Fixing Benefits Starts with Fixing Incentives

The healthcare system is complex, expensive, and confusing. Not just for employees, but for employers trying to manage rising costs. One of the biggest reasons? Misaligned incentives.

Too many middlemen in the system. From insurance carriers to pharmacy benefit managers. They make more money when your costs go up, not when employees get better care.

At Sympl Benefits, we do things differently. Yes, we’re technically a “middleman” but our incentives are fully aligned with the people we serve: you and your employees. We don’t earn extra from markups, spreads, or hidden fees. We’re paid a fixed consulting fee, which allows us to focus on helping employees navigate their healthcare which saves money, reduces unnecessary procedures, and improves outcomes.

The Problem with the Status Quo

Right now, the typical healthcare journey funnels employees through a chain of high-cost services:

primary care → specialist → imaging center → hospital → surgery

No one along the way asks, “Is this the best or most cost-effective option?”

The current system doesn’t encourage it. Employees rarely see the actual costs, so they end up driving up claims and premiums without even knowing it.

Our Approach

Our approach is simple. We realign incentives, educate employees, and intervene proactively.

Here’s how:

Employees can choose high-quality, lower-cost options. For example, an MRI that costs $350 instead of $3,500 and the plan covers it fully. There’s no out-of-pocket cost for making the lower cost choice. And no, lower cost does not mean lower quality.

We don’t wait for employees to call in confused. When high-cost care is on the horizon, we reach out directly to explain their options and guide them to the best path for them.

We get live feeds of prior authorizations and other key data. This allows us to alert employees when a better, cost-effective alternative exists. We recently worked with a family whose child needed ear tube surgery. The same doctor could perform the identical procedure at three facilities with costs ranging from $1,500 to $10,000. The only difference was the facility location. Most families never learn these options exist.

Real change happens when we give people the tools to make informed choices about their care. Employees learn how to navigate the healthcare system confidently, understanding the financial impact of their decisions while accessing the care they need.

The Result

When incentives are aligned and support actually shows up, employees make better healthcare choices. That means lower claims, steadier premiums, and people who feel helped not hung out to dry.

Healthcare should not be confusing or unnecessarily expensive. With the right incentives, benefits can become a tool for lower costs and happier employees.