Behind the Team Making Healthcare More Approachable

The word ‘joy’ is rarely uttered in a conversation about healthcare. 

HealthJoy is a company aiming to change that by making healthcare a little more enjoyable for patients. The healthtech company is using data to automate and personalize the healthcare experience at scale by providing its members with a team of healthcare concierges and an AI assistant. This service helps members navigate their employer-provided benefits more easily, whether it’s finding an in-network provider in minutes or getting help reviewing medical bills.

Ultimately, the big picture at HealthJoy is to “smooth over the complexities, confusion and frustration people experience with their healthcare,” according to Chief Medical Officer Patricia Pechter. 

Historically, healthcare has been opaque and complex for patients who need care. The Covid-19 pandemic only underscored the need for healthcare access, and brought about many significant changes to the industry, particularly toward virtual care. Now, the horizon is wide open for innovators to step in and make a difference in the industry. 

Built In Chicago talked to one such team of innovators at HealthJoy about how the company’s mission, product vision and member experience succeeds in delivering joy to its members. 

From a product perspective, what challenge is HealthJoy trying to solve?

Group Product Manager Brian Fanslau: Our core team is really focused on the benefits experience. We’re focused on what we can do to help our members interact with their benefits, educate them to better utilize those benefits, and focus on quality and cost savings. We’re looking into the future to figure out what else we can do for our users and across the care continuum: How do we get more involved in open enrollment? What additional services can we provide? 

Right now, we’re focused on helping automate the actual process for an individual to find a primary care provider or facility or specialty care. In relying less on human interaction, which can take up to 24 hours to locate a provider, we can connect members with care in a few minutes.

Chief Medical Officer Patricia Pechter: Because we have so much data to pull from our vast number of members, we can really dig into what those personalized recommendations would be faster than if it wasn’t automated. 

We have a team of concierge navigation specialists who can apply the information from a personalized benefits plan — applying the necessary set of rules and exclusions and network tiers — and synthesize which clinicians are in-network and can get members quality outcomes at an affordable price. We’re taking a whole conglomeration of data and serving it up in a selection of care providers we’d recommend and why. Even when we use an automated format to deliver these results, they’ve been vetted and run through rigorous processes behind the scenes. 

How does HealthJoy help its members financially?

Senior Bill Review Specialist Jamie Carey: That’s where my department comes in. Say you’re a member and you have services rendered. You get a bill and you’re not sure if you actually owe what the provider is billing you, or you just want to double-check it. They can submit that billing statement to us. We’re able to access their benefits in our system, see what type of services they have, and make sure that the benefits are applied toward the services accurately. We also reach out to insurance carriers for additional information so we can verify the statement. 

If we see that our member is being charged for something that doesn’t coincide with their benefits, we resolve it. Even if the billing statement is accurate, we’re able to educate our members on why they’re being billed for that amount because a lot of people don’t fully understand their benefits. 

Pechter: Jamie’s department is a microcosm of the bigger picture of what we do: try to smooth over all of the complexities, confusion and frustration people experience with their health care. Navigating benefits can be exhausting for even the most prepared individual. And there are plenty of folks who just don’t have the background to know what the next step would be when navigating billing. That’s where having an advocate in your corner makes all the difference. 

How often are there discrepancies in billing? Why is this a valuable component of HealthJoy’s mission? 

Carey: It’s pretty common for there to be discrepancies in billing for a variety of complex reasons. It could be something as simple as having the wrong claims mailing address, or you may submit a claim and never get a response from the insurance company. A lot of providers are backlogged, too, so instead of reaching out to the insurance carrier to obtain additional information, most providers will just bill the member. 

It is the member’s responsibility to educate themselves regarding their plan benefits. Members should read their plan benefits entirely, however most individuals don’t. So that’s where we play a very important role. When people have access to a service like HealthJoy, they can just take a picture of their bill and send it to us. We do all of the legwork. 

There’s a lot of information we have to obtain to verify if there are inaccuracies. But for us, there are easy ways for these problems to be resolved, whether we’re reaching out to providers directly or by having insurance companies review the claim. 

What kind of feedback do you get from members you’ve helped?

Carey: We get a lot of feedback from our members who say they love the service and wish more employers would use us. We help members figure out whether their billing statements are accurate and what they can do in the future to keep costs down. 

Members can even reach out before having services rendered because it’s not a physician’s job to advise them on payment and how their benefits will work. We get a lot of people who go in for preventative care screenings, then get a bill. They don’t understand that not all preventative screenings are covered at 100 percent. Even if your physician wants you to get a screening, you still have a right to reach out to your insurance carrier and ask if it’s going to be covered, which we can help with. We get a lot of positive feedback from our members on how we educate them and help them out with their future needs. It keeps us going. 

What are some of the changes you’ve seen healthcare undergo since the beginning of the coronavirus pandemic? How has HealthJoy responded to those changes?

Pechter: I think one of the huge changes in the way care is being delivered is that there is a larger acceptance and yearning for services to be provided virtually. HealthJoy has always been this great entry point for care, and now people are turning to us to find out where they can go for care that’s going to be safe, cost effective and high quality. The trend is definitely here to stay. 

Especially in distributed workforces and with people spread out across geographic locations away from their primary care doctor, they can come to our healthcare app to request to talk to a doctor or refill a prescription. They’ll get a call within 10 minutes from a doctor and have that interaction. Not only is that a huge cost savings, but it also provides peace of mind.

Fanslau: We’ve also been seeing a desire for increased mental health services, where people just want someone to work through issues with them. From a product perspective, one of our focuses has been expanding our mental health offerings. 

Pechter: We’ve been working with employers to educate them about what employees need. Employees require access to mental health services to be able to take a more holistic approach to wellness. Being able to connect people with therapists virtually is what our members are looking for, and we’ve been able to guide employers to solutions that address this need. 

One of the huge changes in the way care is being delivered is that there is a larger acceptance and yearning for services to be provided virtually.”

What technological innovations has HealthJoy rolled out in response to Covid-19?

Fanslau: When the Covid-19 vaccines came out, we started hearing from our clients that there was a need to have a place to store digital copies of their vaccination cards. We’re able to accommodate those types of outlier requests from employers, but we soon received about 500 requests on the first day for members to be able to upload their cards to our app. We saw the need and knew it was something we could easily do. It’s been a huge success with a good portion of our clients. 

Pechter: Vaccine cards are such an important piece of the puzzle when it comes to employers deciding how to reopen their offices in a way that makes sense for people’s safety. Because our members already use HealthJoy as the place where they’ve consolidated all of their health information, like medical and dental plans and HSA accounts, it made a lot of sense to add a feature where they could also keep track of their vaccine card. 

What do you find most rewarding about your work at HealthJoy?

Fanslau: We’re trying to attract people who want to innovate in healthcare. There are so many projects on the horizon and ways we want to expand. There are a lot of opportunities with HealthJoy — you see how you’re helping members and improving outcomes, while also being involved in building, delivering and going to market with new technology. That’s what attracted me to the company: being able to help people through AI, machine learning and other tech.  

Carey: I feel most rewarded when I can educate someone about their benefits and help them make better decisions in the future that can help with cost savings. We don’t want people going to providers outside their network because they’re going to risk paying way more for the same services rendered by an in-network provider.

Pechter: For me, it’s hands-down working with other people who have that shared mission to guide our members to affordable, high-quality care. We consolidate that complicated experience into a straightforward, unified digital journey.