Captives take centre stage in driving enterprise-wide risk strategy
The Cayman Captive Forum 2025 brought together risk leaders from across the globe, but few sessions captured the spirit of innovation as vividly as “The New Face of Risk: Captives and ERM in Action.” Moderated by Lorraine Lewis, executive vice president at Alliant Insurance Services, the panel featured two prominent voices in healthcare risk management: Vicki Haddock, director of risk and captive management at ECU Health, and Lisa Athens, managing director of Baylor Scott & White Assurance. Over the course of the hour, the conversation illuminated how captives are evolving from traditional risk-financing tools into dynamic enablers of enterprise-wide strategy.
Lewis opened the session by reminding attendees that the value of the captive community lies not only in technical expertise but also in shared experiences. She portrayed captives as “juggernauts”—vessels of strength, control and adaptability navigating turbulent risk waters. This metaphor carried through the discussion: captives, the panellists argued, allow organisations to steer their own course instead of being buffeted by insurance market volatility.
Haddock began by recounting ECU Health’s shift from a long-standing self-insured model to a captive structure in 2017. Under the old model, she explained, claims tended to be invisible outside the risk department—“out of sight, out of mind”. This created a disconnect between financial decisions and risk realities. The establishment of the captive changed that dynamic almost immediately. Senior leadership saw firsthand how the captive’s performance flowed through to the organisation’s bottom line. Dividends generated by favourable experience became tangible reinvestment opportunities, and risk issues that had once felt siloed now featured prominently in boardroom conversations about operational performance, patient safety and capital planning.
A significant turning point for ECU Health came when the organisation added workers’ compensation to the captive. This move, Haddock said, demonstrated the flexibility of the structure: bringing the risk in-house enabled better data, greater transparency and stronger accountability for outcomes. It also empowered the system to examine its retention strategy. After a thorough analysis revealed that most claims fell well below the previous attachment point, leadership decided to increase the retention. This not only produced cost savings but also accelerated surplus growth—giving the captive greater capacity to support strategic initiatives.
Athens offered a parallel narrative from Baylor Scott & White Health. Following the 2013 merger that created the system, the leadership team used the captive as a unifying platform. What began with professional liability soon expanded, year by year, into a broad portfolio including cyber, pollution, directors and officers liability, law enforcement liability and property. The addition of property coverage proved especially impactful. Prior to this, property losses were managed by individual facilities with little system-wide visibility. The captive transformed this fragmented approach into a coordinated programme with centralised oversight. Once the captive began tracking and analysing property claims—particularly those related to water damage and roof failures—patterns emerged that informed procurement, maintenance and building standards. Athens noted that Texas’s extreme and rapidly changing weather patterns made this oversight invaluable.
The conversation then turned to board engagement and governance—an area both panellists described as essential to a successful captive. Athens emphasised the importance of carefully designed agendas and ongoing education. Each year, her team introduces thematic sessions for board members on emerging risks, ensuring that conversations remain forward-looking. She also highlighted the value of stability: long-term board members provide continuity and help sustain a mature captive culture.
Haddock echoed these points and described ECU Health’s deliberate efforts to immerse board members in the broader insurance ecosystem. A visit to Lloyd’s of London several years ago proved transformative, giving directors a firsthand look at underwriting markets and risk syndication. This shared experience fostered more nuanced discussions and a deeper appreciation of the captive’s strategic role. Both experts agreed that consent agendas, multidisciplinary participation and regular touchpoints with operating units help build confidence and stimulate innovative thinking.
Risk culture featured prominently in the latter part of the discussion. Lewis asked the panellists how the captive contributes to shaping behaviour across their organisations. Haddock credited grant programmes funded through the captive with energising staff engagement. Frontline teams can propose safety and quality projects, secure funding and implement improvements that reduce risk and enhance patient care. This not only strengthens outcomes but also reinforces the idea that the captive exists to serve the people delivering care.
Athens described a similar impact at Baylor Scott & White. She explained that the captive helps break down silos between risk, finance, operations and clinical leadership by generating consistent data and shared performance metrics. Claims management has also improved: early discussions between risk, legal and operational leaders enable more cohesive decisions, taking into account not just financial exposure but also reputational considerations and the behaviour of involved parties.
Lewis reflected that captives have become far more than vehicles for financing losses. As the panel demonstrated, captives can drive cultural change, enable strategic investment and strengthen the resilience of complex organisations. In a rapidly evolving risk landscape, the captive—as juggernaut—offers not only a shield against uncertainty but also a powerful engine for organisational growth.
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