Designing Better Healthcare Experiences (with Ben Callaghan)

This video provides an in-depth exploration of how design and technology can fundamentally improve the healthcare experience, featuring Ben Callaghan, Chief Experience Officer at Empara. Callaghan argues that the healthcare industry significantly lags behind consumer sectors like retail and entertainment in terms of user experience (UX), leading to frustration, mistrust, and complexity for members. The core philosophy driving Empara and its parent organization, Good Root, is the belief that making the healthcare experience "more rewarding and more enjoyable" is the key driver for achieving cost savings and fostering innovation.

The discussion details Empara's strategy for addressing this challenge, primarily through the development of its Health Engagement Platform. This platform is designed to act as the "connective tissue" that integrates the myriad of point solutions common in self-funded plans, solving the problem of "choice paralyzation" for employers and fragmentation for members. A significant focus is placed on operational efficiency for buyers (TPAs, consultants), achieved through deep data integration work to streamline eligibility, file sharing, and consolidation of disparate systems. The company views its mission as Reinventing Healthcare one system at a time, with a broader goal of alleviating and eliminating medical debt, which is cited as the leading cause of bankruptcy in the U.S.

A critical component of Empara's technological approach is the deployment of AI and Large Language Models (LLMs). They are currently beta testing a virtual AI assistant named "M," which is trained on all plan documentation, employee handbooks, and add-on solution details to provide context-aware, personalized answers. This AI is projected to potentially remove 70% to 80% of basic, high-volume calls to member services. Furthermore, the future roadmap involves interrogating actual claims data to deliver customized, relevant content to members, mirroring the personalization expected in modern consumer applications (like social media feeds). The conversation also touches on the importance of driving member engagement, noting that current app utilization is around 50%, and strategies include implementing digital-first approaches (such as digital ID cards) and integrating benefit sponsors (HR teams) directly into the platform's message center to reinforce its value as a central resource.

Key Takeaways: • Experience Drives Outcomes and Cost Savings: The primary lever for innovation and cost reduction in healthcare is improving the end-user experience, making it seamless and consumer-grade to drive positive behavior change and utilization of cost-effective solutions. • AI for Operational Efficiency: The deployment of context-aware virtual AI assistants, trained on comprehensive plan documentation, can significantly reduce operational burden by eliminating 70% to 80% of basic member service call volume for TPAs and employers. • Data Integration is the Connective Tissue: Solving the "point solution fatigue" requires deep data engineering to streamline eligibility, file sharing, and system integration between all trading partners (TPAs, carriers, vendors), ensuring a cohesive experience for the member. • Digital-First Engagement: Moving away from antiquated processes, such as physical ID cards, toward digital-first strategies (like dynamically branded mobile apps with shareable digital cards) is crucial for increasing member adoption and utilization of benefits technology. • Addressing Medical Debt: A core focus for innovation should be on solutions that alleviate medical debt, which is the leading cause of bankruptcy, noting that 80% of those affected had insurance at the time of the claim. • High Thresholds for Financial Assistance: Solutions must connect members to often-overlooked resources like Hospital Financial Assistance, which can apply to households earning up to $120,000 annually, challenging the stigma associated with "charity care." • Customization via Claims Data: The next evolution of member engagement platforms will involve interrogating real-time claims data to proactively deliver personalized, contextually relevant information (e.g., notifying a member on a specific prescription about a more affordable cash option). • Buyer Flexibility and Configuration: Technology platforms must be highly configurable to serve diverse buyers (TPAs, brokers, associations) by allowing them to set up plan templates, integrate preferred partners, and dynamically brand the application to maintain competitive advantage and brand recognition. • The Need for Evergreen Technology: Companies should avoid building or adopting solutions that paint them into a corner; technology must be built to evolve and allow for continuous improvement and feature deployment, avoiding the obsolescence seen in many 10- to 20-year-old systems. • Future of Cash Pay: The industry is trending toward simplified user journeys, potentially leveraging cash pay or reference-based pricing models, requiring robust healthcare navigation support to mitigate risks like balance billing and ensure a smooth member experience.

Tools/Resources Mentioned:

• Empara Health Engagement Platform: A fully native iOS, Android, and web application designed to consolidate benefits and drive member engagement.
• Virtual AI Assistant "M": An LLM-based assistant currently in beta testing for answering member questions based on ingested plan documentation.

Key Concepts:

• Chief Experience Officer (CXO): A role focused on taking responsibility for the end-user experience of healthcare, ensuring consumer-grade quality and usability.
• Future Design: A consulting approach focused on strategic planning and creating purpose-driven organizations by helping executive teams set audacious, long-term goals (3-10 years) and work backward using frameworks like OKRs.
• Hum Driven, Tech Enabled: A methodology for care navigation that prioritizes human support and expertise while leveraging technology to enhance efficiency and reach.