Building the Best Health Plan for Hourly Workers: An Interview with Kobby Amoah, CEO and Co-Founder of River Health

We interviewed Kobby Amoah, CEO and Co-Founder of River Health, and discussed his journey and mission to provide the best health plan for hourly workers.

Hanna: Tell us about your background and what led you to founding River Health.

Kobby: My name is Kobby Amoah, and I am the CEO and co-Founder of River Health. I started River Health in 2019 and launched our first product in 2020. Prior to that, I founded a social venture called Obaa. We built the first mobile electronic medical record system for developing countries. This was a donor funded initiative from some top donors like the Davis Foundation and Clinton Global Initiative. We rolled that out in several different countries, and I had a lot of fun doing that. I proceeded to have a brief stint at Merrill Lynch. I came to the idea of River Health based on my experience with Obaa, where we were all independent contractors and had to navigate the ACA marketplace. This experience got me thinking about how independent contractors and hourly workers can go about finding, buying, and utilizing health benefits.  

Hanna: Would you share an overview of River and the specific gaps you are addressing?

Kobby: River’s mission is to be the best health plan for hourly workers. We currently have a dual class system where full-time employees get health benefits from their employers because of the Affordable Care Act which requires employers to offer health benefits to their full-time salaried employees. At the same time, the ACA does not require employers to offer benefits to their hourly, part-time employees or their 1099 contractors or seasonal employees. As such, these employees either enroll in a Medicaid plan or have to buy health insurance on the individual exchanges. For those who qualify for Medicaid, that is usually a good option for them. However, our focus at River Health is on those individuals who make too much to qualify for Medicaid, but not enough to be able to afford a good health plan on the exchanges.

We have built a unique solution that starts at $50 a month that caters specifically to the needs of hourly workers. We eliminate co-pays, deductibles, and out of pocket maximum and show them what is covered and not covered to make it easy to navigate the healthcare system generally.

If you work at a company that offers River Health, you typically get an e-mail or text from River Health saying you qualify. The e-mail includes a link to begin the enrollment process. Once you enroll, your benefits are effective immediately and you can start using the services included in our plans like unlimited virtual care, access to $0 prescriptions and labs, therapy services, and in-person doctor’s office visits.

Hanna: What role does technology play in River’s approach to healthcare delivery?

Kobby: Technology is a huge part of what we do at River. We think of technology as a tool to reduce the cost of healthcare delivery and make it more seamless and accessible for our members. For example, we offer unlimited virtual care to our members and most of our members use our virtual care services and text messaging as a way to connect with their providers. It is all about how to use technology to make access to virtual care convenient.

We also employ a ton of technology in the way we administer our plans. For example, we have a MasterCard debit system for paid claims, so we do not have to rent a network, further reducing costs.  We have built an application that allows members to do things like finding a provider and picking up a prescription. What we have built from a technological perspective allows us to offer an affordable plan.

Hanna: How do you see policy and regulation impacting River Health?

Kobby: There are two direct policy changes that could significantly impact the business. The first is the advanced premium tax credit, which was passed during the Biden administration. This allows individuals to set an income threshold to be able to afford health plans on the exchanges through tax subsidies. For example, a bronze plan that would have typically gone for $230 with a $7,800 deductible is now available to someone who makes $35,000 a year. That same bronze plan might be available to them for $40 a month with the same deductible. What we are seeing is a lot of the hourly workers we serve are buying these bronze plans because the premiums are low, even though the deductibles are super high. In that case, people are bundling that with our base plan, the Essentials plan. Our product covers their everyday healthcare needs, but in the case of a catastrophic event, they are able to switch to that high-deductible plan. If those subsidies go away, it can be difficult for these hourly workers to afford catastrophic coverage at all, so we are monitoring that closely.

The second part is Medicaid eligibility. During the pandemic, we expanded eligibility, so we saw record enrollment. If that Medicaid expansion is rolled back, it will significantly impact the population we are serving. Our focus has been on those who do not qualify for Medicaid, so a roll-back will increase the pool of those who do not qualify for Medicaid. We feel these are individuals who benefit from Medicaid – the underwriting is significantly different.

Hanna: What has been the most rewarding and/or challenging part of your journey with River Health so far?

Kobby: It is going to sound cliche, but seeing people use our product it in the world. We track some impact metrics around the last time you saw a doctor and so on. We see a ton of workers who have not seen a doctor in four to five years because they don’t want to deal with costs and are afraid of the bill they will get in the mail. Seeing our members have the confidence to see a provider with River has been incredibly rewarding.

The most challenging aspect has been helping employees understand how River Health fits into the broader ecosystem. We are acting as a healthcare fiduciary and supporting members on which product and how to bundle it to save money. Most healthcare companies sell their solutions and don’t take the time to explain to employees the mechanics of the solution and what makes the most sense for that specific individual.

Hanna: What are you most excited about for the company over the next year and beyond?

Kobby: It all goes back to our mission which is to be the best health plan for hourly workers. What gets us excited is that this is a market that has been overlooked for a long time, and we have a solution that works and serves that unmet need. We have seen great retention with the employers offering the solution and are working to get in front of the companies that hire a ton of hourly and part time workers like Walmart, Home Depot, and Best Buy.

Hanna: What is the best piece of advice you have received?

Kobby: Something that I was told at the Seed stage was to learn what actually matters. When you are a CEO there are a million things competing for your attention and it can be difficult to stay focused. You have to identify the two to four things that matter most.