Webinar Recap:
Navigating alternative health plan choices in 2025
by Skylar Rolstad
Published December 19, 2024
Webinar Recap:
by Skylar Rolstad
Published December 19, 2024
As we prepare for 2025, it’s time to take stock of how your organization adapts to health plan trends.
The healthcare landscape is shifting, and traditional plans struggle to keep up. Employees are drowning in a sea of point solutions, battling confusing processes, and facing skyrocketing costs. But there's hope for benefits teams as the "alternative health plan" emerges, offering a more streamlined, cost-effective, and employee-centric approach.
Alternative health plans deviate from conventional PPO and HDHP models by promoting member choice, cost transparency, and the use of high-value provider networks. These plans seek to simplify healthcare and reduce expenditures.
On December 10, 2024, experts on alternative health plans convened as part of a discussion presented by From Day One. Firefly Health Chief Commercial Officer Matt Cook and Erik Sossa, who spent much of his career as the Head of Global Benefits and Wellness at PepsiCo and currently serves as President of E.A. Sossa Consulting, discussed health plan trends and updates heading into 2025. Jenny Sucov, a journalist with extensive experience covering healthcare coverage topics, moderated the conversation.
Its is clear to see that alternative health plans are here to stay and will grow in demand in the future. Alternative health plans offer a more holistic, member-centric approach that addresses many of the shortcomings of traditional healthcare models. By prioritizing employee experience, cost-efficiency, and better health outcomes, these plans can be a valuable investment for employers looking to enhance their benefits offerings.
"People are fundamentally looking for flexible, affordable care,” Matt said. “... If you can provide longitudinal, dedicated, trusted access to a care team... it fundamentally changes the way people engage with their healthcare."
Erik believes that the style of engagement is changing with the times. Members want a health plan experience that supports both personal and professional needs.
"When I think about this next generation of healthcare, it's one that's aligned,” Erik said. “... I want to improve healthcare. I want to make it affordable... and I've got to have an experience that allows my employees to... be productive and healthy at work."
When I think about this next generation of healthcare, it's one that's aligned
While traditional health plans have had deep roots as the standard offering from employers over decades, alternative plans present value and unique abilities to meet modern healthcare needs. Benefits leaders often take conservative, risk-averse moves with regard to health plan offerings. This approach makes sense – these big decisions are too important to get wrong – but can create inertia. Moving to an alternative plan might feel like a leap, but it's a calculated risk with significant potential rewards.
Inefficiency plagues employers. Employers strive to offer relevant health plans that increase employee satisfaction and retention. But sometimes, employers confuse their employees by offering too many complicated solutions, an issue Erik spoke about from his own experience leading solutions at PepsiCo.
"We tallied it up at the end and there were 65 vendor partners within healthcare,” Erik said. “... 42 different engagement points... That's a tremendous burden on them to try to navigate through this.
In painting the picture of how complicated the health plan landscape became at a large employer such as PepsiCo, he remarked on the impact a streamlined solution could have.
“...It's one of the things I'm very excited about – companies like Firefly that are trying to change that paradigm."
About two-thirds of Americans between ages 30-44 use the internet to look up medical information. It’s an easy way to learn more about a concern or diagnosis, but general information online falls short in addressing an individual’s personal health.
With a virtual care team available as part of an alternative health plan, members can learn more relevant information quickly and take steps to address a concern. Under a traditional plan, a primary care appointment may take months, and an appointment with a specialist could take even longer.
Another benefit of alternative health plans: engagement between visits. The virtual availability of the care team in these plans allows members to ask questions conveniently, solving issues employers face with underutilization of the plans they offer.
Lack of price transparency presents a major issue between members and their plans. In an alternative health plan, costs can be estimated along the way. Care teams can discuss expected costs along the way, without a surprise bill arriving in the mail.
The status quo in health insurance offerings ensures that employers will offer an incongruous health plan compared to employees’ needs and motivations. Traditional health plans have proven over the decades to be confusing to navigate, slow to address health concerns, involve higher-than-necessary costs, and struggle to meet a high level of quality care.
“Sometimes cautiously ensuring you don’t get it right means you don’t get it wrong. If you’ve been working with the same carrier for 20 years, what will change?” Matt said regarding the careful approach taken by employers offering plans from the largest corporations.
Sometimes cautiously ensuring you don’t get it right means you don’t get it wrong. If you’ve been working with the same carrier for 20 years, what will change?
Erik is most optimistic about alternative health plans as a solution. His advice? Learn all you can about the inner workings of the business, especially if you are early in your benefits career path. Read your annual report to gain a sense of “rhythm” in the organization. Use the terms that your business is used to, which makes you a more credible partner who is likely to gain internal buy-in. He encourages companies to pilot an alternative health plan in a division of the organization and learn from its performance.