Challenge 05
Employee Health Ownership & Shared Value
What if employees shared in the financial value of better health?
Self-insured employers have an opportunity to build positive, prevention-focused healthcare relationships - helping employees take greater ownership of their health, access benefits already available to them, and potentially share in the value of better outcomes.
01 - The market
Employer-Sponsored Healthcare at Scale
Employer-sponsored coverage is the primary foundation of working-age healthcare in the United States. Because most covered workers are enrolled in self-funded plans, employers directly fund medical claims as well as preventive, clinical, and navigation benefits intended to support workforce health.
- ~166 million
- People under age 65 in the United States with employer-sponsored health coverage, including covered workers and their dependents.
- ~67%
- Percentage of covered workers enrolled in self-funded employer health plans, where the employer funds medical claims directly (worker share, not percent of all covered lives).
- ~110 million
- Directional estimate of nonelderly people covered through self-funded employers, extrapolated from the two KFF figures above - not a directly measured enrollment count.
KFF estimate (nonelderly population)
KFF: Long-Term Trends in Employer-Based Coverage(opens in a new tab)
2025 KFF survey (covered workers)
KFF: 2025 Employer Health Benefits Survey(opens in a new tab)
Directional extrapolation (estimate)
Methodological note: The ~166 million figure is a KFF estimate of the nonelderly (under age 65) population with employer-sponsored coverage, including dependents. The 67% figure from the KFF 2025 Employer Health Benefits Survey measures the share of covered workers in self-funded plans and should not be equated directly with dependent percentages; ~110 million is shown only as a directional illustration.
02 - The problem
Healthcare Has a Relationship Problem
"When was the last time you heard someone say they have a great relationship with their health insurance company?"
For many employees and family members, healthcare interactions still center on claims, coverage questions, unexpected bills, or acute health problems. Health plans and TPAs do conduct preventive outreach, but those touchpoints often feel episodic, administrative, and disconnected from a person's day-to-day life.
At the same time, employees frequently do not know about, understand, or use the preventive services, condition-management programs, navigation tools, and support resources their employer already pays to provide.
Key thought
We have organized much of healthcare around financing, administering, and delivering care - not consistently around a positive, ongoing relationship that empowers people to manage their own health.
03 - Four stakeholders
Four Stakeholders. One Opportunity for Shared Accountability.
The individual should own their health - not the health plan, the employer, or the provider. Other stakeholders have an opportunity to support that ownership through accessible benefits, understandable information, appropriate clinical care, and aligned incentives.
Supporting individual ownership does not mean claiming individuals control illness, genetics, or all health outcomes, nor does it assume health plans and providers are universally operating under value-based contracts.
Center of the relationship
Primary health ownerEmployee / Individual
- Role & accountability
- Owns personal health decisions and day-to-day participation; faces real consequences and barriers.
- Opportunity
- Guidance, access, preventive action, and meaningful incentives for achievable participation.
Plan sponsor
Employer
- Role & accountability
- Sponsors benefits and, if self-insured, funds medical claims.
- Opportunity
- Support workforce health, increase value of funded benefits, and explore verified savings sharing.
Plan administrator
Health Plan / TPA
- Role & accountability
- Administers benefits, claims, networks, navigation, and sometimes care-management programs.
- Opportunity
- Connect members to existing resources and coordinate appropriate services.
Clinical care
Provider
- Role & accountability
- Delivers clinical care, advice, and follow-up.
- Opportunity
- Support prevention, appropriate treatment, quality, and continuity of care.
04 - The opportunity
From Healthcare Coverage to a Positive Healthcare Partnership
Healthcare relationships should start before something goes wrong. Rather than waiting for an acute event or complex claim, a positive, prevention-first approach helps employees understand and use what is already available to them - including preventive care, routine screenings, chronic-condition support, behavioral health resources, benefits navigation, telehealth, and medication support, as applicable to their employer plan.
Employers often already fund valuable benefits that employees do not fully understand or use. The first opportunity is to help employees find and use appropriate existing services - not simply purchase another standalone wellness program.
Relationship -> Ownership -> Action -> Shared Value
- 01
Relationship
Positive, trusted, ongoing communication, not isolated transactions.
- 02
Ownership
Understanding, choice, and decisions within the individual's control.
- 03
Action
Preventive care, earlier intervention, and guided use of available programs.
- 04
Shared Value
Appropriate participation incentives and potential employee share of independently validated aggregate savings.
Design principle
Shared-savings incentives represent a design opportunity to explore, not an existing guaranteed program. Program design must always encourage appropriate preventive and clinical care - never avoiding necessary care - while recognizing that prevention supports long-term health and does not always reduce near-term spending.
05 - How Embel Assist makes it operational
Connect the Programs Employers Already Fund. Build the Relationship Employees Deserve.
Making this model operational starts by leveraging existing employer, health plan or TPA, and provider investments. Embel Assist brings strategy, relationship design, and execution to connect funded programs and partner capabilities into a coherent employee experience.
The partners and technologies below are examples of capabilities Embel Assist can help bring together where appropriate to an organization's environment - not mandatory components or a single pre-integrated software product.
Strategy, design & execution
Embel Assist
Healthcare strategy, program and incentive design, workflow integration, implementation leadership, measurement, and ongoing operational improvement.
Proprietary relationship framework / IP
HealthVia℠
Embel Assist's proprietary relationship framework and intellectual property, supporting continuous, adaptive, personalized engagement based on relevant signals, preferences, and journey context. HealthVia is a relationship framework, not a standalone software product.
Example orchestration technologies
HCL Unica+ / Adobe
Potential enterprise journey orchestration and communication technologies to coordinate timing, channels, and outreach.
Example conversational action
Ushur
Potential conversational engagement and guided action, including benefits navigation, answering questions, and scheduling.
Example earlier intervention
Hibiscus Health
Potential prevention and earlier-intervention screening capabilities, where clinically appropriate and connected to care pathways.
Benefits & administration
Employer and TPA / ASO
Benefits design, eligibility, approved data-access governance, existing clinical and wellness programs, incentives, and administration.
Clinical care
Providers
Clinical guidance, preventive evaluation, delivery of appropriate care, and ongoing follow-up.
06 - Practical example
What a Better Employee Experience Could Look Like
Consider one hypothetical journey that helps an employee discover and use a preventive or chronic-condition benefit already funded through their employer and TPA:
UnderstandPermitted signals & context
With permitted data and appropriate privacy controls, identify an opportunity to explain an existing preventive or chronic-condition program.
UnderstandPermitted signals & context
With permitted data and appropriate privacy controls, identify an opportunity to explain an existing preventive or chronic-condition program.
Privacy, consent & governance
Built on employee choice, consent, and strict data governance: individual participation is voluntary, personal health information remains protected within approved clinical and administrative boundaries, and the employer receives aggregate program results rather than individual medical records.
Start a conversation
Let's Rethink Employer-Sponsored Healthcare
What if the next evolution of employer-sponsored healthcare were about more than managing claims - building positive relationships, supporting prevention, empowering individuals, and sharing the value of better health? Embel Assist welcomes conversations with self-insured employers, benefits advisors, TPAs, and healthcare partners interested in exploring this approach.