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on 9 September 2016

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Transcript of Captive

Agency Captive
With the advent of the Affordable Care Act small businesses have very few options to positively impact their overall healthcare costs.
The insurance companies do not share any medical claims data
Groups that participate in wellness receive little or no benefit premium savings
The insurance carriers do little to control or limit costs
Within Stapleton's small group health book, we have approximately 1,500-2,000 lives that could potentially be segmented out into 40-100 life pools within individual captive mini-cells. Employers participating in the individual pools would receive incentive's (potentially dividends) for profitability and participation in the plans Wellness initiatives.
Cell A
Cell B
Cell C
Cell D
Cell E
Cell F
Cell G
By segmenting our small group book of business into small individual cells, we believe it positions the captive to take appropriate action against poor performing cells and protects the performance of the group as a whole.
Through appropriate incentives and each of the participants in the cell working together collectively to meet health and wellness goals, the captive will receive financial stability which allows these groups to:

Lower their premiums
Control their medical claims costs
Sustain a healthier more vibrant workforce
Captive Small Group Pooling

To positively impact the affordability of health insurance for small businesses we believe that a captive pooling arrangement is one of the best ways to deliver value.

To achieve success in a pooling arrangement we believe that a plan needs to do more than just reduce the cost of insurance, taxes and fees. It needs to be progressive from a risk management standpoint and needs to be able to reduce, mitigate and eliminate claims. To achieve optimum performance we need to have the following:
Incentive based participation / wellness structured rate plans
Wellness strategies
Biometric screening to go up-stream to identify future large claimants (Disease Management Analytic)
Medical Home strategies that will ensure that the patient is receiving effective care all the way through the care continuum (i.e. Rehab, Palliative Care, Hospice, etc.)
Concierge Care Management to make sure that a patient is getting in front of the right medical specialists to avoid unwanted or unnecessary claims and to provide a better medical outcome
Reference Based Pricing to eliminate the gaps between medical plan discounts
Prescription Benefit Management
Tele-Medicine to provide the convenience of 24 Hours / 7 Days a Week / 365 Days a year medical care versus having people wait until its convenient or before the condition becomes exasperated

To achieve appropriate scale we believe that once a plan is established that we should recruit other brokers to bring their clients in
Incentives to other brokers
Need a way to protect their book from ACA
Provide exclusives depending on commitments and also provide brokers with AOR and first in protection
Full transcript