CaptiV, the data ecosystem helping small companies manage rising medical costs

US healthcare companies face a potential tidal wave of claims because of COVID-19 that may not show up until next year, according to Rob Gelb, chief executive officer of Vālenz, the US-based healthcare administration services provider.

“COVID-19 is going to have a whiplash effect on medical spending that is going to be a real challenge for carriers and may not properly show up until 2022,” Gelb says. He points to US cancer diagnosis figures, which have fallen sharply since COVID-19, suggesting a large number of cases out there that are yet to be diagnosed.

“That is bad news,” insists Gelb. “It isn’t that there is less cancer, there is just less diagnosis. When those cases are diagnosed there are going to be more cases coming through the system and because they have been diagnosed later they will invariably be more serious.

“There are going to be more claims and those claims will be larger than they would have been. Businesses need to prepare now.”

Vālenz launched CaptiV, a medical stop loss (MSL) group captive programme for self-insured employers with fewer than 1,000 employees, in early 2021, in partnership with MSL Captive Solutions. Gelb believes now is the perfect time for small and medium-sized businesses to be considering joining such a programme, to prepare for the challenging months ahead as surgeries that have been postponed since the start of the pandemic feed through the system, along with the resulting claims.

CaptiV is not just another group captive for medical stop loss, says Gelb. He describes it as “the next generation of MSL group captives”, a claim that is based on its proactive use of data to enhance medical cost containment. “It is an ecosystem of data,” he says.

CaptiV is managed by Strategic Risk Solutions, while MSL Captive Solutions assists on the underwriting and offers excess on the captive cover layer, alongside P&C insurer Crum and Forster. Each member in the group is underwritten individually. Members can select their own third party administrators to handle their claims, although Vālenz can offer advice if needed.

Ideal members
CaptiV is, in principle, open to all but there are ground rules to admission.

“The ideal member has between 100 and 500 employees and has some experience with self-insurance,” says Gelb.

“Members will have a common renewal period. We are looking for members that will embrace our philosophy, who are not shopping around for new stop loss coverage every year but are looking for consistency and are willing to build over time for improved outcomes.”

Gelb insists businesses need a new approach to how they manage their healthcare costs.

“People need to shift their mindsets, they need to get comfortable with being uncomfortable, that is how you improve results,” he says.

“According to a Wellnet survey 86 percent of brokers think BUCAH (Blues, UnitedHealth, Cigna, Aetna, Humana) do not meet the needs of their clients, and yet brokers continue to place their clients with BUCAH.”

The concept of CaptiV is based around the early identification of issues through modelling and enhanced data analytics, which can increase efficiency and deliver significant cost savings to its members, says Gelb.

“The principle is that engaging early and often leads to faster and better healthcare,” he explains.

“We triangulate the variables of cost, quality and utilisation,” he continues. “Other models tend to focus on one of these, and may consider another as a secondary factor, but we balance all three in a harmonious way. It isn’t always just about achieving lower costs on claims.”

Gelb believes early engagement and a focus on customer service marks CaptiV out from its competitors, as well as its focus on transparency. He describes it as a “concierge product”, offering care navigators to help members fully understand their coverage and help them make educated decisions. It offers ratings of the quality of the providers that are available, for example, to help them make more informed decisions.

“We want to improve experiences for our members, increase their engagement and their healthcare awareness,” he says.