STOP-LOSS CARRIERS AND CAPTIVES

Stop-Loss Carriers

HRM predictive modeling provides stop-loss carriers and managing general underwriters (MGUs) with key information about probable shock losses and overall aggregate spending.

It also provides information on high-cost, high-risk patients in the next 12 months. This includes predicted total cost, the estimated amount to be spent on pharmacy, and identifying major clinical risk drivers and specialty pharmaceuticals.

Stop loss carriers can generate fast, accurate quotes for renewals. Additionally, with monthly reporting, the carriers can monitor planned performance and identify new shock losses before claims are incurred. This allows them to manage their clinical and financial risk effectively.

Captives

Captives provide an additional level of protection to small groups. Captive insurance programs can use HRM predictive modeling to forecast each group’s pricing accurately. They can also track performance over the year by evaluating the individual employer groups within the captive and identify those running ahead of or below cost expectations.

Monthly updates to HRM plus our Daily Dashboard identify new plan members likely to hit the spec deductible within the policy period.

Additionally, groups can utilize the information to engage with population health management to improve health and reduce costs. Since 85% of the cost of the health plan is claims, a claim not incurred is not a cost to the plan. Captives can better manage their overall risk by utilizing predictive modeling and accurately assessing the risk of the individual plans.

Reporting Capabilities

  • Stop-Loss Risk and Profit Management: The system provides regular reporting of loss ratios, retention rates and high-risk areas at the group and book of business level to maximize profitability.
  • Stop-Loss Underwriting: Custom group reports can be generated that reflect the specific risks the department wants to check. It can include forecast high risk/cost members, potential transplants, specialty drug use, top 10 forecast members, etc. to increase underwriting efficiency and quote generation.
  • Stop-Loss and Captive Care Management: Offer groups discounts for using predictive analytics for approved population health management to reduce overall costs, minimize the development of future clinical risks and address the needs of possible shock-loses to manage financial and clinical risks.
  • Custom Daily Dashboard: Automatic reports identifying members with forecast costs above the spec alert level used by the care management team to engage with large case management and care coordination with provider. Outcome reports for such members and the groups are also available.