Episode 03: Supporting the full consumer lifecycle: A discussion on employee savings strategies with Alight
Published on December 3rd, 2020
For many people, 2020 was a year of crisis. New realities forced consumers to focus on the present. What do I need right now? What can I afford right now? How do I maintain my health right now? Naturally, thoughts of the future and long-term savings fell to the wayside. Yet it’s precisely these long-term savings strategies that can help people through moments of crisis. With this in mind, Karli Dunkelberger and Karen Frost of Alight discuss the strategies benefit administrators and employers can use to coax consumers back to a savings mindset. From lifestyle cards to account seeding, learn the best ways to support employees during times of hardship and set them up for long-term financial success.
Karli is the National Sales Leader within our Health and Wealth Solutions group. Managing the Smart-Choice Accounts, Dependent Verification Services, and Compliance Sales Teams, Karli ensures the value of our programs are communicated and shared with existing clients, new prospective clients, Alight’s leaders, and other areas of our business.
Prior to joining Alight, Karli served as the Vice President of Sales at OPTUM, where she led the national sales team responsible for selling HSAs, HRAs, FSAs, Commuter, COBRA, Direct Billings & Payments, and Consolidated Billing Solutions. She successfully launched a sales team and solution set that was stand-alone and separate from the Health Plan integrated solutions. Before OPTUM, Karli also worked in similar roles at both CONEXIS and Ceridian. Karli first began working in the industry in 1981.
Karli’s expertise includes all Health Point solutions, including HSAs, HRAs, FSAs, Commuter, COBRA, Direct Billings & Payments, Consolidated Billing Solutions, Advocacy, Eligibility Management, and Compliance solutions.
With 30 years of experience in health solutions, Karen is responsible for growing and innovating Alight’s health administration products and services. These solutions enable clients to help their people optimize benefits, navigate healthcare complexity and engage in total wellbeing. She recently led Alight’s COVID-19 taskforce providing employers expertise, insights and thought leadership as they made business decisions and supported their people through dramatic workplace shifts.
Karen received her MBA from University of Chicago Booth School of Business. She is a Certified Employee Benefits Specialist and serves on the Executive Committee of the Board of Directors of the Employers Council on Flexible Compensation (ECFC).
Karli Dunkelberger – Don’t forget about the way that people follow money. And that seeding could be taking the FSA forfeitures and using the forfeitures in a way that it is seeding next year for the FSA. The other thing is, those dollars could be repurposed to seed every HSA account that is opened in the coming year, and what a great way to use those dollars in a way that it helps people think about their HSA differently.
Brian Colburn – Welcome to Creating Healthier Futures, a new podcast from Alegeus. I’m Brian Colburn.
Anna Lyons – And I’m Anna Lyons. In this series, we’ll reveal the state of healthcare consumerism through trends and research, our own data, and the health benefits experts that are driving our industry forward.
Brian Colburn – To download the materials discussed in this episode, or to learn more on the topic, be sure to visit Alegeus.com. Thanks for tuning in.
Anna Lyons – Welcome to December’s episode of Creating Healthier Futures. Before we dive into today’s topic, we wanted to let you know about a free virtual event we’ll be hosting next week. The Alegeus 2021 Health Benefits Forum on Wednesday, December 9th will feature a panel of industry experts who will discuss the state of health benefits and the themes we see shaping the industry in the new year. To register, visit Alegeus.com slash webinars.
Brian Colburn – Today’s episode is all about consumer savings, and the impact COVID-19 and the economic recession has had on people’s ability to save. We’ll consider a range of strategies employers can use – from lifestyle cards to account seeding – to support employees during times of hardship and set them up for long-term financial success.
Karli Dunkelberger – Hi this is Karli Dunkelberger, and I am the vice president of sales for Alight’s Smart Choice Account sales team.
Karen Frost – I’m Karen frost, and I lead our solution strategy for the health business at Alight.
Brian Colburn – Karen, for those in the audience who are listening that aren’t familiar with Alight, Can you give us a just a quick background on the company?
Karen Frost – So Alight is the legacy Hewitt associates administration business. So we used to be part of AON – AON Hewitt at that point. And just back in 2017, we spun off to a standalone company. And Alight is focused on really all things HR. We do health, wealth, HR and payroll management services to employers that really are about 500 lives and over. If I look at the health book of business, we serve about 14 million people, representing about 107, I’m sorry, 740 clients. And when I say health, I mean a whole variety of things that starts with Benefits Administration, including COBRA billing, you know, ACA compliance, but we also do the rest of the circle. So we have health navigation services, consumer accounts, as well as benefit verification and other services? So if it’s an HR thing, Alight pretty much does the management of it.
Brian Colburn – That’s great. All right. So the topic, the main topic for today is around savings. And we know, if you think about savings, and spend as sort of two sides of the same coin. We know that COVID-19 has had a major impact on spending this year. So maybe we’ll start with the spending side of it. I’m curious what you guys are seeing at Alight in terms of spend changes or trends. Maybe Karen will start with you and then Karli, you can add to that if you want.
Karen Frost – Oh absolutely. So let’s think about this in two ways. So first, but what’s probably everyone on this call has heard about is what you hear in the press around the significant impact on the delivery system. And so you heard things like, there was almost a $600 billion decrease in q2 of this year in health care spending. But what may not be as widely heard is how that’s rebounded, really starting in the late spring and early summer. And so I was just reading a Kaiser Family Foundation report before coming on to this call. And although there was about an almost a 40% decrease, then in q2, over the summer, we saw spending rebound to only about 10% lower than prior years. So we did see a big drop in things like elective surgeries, those things that could be really delayed without significant long term impact on patients, for what we’re starting to be more and more worried about are the things that could have long term impact, like preventive care screenings for cancer, we saw a significant drop, and that drop has remained. And as we all know, is you don’t if you don’t find those illnesses early treating them is that much harder later, as well as more costly. And then if we think about the impact on people, we see, you know, over 40%, of people telling us that they wouldn’t care, because they were afraid. Nearly three fourths of employers telling us that they’re worried about an overstressed healthcare system and not being able to find a doctor will need one. And then the impact of that with over 50% of people telling us that there’s a negative impact on their overall mental well-being as a result of everything that’s going on in the pandemic. So we see an impact both on the actual spending, as well as people’s outlook on future health care, services and spending.
Brian Colburn – Are you guys seeing anything that employers are doing differently to encourage that type of spend or the screenings?
Karen Frost – We certainly see employers focusing on like the number one thing I hear is mental health, and providing support for mental health to make people more comfortable. And we think that is one way that the rest of the system will be able to recover is if I can be more comfortable using healthcare when I need it. I’m more apt to interact with my doctor and get the right services. Karli, anything you’re seeing there?
Karli Dunkelberger – Well, we have seen that when it comes to the changes if we think back to March and fast forward to where we are now in in q4. At first it was people just stopping. And then health care needs still continued for families or someone that had an ongoing chronic condition, whether they were going to work if their job was impacted by the pandemic, they still needed to get their care. And so we saw a spend and increased spend of using those health care dollars, which did hit the HSAs and the FSAs and HRAs. But also as people were using the health care that they had, we saw a shift in the savings rate because HSA is like a 401k. We can make changes throughout the year if we want to increase or decrease what we’re putting into those pre-tax plans. And we saw the savings rate start to decline. Now when you think about the savings piece, and then you think about using your pre tax benefits you have during the year as people started to use up those pre-tax dollars. And I’m really talking about HRAs and FSAs is now in that area, we saw an increase in declines on the cards that are used with FSAs and HRAs because people were getting the care they needed finding a way to use the dollars that they had. But then when the accounts ran out, then the decline of those cards did increase.
Brian Colburn – So you talked at first about the HSA side, so people adjusting down presumably saving less Is that right?
Karli Dunkelberger – Yeah, that exactly right. And it was about cash flow. You know, that’s just a conclusion that we’re coming to. As we look across our book of business as Karen mentioned, you know, we have the we have the privilege to serve very large clients. The average is way above one thousand employees per company. And when it comes to looking across our mix of clients, it was interesting to look at the aggregate and see that savings rates were being adjusted. In some cases people were stopping doing the pre-tax dollars into their HSA , but again, there is a way to solve for that, Brian, we believe that it’s paying attention to the data for each individual client, using the communication that was planned or possibly new/custom, creative communication to remind people, hey, you can get back in. So once the business climate is shifting or changing, and in addition that people get the work life balance sort of figured out as they did a shift of their family situation, their business situations, reminding them that they can get back in, and they can start saving again. And that I think, is one of the really unique advantages of a health savings account, is that reminder that people can use it when they need it, they can increase those contributions. And you will never lose those pre-tax dollars.
Anna Lyons – Karli raises an important point about the importance of a communication and education strategy. We know that the average couple will need around $295,000 for healthcare expenses in retirement, and yet, 18 years after HSAs were first introduced, very few know how to use or maximize them to build up that savings.
Karli Dunkelberger – We continue to see that ongoing education has great value for people in terms of their knowledge of how well they can use the HSA now or continue saving till the future. And if you think about any one of our clients who might have average turnover, say 10 to 20% a year. And if they started a plan, maybe seven, eight years ago, where they are educating their population, they may be educating 50% of their people are different people today than they were seven, eight years ago. So to do the continuous education about how to optimize the savings, whether you’re putting it away now to use it this year, or putting it away in case you need it next year or the year after that. And then having that emergency fund. I am confident, absolutely confident, Brian, that the ongoing education is not something that people look away from, but they pay attention at a time when it’s important to them. You know, one of the cool ideas that I think more employers need to take a look at is if I was putting in, say the maximum amount of my HSA last year, just default me to that. Give me a little message in my annual enrollment walkthrough that says, hey, you had this much in your HSA last year. And why don’t you do the same thing this year with $7,200 is the max. And if you need to make a change, go ahead and click here and adjust your dollar amount. And because with HSA is you can take it down or increase it and take it up at any time during the year. There’s so much flexibility. Why not just OPT someone in to the same amount they did the year before and help more people keep saving.
Brian Colburn – Yeah, I think that’s great advice. The other thing I’ve always wondered is, if you look at a 401k plan, there’s often auto escalators in there. And we don’t see that on the health side of the house and I wonder why it’s a, you know, because we always think about HSA is, or it feels like on the same track as 401K’s. And so we always say to ourselves, like, if you just look at what they’ve done in 401Ks and you follow the breadcrumbs of the things that have worked, that should give you a lot of the recipe for success. But yet the industry is so far behind.
Karen Frost – I think employers, because they’re 18 years seems like a long time but 401Ks are a lot older. Employers are just, they’re still getting used to this as a savings vehicle. With all of those kinds of capabilities that you’re describing, Brian, we’ve talked to our clients about auto escalation. And conceptually, they get it through a 401k lens, but they struggle with an HSA component, it’s certainly something that we definitely are exploring.
Anna Lyons – Education is important year-round, but especially so during open enrollment. Typically, this is a time when employers are asking their employees to think hard about their unique needs, answer questions and determine what coverage addresses those needs and saves money. There’s another way, however. Alight calls it “reimagining the enrollment process.” They see a major opportunity to switch from “do-it-yourself” enrollment support to “do-it-for-me”.
Karen Frost – What you might find the most interesting is we asked users and what they said to us was, Why do you even have to ask me questions? You know a lot about me. So why don’t you start with answers first, instead of a laundry list of questions. So we actually took that approach in the enrollment that we deliver. So the approach we take is for clients that want to make suggestions around benefits really answer, almost, essentially, who are you covering? And are there some wellness activities that that you might be willing to participate in beyond that, unless you want to model some healthcare costs, we can suggest immediately what the best choice for you might be in medical, let’s assume because we’re all healthcare experts here that that you pick that high deductible plan. And what we’re finding like this year, 34% of people are actually doing that, it’s the highest rate we’ve seen instead of just taking you back to Hey, what do you want to do next? We go right into it an HSA and suggest the dollar amount. You can change it, you can you know, the employer helps us set with that dollar amount is but we find that it increases our enrollment rate in that HSA dramatically. And it helps people have that complete coverage. If you have a low deductible. We pair it with an FSA because either way you need a budgeting tool to save for those out of pocket health care expenses, and then we kind of go through the rest of the enrollments in a similar fashion. So what we’re finding is participants are happier, employers are getting the results that they want that match their strategy. And we take the guesswork out. Because you and like we all live in sort of, you know, pick your favorite streaming device, whether it’s Netflix or Amazon, or, or, or another Disney Plus, if you have younger kids, that’s suggesting what you should be doing based on your past behavior. And that’s the experience that we are pushing for every single day.
Brian Colburn – Yeah, that’s great. Where do you see that in two or three years?
Karen Frost – That’s interesting. Um, so I tell you, I have a couple clients, clients and kind of two schools, one set of clients is saying, Okay, now that you can do that, create the two click enrollment for me. So back to our conversation about auto enrollment, you know, auto escalation, just carry forward what, what, what I did last year, and then we have others that want to go even deeper on using AI, let’s pull, you know, we can pull in claims data. Now let’s go further, let’s go even deeper on helping estimate my costs to help me optimize my total benefit experience. we’re looking to optimize and Karli alluded to this in a couple of her comments across the entire, what we call the total well-being of other consumer, so health and wealth, including outside emergency savings, etc. So we really look at looking at that total well-being as that that’s our goal in the enrollment journey.
Brian Colburn – Makes sense? Karli, anything that you’d add to that?
Karli Dunkelberger – We’ve seen, we’ve seen the lifestyle planning accounts become more popular again, a few years ago, Brian, we really proactively launched the messaging around using account based benefits in a way that you help people get money for things they need, and they value. I know, it was four or five years ago, a couple of my family members that were just graduating from college, they specifically chose jobs, where those businesses would help them pay for expenses to get their master’s degree. And as I think about that, fast forward to what a few of our clients have done this year, some of our clients have said, okay, we know that account based benefits are often part of the savings journey. But what if we could help people that are at different places in their life, reduce their student loan debt, or perhaps also save for their own children’s college education. So we’ve seen lifestyle planning accounts pop up as a way to really diversify how people can spend money. And employers can say, Thank you for everything you’ve done during the pandemic. We value your contributions with our business continuity, we want to give you a little extra money to use in a way that matters. And it matters to your family or your personal situation. And believe it or not, with a really broad list of expenses. More than 80% of the expenses were used for health care things like treadmill, treadmills, bicycles, tennis shoes, healthcare equipment, the majority of the expenses were in the health care area anyway. But what the client said is we got more bang for our buck out of offering this benefit because people were talking about it, they were talking about how great the benefit was, what a different benefit it was. And they thought it was important to do something that they could help their talents. See, we want to think about benefits differently and we care about what matters to you.
Anna Lyons – One of the bright spots during a tough year has been the trend of employers offering these lifestyle accounts to employees as a creative way to engage with and support them during a time of crisis. However, these supportive strategies don’t need to be limited to situations like a global pandemic or economic recessions. In particular, account seeding strategies can play a big role in helping consumers save on healthcare during challenging and prosperous times alike.
Karli Dunkelberger – Seeding HSAs, or seeding FSAs can really make a difference over a long period of time. Because people follow the money, each and every one of us pay attention when there’s a little bit of extra money that comes our way. And that year after year, seeding, dollar amounts can change. But it’s still a way to use a thread of consumer experience or education throughout the year to say, Hey, we’re going to give you some money in your HSA. And it may or may not be tied to behaviors, or maybe with the FSA, the employer takes all of the forfeitures at the end of the year, and they decide to put that towards everyone who participates in an FSA The following year, another way to use dollars to create a conversation and get someone’s attention to look differently at their benefits. here’s an interesting client story. One of our large clients that looked at going to a high deductible on HSA strategy, about seven years ago said, Well, how do we do this in a way that it’s kind, it’s compassionate, it’s educational. And it doesn’t feel like a takeaway, because there’s that belief system that a high deductible plan just creates this big out of pocket expense up front. So what was really cool about what this client decided to do is, they started by saying, Hey, here’s a high deductible, and an HSA. By the way, if you contribute, we’ll put some money into the HSA for you. they’ve kept that going over the last seven years. And what they also did is during the year, they do a survey, they asked people, so what do you think about the high deductibles? So what do you think about the HSA and tell us more, and they would learn, but then there would also be pointed messages that would go out. Remember, if you’re in a high deductible, because you didn’t open an HSA account, yet, you’re missing out on employer contribution dollars. So there was a follow up exercise to remind people, they were missing out on the dollars, and that they could also put theirs in and increase theirs. And do that throughout the year.
Brian Colburn – That’s great. Yeah, we wish we’d see more of that. Are there other examples? Karen or Karli, that you can think of where you’ve seen really unique approaches, whether it’s been this year with COVID? Or just sort of a consistent approach toward driving people to plans that make actually the most sense for them? that make any sense?
Karen Frost – It totally does. For those of you who have heard me speak before you, you often hear me say passive enrollment means don’t do anything. And one of the things that we really tried to push is to help employers balance that message with making it easy. So in this year, in particular, we saw very few plan changes. But we saw more and more employers do active communication, to encourage people to go out there and do their shopping. And so if you think about, you know, think about your cable bill, or your mobile phone bill, you wouldn’t go and renew your service without comparing. But the average employee just wants the easy button for enrollment. And so we’ve been doing a pretty big push of encouraging our clients to just communicate to everybody you have to go in and just take a look. be educated on what’s available, doctor. So network, frankly, do you even have a doctor? Can we help you find one, and we’re finding they’re making better enrollment choices paired with those HSAs or FSA’s. And their satisfaction is higher throughout the course of the years we help them navigate the healthcare system.
Brian Colburn – And are you seeing more usage of digital tools? Again, around the enrollment decision?
Karen Frost – Oh, absolutely, we have to pull the latest data. But usually our enrollment rates are 90 to 95%, across our book. So the vast majority of people are enrolling online using those digital tools, with the focus that employers are suggesting for them. So some are really emphasizing go out do modeling, others are suggesting, hey, let’s I’ve got an easy button for you. So we see a mixed bag. But we do find those there are people that still need hand holding. And so I don’t want to discount in any way the importance of having a high quality customer care organization. And it might be paired like in Alight, we can pair that with a licensed agent population that can help people make really smart decisions across the benefits universe. And so some employers are looking for that kind of support, and others aren’t. But I’d say a combination of that digital plus high touch is really the winning combination for many clients.
Brian Colburn – Okay. So I want to go back for a minute to talk about the sort of full consumer life cycle when we think about not just HSA is not just health plans, not just retirement, but kind of all of that together. One of the things that I’m really excited about for you guys is Alight Total Health. Can you talk about that for just a couple minutes? What is it? How is it different than what’s out there today? And how does it benefit employers and employees?
Karen Frost – Yeah, so as you think about Alight total health is our goal is to really support individuals, that entire health care journey. So it starts with enrollment, I have to help you optimize your choices, get you in the right plan and get you on the path to a good year in in terms of supporting your health care. But it’s when people use health care each and every day. That’s when they really need help. And so we bring together the legacy, you know, our Benefits Administration business that we’ve been doing for a long time, our health navigation business that we that we’ve been doing for the past couple of years, as well as consumer accounts and related services that kind of hang together all of that. And really the goal is to provide that connected ecosystem for the employer. So you know, they’re they tell us they’re, they’re using you know, X number of health plans with different prescription managers with different condition management organizations and we look at our job is to bring all that ecosystem together for an employee in a highly personalized way, highlight opportunities to get people to engage in their health. And make it super, super simple for that person to access through one phone number one, one web portal one mobile app. And so that’s the journey that we are on for a number of our customers. And the results to date have been very compelling in terms of lowering health care costs, by getting people largely to use high quality care in the right setting at the right time, at the right price. And I know that’s a tall order, I know that you guys are doing something similar at Alegeus. But that pays off in spades, both in terms of cost savings to the member cost savings to the employer, and, frankly, overall satisfaction with the with the overall healthcare system.
Brian Colburn – We’re in the thick of open enrollment season in a unique year, with a number of interesting strategies and opportunities to help consumers get the right coverage at the right price. But how do employers start to make sense of all of this and prioritize all of these strategies? I asked Karen and Karli to give me their best tips for employers.
Karen Frost – My #1 tip would be, as an employer if you can get yourself comfortable with not zeroing out the HSA account contribution level year to year, you will find that it encourages people to continue savings, versus that zeroing out of the balances, some people will just not realize they have to re-enroll in their HSA every year.
Karli Dunkelberger – I’d like to go back to some comments I made earlier about seeding. Don’t forget about the way that people follow money. And that seeding could be taking the FSA forfeitures and using the forfeitures in a way that it is seeding next year for the FSA, because employer contributions to an FSA do not count towards the annual employee maximum contribution. The other thing is, those dollars could be repurposed to seed every HSA account that is opened in the coming year, and what a great way to use those dollars in a way that it helps people think about their HSA differently. And my last point, Brian, would be the value of continuous education throughout the year. The makeup of your people this year is probably a little bit different that the people last year, and to even have a three year cycle where some of the same messages come back and they’re updated based on what’s going on in the current market, being able to impact somebody at a time when they have healthcare or health expenses, and they’re in that moment, it changes for all of us, so that continuous education throughout the year can have so much more impact on helping people see the value of saving and using their HSA in a way that it helps them this year, and next year and well into retirement.
Brian Colburn – As we continue through the open enrollment season and wrap up 2020, we hope you’ve found the insights and strategies discussed on this podcast useful for growing your business, guiding consumers to the right benefits and saving money for all stakeholders in the process. We look forward to continuing these conversations and creating a stronger, healthier and more balanced 2021 for all. Have a safe and happy holiday season. Talk to you next year.
Anna Lyons – Our thanks to Karli Dunkelberger and Karen Frost of Alight for being part of this episode. If you’d like to learn more about this topic, our guests, or download the research discussed in this episode, visit Alegeus.com/podcast. And be sure to subscribe on Apple Podcasts or wherever you get your podcasts. While you’re there, leave a rating or review – we’d really appreciate it!