Why are employees not using their health benefits?
HIgh fidelity mockups
I was tasked to help Insurify make a web app to help their corporate partners enable their employees to use more of their paramedical health benefits (e.g. physio, massage). I got to the root of the problem for employees (amusingly including by surveying hundreds of people in a busy train station), and then iterated through the design process to address feasibility challenges.
Employees don’t use their health benefits. This means that employers are paying significant amounts in premiums that aren't helping their employees.
Understanding insurance policies is difficult:
Which services are covered
Max per-visit payout
What % covered
Are referrals required
Navigating dual insurance plans
Opaque pricing before visits
Even if they understand, employees face a long process in using their health insurance:
Scheduling an appointment
Filing for reimbursement
Tracking remaining balances
As a result, the main problems that get treated are the ones that people deem warrant visiting the doctor for. A host of minor ailments go untreated, eventually developing into more serious, lasting issues.
In addition to talking to corporate employees, I also went to Union Station (Canada's busiest railway station) and asked people around what stops them from using up their benefits. People fell into one of three groups:
Group 1: Already maxing out all their benefits (~30% of people)
Group 2: Use what they need, and don’t want to maximize (~20%)
Group 3: Don’t use benefits, but want to use more to not leave money on the table (~50% of people)
For Group 3, I discovered that:
Most employees do not take an active approach to managing their health. Most will not go to a practitioner unless they are in enough pain, due to being busy and the tedious process required in booking.
Once a person understands their benefits and has a practitioner they like, then there is lower friction to showing up for appointments.
If booked for them, most people wouldn’t say no to an appointment. One additional force is the desire to not ‘lose out’ on the benefits they are entitled to.
Challenges for implementing
Based on my conversations and research, the solution and design needed to account for the following challenges:
How to determine which types of health practitioners to include without overwhelming users
How to manage not having access to the employee's remaining service balances (engineering constraint)
How to get them to appreciate a service till they go to their first appointment
How to navigate different types of plans; some have per-service maximums, whereas others offer an annual sum to be used for all healthcare expenses.
Existing solutions primarily fall into four categories:
1. Integrated health platforms (e.g., League, HealthJoy, HSA management tools): These competitors focus on providing cost-saving solutions, often recommending virtual or self-help treatments as the first course of action. They aim to protect employers from rising premiums by controlling costs, which may sometimes result in suboptimal benefit utilization for employees.
2. Insurance company apps: These apps are offered by insurance providers and allow users to file or dispute claims, track balances, and see available services. However, many employees have never downloaded or opened their insurance provider app.
3. Telehealth service providers (e.g., BetterHelp, Nourish & Maple): These platforms focus on connecting users with virtual healthcare providers. While they offer convenient access to care, they may not address the full scope of an employee's healthcare benefits (silo-specific, i.e. only for therapists, or only for dietitians).
4. Healthcare provider listing websites (e.g., PsychologyToday & Zocdoc): These websites help users discover and review healthcare providers, but they don't directly assist in managing or understanding the users' healthcare benefits.
Reduced friction to help employees use more of their paramedical health insurance benefits, rather than letting that money go unused each year
Develop a website for easy access to employee information, focusing on five commonly overlooked services in insurance benefits.
We assign you a care team within your insurance network. For each service type, we give you 3 practitioners in your insurance network to pick between, shown based on:
Whether free first session
Whether accepting new patients
Whether file reimbursement on your behalf
Users can switch out practitioners they don’t work well with, and see to-do items before and after appointments.
We incentivize you to attend your first appointment with each member of this care team.
We check in regularly to see if you want to visit any of your care team, and then auto-book the appointment or you.
We teach you how your health benefits work, and then provide an intuitive interface that breaks down the main benefits in an easy-to-understand format:
detailed video of how to check their insurance website to manage balances
Insurify makes it easy to just say yes, lowering the pain threshold worth going to appointments for.
Throughout this project, I had to evaluate difficult tradeoffs, such as between enhancing functionality and maintaining simplicity, as well as the delicate balance between gathering personal information and preserving user trust.We deliberated extensively on the use of surveys, especially considering the amount of information a new user would be comfortable sharing initially.
Ultimately, I decided to incorporate an optional survey into our final design, carefully limiting personal questions to essential details. These include the user's specific employee insurance plan, contact information, preferred appointment location near their workplace (within a 2km radius of their work postal code), and their personal health goals. This is in addition to the email, phone number and weekly availability that was collected pre-survey. This approach ensured our questions were non-intrusive while still gathering crucial data to tailor a care team and service to each user's unique needs.