Design & Innovation Challenge: Benefit Selection for Financial Security
Can you design an innovation to improve the health insurance open enrollment experience so that it protects the financially vulnerable from hardship?
Commonwealth partnered with CHXD to launch an innovation challenge to prompt the financial, healthcare, and design community to envision a solution that will help employees with incomes under $55,000 balance their health and financial needs at open enrollment.
One of the factors that is increasingly contributing to financial insecurity is health expenses–the average annual deductible grew 125% from 2006 to 2015, causing out-of-pocket health care costs to quickly grow. Part of those rising costs may be attributed to the increase in high deductible health plans (HDHPs). As health insurance markets continue to evolve, employers who offer health insurance are increasingly offering HDHPs.
HDHPs are attractive because they provide short-term cost savings on premiums to both the employer and employee. However, unless they are well designed, they increase the risk of out-of-pocket health expenses for employees, which can lead to medical debt, delayed medical care, missed work, and loss of productivity in the workplace. Lower-income employees, who often do not have access to financial resources such as savings and affordable credit, are particularly at risk.
HDHPs can be offered alongside a range of savings products designed specifically for health care expenses–Health Reimbursement Accounts (HRA), Flexible Savings Accounts (FSA), and Health Savings Accounts (HSA) are the most common. HSAs are specifically designed to accompany HDHPs to offset the risk of the higher deductible.
However, employees with HDHPs do not even have an HSA. Of those that do, more than half of employers offering coverage through HSA-qualified HDHPs do not contribute towards the HSAs that their workers open. According to the Kaiser Family Foundation, only 29% of workers with employer policies have HDHP coverage with a savings option.
With health, productivity, and financial security on the line, both employers and employees stand to benefit from HDHPs that are designed to mitigate the risk of the deductible by increasing savings.
The purpose of this challenge was to deliver innovative solutions so that people are able to make decisions that work for their finances without jeopardizing their health.
To further understand this problem space, please check out the Center for Health Experience Design’s Participatory Workshop Debrief and the Commonwealth Consumer Research Summary. In collaboration with Commonwealth, we compiled this research to provide challenge participants a deeper understanding of the decision-making process employees undergo during open enrollment.
Four key insights were gained from the “Benefit Selection for Financial Security” Design and Innovation Challenge, an open design competition dedicated to helping employees with incomes under $55,000 balance their health and financial needs at open enrollment. Read the full summary of findings.
Insight #1: Limit information to what is relevant in the moment.
Support consumer decision making during and after open enrollment by limiting the information presented to the employee. Ideally, personalize this information based on what is most meaningful to that individual, and consider both their needs and their preferences. Include only the information that is relevant to the decision being made at the time, whether that is deciding what health plan to select, how much to contribute to an HSA, which provider seek out, or how to save money on prescriptions.
Insight #2: Offer contextual resources to build health and financial literacy.
Health and financial services are full of opaque terms, unfamiliar concepts, and poor explanations. There is opportunity to build health and financial literacy before, during, and after open enrollment. Provide resources to educate members on common points of confusion about open enrollment, health plans, HDHP features, and HSA usage. This could be as small as defining unfamiliar terms (e.g., deductible) or as large as providing recommendations about how an HSA can be used during retirement.
Insight #3: Emphasize preventative care.
Since many HDHP members cut back on preventative care, offer ways to connect members to free or low-cost services or otherwise incentivize members to seek it out.
Insight #4: Demystify HSAs.
Since HSAs are such an important part of insulating employees from the burden of a high deductible, services should offer much more support around understanding and using this benefit. We saw duplicate design decisions that we want to highlight: show HSA deposits and expenditures in context, make it easier to access and spend HSA funds via electronic payments, and provide guidance around contribution amount.
High-deductible health plans are likely here to stay, but the entries to this innovation challenge show that they needn’t impose financial hardship on their members. There is ample opportunity for innovation in the HDHP space, and Commonwealth looks forward to supporting these ideas (and the ideas inspired be these challenge entries) in the marketplace. Read the full summary of findings.
Best Open Enrollment Solution: Plan Picker by Team Meercats
Team Meercats created an app called Plan Picker to empower employees to select the most appropriate health plan based on their needs and preferences. Employees complete a questionnaire about medical use, financial assets, and risk tolerance; this information directs employees to the plan that best fits their health and financial needs. Plan Picker also screens users for Medicaid eligibility. Post-enrollment support features within the app include a deductible calculator, a prescription drug price checker, and a doctor visit co-pay estimator. Educational videos explain key healthcare terms, explain how to use an HSA, and introduce users to “employees like you” and the decision-making processes that they went through to help guide plan selection.
- Medicaid eligibility screening
- Select plan by preferred provider, preferred clinic/hospital, medications, health conditions, frequency of doctor visits, preference for high premium vs. low deductible, and availability of liquid assets to cover an unexpected medical expense
- Suggests most cost-effective medications, providers, and clinics
- Written at third-grade reading level and available in multiple languages
Best Ongoing Support after Open Enrollment: General Whealth by CareCollective
CareCollective designed an app called General WHealth that helps people take ownership of their HSAs. Referencing the design and functionality of a banking app, General WHealth features a “virtual HSA card” that gives users instant access to their HSA funds for online, in-person, or phone-based purchases (through Apple Pay and Google Play integration). General WHealth divides its reporting pages into past use, current status, and future projections, presenting data-heavy reports with easy-to-read guidance and statistics. Educational resources are accessed through the app’s library or a Help icon that pops up to explain account management features. CareCollective chose to focus on helping employees fully take advantage of their HSA. During their research, they found that employees often do not feel a sense of ownership over their HSA and are reluctant to invest money into a single-use account, especially when financial resources are limited. General WHealth’s core design principle is that the best way to help people to take advantage of their HSA is to encourage them to use the account in the first place. Our judges appreciated CareCollective’s focus on increasing usage of HSAs, since so many employees start HSAs and then stop contributing after a year, leaving orphan accounts. They thought the concept of the virtual card and transaction management was strong, and felt that though the app was narrow in scope, the design succeeded in making a complex concept simple and usable.
- Virtual account number/debit card billpay
- HSA budgeting tool
- In-app HSA contribution adjustment
LifeCents is a financial health and wellness app that supports employees during open enrollment and throughout the year. LifeCents takes a unique approach by evaluating a user’s holistic financial health, which helps determine where someone may need help and empowers them to improve. Through the app, employers can introduce Challenges that increase employee engagement with financial decision-making and goal-setting. Meanwhile, the app’s Connections feature can be used to help employees pick the health plan that best fits their needs, as well as to set savings goals in order to offset the financial risk of an HDHP. The judges commended LifeCents for their focus on and novel implementation of financial literacy education, especially for teaching numeracy. Judges thought the gamification mechanic was a creative approach, and were curious to see how it would play out in practice. To further support lower-wage workers, LifeCents could add education specifically related to navigating HDHPs and offer more targeted support during the open enrollment process.
Health First, Inc
HF Benefits Champions redesigned its open enrollment software platform, allowing users to compare benefits offerings as well as receive recommendations based on previous experiences, expected healthcare events, and a user’s budget. Due to be implemented in April 2019, the platform also offers the option for a Virtual Benefits Fair, which helps remote or home-based employees to access benefits information at their convenience. The platform’s financial counseling services have also been redesigned in order to better address health benefits.Judges loved that an employer rolled up their sleeves to address challenges surrounding open enrollment. The judges agreed that the initiative showed promise and are looking forward to seeing its impact.
Slalom Consulting created an app called Wilbur to serve the 25 million shift workers in the United States, who have unique needs based on their busy schedules and inconsistent hours. The app is built around a rewards-driven HSA; as employees hit financial savings goals and track healthy activity, they receive “Wilbur Bucks” that increase their HSA contributions. The app uses microlearning by presenting content in short snippets when it is immediately relevant, making users more likely to retain the information presented to them. Wilbur includes a live chat feature so employees can ask questions about their health plan options and up-front care costs. Judges appreciated the micro-learning embedded within the app and that Slalom considered a payment-plan approach to health expenditures, a feature unique to Wilbur. Judges felt the user experience approach was polished, and that further usability testing would help determine how Wilbur Bucks compared to using traditional dollar amounts.