BWF 40 | Healthcare Affordability


Paytient makes it easier for your employees to afford the care they need – regardless of their credit history.

Lou and Chris discuss the impact skyrocketing out-of-pocket costs have on people financially and medically. Paytient is a simple plan addition that ensures members do not have to avoid necessary medical care, and can fill ALL their medications.

The results? Happier and healthier employees, lower healthcare costs because treatable conditions do not go untreated and become high-cost claims.

Listen to the podcast here


Breaking Barriers: How Paytient Reshapes Healthcare Affordability With Chris Labrecque

Let me bring in Chris Labrecque from Paytient. Chris, how are you doing?

I’m doing well. Thanks for having me.

Chris is the Chief Customer Officer at a company called Paytient. I can’t wait to introduce what Chris does, what the company does, and how it addresses this huge problem we have in the US of medical debt, uninformed consumer’s surprise medical bills, and all of that stuff. Chris, I don’t know if you want to give a little bit more of your background, the company’s background, before we get started.

Sure, that’d be great. I cut my teeth as a broker consultant for many years, starting in New Jersey, moving to Florida, and ending that part of my professional life with the Insurance Office of America running their benefits division out of Orlando. I totally understand the broker environment and lived it long enough to understand that real well.

I resigned in December of 2022 and came on board here at Paytient in February 2023. I’m loving it. It’s a great company with a high intellect pact into this group. They are smart folks. What we are doing now is a difference-maker. I heard a broker say to me that we’re measured by our differences, not our similarities, broker to broker.


BWF 40 | Healthcare Affordability


I believe this is a difference-maker. What Paytient does is we provide employees of sponsoring employers with an interest-free, no-fee credit card to help offset expenses that they have across their benefits platform, medical, dental, RX, and mental health, including veterinary costs. We have 800,000 members across our platform and over 1,400 employers.

It’s a simple little thing that has shown to have elegance in its simplicity but effectiveness in its reach. It touches so many things. I like to call it a force multiplier or a performance veneer across a benefits platform. I know the broker community pretty well. I know how hard they work to architect something that’s relevant personally for that employer and their end users, their employees, as well as effective.

The question comes down to whether we recognize emotionally, intellectually, and professionally the struggle that the average person has to come up with the money to pay for a medical event or a healthcare event in and of itself. We can talk more in-depth about what our data is reflecting around that and how painful it truly is based on the utilization that we see.

The company’s doing some extraordinary things, getting some very exciting conversations. We’ve landed a couple of very large employers. We range anywhere from 50 lives all the way up to 1 million. We are kicking the tires now with some Fortune 10 companies. It’s become very clear that people want to use this as a differentiator. They want to use it as something to stand out in the benefits community, but they also recognize that it’s a delightful thing at the end-user level. It’s having an extraordinary impact on day one and throughout the benefits continuum, which we’ll probably get into during this conversation as well.

We’re still both in the benefits industry. I’m still on the dark side, trying to shine a light on the health insurance and healthcare costs. Having gone through this whole spectrum of managed care from the early ‘90s up until now and how the out-of-pocket costs have evolved from $2 to $5 copays in the early days, zero cost prescriptions, zero cost, ER or inpatient hospitals, all the way up to these very high deductible health plans, that process is something that you could argue now because of the transparency laws. It probably was avoidable. These two very large ecosystems of healthcare and health insurance haven’t served their members and patients as well as they should have.

They’ve taken advantage of employer groups’ and plan sponsors. We have to look inward to see how we can address the type of plans that are being offered now, but you’re not going to avoid out-of-pocket costs completely overnight. Although, there are some plans that we can create. I know a lot of advisors, especially in the health community that are building plans with generic zero copay primary care.

We want to get back to the basis of healthcare. You can’t avoid the fact about the economy being what it is and the average person having less than $1,000 in the bank. Still, even with all the legislation, being steered through a healthcare system can lead to very high out-of-pocket costs. Unfortunately, too many people find out after they’ve had the test or avoid tests because they’ve had this issue in the past. That’s the beautiful thing. It is so simple. What you guys are doing is essentially a rolling line of credit for employees that an employer sponsors interest-free for the employees, which is unbelievable. Explain the mechanism or the mechanics of how it works. You get a 100-person group. How do they do this?

I want to scroll back to something you said, if you don’t mind. Throughout my career, the pendulum has certainly swung so far. I can recall when I was a broker in New Jersey, the New Jersey State Health Benefits Program had a $1 RX copay. You could actually submit your copay to your major medical, and if you had met your deductible, you could get $0.80 back on the 80-20 split on every dollar. Now, the out-of-pocket expense is extraordinarily high. That pendulum has improved. How does it work? Let’s say an employer decides they want to integrate this into their benefits platform. They go through open enrollment and we provide all of the talking points and materials.

As of the day that they go live, the employee can download the app onto their phone. They go through a process to sign up and they go through what’s called an ATR process. It’s important to note that. It’s called Ability To Repay. We’re going to ask the member what their monthly income is and what their monthly debt is. As a result of that, we’re going to either issue or not issue the credit that the employer has set the credit limit that the employer has set. Ninety-eight percent of the people that go through that ATR process get approved. That tells us that we are reaching the vulnerable, who we want to reach. We see our highest utilizers being those in economically challenged ZIP Codes. That’s our highest utilizer. That’s exactly what we want.

BWF 40 | Healthcare Affordability
Healthcare Affordability: We want to reach the vulnerable.


We want to reach the vulnerable. That creates a health equity situation. We can talk at length about that as well. The member downloads the app. Once they download the app and go through the ATR process, they instantaneously have a virtual card on their phone. I went through this. My wife was taking the dog fixed, and it was about a $500 expense. We knew that in advance, and we decided to use the card.

I used it again when my wife filled out a prescription for a pair of glasses. The process for me to download and go through the ATR took less than three minutes. Had I been sitting in the waiting room at the vet’s office, I could have downloaded and had it swipe the card, either physical or virtual, swipe it at the provider’s office, as long as they accept Visa because we run on the rails of Visa. The card can be used instantly.

Your app pings you and says, “Great. We got this expense. Pick your repayment term.” It walks you through the repayment terms for my wife’s glasses. I spread it over the next four pay periods and hit set it and forget it. I got an email because I picked email to be how they communicate with me. Within fifteen minutes, I got an email that basically explained everything that I had done and showed me my account balance because that was the second charge that I had.

The member experience, I will tell you, our front-end and backend engineers are incredible. We have an open Slack channel through Trustpilot. We have about 90-plus net promoter score, which, in my years as a broker, I saw very few vendor partners that could boast that. That’s over five years running. They’ve created a delightful experience. We hear about the value of the card and the value of affordability and access from our members, but we also hear about the delight of the ease of use. Ultimately, that can make a huge difference. If you were to call any of the big insurance companies as a member to get guidance on anything, it’s not a frictionless process.

We feel that our card is a frictionless process. It’s very easy to use. That’s the feedback we get from our members. That’s how the program works at that point. That can happen anytime during the year. It’s open enrollment that these things occur. You download the app during open enrollment, so you’re ready when you go live at 12:01 AM on January 1st, assuming that’s your date.

Your medical event’s going to happen when it happens. Your son twists his ankle sliding into the home plate and you’re on your way to the emergency room ten minutes later on April 13th at 3:00 in the afternoon. You swipe that card and the next payroll is going to reflect your repayment terms. We are in constant cadence with HR and the payroll teams to provide them with the information so that payrolls adjust.

It’s a very light lift for HR or anyone who’s responsible for that. The administrative delight is equal to the end-user delight. We have a very large hotel chain that went live with us on September 1st. On the 26th, their senior HR folks were presenting back to executive leadership the success of the launch of the program. What they said to us was, “This is the best launch of any benefit that we have ever launched at this hotel chain.” I’m refraining from using their name because I don’t have their approval yet. I don’t think they’d have a problem with it because they’re so delighted by it. The activation or utilization is well in line, actually north of what they expected, but below the benchmark that we want to see for them.

We’re extraordinarily excited about getting them to that benchmark. Clearly, the administrative ease of use is there. It’s a light lift. For the cost compared to the impact, it has one of the bigger deltas that you’re going to find in an employee benefit. Think of it again as a force multiplier across all those different lines that it can cover.

Employers can choose to say, “I don’t want to use this for dental. I need this for medical and RX, or I don’t want to include veterinary because we have a pet insurance that we want to focus on.” They can choose those things. They also choose the credit limit as well, which is generally set, but the repayment terms are chosen by the individual user so they can help it fit their own budget. I got that question via email. “What are the repayment terms?” My response was, “That’s chosen by the end user. It runs anywhere from 12 months to 36 months, believe it or not.” The average repayment term that we see across the 800,000 members that we have is under six months.

It’s five and three-quarters of a month the payment terms are run through. This is important to stress here. The average swipe amount, what people are financing, as of the end of July 2023, is $118. That is extraordinary. I was very fortunate in my career to be a broker for a very long period of time. I can say that in the last few years, I did pretty well for myself.

Intellectually, I understood the financial difficulty to pay a $500, $1,000 or $3,000 deductible, but emotionally, I didn’t experience that. I don’t know that I recognized that as much as I could have as a broker consultant when I was looking at these plan designs. If I were a broker now, I would be layering this across the top to assure that the vulnerable population that also happens too often, and this is statistically speaking, be in a single disease state or a multi-comorbidity state.

Those are the ones we want to reach. Those are the ones we need to get to. I want to make sure that they are accessing their healthcare benefits in a responsible way. We saw in 2020 a precipitous drop in care. Now, we see inflation. There’s a lot of pent-up demand that is sitting on the sidelines now. As a consultant over the last few years, I was very concerned about that.

I had concerns I was hearing from stop-loss underwriters. I was hearing from carrier underwriters. I was hearing from anyone who’s understood that this is coming. It’s going to continue to come. The financial pressure that people have is causing them not to re-engage in their healthcare journey. Across our 800,000-member platform, we are seeing people come back into their health systems or come back into their own journey in a deliberate and responsible way that provides them with the ability to pay and the dignity to pay that goes with that.

The financial pressure that people have is causing them not to re-engage in their healthcare journey. Share on X

Financial challenges, at the individual level, become mental health challenges, which become overall physical health challenges. To the degree that you can help people in this regard smooth out those payments over time allows them to do so with a sense of confidence. You said it. It is a rolling line of credit. Think of it like a healthcare wallet. The employer’s basically saying to the employee, “We’re going to provide you with a $3,000 healthcare wallet to use as you need to.” I liken it back to when my son was eleven years old. He’s a man now. At eleven years old, he said to me, “Dad, buy me that.” I said, “You have $100 in your savings account. Why don’t you buy it?”

He looked at me and he goes, “Maybe I don’t need it.” The point is the care-seeking patterns change when people have the ability to pay. They’re typically more, in a healthy way, discriminating about how they’re going to access care and how they’re going to use it. I’m incredibly encouraged by what we’re seeing from a utilization pattern standpoint. It’s people going back to their specialists and repeating the ability to afford the prescriptions that they’re on to hold their disease management state in the right way. They’re going back to visit with their OB-GYN or they’re going back to visit with their cardiologist because they can afford to. The inflationary pressures now that are out there and the cost of milk, eggs, and gas, there are lots of pressure out there.

Hopefully, we’ll see an abatement in that. In the meantime, we at Paytient want to make sure that people are accessing the care in a responsible way so they don’t become a stop-loss hit or a high-cost claimant later on down the road. When I think about controlling cost to healthcare, I think of three horizons. There is the immediate horizon, “What is the employer paying now for all the services that they’re getting?”

There’s the midterm horizon, “What are the care-seeking patterns? Are people going in the hospital for an MRI? Are they going to the standalone facility? Are they going to a center of excellence that has typically lowest per unit cost and best outcome?” There’s the third horizon, which is, “What disease states do we have that we need to manage? Do we have diabetics? Do we have cancer patients or pre-cancer patients? Do we have heart situations and cholesterol issues?”

As a broker consultant, you got to keep your eyes on all three of those horizons because if you leave one unchecked, it can cause problems for the other two in the overall system. We feel that we’re checking all three boxes. The first box in immediate cost is we see a much higher plan migration to the high deductible programs with our product on the front end of it. We’re seeing more people.

Ultimately, if the open enrollment messaging is done the way it should be, the Paytient program will pay for itself because the employer’s contribution and the employee’s contribution are both being relieved by the migration to the high deductible plan. The worry is when you do that without a Paytient card, you’re basically baiting that employee out there with a low premium that they bite on, not realizing the implications of what a high deductible plan can meet.

The broker community does a great job in communicating that during open enrollment. Do people hear it? Do they digest it? Do they truly understand it? The answer’s no. They learn that later on when they actually have a claim. We check that box because plan migration helps pay for itself and brings relief to a 30% renewal for a 75-life group in that market where it’s challenging. There are not a lot of things that the employer can do to save money other than take even greater risks.

It’s usually contribution or plan design. It comes with an issue later on down the road because when people do use the system, they’re typically in a much worse disease state because they didn’t use the system in the meantime. There’s the population health management aspect, which is if you’re getting people back into their healthcare journey, you are avoiding from becoming stop-loss hits and degrading health over time. We have the ability also to influence care-seeking patterns. When you attach the product to certain things, it can influence behavior from a buyer’s standpoint.

When you attach the product to certain things, it can influence behavior from a buyer standpoint. Share on X

It’s important for the plan sponsors to understand that if you’re large enough to be experienced rated, if you’re self-insured, your overall cost to ensure the healthcare risk of your employees is continuing upon the expected claim spend then the corridor that the carriers will attach 20% to 25% on top of that. What I love about this is that it’s another tool for an advisor who’s looking to change the conversation and the mindset away from the insurance and onto the cost and the quality of healthcare. You’re putting a tool in that member’s hands that they’re going to use as they enter the healthcare system. It allows us while we’re having this conversation about how great this benefit their employers are extending to them.

How do you use that? How do you take it a step further and teach them how to become a true consumer of healthcare? This is their money. Let’s say I apply for a $2,000 line of credit. I can have that conversation as an advisor now and say, “Did you know that the spectrum of the cost for an MRI within 10 miles of where your office is or where you reside could be in the low hundreds?” It could be a $300, $400, $500, or $600 MRI. The very same MRI could be $5,000. That’s your money now. It always was, depending on the type of tool that you have at your disposal and plan design. You can get that person more and more often to say, “I don’t want a line of credit. Why should I blow through my whole line of credit for an MRI? I’m going to do some research.”

They are going to look for other tools potentially that that employer is deploying, whether it be the carrier site where they have to offer these things now. For me, why wouldn’t an employer do the goodwill to put that in your benefit portfolio when you have your open enrollment here? I would imagine 800,000 is a lot of members. That means there are a lot of people who haven’t even seen or heard of anything like this. They could say, “My employer cares about me. They’ve taken it a step further.” It’s not a 5% interest, which would be competitive in this economy. The 0% interest, rolling line of credit is amazing. I don’t know if you touched on this. This is a post-tax deduction out of payroll.

That is correct. It’s post-tax. It lays alongside of HSAs and FSAs very effectively.

It’s the ability to offer those types of financial mechanisms as well.

That’s correct. They’re not mutually exclusive. They actually complement each other extremely well. Also, of note, if an employee fulfills their full amount on day one, $3,000, and quits on day two, the employer’s not responsible for that balance. That falls on our credit facility, our responsibility to collect from that employee.

Of note, we have an ethos in this company of do no harm. We never report anyone to a credit bureau or a credit facility under any circumstances or sell our debt to a credit facility for collection. We handle it all in-house here. We have a default rate that we think is very manageable. As it turns out, very encouraging. People actually do want to pay their bills. If you work with them and spread it out over time, they’re respectful in that process as we’re respectful with them.

People do want to pay their bills. If you work with them and spread it out over time, they're respectful in that process as we're respectful with them. Share on X

If they can’t pay it back, we’re going to write it off. The employer is not responsible for this. Unlike what you see in FSA, use or lose it on both ends of the spectrum, between the employer and the employee. In HSA, it’s 100% vested right out of the gate. We’ve seen brokers use this in conjunction with the HSA, where the employer doesn’t have to put as much into the HSA because they can offset it with this. With an average rate anywhere between a PEPM, between $2 and $4, depending on the credit limits turnover and some of the other risk factors. It’s an inexpensive way to amplify some of the things that the employer’s trying to accomplish and the broker’s trying to accomplish.

You talk about spend versus price. That’s a conversation I used to have with my P and C partners, who all look at price. What does the market say the price is? We were always focused on spend. What are the underlying drivers and how can we bring that down? Is it the facilities people are using? Is it the health of the population? Is it the education and the understanding of how to use these things? That’s one of the things I can’t touch on enough. Most people understand how to use a Visa card. Given the time and inclination, they become pretty clever about how and when they use it. You need to put it in their hands and allow them to figure that out.

The feedback we get is it’s very simple. It’s easy to use and easy to understand. That actually amplifies how people feel about the entire benefits platform, not Paytient alone. We do business on the ACA platform with a number of the large insurance companies as well. We were told by one of them that they recognized a 70% increase in their net promoter scores when they embedded our product in their product.

That’s the exchange. That comes with what it comes with. Price benefits. It might not be the richest of plan designs and cost that you would see in the market, but clearly a 70% lift. Those are their words, not ours. It is substantial and speaks to that. As a consultant, you always take risk in putting a solution out there for an HR person or a CFO, whoever you’re talking to in the employer. They’re further taking risk by installing the product. The feedback we get is the delta from the cost to the impact and the feedback is substantially greater than they see with other benefits that they put in place. The fact that this touches all the other benefits in the right way based on what our data’s telling us is extraordinary.

I’m assuming the answer to this is any time, but it can be implemented at any point during the year. You don’t have to do this necessarily at open enrollment, I would imagine, where maybe that would intimidate an HR leader or team because they have so much going on at that time of the year. There’s no renewal date. There’s no open enrollment. Everybody who meets a certain criteria, let’s say full-time employees working 30 or more hours per week, if that’s something that the employer determines, that’s it. They’re all technically eligible for the program.

The employer determines the eligibility, they determine the limit, and they determine when they want to roll it out. We had a Fortune 500 company, one of our longer-term clients who loves this program, roll it out for their HSA population. Very shortly thereafter, they said, “I got to get this to everyone else because the HSA population is telling everyone else how great it is.” It worked well for them.

We had another employer who said, “We just went through open enrollment and then did an employee survey. The feedback we got was not great, not glowing. We decided to launch three months after open enrollment, this product, and that turned around the sentiment of their employees 180 degrees.” We love off open enrollment because we don’t get caught in the vortex of noise that all of the other messaging has.

We know we’re going to get individual attention spans and we’re going to create the necessary awareness for people to know this is here, when to use it and how to use it. We also recognize that we are seen as an employee benefit, per se. We know what the rhythms and sales cycles look like. We follow that as well. Recommending off renewal is a strong move. It’s not a big budgetary item. It’s fairly easy to do. The lift of implementation is extraordinarily easy compared to anything else. APBM carve-out would be a tough one. Reference-based pricing would be extremely difficult. Network changes can be disruptive even now to some degree because it’s always the CFO’s wife’s OB-GYN who’s not in the new network.

The way it is, a 99% overlap and there’s the 1%, it’s the CEO’s wife. You don’t have a lot of those issues here. We implemented a 20,000-life group on September 1st, 2023 and we did it inside 30 days, and it was flawless. That’s the hotel chain that loved us. I had heartburn when I thought that we only had 30 days to make it happen, but we pulled it off and did it in fine fashion. I’m sorry for the long diatribe there but off renewal is definitely something we emphasize.

The employer maybe can set the dependent eligibility, but it does it typically follow the benefit medical eligibility.

As determined by the employer, absolutely. One broker used this to incentivize spousal carveout. They attach the card to if you’re doing, if you’re going through the spousal carveout, we’ll help you with this. Some employers use it as a “mini med plan.” It’s not a mini med plan. I don’t want to conflate the conversation. They’re using it for part-timers to increase retention.

Across 11,000 lives and 67 employers, we saw about a 10% delta in turnover for those who actually downloaded and used the card versus those who did not. I don’t think Brian Whorley, my founder and CEO, envisioned that impact when he started the company years ago but I’ll take it, and I’ll brag about it as much as I possibly can, especially in this tight labor market. This can be a difference-maker that works well for the gig economy. There are a lot of clever applications, some of which we are not even coming up with our clients and brokers and others are coming up with. We’re very flexible at this point in our lifespan of product. We’re willing to entertain some unique ways to use the product itself.

I’m thinking of like an HSA plan or a high-deductible health plan. I usually recommend that the patient not to pay at the point of sale because they don’t know yet what the allowable amount might be if they’re using a network. I went through this with my wife with our FSA. My daughter had her teeth extracted. It was an in-network dentist, but the dentist made a cost estimate and said it’s going to be $931 out of pocket.

She used her FSA to pay for it. I said, “You shouldn’t have done that,” but whatever because after all was said and done, and the claim was adjudicated, our out-of-pocket was only $725. I actually had to refund. I had to write a check. We had to refund the HSAs. They wouldn’t offset the difference. I had to refund the amount because it was technically an ineligible charge from my bank account, and then resubmit a paper claim to get a check back, which I got a check. I don’t know if I got a refund check back from our FSA company.

That’s not exactly a frictionless experience.

I guess my question is, you can wait. It doesn’t have to be a point of sale. You get an explanation of benefits. You get an invoice from a provider, usually you get a slip. It says, “Use this Visa information.” You could fill that out, use your Visa information, send it in, and it would be a manual transaction against the card.

It’s easy. That’s the point of it. We have situations where an employee will use our card first, even though it’s eligible or HSA or FSA, and then they’ll repay our card or change. It’s 95% of the employer space clients that we have run their repayment terms through payroll because the banking industry regulates us, we can’t force people to do that. They can attach it to a savings account, checking account, investment account, HSA, or FSA. They can go off payroll. We give them the right to do that. Most take payroll anyway. They’ll use our card first and then repay that through HSA if it’s eligible once they get a chance to sit down.

Healthcare events are not like vacations. “I’m planning to go to Bermuda next year. I’m planning these healthcare events occur.” We get thrown into them. You’re not always thinking as clearly as you need to in the moment. It’s nice to have something to level set, take care of it. Now I can come back and figure out how I want to handle that. In my budget, in my terms. Of note too, if you have an event, you swipe the card and you don’t choose repayment terms, within 24 hours, it’s going to default to whatever you set up when you did the app, 4, 5, or 6 payments. It’ll default to that.

BWF 40 | Healthcare Affordability
Healthcare Affordability: You’re not always thinking as clearly as you need to at the moment. It’s nice to have something just to level set and take care of it.


You can make changes. We have people who have had, in the first month of use, had a $1,000 expense. In the following month, unfortunately, a $500 expense. That changed their budgetary needs. They wanted to change the $1,000 expense repayment terms and they can do that. The ethos is do no harm, meet people where they are and be as flexible as you possibly can to support them. Quite frankly, you’d be surprised at what that does for them from a health standpoint, from a mental health standpoint as well.

I know having gone through as many open enrollments as I have over the last 30 years, there’s two kinds of mindsets. One mindset is, “What if,” and they’ll overinsure themselves. They’re spending more money than necessary because 1 out of every 5 or 10 years, they had an event and they remembered it and it wasn’t pleasant. They’re scared and they’re like, “I’ll pay $100 out of every payroll.”

However, it could be $400 more a month that you’re paying $5,000 for a what if, as opposed to purchasing the plan that you believe under normal circumstances would be the best fit for you and then having this as a stopgap on the backend. That comfort zone of knowing, “I don’t have money in my bank account. I don’t want to put more money on my credit cards I don’t want to go to collection again.” Twenty percent interest rates on a lot of those cards and things these days. It gives you a lot of peace of mind, I would imagine. I could definitely see that migration of members into a more suitable lower option plan being pretty significant.

I think the what if crowd is the ones that actually connect to the card itself and migrate to a plan design that brings them financial relief. They’re paying a lot for that what if. We know this. If you’re delta between a high deductible or even a higher deductible in a PPO with a lower deductible, because you want to hang onto that sleep insurance, that’s pretty expensive. Household healthcare is starting to eclipse mortgages and rent in the average household. That’s frightening.

Creating that relief by providing them with a healthcare wallet and the confidence and ability to pay, it changes. What it does is it right sizes individual premiums, as well as plan design. The other thing it does too is you got a group of 100 and the CEO makes $200,000 a year, and the line worker makes $35,000. That $3,000 deductible that everybody gets offered is looked at very differently between those two parties.

That card levels that out a little bit. Think of it from a health equity standpoint, one of the social determinants of care. We’re leveling that out. Our high utilizers are the ones who are oftentimes the vulnerable. They’re the disenfranchised. Those are the ones that we want to reach. I say it’s a little bit of a moment, the moth and the flame. We’re loaning money to the ones that probably would struggle the most to repay us. What we’re finding through our utilization patterns is they’re pretty smart with their money. They’re judicious with their money. They just need to be able to spread it out over time and they’ll make the right decisions. It’s what we’ve seen, which is incredibly encouraging.

When you look at healthcare and empowerment at the individual level, particularly as we’re staring down the face of transparency becoming something that the end user can use, I think they’ll find the right way to use it very quickly. It changes the perspective of how everyone views that deductible across different strata of income. It levels that out a little bit. The line worker doesn’t feel so pinned in. Honestly, our utilization pattern, speaking of income, are fairly similar, over $75,000 and under $75,000 of income.

I make a decent living. I used my card instead of a cash, check or credit card for obvious reasons. It’s time value of money. Why not? I should max out my $5,000 limit. I prefer not to have medical events to use it for. I try to maintain my own health, but therein lies some of the subtlety of how it’s viewed and what it means. It’s that judicious nature of how to use the car. Yes, I have this $5,000, but like my son not wanting to pull out of his savings account, I don’t want to use it. What else can I do to avoid the next healthcare event so I don’t use it, but I have that comfort knowing that if it does happen, I have the ability to pay?

We’re young, just a few years running, 800,000 members, 1,400 employers. To your point, we’re probably the best-kept secret in the benefits industry right now. I don’t see that lasting very long. In my short tenure here, I can feel the avalanche starting to occur in a very good way. Clearly, we’ve scratched an itch in the marketplace. We found a very small slice of that world, but it’s had a much broader impact overall.

I was looking at the brochure that you guys had shared with me and it’s for HR leaders out there to understand that. Your largest utilization is for pharmacy for your earners that are between $25,000 and $50,000. A lot of people don’t understand that these $10, $15, $25, $30, $50, $80 copays, $200 deductible on an RX plan, they prohibit a lot of people from filling all their prescriptions.

Over the years, that was the one thing when I saw the prices for the first time back in 2016, and I got so upset that I had a flashback of all of those people who had come up to me at the end of open enrollment meetings. They were the most vulnerable typically a lot of the more seasoned employees at companies that have some chronic health conditions, otherwise pretty healthy, but would literally cry.

It was very upsetting that they were already taking only 5 of their 7 medications, and this $10 copay on tier one and $20 increase on tier two medications meant they were going to have to give up another prescription. That’s the last thing an employer wants to hear. Also, the flip side, and we talked about it before, is this is now a ticking time bomb of someone who might not be taking their blood pressure medication or their diabetic medication and becomes a hospitalization.

It’s much more out of pocket for the member but for an employer that’s, again, in the experience rater of the self-insured market, that has consequences on the entire population simply because someone couldn’t afford that $20 medication. Plan design can address some of those things. Consumerism, like real positive, incentivized consumerism to get people to the best doctors. You have to meet people in companies where they are and addressing the needs of their employees, making them capable of paying their out-of-pocket costs and not avoiding care is essential.

BWF 40 | Healthcare Affordability
Healthcare Affordability: You have to meet people and companies where they are.


It truly is. With the evidence of the challenge, particularly around the vulnerables, stop-loss underwriters look at ZIP Codes. They look at ZIP Codes on census because they know that that rate changes in food deserts because chronic disease and high-cost claimants spike and skyrocket in those areas. Those are the exact folks we’re reaching and trying to reach who are using the card in a very responsible way based on the data that we see.

Your comment about at the end of open enrollment meetings, I remember a specific scenario. I used to work with a woman. Her name was Amy Leonard, and she had told me about a story where she sat in the back of the room afterwards for about an hour and a half with this young lady who was a single mom and struggling to make the premium payments that she was crying.

Amy spent the extra time with her. God bless her. She’s such an empathetic soul, and she worked through it with her. That was evidenced with one person. That happens in every single room you stand in during those open enrollment meetings, and oftentimes you don’t know how many of those folks are suffering that. Let’s say $2.70 PEPM or $0.8 a day, why not put this performance veneer over top of a benefit plan and see what it does? Make sure you’re touching and reaching in a very empathetic way, those who are struggling to make $118 average swipe payment. That’s not a big number. I found this company in the fall of 2022.

I had a conversation with Brian Whorley. My expectation was this is for high deductibles, this is for emergency rooms, surprise surgeries, big ticket items. I had no idea it was being used on the frontline the way it is in a responsible way. From a population health management standpoint and from an individual member use standpoint, it is very encouraging. It’s a simple thing, an inexpensive thing, but it has pretty strong implications inside of a benefits plan.

We need to get the word out. I certainly thank you for the opportunity to speak to you and your broader audience about what we do. I’d love to have calls. I’d love to have conversations. I’d love to explore different ways to use this that maybe we haven’t even thought of yet because I know your audience is made up of some of the most creative consultants in the business and the ones who want to drive a difference, who want to make a difference. We need more of those folks. A little commercial for Lou. When He’s doing these moments, listen to what he’s saying. Listen to his guests.

This show is about spreading the news of this alternative universe of solution partners that are out there, including alternative universe of healthcare, health insurance providers, stop-loss companies, independent TPAs, and PBMs that are making such a dramatic difference in the lives of so many millions of members, thousands of plan sponsors, through this eco ecosystem. It’s so much more rewarding. It’s challenging because a significant amount of grooming has happened over the years. In a lot of ways, people have given up and assumed, like death and taxes that out-of-pocket costs and insurance premium increases were a given. They don’t have to be. You can be an employer. You can be compassionate.

You can really not throw things at your, your employees, which some do, some avoid because of the disruption. The first time I heard about this, I was like, “Who wouldn’t want to do this?” I put your website up there. That’s correct. Reach out to the team over there at Paytient. If you want to learn more, if you’re a prospect or client of mine, of course, give me a call. We’d love to have a conversation about building this in to your benefit package. There’s nothing else. I think we’re good. We covered everything we needed to. It’s a busy Q4, so I know your team’s busy.

Thank you very much.

Thank you so much for coming on now and best of luck. Hopefully, next time we talk, you’ll have eclipsed a million members. I’m sure that’s not probably too far off.

We’re pretty close. By January 2024, we should be there. I hope so, for sure. We’re watching that pretty closely as you imagine. That’s going to be a celebration around here. I’m glad it didn’t happen while we were on this interview. It would’ve been incredibly noisy. Thank you. My pleasure. Take care.


Important Links


About Chris Labrecque

BWF 40 | Healthcare AffordabilityChris Labrecque is the chief customer officer with Paytient, a company on a mission to help people better access and afford care. Paytient works with employers, insurers, brokers, and health systems to provide Health Payment Accounts, which offer the power to pay out-of-pocket healthcare expenses.