AI Patient Advocacy Offers Employers a Scalable Fix for Healthcare Cost Confusion

For decades, the strategy of shifting healthcare costs onto employees has been a go-to playbook for employers, but that approach is proving unsustainable. A combination of rising out-of-pocket costs and a healthcare system that has grown too complicated to navigate can leave employees financially exposed even when insured. Much of the resulting pressure lands squarely on benefits and HR professionals, turning them into an unofficial support desk asked to field questions they aren't equipped to answer at scale.

This broken system is the problem physician-turned-entrepreneur Assaf Frajman is focused on solving. Frajman is the Co-Founder and CEO of Octi, an AI patient advocate platform that helps employees manage healthcare claims and costs. Frajman believes the core logic of shifting costs and waiting for employee behavior to change is flawed.

"The long-standing trend has been to expect employees to be smarter consumers. That is almost impossible. This is a system that was complex to begin with, and the situation is is getting worse," says Frajman. He explains that expecting employees to navigate the system alone is the central failure of the current model. In its place, he calls for a shift in perspective with regards to who is responsible for employee benefit literacy. "I think that first and foremost, the responsibility lies on the employer."

• A business payoff: Employers, he believes, must view spending on better tools and increased education as a direct investment in the workforce. "Employers must educate the workforce and be proactive in helping employees actually utilize their benefits. We know that a healthier, more satisfied workforce is a better workforce, so the ROI here is great for the employer."

The solution Frajman proposes lies in frictionless technology that can deliver real outcomes with minimal employee effort. Too many tools, he says, simply leave employees with another decision point or set of instructions to navigate. "For the employee, it should feel like clicking an 'on' button. After that, they do nothing. The AI delivers the end result without the user needing to take another step. Leveraging AI to deliver a final result is the key." That final result is where many of today's solutions fall short. Frajman says the need for a benefits safety net that operates automatically matters most in moments of crisis, where financial stress can compound a medical emergency.

• A $3,000 surprise: To show how the system can fail even those with robust coverage, he highlights a recent example of a surprise bill not from a rare disease, but from a routine trip to the ER. "Just last week, an employee with a great job and benefits plan took her baby daughter to the ER and got a $3,000 bill. We were able to reduce it to $1,400," he recalls. "This is someone with great coverage, and this is exactly the sort of thing that can't happen."

• Stress on stress: For catastrophic claims like cancer treatments, the sheer scale of the cost can render traditional negotiation tactics irrelevant and create substantial stress for the employee. "It's not just that they have to fight cancer. Now they have to fight their bank account and financial stress," Frajman explains. "It's financial stress that affects the entire family."

When workers are under extreme stress, their satisfaction, engagement, productivity, and other business outcomes suffer. He says this dual crisis is where a benefits safety net moves from a nice-to-have to a necessity for employees and employers alike.

For many business leaders wary of overhyped tech, the promise of effortless results invites skepticism. Frajman acknowledges this, pointing out that many vendors fail when their solutions prove harder to use than promised and ultimately deliver a negative return on investment. He makes the case for a wider definition of ROI that supplements simple cost savings with metrics like employee well-being and productivity. "If we ask team leaders, they can tell you if an employee is more or less productive, and then they can trace it back to the origin. While cost is an obvious metric, there are others like productivity that are harder to assess, but must be evaluated," Frajman concludes.