Noah Lang is a champion of health care access & coverage for underserved, low-income Americans who are often left out of the traditional employer benefits safety net. He is the co-founder and CEO of Stride Health, which has helped over 3 million gig workers and self-employed Americans access coverage. Stride is building an individualized, portable benefits system in concert with brands including Amazon, Uber, DoorDash, Mastercard, Allstate, Oscar and Intuit. Noah also collaborated with the US Department of Health & Human Services to help establish a unique public-private sector partnership to expand access to Affordable Care Act health coverage and premium tax credits called “Enhanced Direct Enrollment,” which is now used by millions of ACA enrollees.

The Pulse: Can you share a bit about your background and how you become involved in entrepreneurship and healthcare?

Noah Lang: Stride is my first job in healthcare. I started out studying product design in college. It’s a degree that’s fairly unique to Stanford, but it focuses primarily on unearthing consumer pain points and finding ways to solve problems with real-life, two and three dimensional products. However, I quickly abandoned that path post-grad and went into consulting for 18 months. Though consulting felt like kind of a waste of my time, it gave me a really great foundation for corporate ethics and lit a fire in me to get back to what I had studied. I really wanted to problem-solve on my own. So I joined the founding team for a company called Reputation.com in a totally different sector, with a focus on consumer reputation and privacy. I was running business development and consumer product development to help people track where their data exists online and to help them control it. This whole sector has a much bigger spotlight on it today. Ultimately, what led me to Stride was a deeply personal exploration – I recognized that the company I was helping build was interesting and we were solving real problems for people, but it didn’t tug at my heartstrings. To be totally honest, it didn’t really feel like I was dramatically changing the course of someone’s life. When I really thought about it, what I deeply cared about personally was healthcare. 

I entered healthcare at a moment in time when the Affordable Care Act was being implemented. I had this very obvious observation that every single American has dealt with – it’s really hard to pick your health insurance plan. When I dug deeper into that problem, I realized that, although there was great privacy regulation, nothing was personalized in healthcare, and no decision I made felt like the choice was there for me. I realized that a massive segment of the US labor force was, for the first time, going to have access to health coverage they could afford, were guaranteed access to, and this was going to dictate how much, what quality, and the cost of care they could receive. And yet, nobody was helping them make those decisions – not the government, not other folks already playing in this sector. It felt like there needed to be a breath of fresh air to support the rollout of the Affordable Care Act. At Stride, we built a recommendation algorithm and engine with an elegant consumer UX to help you make a decision on the total cost of coverage / care for the year and quality elements like the ability to keep your doctor or stay on prescribed drugs – it wasn’t based on liking some plan brand or what you perceived as the price of the premium. We want to provide this service for the people who need help the most. 

The Pulse: This year, the WHCBC theme is about the empowered healthcare consumer, which ties really well to Stride’s mission of trying to empower all of your consumers towards financial security through access to affordable health care. We’d love to hear about how you think about building a product to further empower your customers.

NL: When I started Stride, the word I heard most frequently was “transparency” – a call for needing more transparency in benefits. But honestly, that’s kind of BS. People are overwhelmed with data on healthcare, and it’s not that helpful. What I believe consumers really need is help making benefits decisions. What they really need is a partner that helps them understand the impact – usually a multivariate impact – of their decision. Our job is to help people make a smart data-driven decision like it’s a risk weighted investment decision. It’s truly a financial decision. And you should do that in a way where consumers understand and feel comfortable with it, and the decision feels  increasingly easier to make. 

My view is that we need to interconnect data streams better. There is now more access than ever to your own personal health records and data. However, we need a more useful tool where people can actually use information about their providers, procedure history, medications, etc. to make informed decisions. It is about having access and choice. To be fair, there’s no real free choice in healthcare – there are always guardrails and boundaries on the options that exist. Part of our transparency is showing people, “here’s where you can make choices and here’s where you can’t.” The last decade or two in healthcare has also revealed that sometimes you shouldn’t give consumers too many choices. So we really want to coach and guide them towards the ones that matter and remove the noise.

The Pulse: Stride put out a health survey report in Nov. 2022 that highlighted affordability education as a big consumer gap in the benefits space. More specifically, how are you working on finding and educating consumers?

NL: Today, Stride’s number one job is education. Our product is basically a guide – it’s live action, personalized education on what you have access to, how it’s going to affect your life, and how much you’re going to pay for it. I think one of the big jobs that we play currently, aside from working with large, non-benefited gig workforces, is helping extend the reach of healthcare.gov and other government services. Not everyone wants to deal with the government, especially some of the underserved and underinsured segments of the economy. For example, we talk to large Hispanic and Black communities that are not being reached and simply don’t want to deal with the government for a whole slew of reasons. We’ve partnered with the federal government to extend the reach and find people who are uninsured or underinsured and meet them where they work, where they bank, etc. We discuss these benefits like the financial decision they are and bring education to consumers in the languages they speak because healthcare is confusing enough in your first language, let alone your second. We also really need to retranslate healthcare in a more human vocabulary, so that people understand the terminology they’re hearing and can actually use it to make data-informed decisions. A fascinating study Stride did found that ~80% of covered gig workers were getting coverage for less than $100/month. The counter complimentary data point is that, at the same time, ~80% of uninsured gig workers thought their health insurance would cost more than $100/month so they went uninsured. There’s just a clear gap between the expectation and reality. There was also a time in recent memory where many were told the government would kill the Affordable Care Act; some people may have even gotten a little confused and thought it went away. But it’s here, it’s been reinvigorated, and it’s funded, and we need to help spread that awareness. 

The Pulse: I’d love to hear your thoughts on the future of healthcare benefits in the US. 

NL: We talked earlier about why I became interested in this space and how deeply personal I believe healthcare to be. Meeting our customers really drove that home. 

When I started Stride, we partnered with TaskRabbit 72 hours after we launched. We very quickly partnered with a number of other gig economy companies, including Uber. Upon launch, I sat down face-to-face with our customers with an iPad and walked with them through the enrollment process. I very quickly realized that healthcare for them is not just healthcare, it’s a future financial decision. I realized we were not actually a healthcare company, but that we had to be a company building an access solution for people who work for themselves. 

There is a shift in the way people work today, and not just referring to the rise in app-based gig work. We’re in the midst of an interesting shift in the labor force that allows people to apply their skills in ways that aren’t just full-time, W2 jobs, and nothing has filled the benefits gap well for that way of work. Pre-Affordable Care Act, healthcare was entirely dependent on your job or your good health. Other forms of financial security are also tied to your job, including the most appealing retirement plans (401k vs. IRA), and homeownership and mortgages. There is an entire slice of financial security in this country that’s tied to traditional employment, but many people aren’t working that way anymore. The future needs to be about decoupling these things. 

We’re seeing a couple dramatic shifts in the short-term towards individualized and portable benefits in the W2 economy as well. Cross individual coverage, HRAs, allow employers to give employees a stipend to spend on their own benefits. It is the future right? It is a world where you can buy your own coverage, your employer funds it in a tax-advantaged way, and you can take it with you wherever you go. If you fast forward a decade, I think many millions of Americans are going to be getting their benefits in that way. 

The Pulse: Congrats on Peter Lee recently joining your board of directors. Some of the Stride priorities that were mentioned in that press release include expanding into new markets, scaling and DEI efforts. Can you elaborate on these priorities and what you’re excited about?

NL: Peter is an amazing leader who has led a massive organization with over 1200 employees and over 1.8 million customers in our space and at scale. We’re super excited to have him on board. We raised our Series C a little over a year ago and we’re scaling up the team. We are continuing to evolve what benefits look like – not just medical coverage, but delivering dental, vision, life, accident, disability, and even tax assistance for people who are out there on their own. All of these things are connected – for example, the way you pay your tax bill has a huge impact on whether you qualify for tax credits, and therefore your coverage premiums. We’ve also made a big commitment to diversity, inclusion, and belonging. Our customer base is the most diverse you could ever imagine.  We try hard to also have a diverse employee base because we want to deliver the right product experiences and reach individuals where they’re at, and we need a really diverse workforce to bring the best people and the brightest ideas together. We have gaps to close, and Peter’s one of many folks who are tapped to help us to do that. For me, DEI starts at the top with my board, my leadership team, our extended leaders and managers in the organization. Last year we went from 22% to 55% of female director-level employees at Stride. We’re increasing the share of women or people of color on our board, which is now at a third, but we still have a lot of room to grow and do a better job. 

The Pulse: Do you have any advice to share with those going the entrepreneurial route in healthcare?

NL: I’m a first time entrepreneur in healthcare. So to those like me, don’t worry if you don’t know the industry, and don’t worry if you don’t know how to lead. There are so many people in this sector who want to teach you. So don’t try to do it all yourself – ask for help. And better yet, once you get things up and running, hire a coach.

My next piece of advice is that you have to really understand that healthcare is hard. Healthcare is very slow to move, but use that to your advantage. Don’t be scared of it – lean into it, be impatient with yourself, and patient with a sector. 

Lastly, as an entrepreneur, it’s important to set the culture early. It’s going to outlast you. It’ll dictate who you hire and you may fail if you don’t set it early enough. Lastly, get plenty of sleep. I think my worst moments as a leader were most highly correlated with the times I was not sleeping enough. When you’re getting going, you stay up all night and you grind it out. But it’s a long game, especially in healthcare, and it’s taken me a handful of mistakes to figure that out.

Interviewed by Kavya Bodapati, January 2023.

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On Feb 16-17, 2023, Wharton is excited to feature more expert perspectives at our annual Wharton Health Care Business Conference. This year’s theme is ‘The Empowered Health Care Consumer’. Conference details and tickets are available here.