Wex at 7th Annual Healthcare Symposium: Empowering Consumerism in Healthcare

On Friday, 14 November 2025, Wex Inc. (NYSE:WEX) participated in the 7th Annual Healthcare Symposium, focusing on "Empowering Beneficiaries Through Consumerism." The discussion explored both the promising advancements and the ongoing challenges in consumer-driven healthcare. While technology and policy initiatives show potential, complexities in the healthcare system and rising costs remain significant hurdles.

Key Takeaways

• Healthcare spending in the U.S. is nearing 20% of GDP, highlighting the urgency for cost-effective solutions.
• Health Savings Accounts (HSAs) show potential, but only a small percentage of users are investing their funds.
• The role of technology, particularly AI, is pivotal in enhancing consumer experiences and decision-making.
• Policy initiatives like price transparency and surprise billing protections are steps forward, but more comprehensive data access is needed.
• The potential of ICHRA to personalize healthcare plans and drive competition among insurers was emphasized.

Financial Results

• U.S. healthcare spending approaches 20% of GDP, underscoring the need for cost management.
• WEX's HSA planner increases user contributions by about 25%, yet only 10% of Americans invest in HSAs.
• Of the $55 billion deposited in HSAs annually, $42 billion is spent, indicating a focus on immediate healthcare needs.
• Aetna's formulary changes, such as replacing Humira with a biosimilar, swiftly moved 95% of prescriptions, showcasing cost-effectiveness.

Operational Updates

• The panelists identified challenges like the complexity of the healthcare system and limited insurance choices.
• Despite policy efforts, data silos persist, requiring translation into user-friendly formats for consumer benefit.
• Insurers are encouraged to simplify choices and educate consumers on cost and quality.
• Employers are tiering benefits to discourage unnecessary medical visits, promoting cost efficiency.

The Role of Technology and AI

• AI is revolutionizing consumer interactions, with WEX and Oscar Health utilizing AI for personalized recommendations.
• Generative AI aids Health Equity in meeting member needs effectively, while WEX develops agentic AI for enhanced service.
• Only 3% of healthcare data is effectively used, highlighting the potential for AI-driven improvements.

Future Outlook

• ICHRA could lower premiums by 20-30% in individual markets compared to employer plans.
• Personalization and alignment of incentives through expanded HSA access are crucial for cost control.
• The wellness market, valued at $500 billion, is growing at 4-5% annually, indicating a shift towards preventive care.

Q&A Highlights

• Addressing healthcare affordability involves shifting from a "sick system" to proactive prevention and wellness.
• Incentivizing HSA investments requires education and tools to overcome income barriers.
• The potential for AI-driven tools like "ChatGPT MD" is acknowledged but requires careful integration and validation.
• Virtual urgent care's usability could be enhanced by integrating it into consumer-oriented products.

Readers are encouraged to refer to the full transcript for a detailed exploration of the discussions and insights shared at the symposium.

Full transcript - 7th Annual Healthcare Symposium:

Kevin, Introducer, Gabelli Funds: Hi, if everyone can come back in, we're going to get started again in just a minute or two here. Please return from the break. Thank you. Okay, we're going to get started with our next panel, which is Empowering Beneficiaries Through Consumerism. I'm going to invite everybody to come up here. First, Daniel Barasa, who's a Portfolio Manager with us at Gabelli Funds. Then we have Brad Bennion, EVP Strategy and Corporate Development at Health Equity. Chris Byrd, SVP Health and Benefits at WEX. Jill Daly, VP, Commercial Product at Aetna. Finally, we have Jesse Horowitz, SVP Member Experience at Oscar Health. Thank you all for being here, and looking forward to hearing your panel.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Thank you, Kevin, for the introductions, and thank you to all our panelists for being here today. We'll dive right into our conversation today, exploring how we can empower consumers to take a more active role in their healthcare decisions and spending, and hopefully help address some of the rising costs of healthcare in the U.S. Brad is hoping to start with you. Consumer-driven healthcare and empowering individuals to make cost-conscious decisions has been a focus for the industry for about 20 years now. Despite that focus, as we saw in the slides earlier, U.S. healthcare spending continues to increase, now approaching about 20% of GDP. What do you think is happening? Why do you think that focus has not produced meaningful reductions in the spending on U.S. healthcare?

Brad Bennion, EVP Strategy and Corporate Development, Health Equity: Yeah, great question to start this panel with, Daniel. While I think we've made a lot of progress and advancements in aligning consumer incentives with things like HSAs, transparency of value, meaning quality over cost, as well as enhanced consumer education. At the same time, there's been significant advances in the cost of medical technology, as well as there's an increased cost burden that's been placed on the United States with aging population, with obesity, with a number of significant things along the lines of neurodegenerative diseases. All of those things have contributed to the fact that it's difficult to keep pace with the cost of healthcare going up. The United States healthcare system has been very, very quick to innovate and create solutions that are really focused on a pound of cure versus an ounce of prevention.

Those solutions and the associated cost with those solutions have outpaced and outstripped the ability for a more consumer-focused healthcare environment to be able to keep pace. The good news is that we are seeing some green shoots, I believe, in the market with things like LASIK for eyes, now lower-cost GLP solutions available, as well as the ability for consumers to actually go out and see the cost and price of different solutions. Things like musculoskeletal physical therapy that is now available via a virtual environment. All of these things, I believe, point to the fact that if a consumer has correct information, if they have timely information, if they are properly incented to act, then they can actually take and drive behavior that brings down the cost of healthcare.

We need to get a lot more people into accounts similar to health savings accounts to align that financial incentive so that consumers actually are motivated to help make those decisions and bring down the cost of healthcare.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Jill, Jesse, any insurance perspective?

Jill Daly, VP, Commercial Product, Aetna: Yeah, maybe I'll just build on that for a minute. I agree with everything you've said. I think the one thing is we haven't made it easy. It is so hard to have healthcare be a shoppable experience. We're moving in this direction, but we have transparent pricing, but you go to a provider and all of a sudden they do an additional test and what you thought it was going to be going in isn't that. Or you're in there and you see what the list price might be, but you have to understand what that might mean if you have insurance and what that out-of-pocket responsibility is. While we are starting to move in the right direction, I mean, this system is so complex and I think we all see plenty of opportunities to simplify.

Daniel Barasa, Portfolio Manager, Gabelli Funds: It is fair to say that the results have not matched the ambition. One of the ways that the industry has tried to push consumerism is through pushing more of the cost towards the individual through plan designs. One of the examples, obviously, is the high deductible plan. Jesse, you have seen these plan designs in action. Why do you think, to what extent do they actually reduce the cost, or do they actually just introduce more complexity for the consumer?

Jesse Horowitz, SVP Member Experience, Oscar Health: Yeah, look, it's a great question. I think you kind of have to look at two parts of the equation. The first is the kind of theoretical. Does aligning the consumer's wallet with their care help drive down costs? The answer is almost certainly yes. That's just how economics work. If you make a market where consumers are directing their dollars, it's going to drive different behaviors. The other side of it, however, is that there's extraordinarily limited choice. For the vast majority of Americans who get insurance through their employer, you have a very finite set of products that probably have a broad national network, have very generic coverage. It's one size fits all for a population that happens to work together.

Maybe you have more skin in the game, but the cost of that is just like the baseline is much higher than it ought to be. I do think that it's the right levers. We need to create those levers. We need to have the price transparency, as you mentioned. We need to have the simplicity of understanding, not just this is what it meant to cost, and then something totally different happens after your EOB comes two months later. That's how health insurance works right now. I was thinking about this, but on the way in here, you can literally buy a Tesla on your phone, right? Consumers expect to be able to do not just the basics, but significant purchases. You can't do that with healthcare.

I do think that the alignment of, I got to pay for this care, I need to pay for more of this care, works only when everything else underneath it lines up.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Speaking of price transparency and simplicity, obviously on the policy side, the federal government has stepped in with several policies such as price transparency requirements for hospitals, surprise billing protections, and even more recently with the Trump administration announcing Trump RX, where we could potentially have a bit more transparency on drug pricing. Chris, how do you see these policies affecting consumers?

Chris Byrd, SVP Health and Benefits, WEX: I think we are making progress, but I think it's gradual. There's a lot in that question. I'll try to unpack it as quickly as I can. I want to start with transparency because we've already started to talk about that. If you think about it in a very holistic sense, anywhere else in the economy where you have a truly functioning consumer economy, you have information. It's not just data, it's information. What the early Trump 1.0 transparency initiatives did was it began to break down silos of information that exist in healthcare. Everybody thinks that they own the data. The reality is that we own our data as consumers. That's the law.

The bottom line is the PBM wants to silo the data, the health insurer wants to silo the data, the pharmaceutical manufacturer wants to silo the data, and the provider system wants to silo the data. We are trying to break down those walls, but it's not enough to have the data because the average consumer can't read data. I mean, data in a machine-readable format, how is that consumer-friendly? What I think we will begin to see increasingly is tools that actually will allow you to go in and they will turn that data into information that the average consumer can actually understand and use to make reasonable and informed healthcare decisions about where they want to get their care and what their financial responsibility is going to be.

With respect to surprise medical billing, I mean, it's amazing to, I think, all of us that it took as long as it did to recognize the fact that if you go into a facility for a surgery and suddenly the anesthesiologist turns out not to be in network, you have no idea that that is taking place and all of a sudden you get this huge bill because you have a $5,000 deductible and you're still responsible for it. The difference between in network and out of network is this. What we found in reality so far, I think, and I would invite you guys to say something about this, is that there's all these fights, right? There's fights between insurers and providers about, okay, what should you get paid? The consumer's kind of caught in the middle of that.

We're not where we need to be. I mean, drugs, I think everybody recognizes that drug pricing, because of all these numerical drugs that have come out, is a real challenge for the entire economy in terms of cost. I think we're also seeing some chipping away at that. One thing that I would say from the policy perspective is I've always felt as though drug pricing in the U.S. is less a healthcare issue than it is a trade issue. What I mean by that is that the rest of the Western world is benefiting from us subsidizing 100% plus of the global pharmaceutical research and development.

What you're seeing is a very aggressive push on the part of the current administration to recognize that fact with most favored nation pricing and sort of trying to put pressure back on the pharmaceutical manufacturers to say, hey, you guys figure it out, right? It's a zero-sum game and you're going to have to go back to Germany, France, and Switzerland and get a little bit more, and we're going to take our share of the savings or some share of the savings out.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Jill, how much responsibility falls on the industry to proactively simplify choices and educate the public?

Jill Daly, VP, Commercial Product, Aetna: A lot. Also, we are the industry. It's not this other thing over there that needs to go simplify. I will say even with Aetna being part of CVS Health, we have a refresh purpose that was recently introduced, which is to make healthcare simpler, one individual, one family, and one community at a time. To have a Fortune 10 company saying that's a primary focus to bring simplicity to this environment, it's not going to be like any one player has the ability to do it for the whole industry, not at all. There has to be a lot of work happening together just to build off the point you were making, Chris, around the provider and the health insurer and kind of it's an AI arms race and nobody's going to win that in the end, right?

If you look at, hey, my algorithm is better than yours today on rev cycle management, oh now I'm going to find something in my payment integrity program. We are actually really trying to change the dynamic. We have focused on what providers think our NPS should look like, right? What do they actually think about how we work together? That is coming from the top of the organization. It is together that we can start to drive more simplicity. Building on the transparency points, it is cost transparency. I mean, I'm sure there are people in this room who have gone out to dinner and the special sounded really great. You ordered the special.

The check came and you were like, it was not twice as good as the thing that I was thinking about that was on the regular menu, but I did not know how much it cost. I mean, that happens in healthcare every single day. How can we chip away at that transparent pricing? It is not just pricing. I mean, we want really good quality care, right? No one is going to say, I saved $10, but I had crappy care. You want those to go together. Part of it is how can we use tools and insights to help consumers find high-quality, cost-effective care and not have to do a lot of work around it.

For example, if you have certain tools where a member can be searching in a digital app and you can say, well, look, here are three providers we recommend for you, not based on your zip code, but based on the fact that we know these things about you. We know that you only go to this particular system. We know that you like to go to a Spanish-speaking doctor. We know that you are maybe a middle-aged woman with a knee problem versus a high school sports industry injury. That matches up differently, right? How can that get served up in a way that is easy and just kind of no one has to actually put all that information in? Still, again, I am sure I would not be the first person to say people do not always trust what their health insurer tells them about where to go.

We did some consumer research and said, if we go through this process and we do this intelligent matching and then we have a button that literally says, why? Like why did you make this recommendation and list that out? The consumers actually then start to trust the data. Now, in all fairness, they're still going to go ask their neighbor, hey, do you know Dr. So-and-So? What do you think? It is really one of the first times that we're starting to see that level of trust be reflected in consumer behavior because we're making it that easy for them to find the answers they're looking for.

Daniel Barasa, Portfolio Manager, Gabelli Funds: It's clear policy has a role, the industry has a role, but there's still some debate about whether healthcare can truly function like other consumer markets. Brad, I was wondering if information asymmetry and just the urgency of medical care when you need it, are those unique barriers to the healthcare industry or are there lessons that we can learn from other sectors?

Brad Bennion, EVP Strategy and Corporate Development, Health Equity: Yeah, just before I answer that, just I think we're at this inflection point, right, with technology, generative AI. We see it at Health Equity, the way that it's changing the interactions that consumers have. Simple things from just being able to, hey, I lost my card and being able to reorder a card in a human voice, simple interaction, being able to submit claims and have them auto-substantiated and generated. It's really improving the consumer experience. Going to the question that you asked, I would first start by saying we have to recognize that in the world and in particular in the United States, there has been asymmetric information for over a century. I'm going to propose a couple of reasons for that. The first reason is that physicians have the power of the pen.

They write orders, they write prescriptions, and therefore they dictate the therapy that patients are receiving. Now, this has served patients really well for many, many, many years, right? It has been a good thing. It keeps them from homegrown solutions, home-spun solutions, as well as it ensures that healthcare is really based on science-based decisions. That has been a positive thing. The second thing is that the third-party payer system has really been designed much like life and auto to be able to aggregate risk and to really protect the individual from unexpected and high-cost events or disease states, right? That has also served the consumer really well, right? This model of the doctor-driven medicine, as well as the third-party payer system, has really led to an unempowered and an uninformed consumer.

That may have worked in an acute environment where it's difficult to self-manage the illness, things like maybe a complicated pregnancy, appendicitis, trauma, and cancer and things of that nature. An uninformed, unempowered consumer is a bad recipe when you're talking about other types of conditions such as obesity or diabetes or maybe even elective kind of lifestyle therapies such as a knee replacement. We really believe that if we want to change kind of the non-acute, right? I totally believe in the acute environment, the third-party payer system as well as the doctor-driven medicine is beneficial, but we need to bring consumerism to the forefront. The way to do that is to be able to include the financial incentive for people to make proper decisions.

Jill Daly, VP, Commercial Product, Aetna: I think we also have to give them information, right? Because clearly if you're going to go to the and you need to go to the you should go to the. There's a decision that's made that is, do I need to? As much as there are many necessary visits, there are just as many unnecessary visits. Those are driven by a ton of things, right? The financial component. Also just do you have access to the information you need to determine if that's your next best step? I think it comes back to how are we getting into that kind of natural? We have a plan sponsor who's actually, so an employer who said, you know what, we've had such trouble with over or unnecessary utilization of the that they're starting to tier their benefit. What does that mean? This is illustrative.

These aren't actual numbers, right? For your first two visits, your cost share is $100. Your third and fourth visit, your cost share is $300. If you have a fifth or sixth visit, it's going to go up even more. They're trying to draw attention to that decision-making process before you go. By the way, if you get admitted, all of that gets, like, it doesn't count, right? It doesn't count as a visit because it's appropriate use. Just some really interesting models to think about how can you intervene in the decision-making before you're at the point.

Daniel Barasa, Portfolio Manager, Gabelli Funds: AI has come up multiple times in our discussion today. I was wondering, maybe you could just dig a little bit deeper into how your different companies are using AI models to maybe unlock insights that could potentially help consumers make the right decisions. Maybe Jess, we could start with you.

Yeah. I think I'll talk about it in the context of this conversation right now. My opinion on this, and I think what we're seeing is you got to go way upstream, way upstream to influence what's happening in that acute care moment. At Oscar, we think about our product more like any consumer technology experience, not like a health insurance experience. You got to think about what's the best UX design data principles to kind of engage people into the experience. How do you gamify it? Right now, we've recently launched a program called Oscar Unlocks, which just gives people a custom avatar if they do certain things. It gives them a different call center experience. These are not expensive things for us to do.

That allows people to come back to the experience and so they can identify, well, maybe there's a cost differential if I go to the again. Maybe there's a, oh, I can use my virtual urgent care benefit. To tie us into AI, we're also figuring out, I think there are a lot of, there's a long list of very obvious back office opportunities. I'm not going to spend time on those right now because I think that we've probably heard about them. I think on the member and patient-facing side is where we're now looking. We recently launched a new application called Oswell. It's a chatbot. It's hooked into what we know about the member, has access to their claims history, their drugs history, what doctors they go see, what's their demographic.

They can ask questions about, hey, is this or is this not? It's plugged into our virtual medical practice. If it needs to have an instant escalation, it can. I think, again, if you look at this whole thing, I'll go back to my Tesla example or like Airbnb or Amazon. I think people do want access to information and data. I think it's incumbent upon the company to aggregate it, make it useful so that when you have a need, I can go find out who's the right doctor, what kind of care should I be getting, what drug should I be on, is there a lower-cost drug? I mean, these are all questions people may not even have the wherewithal to ask. Historically, they need to pick up the phone, wait on hold, know what to ask.

I think AI creates opportunities to push information to consumers or just make it more easy at any time of day, any day of the week to say, oh, you know what, I need to get a drug. Is this the right drug for me? Where should I get it? Are there alternatives? Should I go to urgent care? Should I sleep it off? I mean, that's the type of stuff that AI can do decently well already.

Jill.

Jill Daly, VP, Commercial Product, Aetna: Oh, I would just, I agree. That's my take. No, I mean, because I do think that kind of what I was talking about with that matching component before too, it's like how do you use the information in the moments that matter and in an intelligent way that makes it super easy for the individual? I think that's what some of these tools will enable us to do.

At WEX, we use AI in a couple of ways. The most important and impactful for the purposes of this conversation is really what are we doing with AI to help people make good decisions? We have a benefit administration business. That's where people are shopping for their employee benefits for the coming year. That is focused on how do I make the right health plan choice among the three or four or five choices that some employers will give? There's a traditional plan, there's a couple of HSA qualified plans, et cetera. What's the right decision for that individual? It takes into consideration not only financial factors, but also risk tolerance factors because I think that's really important. We cannot lose sight of the fact that there's an emotional component to all of this, this entire conversation.

I mean, we exist, we all exist at the intersection of people's emotional health, their physical health, and their financial health. It does not get much more challenging than that in terms of emotion. With regard to the HSA piece of it, it is how much money should I be putting into my HSA? We find that when people go through our HSA planner, they actually will increase their contributions by about 25%. That is very good for them. They are finding ways to put more money away because they are going to need that money at some point, whether it is this year, next year, or in retirement. I think what we believe is the most important and powerful AI development is our roadmap. We are working hard on agentic AI and we will release a concierge. This goes back to this whole idea of transparency.

We think about it on a continuum. There is transparency, there is navigation, which kind of sits next to transparency. Then there is actual care management, which we are not at our company going to go into. If you think about transparency moving into navigation, people do need their hand held. I said that we have to provide information to people. We also have to understand that these are emotions and these are decisions that are very impactful to people. A lot of people are going to feel like they need to have their hand held. The first part of that handholding can be an AI agent if it is developed correctly. We also, I think, have to recognize the limits of AI and at some point you are going to have to have the ability for a human to take over that navigation function.

If the AI gets it wrong, it matters a lot more than booking your trip to Europe, right?

Absolutely. I would just be parroting a lot of what Zahry said. I think agentic AI is changing the way in which we deliver the experience at Health Equity in very, very meaningful ways from kind of how people choose their benefits to how they use their benefits. I think the really important factor here is kind of meeting the consumer where they're at. The consumer needs to be able to ask human-based questions, be able to have that experience served up to them in an easy-to-understand fashion. Like I said, we're at this inflection point where technology actually allows us to be able to deliver on that promise now.

Daniel Barasa, Portfolio Manager, Gabelli Funds: One area where cost-conscious decisions would be especially challenging is with specialty drugs. They're among the fastest-growing components of U.S. healthcare spending. I was wondering just from an insurance perspective, Jesse, Jill, are there any innovations that could be used to help beneficiaries make more informed decisions around those specific class of drugs?

Look, I think the main thing is it's going to be fairly consistent with the conversation. It starts with better engagement upfront so that we can provide better education so that we can help direct people to the thing that's in their best interest. Again, we can use that. That could be multi-modality. I don't care if they're calling me for that because this is an expensive interaction and the more expensive, the more impactful. I'll take a phone call all day for that. We could also serve it with AI, with other chat tools. I think having the information, packaging it up, serving recommendations, it all starts with somebody thinking, let me go check what Oscar has to say, what Aetna has to say. That I think is actually, in some respects, the biggest chasm.

Because people want to, they'll go to Facebook before they go to Oscar, right? Or they'll go to their neighbor before they go to Aetna. You need to pull them in, serve up the information in a useful way so that you can drive a good decision. I'd be curious to hear what you have to say on this.

Jill Daly, VP, Commercial Product, Aetna: Yeah, I think when we look at specialty drugs, and to be clear, I'm on the medical side, so it crosses into that, but it is not all pharmacy. We have to look at a couple of different things. One is where there are substitutes, like what's the actual product on the formulary that you have access to? That is not about denying access to things, but if we look at last year, we removed Humira from our formulary and replaced it with a biosimilar. We did it in a way that it was seamless to the member because it was through engaging with the physician. It was all highly automated so they did not have to create a lot of work. The product is basically the same product, just the biosimilar version of it. We moved like 95% of the scripts in one month.

That was more than the entire industry moved in the whole year. You can use formulary, but you have to obviously have the comparable solution, but also available in things like the intensity of the solution, the vial sizes, all this kind of stuff that gets pretty specific to what a prescription might entail. Another component is where you can use network and benefit design. Network, where can you go for this service and benefit design? What will get paid for if you go there? That's not common across all therapeutic areas, but if you think about where we've been going with gene therapy, those are generally speaking intended to be one-and-dones. They're incredibly expensive. The frequency level is such that it's not like every provider on every corner has done these, right? You actually want to go to an expert.

If it's a one-and-done, you're willing to perhaps even travel for that. You can use benefit design to say, these are the best people to go to at the best price with the best member responsibility. The last thing that really drives a tremendous amount of cost in the specialty space is just site of care. For example, Keytruda is a drug that's been on, like a cancer drug that's been on the rise or multiple indications for it and continues to grow. If there are first few administrations of Keytruda in a hospital setting and you have no adverse impacts, do you need the next 16 treatments to be in a hospital setting? Now, in a certain circumstance, if somebody has other comorbidities, the answer might be yes. In a lot of cases, it's no.

How do you facilitate that awareness, that transition where it makes sense to do so to help manage the specialty spend?

Daniel Barasa, Portfolio Manager, Gabelli Funds: We have covered a lot of ground. Before I open it up to questions from the audience, one last question for all of you. If you could enact one change to accelerate real healthcare consumerism over the next five years, what would that be? Jesse, we will just start with you and then go.

Yeah, absolutely. I mean, I think for me, the answer would be ICHRA. And I think that's how you expand the access to individualized, personalized products to a much broader group of people. You know, I don't need to buy a product that has a network for my colleagues in Texas and California if I live here in New York. I don't need to buy coverage for my colleagues who need to have a certain level of care that I just don't need. I think ICHRA to me, we're at the forefront of this.

Maybe just define what ICHRA is.

Oh, ICHRA. I always forget. Not everyone talks about ICHRA all day. ICHRA.

Jill Daly, VP, Commercial Product, Aetna: It rolls off your tongue.

Individual, now I'm blanking on it. Individual Coverage Health Reimbursement Arrangement, which effectively means my employer can give me tax-free dollars to go buy an individual product. The premiums for products on the individual markets are often 20%-30% lower cost than for employer products. As you can have, Oscar just recently launched a plan design called Hello Meno. It's a menopause design plan for people who want to have first dollar benefits in that part of their life. You can have a diabetes care plan, which has first dollar benefits for their needs there. You can buy the product that works for you. It's lower cost. That to me would be the kind of biggest innovation.

Maybe to build on that, I would really focus on personalization. The World Economic Forum says that about 3% of data that's in the healthcare system is actually effectively deployed. When I say personalization too, that does not have to mean that we know a thousand things about one person. It could be the profile of a person. You keep narrowing it down. In order for it to generate change in behavior at an individual level, they have to feel like it's relevant to them.

I'm going to go a little bit broader, and I'm going to come back to the first question that you asked, Daniel, which is because I think we're really here to talk as well about how do we control costs. I think it's more holistic. I'm actually going to pick up on some comments that Jesse's boss made yesterday on Squawk Box. You might have seen that interview. There was a sort of a profound question at the end, which was, okay, if you're going to put pressure on the system to hold down costs, what's going to happen to the margin, right? This is a group of investors and business school students, so you'd be interested in that.

I want to kind of pick up on that and say from the perspective of the insurance layer, there needs to be more information that empowers consumers to make better decisions. I love the ICHRA idea because it allows people to go out and shop for the insurance plan that makes the most sense for them. What will that do? That will then cascade down to insurers are going to have to get more intensely competitive in how they control costs because people do shop for value. That is going to put pressure back down on the delivery system. The delivery system is simply going to have to get more efficient.

If you put pressure that comes from the payer, which increasingly is going to be the consumer, through the insurer, and in some cases directly to the provider, because be ready for conversations down the road at some point to be between a provider and their patient about what am I going to pay for the service. It's going to force the delivery system to get a lot more efficient to protect its margin. Those who are really good at that are going to be the ones that survive and thrive and are going to find a way to preserve their margin. Because at the end of the day, you think about it from the perspective of the Affordable Care Act is now 12 years old.

It did a lot to try to reform how we finance care, but it did nothing to reform the actual cost of delivering the care itself. That pressure is going to have to come from the top down.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Yeah. Building on what Chris said, how do you align incentives for the consumer to apply that pressure? I think the way to do that is you've got to open the market for accounts that allow people to build a nest egg, a security blanket, an account like a health savings account. We need to open that up for more Americans. The recent legislation did make that available to people on bronze plans, which is fantastic. We need to open that up so that every American can have a health savings account to bring that aligned incentive. I think what Jesse is talking about, people getting into the plans that work best for them.

I guess my answer would be open up so that every American can have a financial account, like a health savings account to save for medical and align those incentives so that people will apply pressure in the system to drive the change that is necessary. Questions from the audience.

Brad Bennion, EVP Strategy and Corporate Development, Health Equity: I'm the first. Okay.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Go ahead.

Brad Bennion, EVP Strategy and Corporate Development, Health Equity: Okay. Jacqueline Olivera Sala. I come from the health, wealth, and well-being on the employer side. I love the panel. Thank you. When I think, when I hear medical inflation rising up and cost containment, and then I think there was a comment that, for example, an employer that's adding additional tiers to get access to your, I want to shift a little bit. Reality is, even if you are employed, you cannot afford healthcare. That has been just creating that beautiful snowball impact on, I cannot afford medicine, I end up in a year. I'm being simplistic here. Have you seen something that's different that would truly look into root cause and prevention, something that's way more proactive than what we see our healthcare plans working today in a way that you could create an anti-inflammatory workplace? That's my.

Jill Daly, VP, Commercial Product, Aetna: Maybe I'll kick it off. Thank you so much for the question. I have to imagine, given the context of this room, that there are some folks who are following what's going on in the longevity space, whether that's Peter Attia or Mark Hyman or Functional Health. I see that I'm very interested in whether that space can impact what you've just described, right? Now let's be clear. It's kind of like the fancy modern way of saying, let's actually do preventive care. We're only going to see this continued ballooning if we continue to treat it, as you had said at the beginning, as like the health, the sick system, not the how do you help people stay healthier.

I do think that one of the challenges in that space in general is when you say expanded diagnostic testing, like that can go off the rails pretty quickly. It has to be obviously with intention, appropriate, et cetera, paired with consultation on what do I go do with this information, paired with incentive to actually take action on what the consultation with the doctor led to. If you bring all of that together, I do think that there's potential to start to shift.

There are a lot of hands for questions. I want to add one thing on this, which is the average term of someone's time with a health insurer is like what, 18 months, 20 months? It's really short. That payer has no incentive to invest in long-term wellness just because they're going to turn over to go to the next one. I do think if we could find a way to keep somebody, you have your Oscar plan, your Aetna plan, whatever, for extended periods of time, those health insurance companies can invest in longer looking wellness and preventive care, which today that whole economic model doesn't align for that.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Go ahead.

Brad Bennion, EVP Strategy and Corporate Development, Health Equity: Hello. Thank you for the panel. I'm a recent CBS alum. One of the greatest benefits of the HSA is the triple tax advantage investment opportunity, right? Across the board, we see barely 10% of the 40 million Americans investing in their HSAs. At Health Equity, it's about 7.8%. Some of your competitors like Fidelity have an investment-first platform. I guess the question is more on how do you align your incentive from your business model to incentivize more people to become investors in their health to build wealth for their future?

Let me take that one to start, Brad.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Yeah. Go ahead, Chris.

First of all, our incentives from a business perspective are actually quite aligned. A little transparency into the business model that Brad and I operate under. We typically, in most rate environments, will make a bit more money on the deposits than we will on the investments. You would expect that that would be a perverse incentive to get people not to invest. The other side of the coin is that the average consumer who has an investment account has two and a half to three times as much actually in deposits as the average consumer who does not. The reason for that is, and research has really confirmed this, people want to cover their deductible. If I have a $5,000 deductible, I want that in cash or a cash-like instrument. I do not want to take market risk on that.

The reason why only 10% of people invest today is because if you look across the spectrum, over two-thirds of people who have an HSA have an estimated household income of less than $100,000. Now, in our research, 60% of people say, "My HSA is an important part of my retirement planning," but only 10% of them invest. There is an aspiration to get there, but we also have to realize that not all people can get there today. In that sense, we're no different than the retirement community. I mean, the retirement plan companies wring their hands over and over and over again over, "Why aren't more people in a 401(k)? And if they are, why aren't they contributing more? Why aren't they maxing?" This is not a new issue, but we do have ways of getting them there.

It's speaking to them in the right language. It's educating them. I mean, it's giving them tools to understand how they can build financial wealth through their HSA.

Yeah. I do not have much to add to that other than we are focused on helping people better save, spend, and invest. You have to remember, as Chris so well stated, that the majority of people are living paycheck to paycheck, and they need to be able to cover their medical expenses. Of the $55 billion that go into an HSA every year, roughly about $42 billion of that is being spent, right? It is being spent because people need to cover their healthcare expenses. Investment options are there. We want to meet the member where they are at. Generative AI and technology is allowing us to be able to do that more and more effectively each and every day. We have to remember that first and foremost, people need to receive the care.

The good news is they are receiving the care because they have money in the account.

Kevin, Introducer, Gabelli Funds: Hi, Henry Wei again. This is a question for Jill Daly from Aetna. Let's imagine that Sam Altman in the next 24 months has Nate Gross over there build basically ChatGPT MD. And it costs about, I don't know, $10 a month out of the $20 subscription. And your membership actually wants access to this. Now, you could argue you have to go through the FDA, get it approved as a "digital therapeutic." We're going to build our own sort of app for benefits or something. Here's something, and then let's imagine just for sake of argument, there's a cohort study showing it actually prevents emergency room visits, almost like a triage tool that you would get. Is there a mechanism that even for Aetna administering self-insured employer plans to even pay for something like that as consumers start to shift their preferences towards AI-driven tools?

Jill Daly, VP, Commercial Product, Aetna: I mean, I do not think there is in today's model, but it is absolutely something that everyone should be looking at. I will say I am not sure that that is the organization that I would say, "Oh, wait, I want to know what is feeding the LLM," right? Like what is going into the answers that are given? Because realistically, there is probably one out of every two people here has used ChatGPT or a like solution to ask a medical question, right? At some point, you may not have acted on the answer, but that is not a that is pulling data from a lot of different places, and some are validated and some are not at this stage. To your point, I do expect that that is going to continue to get better and better and better. If it is where human behavior is, then we have to figure out how that connects.

For example, the CVS Enterprise has three geographic locations where we're testing an AI-first provider, right? That's, we can't see it. It's in Florida, Texas, and Colorado. Unless somebody's going there, sorry. That's the kind of test and learn. We've got to see how do these things work, how to consume, and are they accurate? Because going back to the earlier point, you care a lot more about the health outcome than you do if you booked the wrong hotel.

Jesse Horowitz, SVP Member Experience, Oscar Health: Hi, I'm 85 years old, so I probably consume more healthcare than the rest of the room collectively. There are three, you mentioned virtual healthcare, virtual urgent care. I recently had an opportunity to use virtual urgent care. I didn't even know it existed. During the shutdown, they took it away, but now it's back. I think it's an absolutely wonderful program. I don't think too many people know about it. The second thing is I have an Apple Watch, and I think everybody who buys a phone ought to be given a watch for free because together it's a wonderful healthcare device, or I'm told by my doctors. The third thing is the Silver Sneakers program, which anybody over the age of 60 can participate in. What can you do about getting more people to do it?

Because I tell everybody about it, people go in one ear and out the other. Nobody does anything. What can we do to get more consumers to do what I do?

Look, I think I'll sound like a bit of a broken record. I think you have to stop thinking about health insurance as its own beast and think about it as any other consumer product. Oscar's been giving away free virtual urgent care since we launched our first product in 2014. That's been a part of the offering. It's fully integrated with the experience. It's super convenient. As you mentioned, I use it all the time. I think it's both a great cost-saving tool. It can be used for divergence. It could be for convenience. It kind of runs the gamut. Not everyone uses it. I see this less about we don't want to educate people on virtual urgent care. That is so narrow. It's about driving awareness that there is value.

If you have a healthcare need, you open up your Oscar app, you open up your Aetna app. There are things in there that are useful. It could be a Silver Sneakers program, it could be anything else. Go hire some people who are designing Airbnb and Spotify and all these highly consumer-oriented products. Have them build for healthcare and you'll get better usability. The usability will result in people not understanding how to use these kinds of capabilities.

Daniel Barasa, Portfolio Manager, Gabelli Funds: We have time for one more question.

Jill Daly, VP, Commercial Product, Aetna: He's been waiting forever. A lady over here.

Daniel Barasa, Portfolio Manager, Gabelli Funds: Oh, go ahead.

Sunny Wen, Strategy transformation consultant: Hi, Sunny Wen. I'm a strategy transformation consultant. My question is really linking back to what you were talking about, personalization. That's what consumers are asking for. We're interested in consumers to pick what's the right program plan for them. Now, as you're going on this journey, what are you doing to measure and track the actual health outcome after they picked a specific plan for them and then the long-term financial impact? When you think about 5, 10 years from now, what's the total cost?

Jill Daly, VP, Commercial Product, Aetna: Yeah. So it's a great question because at the end of the day, it is that mix of quality and cost. I started to talk a little bit earlier about kind of that matching thing, right? We know that if someone goes to a high-quality, cost-effective clinician, that from a PCP level, they save a couple hundred bucks a year. If it's an ortho, it's $1,000, right? There's a delta that we match and monitor and say, "Okay, well, if that increases, then there's more savings for the individual as well as whomever is paying for their coverage." I think being able to track that, and we've spent a lot of time as an industry talking about what's the solution for diabetes? What's the solution for weight management?

Name your chronic condition and a lot less time focused on the very question of how do you engage the right people in those solutions. I think that's why we're seeing point solution fatigue in the industry overall. We're seeing consolidation. It's not because the solutions, I'm being very generic here, right, but aren't good. It's that if each time you use it, you save $200 and five people in a population use it, that's not material enough for an employer to cover that. It's interesting times in that sense.

Daniel Barasa, Portfolio Manager, Gabelli Funds: I saw a lot of hands up. Please connect to the panelists.

I think we can do one more, Daniel, if there's a final question.

All right. Go ahead.

Thank you, everyone. I heard a lot of good, interesting ideas, very focused on the consumer, really, really, I think, driving decisions once they're diagnosed with something. I think that's definitely something that needs to continue to happen. I guess my question is more along the lines of what are we thinking about with respect to the consumer on the preventative health side? Would we not get more traction there from a cost standpoint? And then two, what are we doing from a payer perspective to drive, I guess, better decision-making and pushing some of that on the provider and how the provider gets reimbursed to influence the provider in those decisions?

I'll take the first part of that question. On the ounce of prevention, we do see a lot of employers now using incentives to drive people to get their preventive services, to close their gaps in care, to use telemedicine to make right decisions, mail order for pharmacy, things of that nature that really do kind of bring down costs, but also are an ounce of prevention. We are seeing more and more of that as people have a financial account where there is the incentive aligned where the employer can actually put money in and fund. Now, the challenge is that we do not have that alignment broadly enough in the market, right? We need to make these types of accounts. The gentleman, the 85, I believe, congratulations, 85 years old.

Unfortunately, there isn't that financial account to incentivize people that are in Medicare to take advantage of the ounce of prevention. I think there's a lot of opportunity there as we bring alignment with incentives.

Jill Daly, VP, Commercial Product, Aetna: I would say the wellness market is a $500 billion market. It's growing at 4-5% a year. What I think is fascinating about that spend is that the younger population in that mix is, and I think it's like an up to 35 age range, is spending more than their % representation of the population. I'm trying to make a complex thing sound really harder, but really just people who are of a younger mindset and age are actually spending more on wellness when you look at the data. At least that's a glimmer of hope looking ahead.

Daniel Barasa, Portfolio Manager, Gabelli Funds: We'll take a quick 15-minute break and be back here for the third panel on Aging in Place. Thank you so much to our panelists.

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