Employee health benefits must be built around a better consumer experience

For years, employers have optimized benefits around cost efficiency, compliance, and optionality.

On paper, many programs look strong. But in reality, employees often feel confused, overwhelmed, and unsupported.

That gap exists because traditional benefits are built around systems and transactions, not real human experiences.

Reasons for the gap

Some businesses do little to assist their employees through a maze of healthcare complexity.

In many cases, the benefits departments and human resources staff at smaller and medium-sized businesses aren't equipped to provide employee/patient advocacy.

Employers must rethink health benefits beyond plans and cost controls, focusing instead on the human experience.

It can be a stressful, emotional and lonely time if the employee has a significant health problem and doesn't have an advocacy team acting as an advisor between them, doctors and insurance.

Doctors want to be paid.

For insurance companies, dealing with the humanness of the journey is a disruption to their operating machine that's based on accuracy, speed, and productivity.

The impact

Years of research and running a healthcare navigation company have made something painfully clear to me: The healthcare journey encompasses a lot more than health.

A healthcare journey can impact everything from a person's finances to their most intimate relationships.

I remember a member who called us because a claim hadn't been paid properly.

As a result, he was still billed for something he thought should have been covered.

We started investigating.

Usually, when you have a claim issue like that, it's due to multiple points of failure — and they could start as far back as medical billing, for example, if the procedure was coded incorrectly.

The gentleman revealed that he was sitting on $50,000 worth of medical bills.

Our review of those bills revealed there were issues with more than one of them.

In the case of a precertified procedure, the precert authorization (confirming that the insurer would cover the costs) hadn't been submitted.

In the case of an out-of-network provider, there had been no discussion with the provider to see if they would accept an out-of-network fee arrangement (which they sometimes do).

Long story short, after we untangled all the issues related to these bills, this gentleman's medical bill balance came close to zero.

Untangling such a web of failure that crosses the entire processing procedure is inherently complicated and usually too complex for a single patient to figure out.

Plus, if you aren't asking the right questions, you won't get the answers you need.

Compassionate benefits

As a healthcare navigation company, our human-centered design simplifies navigation, anticipates questions, and meets people where they are — rather than expecting them to figure it out alone.

Some businesses, particularly large ones or those with self-insured health plans, include or contract out specialized patient advocacy services within their human resources offerings.

These services are designed to guide employees through the complex healthcare system, manage insurance claims, find providers, and resolve billing disputes.

Compassionate benefits go the extra mile in the healthcare journey.

Whichever kind of agency is acting on an employee/patient's behalf, empathy for them and expert guidance through all touchpoints of the experience are essential.

That's because healthcare is rarely a chosen journey; it's often forced by urgent, stressful and unexpected circumstances.

The experience is often fragmented. It may be disjointed between providers, insurers and specialists, leading to gaps in communication and care.

If you look at the biological impact of stress, it significantly impacts your executive functions.

When someone is dealing with a health issue, financial pressure or a family health crisis, they're not thinking like a benefits expert.

Information overload, fear and time constraints take over.

If the benefits and the journey aren't guided, people may default to inaction or poor decisions.

Care coordination entities are tasked with knowing the next steps and alternatives, removing the burden of the employee/patient having to learn everything on their own and call the doctor's office and insurance company numerous times.

Especially over longer time spans for a complex health event, employees need to know they have a dependable and engaged support team that can advocate and investigate for them — and if necessary, take the system on.

Employers who care

Benefits aren't experienced solely as a list of offerings during open enrollment.

They're experienced in critical life moments: a diagnosis, a pregnancy, a mental health struggle, a financial emergency.

Designing for those moments ensures support shows up when it actually matters.

More employers should start asking their employees how they can better assist them in the healthcare journey.

Employees engage with benefits when they feel supported, not processed.

Experiences that are personalized, empathetic and easy to navigate build trust.That directly impacts whether people seek care early, use preventive services, avoid unnecessary services, make smarter financial decisions and stay healthier overall.

When patients are happier and make better decisions, that's good for both the employee and the employer.

Employers have an interest in lowering costs on their total medical claims, but they also have an interest in making sure their employees are healthier and their out-of-pocket cost is lower, because that makes employees happier and more productive.

The business case for compassionate benefits is stronger than most organizations realize because it can directly impact retention, trust, and productivity.

Workforce expectations have changed.

People now expect the same level of ease and personalization from benefits that they get from other consumer platforms.

If benefits feel hard to use, or if interactions feel impersonal, both signal a broader disconnect between employer and employee needs.

A healthcare coordination team, whether it's built from within a business or hired as an outside agency, can bridge that gap.

Kara J. Trott, the author of No One Alone: Humanizing Healthcare as an Outsider, is the founder, current chair and former chief executive officer of Quantum Health, a consumer healthcare navigation and care coordination company. Earlier, she was an attorney at Bricker & Eckler and a marketing consultant at RPA International.

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