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Many startup companies in healthcare are entrepreneurial or innovative, but true disruptors in the field are harder to come by. These are the companies that are actually shaking the pillars of an established system. 番茄社区 Editor-in-Chief Marty Makary, MD, MPH, of Johns Hopkins University in Baltimore, selected several companies that fit the profile of a real disruptor; we’ll be profiling them in an ongoing series.

Developing an employer-supported insurance plan that's affordable for both the company and its workers, and that does away with the red tape, surprise bills and other complaints that are now commonplace in U.S. healthcare, may seem like a pipe dream.

Enter , a healthcare marketplace and supplemental employee benefit program already in operation that promises a cheaper, streamlined process for employers with self-insured plans for employees.

Founded in 2014, the company runs a proprietary algorithm that digs through employer claims data to find find ways to save from direct contracting for surgical, diagnostic procedures, and lab testing.

"The world is rapidly shifting to a member-first healthcare economy and our job is to help accelerate the shift so we can deliver affordable and amazing healthcare for every person in every community. We built Zero as the unified solution to the member-first economy," according to Zero Card's CEO, James Millaway.

It's an attractive pitch for everyone involved: Zero Card offers "100% transparent, bundled case-rates" to help lower plan costs for employers. Employers save on average 46% on elective procedures, according to Millaway.

Meanwhile, members who opt in get access to hundreds of procedures and services for zero-dollar copays. The company sends the referral for the service to an eligible provider and helps with scheduling and transfer of medical records.

For providers, the program acts as a marketplace to attract new patients and simplify administration. Provider contracts are based on bundled case rates.

"We built The Zero Card so providers could focus on delivering care instead of all the red tape commonly associated with commercially insured patients. There is never anything to collect from the patient, no such thing as pre-cert or prior authorization and we make sure you always get paid 100%," the company website promises providers.

Zero Card currently works with over 80 employers, 100 healthcare facilities, and thousands of physicians in nine markets in the U.S.

Employers in almost every market "would stand to gain from working with The Zero Card as a complement to their self-insured plans managed by insurance companies," commented Daniel Polsky, PhD, a health economist at John Hopkins University in Baltimore.

"The key would be the negotiated rate on these shoppable services. The Zero Card should be able to get good rates from the providers if they can promise volume," Polsky said.

"One analogy here for the provider is the cost of that last seat on the airplane. For fixed cost procedures, like an MRI, the providers who have 'open seats' would give a good deal to get those seats filled, particularly if they are taking business from providers who are in the networks of the employer insurance plans," he explained.

The challenge of the Zero Card would be convincing employees to use it even with the zero deductible, Polsky said.

Patients do not tend to shop around for hospitals and doctors' offices for better deals even when given the opportunity.

Indeed, the high-performance (or tiered provider) network, designed to steer patients to better-value care, has generally in years past, according to Sherry Glied, PhD, dean of New York University's Robert F. Wagner Graduate School of Public Service in New York City.

"Employers choose health plans that their employees want -- and employees are nervous about new networks, even if they offer better cost-sharing," she said.

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