Premiums to Promote Wellness

For consumers, health insurance can feel like a black box, with rates and premiums that have seemingly no correspondence to their own personal lifestyle or wellness. And the insurers don’t have a much better read. With just a few actual touchpoints to their individual customers, their approach to cost management is broad at best and inefficient at worst, costing everyone money in the end. But if insurers worked more closely with providers and patients to have a fuller picture of health—outside of once-yearly physicals and voluntary wellness programs to encourage positive behaviors—they might just be able to start leveraging dynamic premiums to influence their members to make smarter, healthier decisions, lowering overall costs for everyone.

As was also noted in this year’s Tech Trend “Cardio Becomes Currency,” we could soon see payers offering a new class of opt-in and safety-netted products with variable premiums based on our willingness to live a healthy lifestyle. These plans employ AI and technology to monitor and coach participants to maintain or improve a personal levels of wellness. After a baseline analysis, personal premiums would be set and as long as the person maintains or improve their levels of wellness through demonstrated activity and healthy nutrition, they maintain or decrease their discounted rates.

This approach does come with its own set of concerns from both the payer and player perspective. The platform would have to account for fail-safes and guardrails, to ensure that people are not being penalized for conditions or illnesses outside of their control. For the generally healthy population this can take the form of an AI that tracks performance and health stats. When the patient is not demonstrating healthy behaviors or levels of wellness drop, they are provided “probationary assistance” that includes information, coaching and peer support to get the levels back to baseline. If the trend continues and the patient is non-compliant to the support offered, the rates invariably go up to a predetermined ceiling in line with but not to exceed our original premiums.

If designed in the right way, these platforms could finally provide people, providers and payers a common language to more dynamically determine how best to deliver a holistic definition of care.