Aphora Health is a global healthcare services company created by 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 costs. 

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 paychecks 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 employees put off getting the care 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 is 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 consists of clients who self-pay for healthcare services typically not covered by health insurance plans.  There is some competition in the DTC market, with companies like ours mainly focusing on those self-pay consumers.  We launched our service in the DTC market in November in select markets with direct flights to our premier medical facility in San Jose, Costa Rica.  Our focus in this line of business is largely on cosmetic, non-covered healthcare 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 employees’ healthcare claims expenses, representing an ever-growing percentage of a company’s operating expenses.  These self-funded employers are looking for ways to reduce healthcare costs without sacrificing quality, which 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 healthcare program.  The second component of our employer offer is our Pharmacy program which enables employees often needing lifesaving, high-cost medications access to these drugs at a fraction of the cost.  Pharmacy costs represent some 24% of employer health plan spending, and our program provides significant savings for employers and employees.  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 employers save significant dollars.   

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

Millions of Americans cannot afford to get the healthcare they need or desire, with 1 in 5 having accumulated significant medical debt.  Many have health insurance but cannot afford the high deductibles and cost-sharing that can add up to as much as $5000 – $10,000 for 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 worldwide.  Costs are often less than half compared to the US.  Improving affordability and increasing access to care is what Aphora is all about.   

Many people do not realize that there are hospital facilities and doctors outside the US with quality and outcome results equal to or better than the US.  We have identified and assessed these facilities and have built our select network with quality healthcare 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 US, like Johns Hopkins Medical Center.  Our clinical team visits each of these facilities and maintains an ongoing relationship to monitor performance to ensure only the best for Aphora Health clients.    

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 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 and 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. 

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 relationships with our clients and become their trusted resource throughout the care journey.   

At Aphora, we provide a personal experience that builds relationships and instills confidence in those we serve. Our clients have an initial consultation 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 the 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 the 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 costliest 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 traveling with them.   

With healthcare costs in the US expected to rise 8.5% in 2024, more than doubling the previous two-year 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 medical/surgical services offer some of the most common procedures in Orthopedics, Cardiology, Bariatrics, Neurology, Oncology, and General Surgery. Treatment plans for these services are arranged with highly skilled surgeons whom our clients can meet during the selection process. Stays for international services are longer than in the US to allow for adequate post-care services and recovery before traveling home.   

Pharmaceutical costs are an increasing portion of health plan spending 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 US 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 for the average person, but Aphora makes it affordable, safe, and simple, with outcomes on par or better than the US.   

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! 

Several factors contribute to the lower cost of healthcare services outside the United States.  First, we see that, in general, the cost of living and the cost of goods and services outside the US is significantly lower, which translates into lower medical costs.  As a result, medical staff salaries, including physicians, hospital costs, and other related healthcare services significantly lower outside the US.  This lower cost structure also extends to services like diagnostic testing and pharmaceuticals.  We also see impacts from the profit margin demands on healthcare systems in the US coupled with the high cost of malpractice insurance in the United States, contributing to the cost gap.  The bottom line is that an increasing number of US citizens are unable to afford needed care in the US 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 healthcare 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 US, but that is not the primary focus and business model of Aphora at this time. 

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 the 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,  clients travel to a contracted destination to see a board-certified care provider who, following assessment, will issue an identical prescription to the original from the U.S.  The medication will be filled at an onsite pharmacy the same day or the next day for a 90-day supply, and 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 the assessment will issue the same prescription as the original from the U.S.  The 90–day supply will be filled at the established pharmacy abroad and shipped to the client’s home in appropriate, temperature-controlled packaging (if required). 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 produced by FDA-regulated facilities available to you in the United States. You will receive the same brand-name products 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 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 depend on the medication dispensed, typical savings are approximately 40% lower compared to US costs for each member participating in the program. 

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

No, the patient’s treatment plan and care will be continued 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. 

Patients must have up-to-date medical records and a prescription for their specialty medication. Their Aphora Care Navigator will arrange a 30-minute video teleconference with our Board–Certified physician and 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. 

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 at 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. 

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.  

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 our providers’ partners and we 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 on providers outside the country, 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 proper credentials to offer the kind of care delivery we all expect.  Our Aphora Care Navigators, who themselves have a clinical background, do all the legwork for you, guide you, and become a trusted resource for our clients every step of the way.   

The Aphora network of international providers comprises only facilities and practitioners that have achieved and maintained the highest levels of quality in their respective fields. Our contracted hospital facilities have all achieved the rigorous standards established and monitored by the Joint Commission International (JCI).   

Our Care Navigators make all travel arrangements, including coordinating all travel documentation requirements and 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 world’s most desirable travel destinations. 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.   

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.  Oftentimes, these healthcare facilities have a residential setting adjacent to the hospital where patients recuperate for several days post-surgery to obtain the 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.   

The specialty medications included in the Aphora program represent a very low volume of the overall medications filled 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. The Aphora savings on these medications surpass the 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 benefits 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) 

Participation incentives are an important component in ensuring the adoption of health plan members in the Aphora program.  For PPO plans, waiving deductibles and coinsurance is a viable approach to encourage adoption.  Cash incentives can be added to the incentive program as health plan member cost share waivers can decline in appeal as members move through the plan year and achieve maximum out-of-pocket limits.  For High Deductible Health Plans (HDHP), while there are limitations in an employer’s ability to reduce or eliminate upfront deductibles, coinsurance can be waived to lessen member out-of-pocket expenses.  This, coupled with cash incentives, can represent a meaningful incentive to encourage HDHP participation in the Aphora program. 

Cash incentives to encourage participation are taxable income to the employee; however, the employer could choose to gross up the amount to cover the tax liability. While typically, bonus or special payments made to an employee are eligible for a 401k contribution, these rules can vary, and an employer should review their plan document to understand their options.   

The Aphora program can be introduced outside your annual renewal.  Introducing the Voluntary program outside your normal renewal is preferable 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. Aphora can assist 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. This allows 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 in a timely manner, the local pharmacy is always an option for the member to use, and any amounts paid in advance will be refunded. 

The Aphora Specialty Medications program includes a formulary of high-cost medications for treating inflammatory conditions, multiple sclerosis, cancer, HIV, hemophilia, hepatitis, 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 approved for extended stays, allowing for a more robust recovery while in-country. This allows for any unexpected issues that might arise post-surgery to be treated and addressed 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 also their absenteeism and productivity due to their medical condition. Making care more affordable through the Aphora program enables the employee to receive needed care and return to full function, which actually has a positive impact on productivity and overall employee well-being.