Benefits Recap & Forecast: Navigating Alternative Health Plan Choices in 2025
On a summer day in 2024, Matt Cook, chief commercial officer of Firefly Health, suddenly felt some pain in his stomach. He reached out to his Firefly care team and scheduled a 15 minute appointment with a nurse practitioner who ordered him to get a CT scan. The results showed Cook had appendicitis and the next day he was scheduled for a surgery. All of this happened within 72 hours of care.Firefly Health is a virtual-first healthcare company that offers an alternative health plan that aims to make it easier for people to get the care they need. During a From Day One webinar, journalist Jenny Sucov spoke with Cook and Erik Sossa, independent advisor and consultant to Firefly and former Vice President of Global Benefits and Wellness at PepsiCo about health plan trends and challenges employers face with the changing landscape for benefits.The Shortfalls of Typical Healthcare BenefitsWhile Sossa was working with PepsiCo., he felt that employers were leaving employees to manage their benefits on their own. “They had to deal with changes in annual enrollment, finding an in network provider, prior authorization and an explanation of benefits,” he said.Despite the value of healthcare benefits, corporations are taking away from the positive employee experience while they themselves are struggling with the cost of providing care for their workers. “Employees oftentimes are facing the brunt of some of those tough decisions in the form of maybe a more restricted plan,” said Cook. “Affordability is such an issue for both the employee and employers themselves.”Coming from the corporate side, Sossa acknowledges that companies struggle with cost sharing and sometimes burden employees with having to educate themselves on healthcare plans while they may not have the time to learn the ins and outs of health insurance.“For an employee who doesn’t navigate healthcare for a living, they serve our companies for a living, that’s a tremendous burden on them to try to navigate through this,” said Sossa. “That’s part of the dynamic and one of the things I’m very excited about with companies like Firefly that are trying to really change that paradigm.”Matt Cook, the chief commercial officer of Firefly Health, spoke during the webinar (company photo)Cook said that one group that launched Firefly’s health plan alongside traditional plans told them that Firefly was “the first plan they ever offered where frontline workers and executives alike chose the same plan.” The concept of healthcare affordability is not just with money, but also time. For busy workers, healthcare is only useful when it can be accessible according to the member’s schedule.What is Alternative Healthcare?Alternative health care is an alternative to “historical medical plans that have been delivered in this country across a consolidated set of health plans that are out there today,” said Cook.Firefly is trying to “rethink” the medical plan experience by taking off the burden that has been placed on employees. Sossa views it as the “next evolution” of healthcare. “It’s an alternative to a broken system but hopefully that alternative becomes more and more of the status quo as we rethink the way healthcare needs to be delivered in this country,” Cook said.The new generation of healthcare that Sossa envisions is one that is affordable, accountable, productive and healthy. Firefly is using industry wide data sets on wellness, prescription drugs and labs to understand the gaps that need to be filled in healthcare.Firefly’s model allows patients to quickly schedule a 15 minute visit and continue the engagement in between visits. The company found that there were more longitudinal engagements with its members that were dealing with chronic conditions, some of which they were seeing two dozen to 100 times a year. In a primary care system, they might be visiting their doctor once a year, said Cook.The company offers both virtual and in person care through local partnerships. Firefly uses a care model that ensures members are consistently met with the same team throughout their journey.Pitching New Programs to StakeholdersChanges in new programs, like healthcare, can be exciting but it has to be approved by company stakeholders in order to be implemented. Sossa said when something new is being pitched, you have to have a “clear understanding of your audience and speak their language.”When talking to the CFO, understand the marketing, investments and advertising aspects. When discussing with human resources, touch on the represented population, labor landscape and contracts. Sossa says stakeholders will be more receptive to ideas that are half-baked, ones that require some brainstorming.“Bring them the idea at a 30% mark, where you have the ability to sonar ping with them, get their influence and get their reaction. But if you have a chance to sonar ping your ideas as you go through, that makes them part of developing the solution, and they are much more receptive to that,” Sossa added.He encourages corporate leaders to “resist the gravitational forces of short term thinking” and consider how something that will be sustainable and will solve issues takes time. Sossa advises his clients to think of themselves as moving into the first year of a three year strategy. “Aim a little higher in your steering,” he said.The Future of HealthcareAlternative healthcare is at an inflection point, but it is still a slow progressing industry as they introduce the concept to the corporate world, says Sossa. Cook added that the inflection comes at a time where provider shortages are only getting worse.“Ultimately, the average person is going to be looking for that accessible, high quality care and I think that moment is coming. We need to bring great quality care to our people, not leave it to them to go and figure out where to find it,” said Cook.More competitors are entering the alternative health care industry and the adoption of it is going to increase in 2025, predicts Sossa. Especially with growing frustrations on the traditional healthcare models and lack of progression to meet members’ needs.Editor’s note: From Day One thanks our partner, Firefly Health, for sponsoring this webinar. Jennifer Yoshikoshi is a local news and education reporter based in the San Francisco Bay Area.