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The Future of Healthcare: “How to shift health insurance choices from the employer to the employee” with Abir Sen, CEO of Gravie

It will come as no surprise to your readers that our healthcare system leaves a lot to be desired. A big part of the problem is that the end user, the consumer, has very little power or say in the system. For most of us in America, our health insurance choices are made by our […]

It will come as no surprise to your readers that our healthcare system leaves a lot to be desired. A big part of the problem is that the end user, the consumer, has very little power or say in the system. For most of us in America, our health insurance choices are made by our employers on our behalf. As a result, we get into this crazy situation where the HR department at someone’s company has more say than the individual or their doctor about which hospital they can go to if they get sick, or what drugs they may or may not be prescribed. Gravie, the company I lead and co-founded, changes this. Under our model, the employer gives the money that they are already spending on healthcare — which can be as much as $20,000 per employee per year — to the employee through our platform. The employee then uses those contributions to shop in our online marketplace with the help of a concierge service (which we call Gravie Care), to buy health insurance and other benefits that are tailored to exactly fit their family’s needs. In theory, each employee at a single company could end up with a complete different set of benefits.


Asa part of my series about “The Future of Healthcare” I had the pleasure of interviewing Abir Sen, CEO of Gravie. Abir is a serial healthcare innovator, with a series of start-ups to his name. Prior to founding Gravie, Abir was co-founder and CEO of Bloom Health where he led the team that pioneered the private exchange model of financing health benefits. Before founding Bloom Health, Abir was co-founder and president of RedBrick Health. Under his leadership, RedBrick Health launched a health earnings system, created innovative products and achieved health improvement results that surpassed its competitors. Prior to founding RedBrick Health, Abir co-founded Definity Health where he was involved in the creation of the personal care account, the predecessor to the health savings account. Abir has been featured in media including Forbes, Money Magazine, TechCrunch, Twin Cities Business and the Star Tribune. He earned his bachelor’s degree in economics from Lawrence University and his MBA from Harvard Business School. He is a member of the board of directors of Allina Health, and on the board of trustees at Lawrence University.


Thank you so much for joining us! Can you tell us a story about what brought you to this specific career path?

When I was in my early twenties, I became intimately familiar with the healthcare system when I got very sick. My experiences during that time left an imprint and instilled a desire to work in the field to help improve it.

Can you share the most interesting story that happened to you since you began your career?

At a previous company, in its early days, we were approached by an insurance company executive who wanted to meet. I wasn’t thrilled about this meeting. First, because the company was located in a city that was difficult to travel to, and second, because I didn’t think the meeting would amount to much since we didn’t sell to insurance companies. To add to this, the vice president (of the United States) was visiting my home city the day prior to the meeting, resulting in all flights being on hold until late in the evening. This meant that I would reach my destination at 1:00 a.m. for a 7:00 a.m. meeting.

More than once, I thought about canceling the meeting, or at least switching it to a call — but luckily, I didn’t. This meeting turned out to be one of the most important meetings in the life of the company. The insurance company became a big customer, and later on played a large role in the successful exit of the company. To this day, the executive who reached out is someone I admire and respect.

This has happened to me throughout my career — big outcomes driven by events which, at the time, seemed relatively inconsequential. This has deepened my belief that simply showing up is a big part of the startup battle.

Can you tell us about your “Big Idea That Might Change The World”?

It will come as no surprise to your readers that our healthcare system leaves a lot to be desired. A big part of the problem is that the end user, the consumer, has very little power or say in the system. For most of us in America, our health insurance choices are made by our employers on our behalf. As a result, we get into this crazy situation where the HR department at someone’s company has more say than the individual or their doctor about which hospital they can go to if they get sick, or what drugs they may or may not be prescribed.

Gravie, the company I lead and co-founded, changes this. Under our model, the employer gives the money that they are already spending on healthcare — which can be as much as $20,000 per employee per year — to the employee through our platform. The employee then uses those contributions to shop in our online marketplace with the help of a concierge service (which we call Gravie Care), to buy health insurance and other benefits that are tailored to exactly fit their family’s needs. In theory, each employee at a single company could end up with a complete different set of benefits.

How do you think this will change the world?

One large problem with our current system is that no one thinks of the consumer as the customer. Insurance companies think of brokers as the customer, brokers think of employers (whose primary concern is often cost-savings) as the customer, and the consumer is just a captive audience that the employer brings to the table. This leads to an incredibly inefficient purchasing process. Insurers focus on keeping brokers happy, who in turn focus on keeping employers happy. A lot of golf is played. Consumer experience isn’t necessarily discussed on the golf course.

Gravie’s system gives the consumer the ultimate power — the power of the purse. In our model, if consumers don’t like what they have, they can simply choose a different option next year. Their experience with a product or company, good or bad, can be shared with other consumers looking to make similar purchase decisions. In turn, insurance companies and other industry players now need to think of pleasing the consumer in order to get and keep them as a customer — designing products and services that address their needs and concerns. Just like in any other consumer industry, competitive pressures lead to product innovation, which in turn will improve the way the healthcare industry serves its true customers — people like you and me.

Keeping “Black Mirror” and the “Law of Unintended Consequences” in mind, can you see any potential drawbacks about this idea that people should think more deeply about?

Healthcare and health insurance are complex — and most people are not equipped in terms of time, resources or industry awareness to make the best possible insurance decisions. This is why it is critical that in this transition to a consumer-focused system, we have robust “training wheels.” In other words, we offer services that guide and advise the consumer without any hidden agenda and with only one goal: to ensure that the consumer succeeds in making the best possible choices for themselves.

Was there a “tipping point” that led you to this idea? Can you tell us that story?

Prior to Gravie, I was at another company in the healthcare space that sold through brokers. I was in a meeting with a health insurance broker discussing our solution, and what I vividly remember from the conversation was the broker telling us, “I’m not going to put this in front of my customer until we decide what my commission is going to be.” There was no discussion about how this may help the consumer. There wasn’t even a discussion about the employer’s needs. I knew in that moment that there had to be a better way.

What do you need to lead this idea to widespread adoption?

We primarily need awareness. As more companies learn about the Gravie model, we’re seeing adoption among businesses of various sizes, industries and employee demographics.

Employers know how inefficient and ineffective their current healthcare purchasing process is, but they don’t all yet know that they are putting themselves through hoops that they don’t need to, managing decisions and administration of plans, when they could transition to just becoming a co-financier.

We also need to drive awareness and education among end consumers. There is no reason why every year individuals should have to choose from one or two fairly inadequate options. We can build an ecosystem where individuals are treated as the customer, and all the industry players are focused on meeting their needs.

What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)

I don’t have five, but I’ll tell you the one that comes to mind most often for me: Crafting the right initial team is way more important than crafting the right initial solution. Across the four companies I have co-founded, none (none!) ended up with a business model that was the same as when the company was launched. The business model is not what makes the company; rather, it’s thoughtful, resourceful people that are determined to solve problems for an industry. The right team eventually experiments its way into the right model. Otherwise, things are a lot more painful.

The future of work is a common theme. What can one do to “future proof” their career?

The best way to future proof your career is not to think of your career as something that should be future-proofed. I’ve found that the people who have had the most success in their career were able to find something that they really liked doing and did it simply because it brought them joy. Not that they didn’t have to adapt to changes, technological or otherwise, in their chosen field, but they adapted because it allowed them to do the thing they liked doing better, not because they were focusing on the long-term implications of their career.

Based on the future trends in your industry, if you had a million dollars, what would you invest in?

I would invest in services that improve the consumer experience in healthcare.

Which principles or philosophies have guided your life? Your career?

I live by two principles, which are the same across life and career: 1) I have a “no jerk policy” — choosing not to work or in any way associate with people who are jerks, even (especially!) when it is inconvenient or expensive, and 2) I trust my gut more than my brain.

Can you share with our readers what you think are the most important “success habits” or “success mindsets”?

Two success mindsets that are invaluable are optimism and persistence.

  • Optimism, because believing something will happen is a precursor to making it happen
  • Persistence, because as Edison said, “many of life’s failures are people who did not realize how close they were to success when they gave up.”

Some very well-known VCs read this column. If you had 60 seconds to make a pitch to a VC, what would you say?

To any VCs I’d say: Come join us in changing the largest industry in the country!

How can our readers follow you on social media?

My twitter handle is @abirsen.

Thank you so much for joining us. This was very inspirational.

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