APS Healthcare serves 20 million members in 27 states and Puerto Rico.

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A well-managed, affordable healthcare system where patients receive the care they need shouldn’t be considered wishful thinking, APS Healthcare Chairman and CEO Greg Scott says.    

Since it began in 1992, APS has been making good on its mission to help create a patient-centric population health improvement model in which healthcare delivery is physician-guided, but patients are informed and empowered to manage their long-term health. Quality of care is only one side of the healthcare equation. Patient behavior makes up another significant portion, but it is one that isn’t as well-managed. This is where APS shines, Scott says.    

The Westchester, N.Y.-based company has evolved into a multimillion-dollar organization providing services including health management, behavioral health and improvement services for roughly 20 million public sector and commercial members across 27 U.S. states and in Puerto Rico.

Founded by psychiatrist Kenneth Kessler in 1992, APS initially focused on the behavioral side of the equation but soon realized that the medical side also needed to be integrated into its programs.    

Since the early 1990s, the firm has changed its leadership and business focus to be a total healthcare management solution provider. “We’ve really pushed hard and fast to become a total healthcare business,” Scott says.

Success in doing so attracted interest from private equity firm GTCR Goldner Rauner LLC, which acquired APS in 2007. The acquisition is providing the perfect launching pad for the company to grow the business, Scott suggests.    

Continued growth is something APS is always aiming for. The firm has become a total health management company by focusing on health and wellness; disease management; utilization management and review; case management; behavioral health; employee assistance programs; and work/life services.   

“We are not just a disease management company,” Scott asserts. “We are a key part of the solution when a customer wishes to provide a range of services over an entire population; and have those services tailored to an individual’s needs.”     

APS operates more than two dozen centers across the United States, with most programs community-based.    

“We believe in the tried-and-true principle that healthcare is a local business, and it is our feeling that if we are going to be effective in managing the health status of people, we have to be accessible to those who use us,” Scott says.    

The firm uses clinicians and social workers who are trained to help patients generate behavior changes and create care patterns that keep them out of the hospital. Of the 1,800 people APS employs, roughly 1,200 are clinicians.   

The company works with more than 1,000 clients, including Medicaid programs, state and local governments, employers, Taft-Hartley Trust Funds and health plans.

Controlling Costs
Current economic conditions paired with pressures placed on state budgets to cut spending have created the perfect platform for APS to expand. “We really rely on good medical and disease management techniques to deliver cost savings,” Scott says.   

One of the differentiating factors is APS’s ability to customize programs. The company offers a variety of health management programs in the areas of diabetes, asthma, cardiac, cancer, maternity and wellness. Each program’s goal is to integrate medical management and behavioral health. By developing programs that change behavior that negatively impacts health status, the company can ultimately help states lower their healthcare costs.    

When it comes to tracking how healthcare providers and systems are utilized, Scott refers to the 80/20 rule, which says that roughly 80 percent of the costs in healthcare are generated by roughly 20 percent of the population. “We’re trying to understand what is driving so much of that expense, and we perform data analysis to identify certain populations that are driving excess costs,” Scott explains. “We then try to build a program that addresses those needs. I think that if we focus our time, energy and resources on improving the health status of those unique populations, we will solve a lot of the expense problem in healthcare.”   

Once APS enrolls a new customer, it finds the patients in that customer’s population who will benefit by conducting data analysis, understanding what disease states exist and then reaching out to the customer’s patients in that population.   

APS operates in both the public and commercial sectors. In the public sector, APS  works with state agencies that contract with the company to provide disease management services for the patient population. APS’s certified clinicians and health coaches then reach out to patients through the telephone or through visiting the centers where patients receive their care.    

In the commercial area, APS wins contracts with employer groups or health plans to provide disease management and/or health and wellness services for their employees or members. The outreach process is similar to the public sector.

Getting Buy-In
APS uses a three-pronged approach to dealing with populations of individuals who have one or more diseases or conditions. The first, Scott says, is to make patients knowledgeable about their condition and help them understand how to better treat the condition using preventive measures. “We want them to rely less and less on the emergency healthcare setting, so we feel it’s very important to work collaboratively with the essential provider community,” he notes.    

APS develops a plan for care with the provider, and creates better communication and access between the provider and patient. Lastly, APS can provide incentives for providers who offer preventive services to their patients.   

In 2007, APS devised an internal recruiting team that generates leads to recruit management in the field and support its growing list of clients. “This is a people business, and I am thrilled with the team we have assembled,” Scott notes. “The team is second to none, and I think we’ve been extremely successful in recruiting. We’ve added 400 jobs in the past year. We are a rapidly growing company, and I am looking forward to adding additional employees next year.”    

In December, APS was awarded new case management and health utilization management accreditations from URAC, a Washington, D.C.-based healthcare accrediting organization that establishes quality standards for the healthcare industry.   

The case management accreditation applies to APS operations in Las Vegas, and Hilo and Honolulu, Hawaii, adding to three other sites previously accredited for case management.