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Lowering Health Care Costs - Group Health Captives for Mid-Sized Employers
Many employers are faced with the rapidly growing cost of health insurance, second only to payroll. The average cost for family coverage is almost $13,000 a year. Larger employers are capable of taking control of their costs because most of them are self insured. Since this allows for transparency, large employers can implement wellness programs targeted at what their true problems are.
Most mid-sized employers are fully insured and do not have the product options that their larger counterparts have available. They do not know what claims they have or where their premium dollars go. The lack of transparency prevents them from taking control of the cost of health insurance.
So how can mid-sized employers change what they are doing? They can form what is called a captive program. A captive can be formed by a group of employers in an effort to reduce the costs associated with providing health benefits to their employees. These employers can come from a wide variety of backgrounds including existing risk retention groups, trade associations, franchises, portfolio companion of private equity firms, and clients of an agency or broker. Employers have been using captive programs for workers compensation for years with high success.
Each captive can be customized with its own terms, rules of participation, and financial structure, and the typical captive program takes 3 – 6 months to create depending on multiple variables. Launching a captive usually requires a minimum of 3 employers with a total of 500 or more employees.
Ideal employers should have 50 to 400 eligible employees for the company's health plan and have the financial resources to assume a portion of the risk associated with their employee benefit plan. They should have forward-thinking management who are focused on taking control of rising health care costs and are willing to lead the change. They need to be able to communicate with their employees about the importance of being proactive in lowering the cost of healthcare. Allowing the smaller employers that were fully insured to go to a self insured plan has many potential advantages, and it allows them to spread out and share the risk with other companies in the captive program.
Employers can maintain a single plan across all states, which can potentially decrease administrative costs. Employers also have greater access to claim and behavioral data (in a HIPAA compliant manner), which allows them to influence employee activity and decrease costs. They can assemble an all star-team of vendors instead of being forced into the one-size-fits-all approach of the fully insured market. Employers can choose to eliminate or reduce some of the mandated benefits imposed by each state; this allows them to remove the cost of potentially unnecessary benefits. Often the employer with better than average risk profile achieves additional savings.
In order to protect themselves from financial loss, most self-insured employers purchase a stop loss policy that provides insurance against both large individual claims and an aggregation of small claims. The majority of large employers operate self insured plans due to the benefits previously described. Many medium sized employers want the benefit of a self insured plan, but dislike the inherent trade-off associated with such plans. Captive programs are designed to allow employers to maintain the majority of the potential savings associated with moving to a self insured plan without all of the volatility of a high retention stop loss policy
Captives accomplish this through a unique risk and reward structure. Each captive program can be structured for a group of employers with a common tie. Each employer retains the losses that are predictable for it. The group of employers share losses that are unpredictable for any one employer, but that are predictable for the group. The group transfers losses that are not predictable for either an individual employer or the group to the insurance carrier. Each employer retains its predictable portion of risk through a self insured retention. The employer limits this risk by purchasing a stop loss policy. The policy provides both specific and aggregate coverage. All employers within the captive program share in the economic results of the layer of risk between the individual employers' specific and aggregate retentions and the groups' specific and aggregate retentions. And the employers transfer the risk of unpredictable and catastrophic losses to the stop loss carrier.
This flexibility allows each program to be designed to meet the specific needs of each group of employers. Each captive program may have different employers' self insured retentions. For example, one employer may insure $10,000 per individual, and a different employer can insurance a total of $250,000 per individual. The stop loss carrier will cede a portion of the policy's premium to the group's captive. The premium for the layer between $10,000 and $250,000 per individual is a large portion of the overall stop loss policy premium. This also means that the layer will likely contain a large portion of any cost savings associated with a self insured plan. In addition to the premium, the captive should be funded with collateral provided by employers of the captive program. The collateral is typically 15 – 20% of each employer's comparable fully insured premium and can be provided by a letter of credit or cash. Unused funds in the captive are returned to the employers. The timing of the distributions is determined by each captive. The captive is acting only as a reinsurer of the stop loss carrier. It is not a primary or direct insurer of the plan, the employees, or the employer. The stop loss carrier is responsible for paying all covered claims, and then seeking reimbursement from the captive.
Each employer within a captive program will have its own benefit plan. The sponsoring employers should have a common stop loss carrier and reinsurer. The employers can reduce the cost of their insurance through the economic results of the captive. There are no shared plans; each employer maintains its own single employer plan. There are no group policies; each employer is issued its own stop loss policy. There are no group rates; each policy is individually underwritten for each employer.
There is no commingling of plan assets; each employer is responsible for its own plan assets. There is no joint or severable liability amongst employers for their self insured retentions. The employers are not acting as reinsurers; they are participating in the economic results of a reinsurer (the captive program).
So what is the value of being in a captive? The concept behind a captive program is simple: provide medium sized employers with the advantages of self insurance while decreasing volatility. Participation in a captive program is a means to an end. The real objectives are transparency, control, stability, and profit. A captive program can help achieve these objectives.
Participation in a captive program is not for all employers. Some employers may prefer to remain in a fully insured product, while other employers may be perfectly comfortable with the volatility of traditional self funded product. Captive programs are not a miracle cure for the high costs of health insurance.
They are a tool to help employers gain more control over their health insurance and reduce its costs. A captive program must be coupled with a long term commitment to reducing cost drivers. Implementing wellness programs and medical tourism programs are ways to address cost control measures.
There are two notable fallacies associated with health insurance. The first is that employers cannot control their health care costs. This is a view held by most. Without adequate data and transparency, it is probably a true statement. If an employer is fully insured, they likely don't know the answers to the following three questions:
- How many times did your employees visit an emergency room last year, when they could have just as easily waited a day or two and gone to their PCP?
- How many of your diabetic employees are taking their prescriptions regularly?
- How many of your employees are current on their recommended cancer screenings and physicals?
- However if an employer had the answers to these questions, they could begin to build a program to control the underlying cost drivers.
The second fallacy is that discounts are everything. There is a myth in the industry that discounts are the single most important factor to lower costs. The logic is that without the steepest discounts, the cost of health insurance will be greater. Comparisons of discounts in isolation are useless as the analysis must also consider the amount of services consumed. It is the combination of unit cost, quality of care, and quantity of care that ultimately determines cost. The total costs of health insurance are not determined by the cost of doctor visits; they are driven by the health of the employers' population and the decisions made by the population. Preventing the medical condition that creates a claim is always preferable to simply reducing the cost of the claim. A healthier employee population has many associated benefits including improved efficiency, higher morale, and fewer absences.
In closing, a captive program gives the ability for mid-sized employers to take advantages of being self insured as long as they are able to act upon the information they are able to glean by being self insured. The potential long term changes should benefit employees by lowering claim cost, lowering employee contributions, improving service, and increasing the commitment to improving health.
Gary Becker is the President of Becker Benefit Group, which is a employee benefits consulting agency, providing employee benefits to help employers recruit, retain, and reward key employees. Our agency is based in Owings Mills, MD and we have created the first Group Health Captive in the State of Maryland. We have put into place incentives for employees to participate in our Wellness Initiative and are proud to report that we have over a 90% participation rate. The Wellness Initiative includes an annual biometric screening, an online health risk assessment, and ongoing online quarterly wellness education customized for each employee.
Typically, 20% of the employees incur 80% of the claims. We use sophisticated data mining software that is able to identify the high-risk, medium-risk, and low-risk employees. Our predictive modeling software is able to show employers the claims risk for their employee population, and we implement strategies such as nurse outreach to these high-risk and at-risk employees to engage employees to better manage their health. Our program works and we have found that groups using our strategies are trending under 3% per year.
Our agency is focused on being a proactive, actively managing plans and providing innovative solutions for clients. We keep apprised of trends in the industry and focus on wellness as a preventative cost control measure. Our focus is helping employers with wellness, and global healthcare design, implementation and administration to take control of rising health care costs.
Designing a health care plan is only the first step: managing it is the most important! Becker Benefit Group meets with clients to determine the strategy for the benefit plan design, then builds and negotiates on behalf of the client. Becker Benefit Group is a proactive insurance agency, helping employers design employee benefit plans and wellness programs to help take control of increasing insurance premiums. We help by managing employer's health insurance every day, instead of being reactive at renewal.
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Group Health Captives for Mid-Sized Employers ... Turn Premiums Into Profits. Call me for Information.
About the Author
Gary Becker, President 11000 Owings Mills Boulevard, Suite 6A Owings Mills, MD 21117 gary@beckerbenefit.com 888-502-8800
Battling an Eating Disorder: When Bulimia Becomes a True American Idol Sized Problem
In a People Magazine article, American Idol contestant, Katherine McPhee disclosed that she has secretly suffered from bulimia for the past five years. It was her success in television's American Idol competition that inspired her to come forward and get help to recover from her life-threatening eating disorder. Katherine, a vocalist who at her worst point was self-inducing vomiting up to seven times a day, claimed that she realized her bulimic behaviors were "equivalent to taking a sledgehammer to her throat" and brought herself to treatment.
Glamorizing Eating Disorder Illnesses? Or Becoming an Invaluable Role Model?
Some may think when celebrities like Katherine come forward with such problems it only "glamorizes" the illness and encourages dysfunction in impressionable young people. In reality, some impressionable youngsters may respond by engaging in self-destructive experimentation, but for the most part, the responses of people like Katherine McPhee provide invaluable role modeling for fans.
Though statistics show that 1 percent of young females in this country suffer with bulimia, the numbers most likely do not reflect the enormity of the problem, as bulimia is among the most frequently missed diagnoses, and only a minority of people with eating disorders, especially with bulimia nervosa, are treated in mental healthcare. A problem cannot be solved until it is defined. In coming forward as she has, McPhee has displayed the courage and intention to achieve her dreams, to become proactive in making her life as healthy, gratified and fulfilled as it can be. Despite the widely held misconception that "once eating disordered, always eating disordered," eating disorders are fully curable in 80 percent of cases where recognized early and treated effectively. In her forthright and courageous stand, this American Idol contestant has become a true American idol.
Uncovering the Secrets of Bulimia Nervosa and Anorexia Nervosa: The Most Lethal Mental Health Disorders
The most lethal of all the metal health disorders, bulimia nervosa and anorexia nervosa are extremely hard to recognize. Highly secretive diseases, they rarely show up in doctors' offices during physical or functional assessments; even laboratory tests do not show evidence of eating disorders until they are in their most advanced stages. By their nature counterintuitive, eating disorders typically give victims a pseudo-sense of power and control, creating the illusion of feeling and becoming "better than ever." In actual fact, certain stages of recovery feel more precarious and painful than does the disease itself. Making matters even more confusing, many of the symptoms of these lethal disorders lay somewhere along the continuum of normal human behaviors. Who doesn't overeat, under-eat or engage in emotional or social eating at times?
Eating disorders, which essentially represent an abuse of food in an effort to resolve emotional problems, transcend a dysfunctional relationship with food to represent the tip of a physical, emotional, cognitive, behavioral and social iceberg, with early signs of clinical eating disorders typically evident in diverse life spheres.
8 signs that parents and families may see at home, around the dinner table, in the family bathroom, or the child's bedroom:
• Erratic eating, eating too much or too little, too frequently or too seldom.
• Dieting and other restrictive eating behaviors (in some instances vegetarianism or skipping meals) that can result in extreme hunger and gorging, irregular menstrual periods.
• Fear of putting on weight, with an all-encompassing preoccupation with food and eating that can account for as much as 80 percent of an individual's thoughts
• Hiding food, and feeling shame and guilt after eating it. The refusal to eat in the company of others.
• Depressive moods
• Various forms of purging, including self-induced vomiting, excessive exercising, laxative, diuretic, or Ipecac abuse
• Disappearances into the bathroom during or following meals
• Impulsive, immoderate and out of control behaviors beyond the realm of eating, that might include shop lifting, promiscuity, cutting, engaging in chaotic relationships, abuse of substances such as drugs, alcohol, nicotine, diet pills, etc.
There is nothing passive about eating disorders. Always on the move, they are either getting better or you can be certain they are getting worse. Eating disorder recovery can be a long-term process, requiring input from a diverse team of professionals including physicians, psychotherapists, family therapists, nutritionists, psycho pharmacologists and school counselors. The course of recovery will be as variable, must be as comprehensive, and in many ways will feel as convoluted as the course of disease, typically combining outpatient and inpatient treatment milieus and diverse treatment modes. Victims of eating disorders, as young as age 5 or as old as 60, male or female, individuals alone or living within the context of a supportive or not so supportive family system need help to recognize, accept and conquer these diseases...to become capable of reclaiming their lives, proactively, with steadfast commitment... to fight the good fight for life and life quality.
About the Author
Specializing in the treatment of eating disorders for the past 36 years, Abigail Natenshon, psychotherapist, author of When Your Child Has An Eating Disorder, and director of Eating Disorder Specialists of Illinois is on the cutting edge using techniques that enhances your body-and self-image healing. For free resources or to have Abigail speak at your next parental or professional group go to http://www.empoweredparents.com
