Q&A with Ben Simmons, Chief Strategy Officer, Gravie

Ben Simmons – 2023 honoree of Minneapolis/St. Paul Business Journal’s 40 Under 40 award

Ben, what does your role as Chief Strategy Officer entail?

As Chief Strategy Officer, I spend a lot of my time focusing on how we build products and services that our members, our employers, and our brokers will love – ultimately, through a health plan that makes it easy and affordable for our members to get the care they need and that makes our employer customers wildly successful in offering benefits to their employees. More specifically, that means focusing on product strategy as well as underwriting, how we are pricing and managing the risk of our products in the market, as well as the data and analytics that are really the underpinning of much of our competitive advantage and how we bring those products to market.

Gravie is solving complex problems that no one else has really solved in the way that Gravie has – why is that? How has Gravie been able drive sustainable innovation?

I think it starts with the right focus. At Gravie, we believe that the right way to look at making healthcare better is to start with the person who’s actually using the healthcare, which is the consumer or the member. And that’s not how a lot of the legacy carriers approach things.

That’s been that principle that has led us to develop Comfort. We knew there were major cost and value problems for consumers where people are spending all this money on a health plan and not feeling like they’re getting any value out of it. Our goal is to offer a health plan that everyone can love that removes barriers to entry for care for everybody, not just the highest users on plans. With Comfort we’ve removed deductibles and made 85% of people’s encounters with the healthcare system free. That also had to be shored up with a structure, a design and operational model that is sustainable – including sustainably affordable.

How does Gravie pull off that sustainable affordability?

That’s where our investment in underwriting and data and analytics has really paid off and helped to solidify our competitive advantage – because not only have we designed a plan design that really benefits consumers, but it is also reliably more affordable than other carriers’ plans in many cases.

Thanks to our innovation in underwriting, we’re able to price risk both more accurately and more affordably in the long run, so that we’re not just a flash in the pan. Keeping the member in mind, we’re not afraid to look at problems differently from the incumbents, and have the rigor behind our pricing and our operating models to deliver on this in the long run and continue to outpace what the competition is doing.

What have been some of the most head-scratching moments for you at Gravie as you try to crack the nut of health plan design? Can you describe any breakthrough moments?

The idea for Comfort was simple, it provided so much more appeal to members … we’d think, “yes, of course this would be worlds better than what we have today.” But figuring out how to bring this simple idea to life was the challenge – a challenge that included determining  how to price for it and how to actually make this rich benefit financially viable.  We also had to design our systems so that claims would be paid exactly the way that we promised. It should be easy to pay claims on a simple plan design, but the way that doctors bill for claims and that health insurance companies historically have adjudicated those claims and decided how they get paid by the insurance company versus the member is very, very complicated and completely counterintuitive in many cases.  It was a difficult problem to solve.  Figuring all of that out – figuring out how to make Comfort work – was a major breakthrough.

You don’t come from a background in healthcare – how has that served you in the perspective you bring at Gravie?

My background from outside of healthcare has given me both an opportunity to learn an incredible amount about this industry, and it has also given me a perspective that is not shackled by the way that the industry has thought about things for a long time. I think that has made it easier in a way to see what the right path forward ought to be, and then to figure out what we could do to get there, which may or may not look like what other companies have done in the past.

Thanks, Ben, for your strategic vision and congrats on your 40 Under 40 nod!

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