Joan Enoch, Human Resources Manager at Lift-All Company, spends a lot of time thinking about the company’s medical plan costs, as one might expect. But making sure Lift-All offers employees and their families the best possible medical benefits is even more important to Enoch. Fortunately, as a Medical Stop Loss group captive member, Lift-All has access to unique resources that enable the company and its fellow members to offer employees superior medical coverage while controlling healthcare spend.
During a recent episode of Captive Intelligence’s Global Captive Podcast, Enoch and Mike Van Ham and Joe Parrilli of Captive Resources — which supports several Medical Stop Loss group captives — explained why the group captive structure can deliver both better care and cost savings.
Here are a few highlights from their conversation with host Richard Cutcher. You can listen to the full episode here.
Enoch said Affordable Care Act reforms provided Lift-All, a Pennsylvania-based load securement manufacturer with five plants in the United States and around 250 employees, the opportunity to offer employees new and better medical benefits.
Enoch provided insight into the innovative features of a Medical Stop Loss group captive. For example, the group captive helps Lift-All structure plans to include preventive care — and educate employees and their families to use it. “We get close to 85% of our employees participating in onsite wellness screening,” Enoch said.
Employee health education also has prompted many Lift-All employees — 30 percent of whom speak English as a second language and are typically unfamiliar with the U.S. health system — to enroll with a primary care physician (PCP). That has yielded money-saving choices, Enoch said. The typical co-pay is $10 to see the PCP compared with $150 for an emergency room visit.
Van Ham, Captive Resources’ Senior Vice President for Health and Wellbeing, noted that the captive has urged member-companies to own and understand their medical plan data and financials as plan fiduciaries, as outlined in the Consolidated Appropriations Act (CAA). Lift-All has used its understanding of its costs to employees’ advantage, Enoch said. Having used data analytics to uncover the high costs of bloodwork and diagnostic lab work at large health systems’ labs, Lift-All determined that third-party labs could be a lower-cost alternative for employees.
As a group captive member, Lift-All can realize further plan savings by setting its deductibles and co-pays and structuring its own wellness plans. Additionally, the company can choose its third-party administrator (TPA) and pharmacy benefits manager (PBM).
Enoch said group captive membership has given Lift-All access to data analytics, enabling the company to source medications creatively and lower costs. She said Lift-All has been able to source some FDA-approved drugs from vendors outside of the United States for 30%–40% savings. With the availability of more data, she added, Lift-All will challenge more vendors to offer cost-effective solutions.
Van Ham pointed out that group captive member-companies have win-win relationships enabling each one to offer employees exceptional medical coverage while containing healthcare cost inflation.
“The ability to implement and share these ideas — it’s not only going to help Joan and Lift-All in being able to report to her leadership around the cost savings and being able to reduce their spend and trend,” Van Ham said. “But cumulatively, this has an impact across the captive.
“So all of these employers implementing similar strategies … helps create efficiencies across the captive, which ultimately leads to the captive layer and the reinsurance layer taking on less risk. With less risk to absorb, we’ll see lower premiums and program spend going forward.”
“The emphasis on well-being and health management really gets down to an element of control,” said Parrilli, Captive Resources’ Senior Vice President for Medical Stop Loss. “The like-mindedness of the employers, the sharing and networking of ideas, really allows those groups to have the ability to learn new innovative approaches from each other but still have the ability to create a plan that fits their company and culture.”
Parrilli pointed out that the group captive has created ad hoc committees for areas such as cancer treatments and pharmacy spend. “When you have members like Joan and others leading the charge in specific areas, you have buy-in from the members, all trying to drive toward the same conclusion, even though they're all going to do it a little differently,” Parilli said.
Listen to the full conversation on the Global Captive Podcast.