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It’s easy to feel pessimistic about the state of healthcare today. So during our recent Believers in Better webinar, “Healthcare Affordability: When Access Becomes Possible,” we chose a different route.
Led by Paytient’s Chief Outcomes Officer, Dr. Trent Haywood, the session included Pam Klein (SVP Transparency and Member Engagement at Zelis) and Tracy Watts (Senior Partner and Head of U.S. Health Policy at Mercer).
Instead of ruminating on the problems, the trio of healthcare veterans dug into the "A-word" — Affordability — and shared strategies employers can use right now to redefine, measure and make it easier to help their teams pay for and save on healthcare.
If you missed the live session, you can watch the full recording here.
In the meantime, here are just a few of the key insights and takeaways.
Why ‘insured’ no longer means ‘protected’
Affordability isn’t just about premiums and deductibles; it’s a personal experience. For many employees, the real test of a plan happens at the point of care, where the fear of cost can lead to delayed or avoided treatment. That trade off between getting healthcare or experiencing significant personal financial strain is a regular decision for millions of Americans.
The National Academy of Medicine recently updated its definition of affordability to reflect this reality, describing it as a person's "sustained ability to obtain timely, appropriate, high-quality care... without harmful financial strain, excessive time, or administrative burden."
We've spent years hiding behind the 10% income benchmark to define affordability, but that metric has failed the American employee. It’s not as simple as a math equation. True affordability is the peace of mind to seek care the moment you need it, without fear of the financial impact.
Tracy shared a few staggering statistics from Mercer’s annual survey titled Inside Employees Minds, in which 4,500 employees across the U.S. participate:
- 70% of workers are experiencing increased financial stress.
- Nearly 33% say that it’s causing them to either not save or that they've had to tap into their personal savings to make ends meet.
Paytient research also backs this up, revealing the ripple effects of this financial stress: 40% of Americans with employer-sponsored health insurance delayed medical care in the past year specifically because they could not afford the out-of-pocket costs.
The end of one-size-fits-all: Embracing the personalization of healthcare coverage
When you visit a doctor, you expect a treatment plan that is customized to your specific symptoms and medical history. Pam shared a story of a member who needed a closed MRI but was severely claustrophobic. When they reached out for assistance, a benefits navigator not only helped them find an affordable option — they helped them find an open-air MRI to ease their worries.
Clinical care has long been highly personalized, but health plan design has not caught up. For decades, standard benefits packages asked employees to conform to a rigid system, offering just one or two options and calling it ‘choice’.
Today, leading employers are flipping the script.
Pam highlighted the rise of Alternative Health Plans (AHP) — such as tiered copays and reference-based pricing — that give members the predictability they crave. "Employees can have the same exact benefit plan, but experience those benefits in very different ways based on their personal situations,” she said.
She noted that as healthcare becomes more consumer-driven, employees want the ability to shop for care. And when employers provide transparency tools, employees are eager to use them to research providers and understand their out-of-pocket responsibilities, citing a 33% engagement rate with Zelis’ Smart Shopper tool.
Tracy agreed, emphasizing that the era of offering just one or two health plans is ending. Employers are moving toward customization, giving employees the autonomy to choose the plan that actually fits their life.
"Don't be afraid to try new things," Tracy urged. "The more sizes you have, the better chance you have of meeting the needs of everybody in your population."
Moving the needle on healthcare costs: Actionable strategies for employers
To close the session, Dr. Haywood asked the panelists for the most important steps employers should take moving forward. If you’re currently planning for 2027, the panelists shared several immediate strategies to bridge the affordability gap and drive healthier behaviors:
- Focus on the most vulnerable: Tracy stressed that employers must focus on those who desperately need care but lack the financial wherewithal or health literacy to navigate the system. By focusing communication and support on this specific group — which typically drives employer costs more than their more literate and financially stable counterparts — employers can prevent massive surprise claims and catastrophic emergencies that occur when basic care is skipped.
“Healthcare affordability and healthcare literacy are truly a double whammy, and anything that we can do to help bridge the gap there will be time and money well spent,” she said. “Because those are the people who need it the most, who aren't getting it. That's where the really big surprise claims, catastrophic claims show up, because the basic work is not happening.”
- Surface what you already have: Pam urged employers to review their current employee benefits — tools like cost estimators, navigators and payment solutions that are already offered — and evaluate their effectiveness and utilization. Often, these benefits are buried in an internal portal. Optimizing how you communicate and surface existing benefits is the fastest way to drive engagement with more affordable and better healthcare.
- Out-of-pocket smoothing: The January reset of a high deductible can be a massive shock to an employee's budget. Consider offering a healthcare payment card that makes it easier for your team to pay for healthcare over time without interest or fees.
When we put healthcare dollars and decisions back in people's hands, the whole system thrives. Affordability is no longer just a buzzword — it’s the primary lever for keeping your employees healthy and your business strong.
Watch the full webinar recording here, and stay tuned for our next Believers in Better webinar in May.
