ECFC Panel Recap: Unlocking the potential of self-service tools in CDH

A recap of the self-service tools panel at ECFC's 36th Annual Symposium

The Employers Council on Flexible Compensation (ECFC) community headed to Nashville at the beginning of August for its 36th Annual Symposium. The ECFC advocates for the advancement of tax-advantaged benefit programs, so as you might assume, the agenda featured insightful conversations on flexible spending accounts (FSAs), health reimbursement arrangements (HRAs), health savings accounts (HSAs), etc. And with this year's location, some networking sessions on Broadway Street.

First Dollar was honored to be part of this year's agenda as our CEO, Jason Bornhorst, participated in the "Unlocking the Potential of Self-Service Tools in Consumer-Directed Healthcare" panel. The session included:

Consumer-directed benefits (also known as tax-advantaged or pre-tax benefit accounts) feature complex regulatory requirements, technical debt, and evolving user expectations. The panel discussed the challenge of implementing self-service tools in this space, sharing their best practices for identifying clunky workflows and implementing self-service tools as a solution. Here are some of the questions that the panel addressed:

  1. How do you ensure that you're prioritizing that user experience when you're considering self-service tools?
  2. What metrics or signals do you use to determine your investments in self-service tools?
  3. What is your advice or recommendations for people in the audience who use a technology platform provider?
  4. How do you balance the complexities of this industry when thinking about the need for self-service tools?
  5. Is there an outside organization or platform that you reference to say, "This is who what we want to be for CDH?"

If you couldn't attend the panel or the symposium, you can still learn from the panel's insights! Watch the video recording or read the session's transcript below. (We can't help you make up for the time missed on Broadway Street.)

Video Replay

Please enjoy the video linked below. 


Below is a written transcript from our recorded webinar.

Panel Introduction

Becky Seefeldt (00:05)

All right. I am Becky Seefeldt. I am VP of Strategy at Benefit Resource. I have been in the consumer directed benefits industry for about 20 years now and have spent a lot of that time working on education, marketing, product development, and overall advancements in consumer directed healthcare. We have a lovely panel today. I'm going to allow them to introduce themselves. We'll start with Jason.

Jason Bornhorst (00:35)

Hey, folks. Jason Bornhorst, co-founder and CEO of First Dollar. We are one of the new platform providers on the scene. We provide flexible infrastructure for all manner of health spending benefits, everything from HSAs, FSAs, ANDAs, even into vision, dental and OTC. Super wonderful to be here today.

Amit Ahluwalia (00:55)

Hi, everyone. I'm Amit Ahluwalia. I am not going to say how many years I've been in this business. I will say I see people in the room whose parents I worked with here. You think I'm joking, but I'm not. I have been in this business for a long time and I've seen it kind of grow from way, way, way back. I am the Chief Revenue Officer at Lively and what we're trying to do is modernize HSAs and the customer experience. I'm really excited to be able to talk about that today.

Steve Jackson (01:26)

All right. Hello, everyone. Steve Jackson. I'm the Senior Vice President of Sales at Healthy Commerce, which you probably know us as a FSA store and HSA store. Prior to joining Healthy Commerce here about 10 months ago, I had the opportunity to help launch a TPA service with another CPA and worked with them for over 18 years. I've had my hands in a lot of the, not just product development, business development, operations, strategic vision. Love this space, have enjoyed it for now over the last 20 years. So happy to be here.

How do you ensure that you're prioritizing that user experience when you're considering self-service?

Becky Seefeldt (04:22)

That's, I think, the goal that we're looking to accomplish is what are those frictionless moments that you can create with your customers? Oftentimes, we think self-service is if we give them a tool to do and accomplish something, we've solved the problem, but really it goes beyond that. How can you really make that interaction frictionless. Let's start with the panel. How do you and your teams really ensure that you're prioritizing that user experience when you're considering self-service?

Jason Bornhorst (05:00)

Should I start?

Becky Seefeldt (05:01)


Jason Bornhorst (05:02)

Cool. Yeah. I think, at a high level, when we think about self-service, I want stress that we break it into two buckets. There's the user, which Becky has been talking about. Give them the tools and the ability to handle, ideally, every single thing themselves. If a user can work with our company or our partner's company for five years and never speak to a human, that's success. The other goal is administrators too. I think this is often forgotten. With all this energy on the consumer facing side, what about all the administrators and the plan designers and the folks that are selling employers and having to stand it up? Are we giving them tools to help them be effective in doing that without having to ping the platform provider or raise a ticket? That's another area of focus for us.


Two things that we're doing to sort of make self-service at the forefront. The first is design has a first class seat at First Dollar. We have a VP of design on the leadership team. They're involved. It's not uncommon for them to be on a discovery sales call all the way through to implementation. We're really seeking to understand the pains that our partners feel so we can thoughtfully design software to wick out the work. Again, calling a human raising a ticket that is the enemy. Let's make it all self-service to the extent that we can.


The second thing that we're doing is, I like to say the acronyms themselves, I don't actually think a consumer cares what an HSA or an FSA or an HRA or any of those things are. They're just trying to buy healthcare. To the extent that we can wick the complexity away from the actual experience, I think that also helps drive self-serviceability forward to. We call that the health wallet. That's our positioning of this is, is ideally in five years, maybe the consumer isn't even aware of the FSA, they're just swiping the card to spend. Those are two things that we're doing internally.

Amit Ahluwalia (06:48)

I'm going to give a slightly different answer, but to put the answer in context, I'm going to ask you to repeat the question because I want to focus on a slightly different part of the question.

Becky Seefeldt (06:54)

Sure. How do you and your teams ensure that you're prioritizing the user experience when considering self-service?

Amit Ahluwalia (07:02)

Thank you. The words that I want to really kind of point out here are user experience rather than self-service. We think of this not as a transactional opportunity, but as a relationship opportunity. Let me give you an example that I saw many, many years ago. That was we picked up a client for HRAs, but we were doing retiree HRAs. The average user was a retired auto worker. You can't self-service that effectively unless you jump through a bunch of different hoops. You've got to really start to think in terms of what is my relationship going to be with the user over a long period of time. The way that we enabled self-service in that environment was to look at this as a multi-year relationship and what is the education and investment that we need to make in the individual on the front side.


What we did is we changed the call center that they were coming into, for example. Instead of tracking call time, we tracked response. In other words, was the user happy? We didn't care if it was a three-minute call or a 30-minute call. That wasn't really about self-service at that point, it was about education and getting somebody comfortable to get to the point where we didn't have those moments of truth later on where we could potentially fail because we had a user that didn't understand. I think self-service really needs to come in the context of is this transactional or is this relationship? When do you really want to start to transition the service from you over to the customer? We look at it slightly differently in that space.

Steve Jackson (08:37)

Yeah. Great stuff. Love being on this panel because hearing it from your two perspective and then seeing how we interact from an FSA store, HSA store perspective is really kind of cool. When we think about user experience, some of you may know our mantra or our mission is 'together we benefit better'. That means that we need to actually work very closely with our partners to understand ways in which they do seek out participants, provide information, grab data, get data from their participants and how they use it. We also want to understand their platform extremely well, because we have shared assets. We need to try to understand how a user is accessing your public sites, your mobile, your portal, any other sites that you may have, and really understand where are those eyeballs to be best placed so that they have an easier experience in figuring out whether it's new educational assets.


Like many of you may use our eligibility list, for example. We want to make sure that that list is prevalent because we know that more education helps with user experience. Once they have that information, we now need them to maybe understand where to go or have access points to places where they can actually purchase those things. At Healthy Commerce, we're always considering where are those eyeballs? When we think about user experience, how can we ... You talked about less friction. How can we reduce the amount of clicks and overall exposure time so that participants are looking on those assets more quickly and then more easily be able to access the information they're trying to achieve.


I'll go probably more deeply into some of that here in some other questions, but it's very important for us ... Think about this, not just from Healthy Commerce side, but think about the vendors and partners that you utilize today. It's very important that they understand how you provide information, how you communicate, how you distribute to your participants. For us, it's been extremely meaningful so that we really fully understand how we then can partner with you in the best way that you see success, that participants see success, that employers, that your broker, referring channels see success as well. So the partner aspect is really important. Think about how you connect with your vendors to understand that user experience.


Secondly, then on our side is on the product itself. Being an e-commerce site, we have great knowledge and access to where people are clicking and understanding kind of their path, their journey to ultimately filling their cart and purchasing those products. We do and perform a lot of consumer insight studies, either through our customer service team or through outside market studies. We interview, consumers, which are your participants. We try to gain really strong knowledge as to why are they shopping. Did you get what you need? Do you understand deadline? Do you understand your FSA and what it means? What we found is that many participants perceive an FSA, HSA as kind of risky, a risky account. Okay. All right. We've got to build more confidence. We need to figure out how we can better drive more clarity about these accounts so that then they would be better users of their accounts.


We're really focused on these two key areas. One, you as a partner, the TPA, let's really understand it from that side, but then also direct to the consumer as well.

Considering self-service tools, what metrics or signals do you use to determine your investments?

Becky Seefeldt (12:40)

Awesome. As you think about self-service and where are you going to make your investments, what are some of the metrics that you look at, or signals that you would use to determine your investments and how you're going to approach it? I'll give an example. My company uses call stats. The number one reason …

Becky Seefeldt (13:03)

Uses call stats. And the number one reason people call is to learn how to log in to the site. And year after year we saw these trends, and it's like what can we do? So we took it into approaches.


One, we looked at our tech stack and said, "Okay, how can we improve that registration experience so that it's easier to do and that they have the information they need to register?" And then the second piece we did is we embedded those components that they needed in every single communication that we sent out so that no matter... They didn't have to go back to the first email we sent and see, do you have the company code that you needed to register? They had it every single communication. Since doing that, we have seen a 25% reduction in login requests to our call center. Some of it was technology oriented, some of it was communication oriented, but we were able to look at that situation and do something to kind of change that dynamic. And now they no longer need to call, or less people are calling. So that was my example, but certainly...

Jason Bornhorst (14:21)

Cool. Yeah, that's a great one. So just to kind of restate the question, what are we doing to identify friction points and how are we measuring it? And so I would say off the bat, we do track all of the usual stuff, NPS, analytics throughout the application and things like this. And we've been pleased with the results. NPS is 71 as of the last reading, utilization boost of about 36%. So people are using First Dollar products at almost a two X rate compared to the typical incumbent.


And the primary way that we're identifying and solving this is what we call journey mapping. And so we will actually, we have something like 15 some odd personas that we track within First Dollar. Everything from five different types of consumers to 10 different types of administrators tracking both their travels throughout the software, but even in the physical world.


So before I open up an application to request a card, what am I doing in the physical world to cause me to have that question, for example. That has unearthed all sorts of friction points that I think traditionally have existed. A couple of things that have been born out of that.


And so on the consumer side, we have completely self-service card management, everything from freezing, reordering, adding dependence, all that is done internal in the software. Similarly, consumers also have full control over the actual transaction ledger. So everything from managing rollovers myself or recategorizing transactions, if I made a mistake, all that can be done without making a phone call, as an example.


Another thing that has come out of this is something we're announcing this week. We call it the Benefit Builder. So a pain point that we've often observed on the plan administrator side is, "Hey, I go out there, I sign all these employers, everyone wants a different type of benefit design, custom HRAs, LSAs with specific componentry, and now I got to jam all that into my software." And that turns into a lot of forms, a lot of phone calls with account managers, and it's not as self-service like that to be. So our response to that is benefit builder, it's complete on your own design. So plan designers can encode any benefits, stack templates, deploy down to cards. It's all a few clicks in publish and can be done entirely dynamically. So that's another good example of journey mapping, unearthing, hey, this is really, really annoying and people have huge teams working on this stuff. How can we make it better? We think it's through thoughtful software.

Amit Ahluwalia (16:45)

I think we start from the same place. So we first identified the types of stakeholders that we have outside of our organization. So we've got the employees that are participating in the accounts, we have the employers, we work with plant service providers who are referring business. We work with brokers. We are white labeling and also gray labeling for financial institutions. And I can keep going down that list. We have lots of different partners and stakeholders that are out there. And so the way that we've kind of done this and institutionalized this in our organization is we've come up with user journeys for each of those. And I think that's very similar to what you were talking about is we've kind of come in with what the mission is that each person is trying to accomplish when they come in.


And then we've also set ourselves up so that we actually have several different teams inside our organization that are measuring different things. As an example, our product team is looking for effectiveness in a variety of different areas as we design the product. Our engineers are testing how their product that they built is actually going out and looking for different metrics. We have our member support associates that are tracking metrics that are out there. We even have our product marketing team that is taking everything that we do, putting it into our voice, and communicating it out, that's tracking all of this. And so we've found that, it's difficult for me to say that there's one number to look at like an NPS score or one measure. We've actually kind of distributed that throughout the organization and built it into the DNA by saying each one of these different entities needs to measure in some way the effectiveness that we have in modernizing and making these experience delightful for each of our customers and each of our constituencies.

Steve Jackson (18:30)

Good. Yeah, I would say just to maybe give an example here of where we at Health-E Commerce kind of recognize some unique opportunities for self-service. Many of you may know Highmark, they're a carrier in Pennsylvania, kind of the Pittsburgh market, and a big health system out there is Allegheny Health System. And what they ended up partnering with a company called Cedar. So just if you ever want to look that up and look at this article about this study. But they noticed that when their individuals would go and get care that there was oftentimes a delay in payment for services, and they were trying to figure out a better way for those individuals to utilize their FSA account balances or their HSA account balances for payment.


And so they partnered with Cedar which actually enabled the balance... So when that individual was going into pay or look at the bill or invoice, that the balance from their FSA or HSA real time was actually listed right there. That they would have... It was all single sign on access directly onto that site. And so that individual then could right there, they know exactly what they have in their FSA or in their HSA and choose. They now have a choice. They have some flexibility to be able to go ahead and make payment. So again, reducing friction. And so when you look back now as you read the article in six months' time utilization on these accounts increased by 33%. So don't know exactly where to take that as far as, well if that's HSA's grade or FSA's bad, was that... Did a lot of folks remove forfeitures at time of deadline and so forth? That'll soon to be determined.


But I point that out to think about what we're doing as well to provide greater insight or clarity. So we have an opportunity for FSA participants on our site on to actually enter in their deadline date. And by doing that, they enter it manually, can do that manually. And by doing that, it enables really our growth marketing engine digital team to be able to connect with those individuals at the time of prior to their deadline time and be able to provide specific messaging to them, much like you guys may do through automated reminders and things of that nature or other emails that you may have.


But it's really giving them two things. One, really focus it on education. Let's make sure you understand what is eligible. And then secondly, here's what you can purchase through that. So I wanted to mention at least those, the deadline entry is a big thing.


Other opportunities for self-service, I was thinking about this just in preparation. Many of you have additional resources for your participants as it relates to open enrollment, flyers, maybe videos, FAQs. You're going to have a lot of those resources that you're providing, which is really good, direct to the participant. But I also want you to think about other users of your services is also the employer, is also your referring channel through the broker, or another type of channel. And so just think about, too, ways in which you can empower them to be able to communicate that more effectively directly with those users.


But there are other opportunities such as we're going through a lot of HSA personas. We've put a lot of work into the different types of personas that would fill for an individual that would be an account holder, and then be able to try to figure out best ways to tailor messaging specific to those personas. On our website, we call it our Style Finder, HSA Style Finder where someone can kind of go through a flow chart if you will, and determine, hey, what am I? Am I a spender? Am I a saver? Oh, I'm retired. And those kinds of things. To really then determine based off of that information, we then help guide them to certain areas in our site that would be most beneficial to them. So it's really looking at ways, I think, within your portal or outside other various means of communication to be able to distribute those resources really at the source, which would be directly at open enrollment and throughout the year.

What is your advice or recommendations for people in the audience who use a technology platform provider?

Becky Seefeldt (23:28)

So many people in our audience today likely are using a platform for their technology. What is some advice or recommendations that they can take away from this session today as far as things that they can do to employ more self-service or guide that user experience a little bit more?

Jason Bornhorst (23:53)

Cool. Definitely. So I think I'll first start off and say at the end of the day when a consumer or an employer has a bad experience, unfortunately that great experience goes back to your brand, but the bad experience also goes back to your brand. And so whether it's a completely in-house stack or assemblage of parts, I think it is important to take a very holistic view on that. And if something's not going great, it takes six weeks on a check run around, own that, and try to do some root cause analysis to help kind of run that stuff out.


I will say a couple of things that we are seeing in industry, we talk to a lot of TPAs. I think it's becoming somewhat of a trend to take back tier one servicing. So I think folks in the past have outsourced claim adjudication or even frontline call support to other partners. We're starting to see a reversal of interest there. So people are bringing that back in-house saying, "Hey, I want to make the claims decisions. I want to be closer to the employer on those decisions. I also want to be the frontline call support." So we're seeing folks doing that.


Second thing we're seeing is people taking back control of marketing. So maybe potentially this has been someone else's kind of marketing campaigns, white labeled, and being sent. I think as the panel's been discussing here, there's a heavy consumer interest now and like, "Hey, help me understand how to use this stuff, up level my education." And so I think people are finding that one of the better ways to do that is actually to bring a marketing platform in house and do such a thing. So those are just some trends that we're seeing in this space today. What do you think?

Amit Ahluwalia (25:27)

So I think I agree. That is one of the things that we all have to kind of deal with is we may not have control of the underlying platform, but let's think about it in terms of a hotel. When we go into a Hilton, a Hilton is a Hilton is a Hilton, and Marriott is a Marriott is a Marriott, right? It's the underlying system. You're going to get the same restaurant, you're going to get the same furniture, you're going to get a lot of the same stuff in each of those, but each of them can be different. It's the people that make it a little bit different. You can also personalize the experience. And so I would go back and look to see what is it that we're doing that's different? What is our real value proposition? So there may be many, many other.

Amit Ahluwalia (26:03)

... different. What is our real value proposition? So there may be many, many other people using that same platform, that same system. But we can customize it, we can make it different. Actually, as I look around the country and I see different plan service providers, they may be on the same platform, but I think that they do differentiate because there's expertise that you're bringing to the table. There's that interest in making sure your customers are happy. It's that ability to build a relationship with your referral sources. I think that, again, this goes back to the lifecycle of the relationship and understanding where you need to push for self-service and where you need to go to handholding to differentiate, even though it may be the same platform.

Steve Jackson (26:43)

Good. I guess as I was thinking, many of you have been in this space for a long time, I have. I feel like we have still a lot of the same issues with forfeitures that are occurring, although I think they were reduced a little bit from last year, I think Renee had mentioned here in their study. But we still have all of these impacts that are going on and ultimately those impact the individual from either enrolling for the very first time or actually re-enrolling, but contributing a lot less because of that negative impact. So a couple of things, I guess as far as strategies. I think life experiences, I think what we've lost out on is the water cooler talk a little bit. Wait, is that even a thing anymore? I don't know if it is, but there was a time-

Becky Seefeldt (27:44)

A virtual water cooler.

Steve Jackson (27:45)

A virtual, I suppose, just doesn't seem to be the same. But the water cooler, your coffee station and you come together and usually what really promoted a lot of these benefit programs was an individual talking about, " Oh man, I just went through a medical situation," whatever it may be, "But man, I'm so grateful I had my FSA for payment and so forth, and this is how it works." So I think how do you do that? Because I think humanizing the experience is pretty important here. It is tough to humanize it for absolutely every single situation, but if you have the ability to bring out the life hacks, the life experiences that employees are facing. So as I think about strategies here for this, think about ways that you can personalize that message, but do it in a humanizing way. Instead of use it or lose it, say, "Claim your dollars." Just different wording. I don't know who said it earlier. I'm trying to think, was it Tinay, but talked about the phrase high deductible health plan, right? It's like, "Oh, is there a way that we can actually rephrase that and return that?"


So life experiences, when I think about self-service, they're going to want to understand how it impacts them personally. I know at Healthy Commerce, we have spent a lot of time, energy, and resources in this area. We have a TPA advisory board and they were very clear to us early on that these types of resources are needed. It's not just the what is an FSA? It's really just how does this FSA impact me and how I can best use it. So that would be one thing. Personalized messaging. Another thing when I think about user experience here and self-service is access to what is eligible. All right, so in a lot of our studies, discussions with our partners, what we have consistently heard is that... And actually it was in the Visa study. If the individual just understood the benefit more, understood how they can spend their money, they would feel more comfortable in enrolling in it.


So understanding the eligibility of expenses as part of a self-service function, whether it's something like an eligibility list or other types of vehicles that could be used to provide just detail as to what is eligible, I think is really vital. Because once you know how you can spend your money, you're certainly more apt to understand, okay, I'm definitely going to have that. I'm going to have that over the next year and I can really plan on contributing and enrolling in a much better way, more confident way. So the eligibility of expenses I think is really critical when you think about user experience, them knowing more about that. The last other strategies that I guess I would just think about is there's power in your portal. You are directing traffic all the time to your portal, which is great. You want them to seek out resources, information, account balance, all sorts of things that you have placed on that portal. Think about all of the additional partners, vendors that you have relationships with. How can you create one unique experience through your portal?


That's through simple SSO, like the example that I gave you, that Cedar kind of connected through SSO balance information. It could be card information. At Healthy Commerce we're integrating with partners not just on an SSO basis, but also on getting card information over into our portal so that when a participant goes from your portal over to ours, we actually have their card information. They don't even need to enter it. It's already there. Just pick what you need and purchase it, right? Reducing the clicks, reducing the amount of typing and time that it takes. And then lastly too is balance. Balance displays is pretty big there too. But my main point here is think about your portal. You want everyone directed there as much as possible. How can you create a more inviting, seamless, more efficient structure where they're connected to more and more of your partners? Really critical. I want to go one place, right? Everybody talks about one stop. All right, one stop shop.


It may not get there entirely, but I think you guys, even if maybe this isn't your portal or your proprietary platform, I think that there's still opportunities for you to add value to the consumer relationship.

Jason Bornhorst (33:14)

And if I may just kind of quickly extend Steve's point with maybe a bit of a provocative North Star just to get some thoughts flowing. I'd start to make the claim that healthcare spending benefits like HSAs, FSAs, so forth are features as opposed to full first class businesses. What I mean by that is I think that the winners of the future are going to be people who operate large, trusted brands and platforms that consumers are coming to do all manner of things beyond just transacting an HSA or an FSA. I think the people that are going to win in the future are ones that we're going to thoughtfully bring those accounts into these large trusted experiences. I long look forward to a North Star vision where I can pull out my Chase app and my HSA, FSA, HRA and heck, even potentially the healthcare claim experience itself lives right inside of that app.


I simply swipe my Chase credit card and everything just debits through. I believe that we will get there. I think thoughtful software integration is the way, but ultimately I sort of pose that to the group because I think many of you operate organizations that have this ability. Maybe you're a large trusted TPA handling all sorts of responsibilities in addition to just CDH. Maybe it's a large payroll all-in-one HR type solution, so on and so forth. So it's just kind of a call to action for our industry to think about new ways to package this stuff and the ways to go forward.

How do you balance the complexities of this industry when thinking about the need for self-service tools?

Becky Seefeldt (34:42)

So I'm going to add a slightly different, more tactical perspective just because I know that a lot of people don't have everything in their control, but you do have a lot of tools within the platforms that you already have. Some of it is understanding how you can optimize for the best result. That might be getting more people to use their debit card, getting people to understand when things need substantiation and maybe you proactively are requesting receipts in those dental/vision type scenarios where it's going to be common. Or getting people during their claims' entry to sign up for direct deposit because who wants to wait 10 days and the mail service, which is horribly these days, for a check in the mail.


So it's looking at all those things that are ready in your toolkit and seeing how you can help to optimize them with your customers to make those truly self-service experiences and avoid some of those maybe negative friction points that they may have. So we often hear that what we do is so complicated and therefore there's some hesitation to really think about self-service. People have to call us, they can't understand substantiation. So what are some of the things that you guys do to balance the complexities of this industry with self-service enhancements and needs that might be out there?

Jason Bornhorst (36:23)

So I'll make a second provocative statement, which is I usually think when folks put our service, our ability for our people to be the reason they buy from our organization, I actually think that's a red herring masking perhaps software under the hood that could be a bit better. I ultimately think goes back to the conversations we've had from earlier today. People and administrators just want to handle things themselves if given the right tools. So how do we get here? I think there's probably three reasons for that. One is a pretty difficult regulatory environment. Second is technology debt. These accounts have been around for 10 or 15 years. Many of the solutions built 10 or 15 years ago are still in place today. The third is evolving consumer expectations. So five or 10 years ago, the status quo totally worked. I want to pick up the phone, I want to talk to somebody. These days I would argue in any other facet of our life, it is uncommon that we're picking up the phone to get something done.


I've been a Chase Bank customer for 10 years, I think I've been in their branch twice and that's because I had to sign an affidavit to get stamped. In any other case, I've gotten that done on a mobile application. So those are the three buckets. To unpack them a bit, the regulatory one is interesting. This entire conference is built around educating an industry around those notions and it's constantly evolving and that is important. I don't want to underplay that, but what I want to point out is if you just simply take the rules and regs behind these accounts and hand that book to a product manager and say, "Hey, I need some products to follow this," the output is going to look a lot like the status quo today and it's going to be difficult to use. It's not a shock that half of FSA balances are forfeited every year because ultimately to make that account work for you, you kind of have to be an expert in IRS tax compliance and you have to remember X, Y, and Z. I have yet to meet a consumer who actually wants to do that.


So I think my charge for you guys back to your organizations is, absolutely, let's take all the rules and regs very seriously. There's tantamount importance for that. But let's rethink from first principles, what someone's trying to do. What is the goal? They're trying to use their benefit dollars to buy healthcare and get the maximum tax savings. I think there's a way to rethink that delivery in a way that really matters. That's closely linked to the consumer evolving expectations. Again, how can I get these benefits in the Chase app someday? That is ultimately what I think consumers are asking for is just a North Star design idea. What can we do in our organizations to help us advance to that particular goal?

Jason Bornhorst (39:02)

... to help us advance to that particular goal.

Amit Ahluwalia (39:52)

So again, I'm going to answer this differently. So FSAs are 33, 34 years old, right? 1989, 1990, FSAs really started to take hold. HSAs are about 20 years old. So let's go back. Let's just look at HSAs for a moment.


In those 20 years, imagine a typical employee that started off with selecting a high deductible health plan that was HSA compatible and they opened an HSA 20 years ago. How many jobs do you think they've had in that last 20 years? Some of us are very stable and we may have had one, right?

Jason Bornhorst (39:41)

Probably 10.

Amit Ahluwalia (39:43)

And some people may be at 20 to 30. But I'm going to say that the average is probably close, right? It's probably 10. It may be seven, eight, 12, something like that. They may have had the opportunity to work with seven or eight or nine or 10 different HSA custodians during that time period. Look at the top 10 that are out there. They could have bounced all the way through.


Now, take that individual, let's take them out of their job for a second and say which one of their HSAs do they really want, which one of those custodians did they really want. That's who we want to be. That's the one that we want to be. And so, we need to think about, well, if we were marketing to that individual... And because, by the way, they're out there. I mean, I can tell you from our experience, we see HSA accounts that have very high six figures and low seven figures in their accounts. There are people that have maintained their accounts for many, many years. Many people out there. And those are the people that we want to build towards because they're the ones that are going to tell us if we're doing this right.


They're typically, I'll tell you what they're doing is they're using the HSA that their employer tells them that they need to use because they have to. And then when they switch employers, there's another HSA in the back that everything gets moved over to. And you see people doing this also with their 401(k), for example, right? You use your 401(k) provider while you're with your employer and then roll it over into another account somewhere else at some point after you leave your employer.


And so, those are the people that we've thought about. At Lively, what we looked at was how do we get those people, how do we enable them to be able to get everything that they're looking for. And it starts with very, very little, minor changes.


So an example is when they come into the system, what do you think the very first thing they're looking for when they log into their HSA is? Just somebody toss-

Audience (41:39)

Balance. What's my balance?

Jason Bornhorst (41:40)


Amit Ahluwalia (41:40)

Exactly. Top of the page, bold letters or bold numbers right in the center, very top, standing out is what's their balance. That's the number one thing.


And so, going back to what we talked about with the previous question is this is a combination of different teams coming up together, but that's who we're building towards, is that individual who can make the decision. Instead of the employer making the decision, imagine the individual could make the decision. And are your self-service tools set up to enable that person to be able to say, "You're the one that I want to work with?"

Steve Jackson (42:16)

Yeah, I guess I would say one word, test. As James Clear from Atomic Habits says, "You don't rise to the level of your objectives, you fall to the level of your systems." So I think as you look at self-service needs, you just have to continually test. I know at Healthy Commerce, we A/B test all the time, just all the time. So that had to be tested, right? I mean, is it account balance? Is that what they want to see? Well, over time we recognize, yeah, through the heat map, we know that they keep clicking on that specific item, so test it. So a lot of A/B testing, just how this one looks versus this one, and test that within your population and really get a good handle.


We provide assets, trackable assets to partners. So it gives us great vision through Google Analytics to be able to see what kind of session growth are we seeing here based off of that click, how many clicks, how many of these converted over to an order and so forth. So we can tell above the fold, the welcome banner, that's going to get a lot more types of clicks. So what else could you put there that's not just a banner, but it's actually informing them really what they want to know there on a consistent basis.


We also have things like Similarweb, and that's just one entity that's out there, but being able to track traffic so we can look at what our assets are doing in, let's say in your portal, in a TPA's portal, so we can see and gauge all of that. But how does that stack up with the actual traffic on the site, and be able to try to understand how we can better maximize those particular items on a partner's site.


So testing, I think is really important. Don't necessarily assume that once you've distributed or you've presented something in a way that it really is the right way. Because as was mentioned earlier, many generations here right, from Gen Z and X and millennials and so forth, and so, they all want something different. So just think about in how you're doing it, test it on a regular basis.

When you think of self-service, is there a gold standard outside of this business that you think of and you really aspire to when you're delivering your solutions? Who you think of or what organization or technology or platform do you reference and say, "This is what we want to be for CDH?"

Is there an outside organization or platform that you reference to say, "This is who we want to be for CDH?"

Becky Seefeldt (44:52)

We have about five minutes left. Does anyone have any questions for our panel? All right, I will ask one more question. When you think of self-service, is there a gold standard outside of this business that you think of and you really aspire to when you're delivering your solutions? Who you think of or what organization or technology or platform do you reference and say, "This is what we want to be for CDH?"

Jason Bornhorst (45:30)

Good question. Let me think. I'm going to go with Amazon. Have you ever returned something on Amazon because it was broken and you needed a replacement shipped to you? It is fricking awesome. Honestly, before that form is even filled out, the new item's being shipped to me. That's how predictive they're being. And they actually have underlying machine learning. That item is literally on a truck in my city already because they know some percentage of people who order it in Austin, Texas are going to order it, that's why it shows up within five hours. That's the kind of power that I think we as an industry should hold ourselves to. And if we don't, I worry that we will lose.


Understand, employers are evolving. They are now used to, in other capacities, "I don't want 50 vendors anymore. I want a handful of people who really get it. I want health insurance to work holistically. I want payroll to work holistically. I want CDH to work holistically." And that's because they use Amazon, they use Chase Bank, they use those other things. That's what they're expecting.


And so, I'm sure all of you guys have encountered this, right? You're starting to sell to tech companies in your portfolios, and the expectations of those companies are at a higher bar than typical employers. Well, they're going to pull the rest of the employers along. And so, again, kind of a call to action for us as a group. Let's think about how can accounts like HSAs, FSAs, and so forth work differently, besides just a rote implementation of the IRS rules and regs. That's my ask of the group.

Amit Ahluwalia (47:08)

So I'm going to give an answer for an industry that does a fantastic job with self-service, but an abysmal job if you don't self-service, and that's airlines.


So I was on a flight a while back, where I bought my ticket on United by going into the mobile app, only took me a few minutes. My TSA information, everything was already there. When it was time for me to check in for my flight, I was able to do that. I was able to board the flight with just scanning my phone. I got to Chicago, I was able to find my gate because I got a message saying that I'm coming into Gate X, my flight leaves from Gate Y. When I was at Gate Y, we boarded the plane. Again, I was able to just use my app, not talk to anyone. And we had a flight delay, we had a mechanical issue, and we were told that we need to deboard the plane. As we were coming off of the plane, I got a text message from United saying, "Sorry about the delay. Here's your travel alternatives. You can rebook if you'd like or you can wait for the delay." And so, they'd already thought through the self-service for me and done a fantastic job.


Now, if I talked to somebody, it went south very quickly. But as far as on the technology side, they have absolutely nailed self-service. Now, I think they need to get the other part right.

Jason Bornhorst (48:21)

Yeah, like on time flights perhaps?

Amit Ahluwalia (48:22)

Yes, that would be great.

Steve Jackson (48:26)

I guess, maybe two examples. I mean, one is actually in kind of retail, just the app space, from a Chipotle, you name it. Kind of fast food, being able to get mobile, on the go, or takeout anymore. I mean, when you go into Chipotle's app, how easy is that thing to be able to pick what you want and be able to pick it up and, "Oh, you need it right now? Sure. Oh, you need it a half hour from now? Fantastic." So that's just one example, at least that, in really creating an experience from start to finish that is very comfortable.


Another one that I just had gone through is, and maybe it's a little on your Chase theme there, but Capital One. If anyone has ever opened up a bank account in Capital One recently, it takes seconds to be able to do that. And the banking experience probably for most is kind of unnerving. I mean, to a degree, possibly, just kind of sounds complicated. It's finance. Wow, they're going to ask for a lot. And the Capital One experience was extremely easy.


And once that account was opened, to have instant access to transferring dollars to my bank account, whatever it may be, they really gave, again, one area, one spot where I can really get all of my information from chatting. That's one thing we haven't necessarily maybe talked about, but the chat features are tremendous on that site to get quick answers. I think at Healthy Commerce, we have a significant volume of customers that are on our site that are using a chat feature, and I think it's been extremely valuable for taking time then off of the calls that you're going to have.


So those are two I think that I would mention.

Becky Seefeldt (50:37)


Jason Bornhorst (50:37)

And real quick, just to interject, Steve's comment makes... You know who the biggest mortgage originator in the country is? It's Rocket Mortgage. It's an app that you download on the App Store and it originates mortgages. I fill out a couple forms, click a button, get a quote, mortgage originated.


Five, 10 years ago, that would've been a ridiculous concept. Mortgages are hard. They're complex. People want to talk to a human. They need facilitation to get this done. Not true today, guys. It's all being done digitally. And Rocket Mortgage, I think is a great example that Steve's comment made me think of.

Josh Hostetler

Josh leads content for First Dollar, a fintech company that builds infrastructure for health spending benefits. Before First Dollar, Josh led course creation at Aceable, taught First Grade, waited tables at Olive Garden, and wore many other hats. He misses the breadsticks.