Overcoming barriers to access, outcomes, and value starts with benefit design
For decades, the US healthcare system has grappled with rising costs and stagnant or declining health outcomes. Billions have been poured into improving the “Last Mile" of care, the point where patients interact with providers and care solutions. Between 2014 and 2023 ~ $586 Billion in Venture Capital has been invested in HealthTech, BioTech, and Pharmacy start-ups.
These investments resulted in incredible advancements across a range of categories:
- Telemedicine (Teladoc Health, Amwell, MD Live by Evernorth) expanding access
- Behavioral Health (Lyra Health, Modern Health, Spring Health) filling crucial care gaps
- Chronic Disease Management (Omada Health, Livongo, Monogram Health) living better
- Member and Patient Engagement (Transcarent, League, Rightway) personalized solutions for each individual
The result - improved access, better outcomes, with more value for each dollar spent.
With a decade of advances in access, patient navigation, and member engagement, you would expect a decline in the cost of health insurance or at a minimum a reduction in the rate of increase. However, during that same period of time, health insurance premiums continued to increase unabated, reaching an average of $25,572 per family in 2024.
Healthcare has a “First Mile” challenge:
the complex interplay of benefit design, employer adoption, and employee engagement that shapes healthcare experiences before patients even reach the doctor's office.
This challenge is more than an employee attraction and retention challenge. Mid-market employers and their employees are overpaying for Health Insurance by 20 - 30%. This amounts to $220-$330 Billion in overspending of scarce investment dollars that would otherwise be reinvested in other business initiatives.
Solving the "First Mile problem" requires a fundamental shift in perspective. We need to move beyond a focus on cost containment to a focus on providing the highest level value to employers and employees at the first mile. This means:
- Simplifying Benefit Designs: Benefits should be straightforward and clearly connected to value.
- Prioritizing Employee Engagement: Communication strategies should empower employees to understand and utilize their benefits effectively.
- Demand more Value for Employers and Employees: Chief Financial & People Officers (CFOs & CPOs) need to demand more from their benefits advisors.
- Data-Driven Decision Making: Data & analytics can be used to understand employee needs, preferences, and the impact of benefit design decisions on access, outcomes, satisfaction and value.
The good news is that solutions already exist in the health Insurance market. The challenge is understanding the best product for each employer and their employees based on their unique set of circumstances.
Sounder Benefits is designed to fundamentally solve this issue. Advancements in benefit solutions, like Sounder Benefits, are the critical onramp to accessing the value from healthcare market innovation.
.png)