How Comfort is Promoting Engagement, Driving Down Claims Cost

When it comes to health benefits, engagement is one of the most important measures of success. Engaged consumers are typically healthier because they’re accessing preventive care early and often. These individuals are more in tune with their health, and as a result, less prone to needing a visit to the emergency room or experiencing major medical issues. This can also lead to significant cost savings for both them and their employers.

Unfortunately, the healthcare industry has seen a sharp downturn in engagement over the past few due to the pandemic. A recent study found that more than one-third of surveyed members and nearly half of surveyed members age 57 and older reported no engagement with their health plan. Even before the pandemic, engagement was dropping among healthcare consumers, as traditional plans designed to deter utilization became the industry standard.

Rising healthcare costs are directly tied to decreased utilization – and with costs rising more than 20% for patients on employer-sponsored health plans, it’s no wonder why people are putting off going to see the doctor. With these costs growing at an unsustainable rate, patients need health plans that truly help them to afford care, and employers need those same plans to reduce the number of catastrophic claims. The industry is stuck in a vicious cycle – one that we’re rising above with Comfort™, a health plan design that flips the current model on its head.

Traditional Health Plans Aren’t Working for Anyone

Today’s health plan designs – originally intended to prevent patients from breaking the bank on medical care – now prevent many individuals from seeking care at all. With some deductibles at more than $5,000 per year for a family, Americans are often left to determine how much money they are willing to bet against themselves that they won’t get sick or have a major accident that makes it necessary for them to use their insurance.

Offering 100% coverage on most common healthcare services, Comfort incentivizes people to actually use their health benefits in order to stay healthy and avoid costly and catastrophic claims down the road. Need labs and imaging? It’s covered. Mental health support? It’s covered. Generic prescriptions? They’re covered.

Not only does this model lead to better health outcomes and cause members to value their benefits more, but it also drives down claims costs for employers. Truly a win-win for everyone involved. 

Making Waves in an Industry Gone Stale

Many traditional health insurance companies are weighed down by bureaucracy and struggle to effectively implement innovative programs. But a plan like Comfort is pioneering a new, consumer-focused approach to health benefits, and with the first few years of Comfort under our belts, we’ve got the data to prove our revolutionary benefits model is creating real, positive change.

We’re seeing members access more services than ever before. Simply put, when compared to individuals on traditional copay and HSA plans, Comfort members are getting more healthcare. They’re accessing a wide array of no-cost visits including preventive care, primary care, specialist visits, labs and imaging, generic prescriptions, online care and more. In fact, Comfort members experienced 6% more healthcare encounters on Comfort vs. traditional copay and HSA plans.

The result of that increase in utilization is just as we had predicted. Members’ increased healthcare engagement is leading to better outcomes and better plan performance — which translates to more savings for employers. Comfort members are experiencing 7% fewer inpatient hospital encounters and 5% fewer emergency room visits. Instead, they’re more frequently tapping into lower-cost services like urgent care or preventive care solutions to get the care they need before their health issue becomes catastrophic.

Driving down claims costs isn’t rocket science. It’s as simple as prioritizing the member and their health first – and then experiencing the savings that naturally result.

Reach out to see how our solutions can help impress your clients today.