A Vision for the Health Plan of the Future
For all the positive disruption advancing change in healthcare, it’s no secret that the health insurance industry has been slow to catch up to the innovation happening in other areas of the healthcare ecosystem.
While digital health companies are revolutionizing the consumer experience, health systems are revamping care delivery models, and telehealth providers are bringing medical professionals into people’s homes, health benefits companies overwhelmingly remain entrenched in the old way of doing things. From weak technology to stale plan design to a lack of creativity in funding mechanisms, status quo has become the norm in employer-sponsored health benefits.
That’s in part because traditional insurance carriers have done little do move away from the legacy cost-shifting model that has worked for them, especially in the small and midsize markets. Carriers have figured out a cost-shifting equation that behooves them and protects their profits. In exchange, they’ve given employers the ability to manage their own costs by making premium trade-offs for higher deductibles and copays. To carriers and employers, this might feel like a win-win. But what about the consumers? For them, it’s a zero-sum game.
We are on a mission to build a health plan everyone can love, and we think this happens by centering the health plan design around the consumer. That’s not to say the health plan of the future won’t also serve the needs of carriers and employers. Instead, we believe that in the future state truly everyone in the equation wins.
Building a loveable health plan starts with offering benefits that are valuable. Deductibles before benefits kick in for generics drugs at the pharmacy? No, thanks. Copays on common services and maintenance appointments for the privilege of fewer out-of-pocket expenses in the event of a serious illness or injury? That doesn’t make any sense. Valuable benefits are the ones that are there for consumers in both the mundane and catastrophic healthcare events—it shouldn’t be one or the other.
Employers ultimately will also love a health plan that is consumer-centered, because a healthier workforce is less costly, and a happier workforce drives employee retention. But that’s not all they will love. By embracing new funding mechanisms like level-funding, employers can mitigate the risk of claims outpacing premiums, and they can do so while still maintaining control over the operations of their health plan. Finally, a win-win.
And what about the carriers themselves? Well, if employees are free from the shackles of deductibles and copays and are empowered to get care, and if employers use level-funding to remove risks that have previously led them to increase premiums, then claims are more likely to match underwriting projections that carriers use to manage their loss ratios. We call that a win-win-win.
We envision a world where consumers can say, “I love my health plan.” To those who have grown disgruntled with an industry that has continuously let them down, this may seem like a fantasy. But we’re proving with our Comfort® health plan that it’s not too good to be true. With the health plan of the future, there is no catch. It simply works better for everyone. What’s not to love about that?