Every year, Captive Review releases their Power 50 list, which spotlights top professionals in the world of captive insurance. This year our SVP, Prabal Lakhanpal was featured on the list at #42. Check out the full article here.
When it comes to Actuarial Services, many people are unclear what it entails. The video below breaks down how actuaries can help cut costs and optimize benefits plans.
This year we had the pleasure of spending Valentine’s Day with some of healthcare’s sharpest minds within the Boston area at the Boston Business Journal’s “State of Healthcare” luncheon. Spring was excited to sponsor the event again as we take pride in both our Boston roots and in our commitment to advancing innovation in healthcare. As attendees enjoyed a delicious lunch, an impressive panel took the stage to share their different viewpoints on healthcare: Anne Klibanski, MD, President and CEO of Mass General Brigham (the Brigham); Lora Pellegrini, Esq., President and CEO of the Massachusetts Association of Health Plans (MAHP); Kevin Tabb, MD, President and CEO of Beth Israel Lahey Health; and Greg Wilmot, President and CEO of the East Boston Neighborhood Health Center.
After every conference or event, I like to take the time to reflect. Here are my five key forces impacting healthcare today, in Boston and beyond.
1. Capacity
Anne kicked things off by addressing a crisis in national healthcare: capacity, meaning there is not enough room to take in the patients who need the kind of care in which Massachusetts prides itself. In fact, every day over 200 patients within the system sit in the emergency room or elsewhere because there is no bed for them. This type of emergency capacity used to happen once every few months, but it is now the daily norm.
The problem is obvious. What is not so obvious is the solution. However, Anne provided the following insight: access is capacity. So, when we think long-term, we need to focus on efficiency and access in order to solve for capacity issues. The discussion called to mind the following questions:
– Are community hospitals being fully leveraged for the kind of care they are best suited for?
– What kind of care can be delivered virtually, and are we maximizing those capabilities? A recent development here is virtual urgent care.
– How can we increase hospital at home usage? The fact is that people prefer this method, and it increases care while decreasing costs.
– How can we increase our ability to treat patients in an outpatient or ambulatory setting? Massachusetts is near the bottom in the country when you look at the number of outpatient sites available. We need more sites, closer to home, with a lower cost model, so that we can save beds at highly specialized facilities like the Brigham for patients who need them most.
2. Affordability
Lora joined the stage to help uncover the factors behind the longstanding issue of affordability. At MAHP, they are focused on trying to make healthcare both simpler and more affordable. In Massachusetts, Lora said, we have the best data in the country regarding the drivers of healthcare costs, and that data identifies the two top drivers as unit price and pharmaceutical costs. Lora stressed the importance of the pharmaceutical and life sciences companies taking responsibility and being a part of the conversation around healthcare costs. While health plans traditionally take very little margin, and instead make most of their money from investment income, pharma on the other hand is taking in approximately a 30% profit for drugs that are sometimes federally funded. In this regard, more transparency around pricing and accountability is needed. Additionally, Lora highlighted the following affordability factors:
– Technology can and should be leveraged for things like prior authorization and streamlined credentialing. “There should be no paperwork,” said Lora. While you might be surprised that telehealth is not its own item on this list, the panelists pointed out that it is critically intertwined with affordability. Kevin pointed out that the big costs in healthcare are not individual visit payments, but rather frequent trips to the ER and people becoming sicker because they didn’t get care sooner. By marrying this goal of moving more people to outpatient or community health centers when appropriate with the access benefits of telehealth, we can make a difference in costs.
– Healthcare costs are prohibiting employers from offering other innovative benefits to employees. How can employers find a balance? For self-insured employers, which Lora says make up about 60% of the MA market, there is more of an ability to customize programs and invest in wellness initiatives and other perks. On the flip side, for fully-insured employers, especially small businesses, this is harder to do. What we see sometimes is when costs are added due to new legislation or another development, employers start considering a self-insured model, but when more parties leave the merged market, the older and sicker populations are left behind.
– The Massachusetts Health Policy Commission (HPC) is doing great work, but Lora says they hold too little authority, something that needs to change.
To expand upon this topic, Greg pointed out that the key to the cost problem was to increase access and utilization of primary care and preventative medicine, stressing that by improving health outcomes upstream, we can mitigate the downstream impacts on the rest and more expensive aspects of our health system. Community health systems like the East Boston Neighborhood Health Center plays a big role here.
3. Workforce
Kevin brought us up to speed on the core challenges in healthcare related to workforce, a topic which he emphasized is a widespread issue across industries and geographies. In healthcare, though, he explained that it is the top issue keeping executives up at night and described it as an “acute on chronic crisis.” Importantly, Kevin noted that the workforce crisis didn’t come to fruition overnight, and we won’t get out of it overnight either. We were at the edge of a precipice, and the pandemic tipped us over. At Beth Israel Lahey Health, they are focused on competitiveness of job offers, adaptation of roles and flexibility, and partnering to train up both within the community and within their system.
As Greg noted, healthcare workers have “been running a marathon at a sprinter’s pace.” He is focused on rebuilding the workforce, one that is reflective of the populations they serve and emphasized the need to focus on the next generation of talent.
On the topic of workforce, Anne added that it’s not just about salary. At the Brigham they are rethinking how to create a safe and healthy work environment. We have seen a rise in workplace violence in healthcare and beyond, so how do we better protect our staff? “We are what we tolerate,” remarked Anne, so we need to make sure we’re not tolerating behaviors and practices – both from staff and from patients and other constituents – that we shouldn’t. This brings us to our next point.
4. Equity
As Anne pointed out, allowing gender-based or racist remarks, or violent behavior prohibits the development of a safe and inclusive workplace. Greg brought a unique viewpoint to the conversation as his community health center serves a very diverse population. Smaller clinics and health centers are often over-looked, but as Greg noted, one in five MA residents are receiving care at a community health center. He stressed the need for a two-prong approach:
- What happens in the exam room, which at community health centers is largely primary care and preventative medicine.
- What happens outside the exam room. Here Greg noted the importance of social determinants of health such as behavioral health, housing stability, food insecurity, education disparities, language barriers, and technology. How do we bring these issues into governmental policy? How do we invest in communities of color to address things head-on instead of waiting until they fester into bigger problems? How do we ensure equitable opportunities in the job market?
Greg argued that only by focusing on these two health components in tandem will we make any difference in health equity, and healthcare at large.
When it comes to telehealth, a digital divide still exists related to broadband, Wi-Fi, devices, medical literacy, and age (there is a large gap in senior utilization of telehealth). This needs to be part of the equity equation too. Do we need fancy technology? Or, as Kevin pointed out, “almost everyone has a phone.” Could a phone call suffice in some cases?
Lastly, all panelists agreed that COVID-19 highlighted the inequities that had been there all along, creating an urgency around equity that we very much needed.
5. Unity
Greg left us with a powerful, albeit brief poem by Muhammad Ali to ponder: “Me, We.” His point was that while we all have a personal responsibility for affecting change, we also can’t achieve that change on our own. It takes a “me” and it takes a “we.” The consensus was that each stakeholder has a role – providers, insurers, pharmaceutical companies, the government, and so on. When these cogs in the wheel operate in silos, the wheel does not turn.
Anne remarked that when the pandemic hit, it created a galvanizing force that brought all types of parties, including so-called competitors, together for the common good. Now, the impacts of COVID-19 have faded, but the panelists pondered why we can’t use our broken system as the next galvanizing force to bring everyone to the table. Numbers 1-4 on this list cannot be addressed without prioritizing number 5. This will require more active listening and compromise.
Overall, the Boston Business Journal’s State of Healthcare luncheon provided a thought-provoking and multifaceted conversation that gave me much to think about. But as we move toward what is hopefully a brighter future for healthcare, I will leave you with one final thought from Greg Wilmot:
“If we were to rewrite our [healthcare] system, would we design it the same way? We have been writing the same story and changing the last chapter and expecting a different outcome. That doesn’t work. We need to go back and start at the beginning, and rewrite chapters 1-10.”
Greg Wilmot
Spring Consulting Group provides a wide range of Captive Services when it comes to the Employee Benefits and Property & Casualty (P&C) industries. In this Whitepaper, you can learn more about our captive services and how we approach captive implementation/optimization.
In 2023 we are expecting to see lots of changes when it comes to Paid Family and Medical Leave on both the state and nation-wide level. In this whitepaper, we break down the current landscape of paid leave programs and recommendations for employers to adopt and manage effective paid leave policies.
Title:
Senior Vice President and Co-Founder.
Joined Spring:
I was one of the original founders of Spring (alongside Karin Landry) back in 2004, as a spin out from Watson Wyatt Insurance & Financial Services, Inc.
Hometown:
I was born and raised in Golden Valley, Minnesota (Minneapolis area), but went to college in Wisconsin.
At Work Responsibilities:
I lead our absence management team, and work with employers of all sizes and industries and leading insurance carriers and administrators in the space. I also head up our Spring’s market research surveys and benchmarking.
Outside of Work Hobbies/Interests:
Being outside, going for walks; spending time with family, and of course, watching my kids play basketball.
Fun Fact:
One thing many people don’t know about me is that I actually use to run track in high school and led the 4×100 relay.
Describe Spring in 3 Words:
Interesting work & caring culture, I guess that’s actually 5 but that’s how I would describe Spring. The people all care about each other and have each other’s backs and support each other. We have a motivated team that is eager to collaborate.
Do You Have Any Children?
Yes, I have two beautiful children, my daughter is 17 and my son is 15.
Favorite Place Visited:
Greece, by land and sea! It has to be my favorite because of the history, beautiful architecture and amazing weather!
If You Were a Superhero, Who Would You Be?:
It would be Elastigirl from The Incredibles because her arms are so long and she can hold everybody. She can take care of everything!
Last week we wrapped up Business Insurance’s 2023 World Captive Forum (WCF) in Miami, FL. This year’s conference brought together hundreds of stakeholders in the captive space to network and discuss leading trends in the industry. As a member of the advisory board, I’m glad the event was such a success; below are some of the topics I found most prevalent during this year’s conference.
1) Captive Updates
When it comes to captive regulations, we have seen many changes in just the last year. With the growth and development of different domiciles all around the world comes new regulations to which captive owners and employers must adhere. Below I have included a couple interesting sessions that explain how regulations surrounding captives have changed across the globe.
– Government insurance representatives from North Carolina, Vermont, Oklahoma, Bermuda and Michigan discussed trends, best practices and laws impacting the captive industry (and their respected domiciles).
– As Latin America has been growing their position in the captive space, a session featuring the Official Advisor for Latin American Affairs from the Government of Bermuda spoke about current LATAM trends and what we can expect to see from the region moving forward.
2) Cyber Captives
Although writing cyber liability coverage into a captive is not a new practice, it is still nowhere near as common as placing medical stop-loss or property & casualty lines into a captive. This year cyber coverage was a hot-button topic at the conference and will most likely continue to be, as cyber attacks continue to pose substantial risks.
– In a breakout session titled “Cyber Captives” a group of risk experts discussed current trends in cyber insurance and the limitations for captive coverage in cyber.
– In a session titled “Secrets Cyber Criminals Don’t Want the Insurance Industry to Know”, the CEO of BlackShield Cyber, Dioly Alexandre, explained how cybercrime has changed over time and what insurance companies need to do to keep up.
3) Healthcare & Captives
Whether an employer in the retail space is looking to use a captive to fund health benefits, or whether a hospital organization is leveraging a captive for its medical malpractice and other unique liabilities, captives and healthcare have always been closely intertwined. At WCF this year some highlights of this dynamic included:
– Spring’s Managing Partner, Karin Landry, presented on trends in medical stop-loss (MSL) and how this tactic can help employers proactively manage healthcare costs and lessen the impact of catastrophic claims. The discussion included a deep dive into what is driving upticks in healthcare costs; walk-throughs of case studies illustrating MSL advantages, including an overview of Canon USA’s captive story; and a detailed explanation of Medical Expense Cost Containment (MECC) and how it comes into play.
– The first session of the final day reviewed implications of medical malpractice coverage following the Supreme Court’s decision on abortion services and best practices for healthcare providers.
– In the session “Global Medical Claims Developments – Covid-19, Hyperinflation, Musculoskeletal and Mental Health,” the panelists discussed how captive managers should address specific medical conditions and unusual medical claim patterns.
4) The Future of Captives
Although nobody knows for certain the future of the captive industry, we are seeing various patterns that suggest we will see many changes to come. Aside from new domiciles and new types of coverages, we are also seeing different approaches when it comes to current captive practices.
– In a session on “Hybrid Captives,” I presented on innovations in the property & casualty market that allow captives to more meaningfully control property exposures and premiums.
– As a newer member to the World Captive Forum Advisory Board, I was joined by University of California’s Karen Hsi in a roundtable for younger professionals entering the industry, including a discussion of what the next generation of talent is looking for and how they can get themselves on a promising career trajectory.
– As diversity, equity, and inclusion (DE&I) is a current top priority for many companies, this session discussed how by reinvesting underwriting profits, captive programs can be used to finance DE&I strategies to meet the needs of a diverse workforce.
Getting a break from Boston winter was a plus, but the ability to reconnect with industry leaders and collaborate on strategies was the real draw. We are excited to see what the World Captive Forum holds in store for us next year and we will continue to keep you up-to-date with developments in the captive space.
Our captive insurance team was spotlighted in an article by Captive Intelligence, after helping a client reinsure their employee benefits under the United States’ Employee Retirement Income Security Act (ERISA) into their captive. Our client received final approval from the Department of Labor (DOL) in February 2022, with the last successful applicant obtaining approval in 2017. Check out the full article here.
the International Foundation of Employee Benefit Plans recently wrapped-up their 32nd Annual Health Benefits + Conference Expo (HBCE) in Clearwater Beach, Florida. The conference brought together healthcare and benefits professionals from a range of industries to discuss leading topics and share expectations for the future. Having heard such positive feedback about the event, Spring was glad to attend, exhibit, and speak at the conference. Below are some of our biggest takeaways.
1) Pharmacy Cost Containment
This year there was a lot of talk surrounding the price of prescription drugs and tactics employers can adopt to help control costs without cutting benefits. There are many factors influencing the high costs of pharmacy drugs, some of which include chronic disease prevalence, the aging population and the growing volume of specialty medications. Below are some of the top sessions focused on controlling Rx costs.
– Representatives from Express Scripts explained the upsides to working with a Pharmacy Benefit Manger (PBM) and how they can help address pharmacy policies in their session titled, “How to Work With Your Pharmacy Benefit Manager.”
– The CEO and Co-Founder of TruDataRx, Cataline Gorla, discussed how comparative effectiveness research (CER) is being used by other countries to decide which drugs work best for specific medical conditions, and how self-insured employers can save money with said data.
2) Addressing Chronic Conditions
According to the Center for Disease Control (CDC), 90% of the nation’s healthcare spending goes towards people with chronic and mental health conditions1. As chronic diseases are very common among the American workforce, employers have started implementing specific benefits and policies to address common conditions, such as diabetes and obesity. Some of the sessions around this topic that we found most interesting include:
– Speakers representing the Nashville Public School System explained how they were able to introduce free resources such as telenutrition and fitness center access to help combat obesity and other health disparities.
– Dr. Mudita Upadhyaya from St. Jude Children’s Research Hospital presented on prevention strategies to address mental health and obesity in a pre- and post-COVID world; and why a mixed approach may be best.
– The Diabetes Leadership Council’s CEO, George J. Huntley spoke on diabetes and chronic disease risk management strategies, including medicines and technology that can help patients manage and prevent the disease.
3) The Future of Healthcare & Benefits
In recent years we have seen a great shift in the healthcare and benefits industry; we saw a great increase in telehealth, mental health resources, new/alternative types of paid leave, including sick leave and more. As we transition to a post-COVID world, we expect the evolution to continue. Below are some of the top trends professionals believe we will face in the coming years.
– Our Senior Vice President, Teri Weber, presented on market forces employers can utilize to meet future absence management challenges. Her session listed techniques employers can adopt to improve day-to-day administration of disability, absence and accommodations.
– In a session titled “Innovative Health Care Models—The Future of Direct Primary Care,” the presenter explained how many employers are changing to value-driving healthcare models to boost access and reduce costs.
– A session titled “Breaking the PTO Mold, Without Breaking the Bank,” reviewed how typical Paid Time Off (PTO) programs can be altered to better support employees’ well-being and financial health.
– The final session of the conference spotlighted how the pandemic has led to an increase in personal, economic and other stressors and has had a drastic impact on mental health, substance misuse and addiction. Attendees were informed on how they can implement workplace solutions that address these issues as well as identify warning signs.
The warmer weather was certainly a bonus, but the insights we gleaned and connections we made were what will keep us coming back to the HBCE conference. We want to thank IFEBP and our fellow colleagues who took the time to share their experience, stop by our booth, and make the energy so positive.