Despite decades of innovation and legislation, navigating the health plan maze and then figuring out how to pay for the care we need has gotten more labyrinthine and more expensive, not less.
Digital platform solutions are available to help workers manage care and costs and assist employers in selecting the right offerings. But PYMNTS research finds that nearly 60% of workers are unfamiliar with their benefits — it’s closer to 70% for workers earning under $50,000 a year — so the pressure is on to make meaningful progress against the moving target of manageable healthcare.
Joining PYMNTS’ Karen Webster for the series segment “Tough Questions: How Can Digital Platforms and Payments Drive Better Healthcare Outcomes,” Matt Renfro, co-founder and CEO of FinTech healthcare platform Lynx, and Karen Frost, senior vice president, health strategy and solutions at benefits administrator Alight concluded that healthcare ails from fixable complexity and opacity.
With Alight’s client base of roughly 4,300 employers and their workers, Frost is on the front lines, noting that between common high-deductible health plans, health savings accounts (HSAs), Flexible Spending Accounts (FSAs), EAP offerings, and a huge array of wellness programs, “Most consumers don’t understand, as they’re working with their employer medical ecosystem, how all of that fits together.”
She said when it comes to the payments piece, “it gets even more confusing.”
Renfro agreed, noting that his recent experience signing up for a family health plan was bewildering. He got little support from his payroll provider, adding, with irony, that “I run the company.”
That’s another way of imagining the heavy lift for the average employee. He said, “For me, it starts with how we take a consumer-first or FinTech or retail-like approach that helps people understand these are your benefits, this is how you maximize it, and this is how you optimize it through the year without having to create 100 different relationships across pharmacy, financial services, and digital health.”
Employers decide what benefits workers receive, and Frost said more are “recognizing that opportunity for change, and many of them are embracing it. The piece that’s missing, and Matt, you hit it really well, is there’s nothing to date that’s tying it all together.”
That’s where platforms like Alight come in on the benefits administration side, assisting companies in deciding what to offer, as platforms like Lynx provide an embedded healthcare payments experience that unifies and simplifies disparate health payment data into one comprehensible view.
Frost observed that during the pandemic years, employers doubled the number of health-related programs offered to workers. She said that’s laudable, but what’s missing now is how to winnow that down to the three of the 25 programs “that are important to me at any moment in time.”
Having spent years with Optum Health before forming Lynx, Renfro sees connected technology as the cure, and that’s happening. Just not fast enough for millions of workers and thousands of employers.
With a nod to findings from the study Healthcare In The Digital Age: Consumers See Unified Platforms As Key To Better Health, a PYMNTS and Lynx collaboration, Renfro said, “As the study has shown, it’s complicated to even do the baseline of maximizing my benefits. Future state, envision that we are infrastructure that can help support a company like Alight that touches so many employers, has so many assets that help aggregate how people can manage health and wealth.”
Using this approach, employers can aggregate dozens of programs and related payments in one place, effectively in a single view, maximizing return on investment while making healthcare utilization and payments far easier for employees.
From the Alight perspective, Frost said, “We’re seeing very positive reactions from employers to the idea of bringing it all together and having that closed loop of how do I, on the front end, get the right employees to the right place, and then on the backend, measure the outcomes and make sure that these programs are achieving what they want.”
That kind of data-driven healthcare benefits and payments ecosystem resonates, as 79% of consumer respondents to “Healthcare In The Digital Age” surveys said they want to pay all their medical bills within one digital platform that can also be used to complete other healthcare-related tasks.
Within an ecosystem of benefits and payments, consumers and employers are connected via programmatic APIs to the data behind it, vastly simplifying the process for users.
“Everything can be consolidated in a digital or a physical card type of mechanism,” Renfro said. “You could have proven value to employers to say, if you loaded money … on the Alight marketplace, we already know that these solutions that are on our marketplace have a proven ROI, and there’s no opportunity for this person with these pockets of funds to go out of network.”
That not only makes things easier to understand and pay for but, as Frost noted, “If we start at that simple end of the spectrum to say, we’re going to make it easy for you to have a much more seamless experience when you need access to care, I think that will have a material impact because we’re going to get people that need to be seen in the right setting, we’re going to get them care, then they have a facility to pay for it.”
Additionally, the controls that a platform like Lynx offers employers can ensure that the fully insured or underinsured, who may be hourly workers, can be incentivized with healthcare funds that promote access and proper use of employer-provided healthcare dollars.
“People have needs with trying to save money on their prescriptions or to get access to virtual care,” Renfro said. “Realistically, it’s not as expensive for an employer if they load, let’s say $500 to $1000 on a card that can only be spent at a discount online pharmacy or at a virtual care provider.”
Asked how this intersects with HSAs and high deductible plans, Frost said they are typically offered in tandem, and a platform ecosystem encourages workers to hold onto some of the dollars in their HSAs for the inevitable health emergency. However, at present, 75% of employees spend it all within the year.
She called HSAs “a healthcare budgeting device.” Renfro agreed, adding that Lynx is also in discussions with alternative lenders with installment products that can be embedded in his platform.
This type of seamless online experience also works as an employee retention tool, on the one hand, while giving employers a clear view of when and how health incentives are consumed.
“This intersection of health and financial services or financial security for people is one that I feel pretty strongly about as the way to prove value to employers as far as how you know it’s not just a bells and whistles front end type of discussion,” he said. “There’s a real multimillion-dollar savings benefit.”