SimplePay Health: This New Health Plan Empowers Employees With Simpler Payments And Care

By Amit Chowdhry • Jun 21, 2023

SimplePay is known as a new health plan that empowers employees with high-quality care, concierge support, and easily understood payment structures. To learn more about the company, Pulse 2.0 interviewed SimplePay Health co-founder Wally Gomaa.

Wally Gomaa’s Background

Wally Gomaa

Gomaa founded SimplePay Health with Scott Schoenvogel. “Scott was the CEO and founder of one of the country’s largest patient navigation businesses, and I had background in all sides of the industry, including the hospital side, the insurance carrier side and the consulting side prior to starting the company. After many years of being involved in the industry, and seeing the challenges that continue to worsen, we felt motivated to create a new model of health insurance to deal with cost and complexity once and for all,” said Gomaa.

Gomaa focuses on educating the industry on new models of insurance and the opportunities to deal with the affordability and complexity challenges. 

“I spend most of my time educating brokers, consultants, and employers about these new opportunities to improve the performance of employer sponsored health insurance plans,” Gomaa added.

Challenges Faced

What are some of the challenges Gomaa faced in building the company and has the current macroeconomic climate had any effect on the company? “Health Insurance is a legacy industry that is responsible for more than 20% of the GDP. Starting a company that is coming in and disrupting the legacy infrastructure of the healthcare industry is not easy. We’re fortunate to have strategically partnered with national Insurance carriers to make this new model of insurance available on a broad scale. And while the macroeconomic climate has had a negative impact on businesses, it creates even more demand for our services to help create savings and affordability for employer sponsored health care coverage,” Gomaa acknowledged.

Core Products

What are SimplePay Health’s core products and features? “We define our service as an alternative health plan. Our new model makes the purchase of healthcare as simple as buying any other product or service in life. We have dramatically simplified the insurance model and we use that simplification to naturally self-motivate individuals to choose higher value providers on their own. We deliver our model through a blended concierge and technology self-service platform. We often describe ourselves as The TripAdvisor of healthcare, helping individuals to navigate to the best value providers in their community,” Gomaa revealed.

Evolution Of SimplePay Health’s Technology

How has SimplePay Health’s technology evolved over time? “Our insurance model uses traditional monthly statements and banking features that replace the very administratively complex insurance forms and billing systems used by the rest of the industry. Instead of confusing paperwork and EOB’s, individuals get one monthly statement, which is available to them online. They can have that monthly statement auto paid from their account of choice or choose to finance their out of pocket cost with a 0% line of credit that is automatically embedded in the model. This is an important benefit that allows patients to focus on their health and providers focus on practicing great quality care,” Gomaa noted.

Significant Milestones

What have been some of SimplePay Health’s most significant milestones? “Our largest milestone has been forming a national relationship with one of the country’s largest insurance carriers, which makes our services available on a national scale. This created an insurance program that is now available as a standard offering in all states throughout the U.S.” Gomaa revealed.

Customer Success Stories

When I asked Gomaa about some customer success stories, he pointed out that there are multiple. “One of our greatest successes is with a national restaurant client with employees in markets all over the United States. Not only have we been able to create a better experience for those plan participants, we also have reduced the overall cost for the employer and their employees by over 30%, all while ensuring that care is delivered by the highest quality providers in their local communities,” cited Gomaa.

Total Addressable Market (TAM)

What total addressable market (TAM) size is SimplePay Health pursuing? “Our addressable market is focused on the 150 million Americans that get their insurance through their employer. Many of these companies are categorized as self-funded, meaning that they are directly funding the claim cost of health care for their employees. By providing a simpler model that brings higher-quality care to members, we help employers improve their financial performance and profitability,” Gomaa analyzed.

Differentiation From The Competition

What differentiates simple pay health from the competition? “SimplePay Health operates in the Alternative Health Plan space. Today there are only a few companies in this space, and there are unique elements within our model that helps us stand out amongst the others. Our single monthly statement model is a unique, first of a kind approach that transforms the entire payment model used by our industry to one that is simple and works like any other purchase we make in life,” Gomaa replied.

Future Company Goals

What are some of SimplePay Health’s future company goals? “Our goal is an ambitious one. We would like to entirely transform the legacy insurance model with something that creates a win for employers, a win for providers and most importantly, a win for the patients that we serve by simplifying healthcare and aligning the cost of care with the quality of care provided,” Gomaa concluded. “We believe that by aligning the financial incentives and creating a true consumer model, we will create permanent and lasting transformation in the healthcare and health insurance system for our country. Ultimately, this will help to extend the quality and quantity of people’s lives.”