Tech startups help employees navigate health care system

Technology has clearly revolutionized health care – from mobile apps that help employees stay fit and eat right to telemedicine that brings operational efficiency to treatment. But perhaps most compelling is the way it is helping elevate the open-enrollment experience in keeping with the intended consumer-friendly spirit of the Affordable Care Act.

This annual rite of autumn turned out to be “much more human and approachable for our employees,” reports Jon Thompson, experience director and partner at Bolster, a small marketing and communications firm in Minneapolis, which enlisted the help of a nearby startup called Gravie. He cites customer satisfaction among their 10 employees as the most important metric in measuring the impact of a more consumer-friendly open enrollment for 2015.

“We immediately started hearing feedback from our employees about how easy setting up everything was and transferring employee plans over as seamless as possible,” he recalls. The timing was serendipitous for an employee whose newborn baby arrived in January, while at least two employees recently were easily able to mitigate issues with their insurer.

Also see: Big bets on exchange tech signal consumer-friendly future for benefits

Gravie is riding a tide of opportunity in terms of helping guide employee populations through a bevy of options both on and off the exchanges. There are anywhere from 75 to 125 startups “in various stages of trying to get their technology to market and looking for investors,” according to John Sarich, VP of strategy VUE Software, an insurance automation company. He says most of them offer mobile apps in the business-to-consumer market.

For those that have developed enrollment tools, he sees more growth potential on the private exchange side than state and federal exchanges. Areas with the biggest need include coordinating billing and claims information between individual carriers and exchanges. “The investment right now on the technology side is basically going to IT infrastructure,” he observes.

Between the ACA and macroeconomic factors, many small and midsize companies that lack the purchasing power of large corporations have finally reached a point where “they don’t necessarily want to be in the business of health insurance,” observes Gravie CEO and co-founder Abir Sen. “They’d rather just get out, if they could, while making sure that their employees are well taken care of.”

Also see: Considering new benefits technology to boost the employee experience

That means steering employees to the individual market, offering assistance with purchasing decisions and navigating their way through the process. It also may involve a higher salary to make up for the change in coverage.

There’s confusion surrounding most transactions in a doctor’s office or at the pharmacy, as well as how to wisely invest health savings account dollars, according to Stride Health CEO Noah Lang, another health care tech startup serving this market niche. But he says the time is right “to bring personalized intelligent transactions to health care,” since the technology is now well-refined and the data is well-constructed and machine readable under the ACA.

“What we do for employers is power the plan decisions for their 1099s,” Lang explains, noting that his firm’s biggest partner in this space is Uber, a popular alternative taxi service with the nation’s largest freelance workforce. “We work with them to make sure that all of those drivers, who are independent contractors, get covered, don’t get fined by the government, can do it efficiently and quickly, and it fits right into their system that they use to manage their workday.” The potential for similar opportunities is tremendous. He notes that as many as 40% of the U.S. workforce is projected to be made up of independent contractors by the end of the decade.

Fine line between help and hype

There’s no shortage of activity in the health care tech arena, but there’s also a lot of hype, cautions Robert Booz, a health care analyst with technology consultant Gartner. He says new applications being rolled out have already been brought to market by companies such as eHealthInsurance or even payers such as Oscar Health.

His larger point is that any new entrants to the market aren’t shaking it up with stunning solutions that deliver greater value as much as they’re simply augmenting what’s currently in place. “They’re bringing greater notoriety to the need” for better tools, he adds.

Also see: Technology plays growing role in benefits

Booz describes Stride Health, Gravie and others as “product configurators” that enable consumers to customize coverage that suits their specific needs, including price points. “As employers move toward more defined contribution benefits in health care, it’s important for them to help employees make informed decisions, which these kinds of products do,” he says. The result will be a better outcome for employers based on higher employee satisfaction with their health insurance coverage, according to Booz.

The HIX marketplace is still a largely conceptual experiment that entrepreneurs are trying to improve upon with practical tools to help elevate the consumer experience, Sarich opines.

“What you’re seeing is some smaller technology companies kind of playing around the edges identify areas where technology, workflow, business process, data management and those types of things that are becoming useful and important,” he says. Sarich also notes how Aetna finally acquired a key startup in this space to capitalize on business opportunities in the wake of significant regulatory reform and its resulting chaos.

Its roughly $400 million acquisition of privately held bswift, whose tech platform offers a retail shopping experience for health insurance exchanges and employers, was deemed a good fit with Aetna’s proprietary exchange strategy. The deal also meshed well with the carrier’s overall strategic goal of offering a more consumer-friendly experience for health plan members, explains Cynthia B. Michener, an Aetna spokeswoman.

Also see: Aetna’s bswift acquisition: A sign of more to come

Founded in 2000, bswift will operate as a separate business within Aetna and help “deliver a new private-exchange offering for employers of all sizes where the focus is on helping people easily choose a plan that’s right for them and their families,” Mark Bertolini, Aetna chairman, CEO and president, said in a statement announcing the acquisition.

Expanded toolkit

This health care tech trend clearly revolves around improving decision support. One handy tool Gravie offers is an iPhone app called “Is this covered?” to help answer coverage questions or find a network doctor. It provides enough meaningful insight into how people shop for their health insurance to actually help improve the functionality from one year to the next.

Sen says demand for Gravie’s service to employers, which is financed by health plan carriers, is running about three or four times greater than expected for the 2015 plan year. Aside from guiding working Americans through health plan selections, the company helps answer questions about claim denials, hospital bills and a host of other problems they may encounter downstream with the health care system. Gravie also does an initial assessment before laying out what it considers to be the most appropriate plan choices for each employee.

Also see: Employers maximize dollars spent on benefits technology

“At the end of the day, they’re going to have one dashboard where they understand what’s going on in their health care life, and if they run into trouble, they come to us,” says Sen, who estimates that about 20% to 30% of his members qualify for HIX subsidies, while the rest buy plans from the private market.

Gravie unfurled its shingle in September 2013, which means the startup was fully involved in the first two years of public HIX enrollments. Sen co-founded Bloom Health Corporation, which he describes as “the first private exchange,” as well as RedBrick Health Corporation, a health and wellness firm. In addition, he has served as an executive officer for Definity Health, the first consumer-driven health plan and a unit of Unitedhealth Group Inc.

Gravie takes a holistic approach to plan selection, attempting to maximize employee dollars to round out their coverage much like an overall financial plan. “We are in the process of curating our marketplace both based on what we think people would like, but also what we actually observe as to what they are buying or not buying,” according to Sen. The approach includes helping consumers assess not only health insurance, but also dental, vision, accident, disability and other voluntary benefits. Other layers include innovative products or services such as telemedicine, as well as next-generation fitness and wellness programs, and transparency tools.

Also see: Employers hungry for improved enrollment, communication tools

One significant finding among Gravie customers for the 2015 open-enrollment season was a wide variation of pricing among health plans, with carriers significantly raising or dropping their prices. Another issue was that with more health plan options this year, people were better able to weigh the trade-offs between price and quality of care. Sen also references operational efficiencies, noting that some health plans have invested in a single-click enrollment for a much more consumer-friendly path to plan selection. 

Asked what they wanted from their health care coverage or service provider, Bolster employees rattled off about 10 different answers when only about two or three specific points were expected. “It made us realize that we needed very tailored customer service support,” says Jason Hammond, Bolster’s brand director and partner. He describes Gravie’s interface as intuitive, noting that it walks employees through the plan-selection process “in a way that makes it easy to understand.”

While Bolster isn’t obligated to provide health care benefits to employees under the ACA, the company offers coverage to compete for a highly skilled labor force in a fiercely competitive industry in the Twin Cities.

“For its size, Minneapolis is packed with creative agencies,” Hammond explains, “and being small, we’re competing with bigger agencies, at times. So we needed to have a benefits package that was comparable so that we could lure talent to our business.”

Also see: How new technologies are changing the face of benefits enrollment

Boster allocates a set dollar amount per employee toward health care coverage, providing access to a broker who helped them select the most appropriate plan to fit their needs. Health care coverage didn’t change much over the past year other than a previous arrangement involving third-party reimbursements to individual plans was turbo-charged with a more meaningful level of customer support heading into the 2015 plan year.

Apart from asking for an individual’s age, income and other demographic factors, Stride Health probes which doctors its customers prefer, as well as aggregates the prescription drugs they take and their health conditions to protect their privacy.

The company’s recommendation engine is built around key questions consumers ask. “We prove out the value of the engine by building that forecast with them to figure out their medical consumptions for the year and pump that through every single plan available to build a true cost of coverage forecast,” Lang explains.

Also see: How technology decodes the impact of benefit decisions

An entrepreneur with Silicon Valley ties, Lang has a passion for health and wellness, noting that when he considered entering this space, “it became very obvious very quickly that nothing was personalized. So any consumer transaction was typically either dealing with no data to make an informed decision, or only macro-level data.” One of his pet peeves is the way exchanges and health care industry in general present information.

Launching in California at the tail end of the first open-enrollment period for public exchanges for the sale of off-exchange-only health plans, Lang says Stride Health has since expanded to cover 41% of the U.S. population for 2015 as a web-broker entity. The product suite includes both on- and off-exchange plans with subsidies through HealthCare.gov, Covered California and NY State of Health public exchange platforms. He estimates that 70% of his business involves off-exchange options involving more than three dozen insurance carriers for consumers who don’t qualify for a federal subsidy.

Lang partnered with Matt Butner, the architect of personalization and search engines for Priceline, Netflix and MINI Cooper – spending about six months building health care data sets for provider networks, claims, formularies, real-time drug pricing data and self-reported consumer information to help shape health plan recommendations. The aim was to help consumers come up with better projections of what they can expect to spend on insurance and health care services in the coming year.

Also see: Technology pushing HR delivery changes

As the marketplace moves forward, the need to improve decision-making will become increasingly critical. Sarich notes “a huge burden” on benefit brokers and advisers to help employer clients and their employees navigate their way through open enrollment. The biggest challenge is offering guidance to people who lose their group insurance and are cut loose in the individual market, while he says technology and support systems are evolving with insurance agents in mind to help manage the chaos in this vastly expanded online marketplace with more options than ever before.

With growing use of technology, health care enrollment has never been easier. “We support any steps that federal and state policymakers, as well as those in the private sector, can take to improve the consumer experience and make sure consumers have up-to-date and complete information that will help them compare and pick the best health plan for their needs,” adds Jessica McCarron, a spokeswoman for Enroll America, a nonprofit and nonpartisan group that has conducted grassroots campaigns to encourage people to enroll in HIX plans.

Bruce Shutan is a Los Angeles-based freelance writer.