E-commerce: The Fourth Lever of Consumer-Directed Healthcare

Why the Future of CDH Isn’t Just Administering Accounts, It's Owning the Marketplace at the Moment of Spend

Consumer-directed healthcare (CDH) was designed to empower members. Yet adoption and trust remain stubbornly low because the experience breaks at the exact moment members need clarity. 

Funding isn’t the problem. HSA eligibility is expanding in 2026, including new relief that makes Bronze and Catastrophic coverage HSA-compatible. At the same time, employers are pouring capital into post-tax Lifestyle Spending Accounts (LSAs) to support wellbeing and retention.

The problem is friction.

Meanwhile, CDH administrators are stuck in a commoditized trap. The industry has historically relied on three "control levers:"

1. Funding: HSA, FSA, HRA, LSA dollars
2. Eligibility: Plan rules, IRS requirements
3. Networks: Where dollars can be spent

Financially, many administrators are anchored to a "set it and forget it" model: PMPM fees, net interest income, and interchange. That model rewards holding balances and swipe volume, but it does not reward better decisions at the point of purchase.

It's Time for the Fourth Lever: Embedded E-commerce

E-commerce is no longer a "nice-to-have" add-on. In CDH, embedded e-commerce is the decision layer. It is what turns rules into clarity and benefits into action. When you embed commerce directly at the point of spend, you stop being a back-office account administrator and start becoming the marketplace where health decisions actually happen. That shift matters because the moment of purchase is where trust is built or lost.

The Economic Argument: LSAs Expand the Marketplace (and the Margins)

The traditional HSA/FSA business is increasingly commoditized and volume-dependent. But when you layer LSAs (post-tax) alongside pre-tax benefits, the economics change. An HSA-only marketplace is constrained to IRS-eligible spend. A marketplace that includes LSAs opens higher-frequency categories, such as fitness, nutrition, mental health apps, and wearables. This creates a destination members actually return to.

This unlocks three critical opportunities:

1. Share of Wallet: Capture health and wellness spend across clinical needs and daily wellbeing
2. Unit Economics: Improve margins through higher-margin commerce and better engagement
3. Frequency: Members may check an HSA balance occasionally, but lifestyle benefits drive weekly touchpoints

Of course, LSAs are post-tax by design, which makes tax handling and reporting a challenge. That is exactly why owning the marketplace matters. The winner isn’t who has the ledger, it’s who can orchestrate the experience cleanly.

Infrastructure Is the Bottleneck

So why hasn’t this happened?

Because legacy infrastructure forces accounts into silos. Most platforms can process an HSA transaction or reimburse an LSA claim in isolation. But they can’t unify those experiences into a single modern checkout. They rely on batch processing and static merchant category logic that can’t reason about a mixed cart.

Modern CDH requires:

• Unified Wallets: Routing a single cart across multiple purses (e.g., HSA + LSA split tender)
• SKU-Level Precision: Tagging and validating items in real-time
• API-First Architecture: Unifying banking, payments, and commerce into one seamless flow

Picture a single cart: Tylenol + a smartwatch + a nutrition app. A modern platform can route the Tylenol through HSA/FSA eligibility, route the smartwatch through an LSA purse, and keep the audit trail clean without the member guessing.

This is why we built Lynx. Not to digitize the old model, but to build the infrastructure where pre-tax and post-tax worlds can coexist in one shopping experience.

The Power of Partnership: Lynx + Truemed

We don’t believe platforms should build everything. We believe in ecosystems. Our partnership with Truemed is a great example. Truemed connects members with licensed clinicians to support Letters of Medical Necessity (LMNs) for qualified customers, expanding how members can use pre-tax accounts for wellness purchases. The partnership allows benefits administrators to internalize e-commerce and expand into LSAs while delivering a consumer-grade experience.

The Future Is Decided at the Point of Spend

The next era of CDH won’t be defined by who has the most accounts. It will be defined by who owns the moment of decision, and can prove it with better conversion, fewer denials, and new commerce-driven revenue. We are moving past reimbursement and into guided health commerce.

So the question for plans and administrators is simple: Are you just holding the money, or are you building the marketplace where it’s spent?