How group health care captives save employers money?

Fully-insured vs. self-funded plans:

Put simply, self-funded employer plans through the use of MediCaptive’s services, allow employers to enjoy the rewards of well-managed claims. With fully insured plans, you pay your premium and receive none of the potential rewards – and you pay the 12-15% annual premium increases.

Claims Management Programs

Employers can also reduce insurance costs through claims management. Reduced claims translate into reduced costs when you are taking on your own health care risk. It also bodes well for stop loss rates at renewal time. Claims management is a function of two complementary components: 1. Risk prevention and 2. Risk mitigation.

This is the key to the employer group captive, and it is all driven by the data that becomes available to employers when they enter the MediCaptive program.

Risk prevention is driven by the health of your employees. It is a function of claims data analysis correlated with the biometric data of your insured employees. Linking these two data sources allows employers to develop coaching and wellness programs, which incentivize employees to become healthy and stay healthy – thus reducing employers’ health care costs.

Data Analysis: Population health translates into fewer high-cost claims. MediCaptive’s analytics team, in conjunction with your health care provider, will identify three important risk categories among your employee population: 1. Low risk, 2. Moderate risk, and 3. High risk. A process is then implemented to ensure those with the least risk don’t trend upward, and those already at risk are being well managed.

Risk mitigation is the process that manages costs. Most health care spending is comprised of two elements: 1. Facility claims and 2. Specialty pharmacy.

Bundling: By paying cash for services at the time they are rendered and bundling physician, facility, anesthesia, pre-operative, and post-operative services, costs are dramatically reduced. Members are incentivized to participate in the program by eliminating deductibles and cost sharing.

Specialty pharmacy: Patient assistance programs, which subsidize costs of certain medications by the manufacturer, co-pay, or other programs, can dramatically reduce plan spending. Currently, 200+ drugs qualify for patient assistance programs.