Pat Dileo, founder and CEO of Endeavor Plus, launched this Fair Haven-based tech-enabled startup in the fourth quarter of 2016. Merging his background in healthcare and finance, Dileo developed a new healthcare insurance product that provides self-funded healthcare to small and medium-sized (at least 20 employees) companies.
The Endeavor Plus team has other members with significant experience in online healthcare products, such as Vincent Esposito, COO; Antonio Cipollone, CFO; and Daniel Wells, executive vice president of business development, who was part of the original staff of eHealth (Mountain View, Calif.), Extend Health (South Jordan, Utah), GoHealth (Chicago, Ill.) and hCentive (Reston, Va.).
There is a lot of computer technology, both front-end and back-end, involved in the streamlining and implementation of the claim-payment process, said Esposito. Endeavor Plus has a patent pending on its claim-payment software.
The front end of the software handles benefits, and is a cloud-based portal to many different apps. The apps and communications are secure and HIPAA-compliant. The front end works seamlessly with the back end. Being cloud-based cuts down costs for Endeavor Plus and its members, Esposito said.
At the front end, like many other entities in the healthcare industry, Endeavor Plus offers a wellness plan, available online, as an option for mobile platforms. The participant provides his/her gender, age and preconditions, Esposito told us.
Recommendations are made regarding diet and exercise. The content for the wellness platform was provided by a New Jersey healthcare provider, Suzanne Shugg, APN, DNP and CLS (clinical lipid specialist); she is also a fellow of the National Lipid Association. There are discounts and cash rewards for participating, such as discounted gym fees and additional deposits towards a Health Savings Account (HSA), he noted.
In addition, telemedicine is provided by MDLIVE (Sunrise, Fla.) through the portal. Members can talk to doctors, live, about their medical issues.
Price transparency, which enables members to compare doctors’ fees, is a feature that will soon be added to the front-end portal and offered as a mobile app, Esposito said.
At the back end, there is a dedicated medical team overseeing case management to ensure that members are getting the proper care at the appropriate cost.
On the back-end financial side of the business, according to Esposito, Endeavor Plus’ patent-pending tech solution combines machine learning, artificial intelligence and analysis with data from the contract between the payer and the provider to generate an accurate, realistic claim evaluation after all the deductions and discounts.
In addition to traditional full health insurance coverage, the premiums go to potential claims, administrative costs and catastrophic coverage. Also, companies pay a sales tax on the premium. With self-funded insurance, money that isn't used for claims is returned at the end of the year, and there is no sales tax.
Citing a study by Manning & Napier (Fairport, N.Y.), Esposito said, “Ninety percent of companies with 5,000-plus employees have self-funded plans”, but, until now, this option has been used far less by small and medium-sized companies.”
Endeavor Plus was incorporated in 2014. Dileo, a New Jersey resident, started out in this state and then expanded to New York and Tampa. First, he developed his concept. Then he obtained a salesman, followed by a New Jersey investor. The startup was funded through a private network of personal and business contacts.
The innovative healthcare payment process provides Endeavor Plus with income, Esposito explained. Traditionally, insurance carriers reimburse hospitals and providers for claims. This can take time, an average of 60 days. Endeavor Plus, in a manner similar to factoring, buys the hospital's receivables at 85 to 90 percent and pays the hospital immediately.
If the receivable is not paid within 90 days, the healthcare provider or hospital exchanges the original receivable with a new one of equal value, which is also secured, while keeping all of the initial money used to purchase the first receivable. This helps capitalize the healthcare provider or hospital without a loan, he said.
By offering these financial services and requesting reimbursement levels that are better than the market rate, Endeavor Plus can negotiate below-market prices for its members. The intention is to reduce the cost for Endeavor Plus members over time, Esposito said.
Also, Endeavor Plus assists with “stop loss” to cover catastrophic claims that exceed a reinsurance partner's ability to pay if its predetermined risk has been exceeded. This protects businesses and members against any large claims exceeding expected risks, he explained.
If a large claim is submitted to one of Endeavor Plus’ reinsurance partners, the Endeavor Plus’ financial team can purchase the receivable on behalf of the stop-loss partner, and enable the partner to pay back the claim over an extended period of time. Mortgaging the cost of the claim over an extended period prevents the insurance rates from rising, he explained.
When one of Endeavor Plus' members has a large claim, Endeavor Plus offers its partners who cover its members against catastrophic events a three-year period to pay at 0 percent interest. This is a win-win situation for all concerned. The hospital gets its payment immediately, which more than justifies the discount, and the insurance carrier has a lower cost per claim payment. Endeavor Plus makes money on the financing.
While showing rate comparisons with a major insurance carrier, Esposito said, “The insurance plans offered by Endeavor Plus have helped companies save on up to 20 percent of their insurance premiums. Savings commonly range from 7 percent to 15 percent.”
Endeavor Plus’ HSAs are partially funded by the premiums, up to $1,500 per year for an individual and $3,000 per year for a family. The funds roll over from year to year, and can be used for any health expense, tax-free upon withdrawal. HSAs are available to those enrolled in a Qualified High Deductible Health Plan (QHDHP).
Esposito said, “This gives Endeavor Plus the lowest out-of-pocket expenses on the market, at $3,500 per person or $7,000 per family. This is achieved by having the deductible of $5,000 per person or $10,000 per family being offset by the HSA.”
Also, Endeavor Plus offers “No Network” or “Your Network” options. Esposito said that an employee has a choice of any doctor, with no coinsurance payments — ever. Once an employee has met his/her deductible, there are no out-of-network expenses.
Citing a Harvard study that found that medical expenses for rare or serious diseases or injuries cause 62% of all bankruptcies, Esposito said, “This is a very good healthcare product feature, which avoids the number-one cause of bankruptcy in America: having to pay coinsurance for out-of-network health care, for accident and catastrophic care, typically out of the state of residence.”
Esposito also noted that Endeavor Plus is looking for coders interested in outsourced work.