medications that are produced by FDA regulated facilities and available to you here in the United States. You will receive the same brand name products that are sent worldwide, including the U.S., through a coordinated process led by our Aphora Health Care Coordinator, a licensed physician, and an accredited pharmacy. 

Aphora sources only FDA approved medications and follows all guidelines of the Federal Food, Drug & Cosmetic Act 2003 804j for self-importation. All shipments are subject to examination at the border by the appropriate governing body (FDA, CBP, and USDA). The Aphora approach is a second opinion program that requires a consultation with an international, U.S. Boarded and Licensed MD and a U.S. boarded and licensed physician. 

Yes, Aphora directly sources these brand name medications from the same manufacturers that supply to U.S. pharmacies and healthcare facilities. 

There is no administrative cost to the self-funded employer to use Aphora. For health plan members that utilize the program, an invoice will be created reflecting an all-inclusive cost including medication which is good for a 12-month period. 

While actual savings is dependent on the medication dispensed, typical savings are approximately 40% lower compared to US cost for each member that participates in the program. 

Health plan members and their dependents who are on their employer’s plan and are prescribed a specialty medication included on the Aphora formulary can be sourced through Aphora. 

No, the patient’s treatment plan and care will continue by their physician. This program allows patients and employers to save on the high costs of specialty drug treatments. It does not replace the patient’s relationship with their treating physician. 

Members must possess a U.S. passport when using the Destination Travel pathway to travel to receive specialty medications. Members must also possess a U.S. passport as per U.S. Customs shipping requirements when using the Virtual Care Home Delivery pathway Program, to show citizenship for self-importation even if the passport is expired. Documentation requirements will be explained and provide support to obtain a passport if needed by the Aphora Care Navigator. 

Patients must have up to date medical records and prescription for their specialty medication. Their Aphora Care Navigator will arrange for a 30-minute video teleconference with our Board Certified physician and also with a U.S.-based Board-Certified specialist, licensed in their state who will write the prescription. 

The patient will receive a 90-day supply of their medication with each shipment. Aphora will monitor the shipment closely and follow up with the patient after the shipment arrives. 

The Aphora Care Navigator tracks each fill and contacts patients well before it is time for their next consultation. Just like the initial fill, the Aphora Care Navigator will assist the patient every step of the way. 

Yes, cold chain (refrigerated) shipping is assured. From ambient room temperatures, to controlled room temperatures (20°C to 25°C), to refrigerated (2°C to 8°C), all medication shipments arrive to facilities and shipping hubs that provide temperature control. All pharmaceutical packages ship via FedEx Express or DHL Global Express and are tracked and monitored to ensure the least amount of time in transit, while allowing for clearances by CBP, FDA, and USDA. 

The Aphora program can be added at any time during the plan year or at renewal based on the structure and language in the program plan documents.