Vālenz CaptiV: Medical Stop Loss Group Captive Solutions

Reduce risks and gain control of your health plan spend with data-driven collaboration

As health care costs continue to rise, self-insured employers are facing greater risks of high-dollar claims. Roughly two out of every three self-insured health plans incurred a claim in excess of $500,000 last year, and more than 30% had a truly catastrophic claim of more than $1 million.*

Recognizing the significant advantages and cost effectiveness of combining employer plans in a medical stop loss (MSL) group captive program, Vālenz® CaptiV offers self-insured employers the opportunity to participate in the next generation of MSL group captives.

Vālenz CaptiV goes beyond risk sharing to provide a fully integrated, data-driven cost and risk reduction model. Success is built upon group members engaging early and often in managing their medical costs while improving health outcomes — and that’s precisely what Valenz CaptiV does.

How it works:

Vālenz operates at the forefront of risk and cost management by offering a complete and integrated ecosystem of data and service solutions to energize employers through data-driven control over their risk costs. Concurrently, Valenz CaptiV optimizes the health plan and benefits to reduce costs for both the employer and employee.

For self-insured employers with less than 1,000 employees, Valenz CaptiV leverages a larger and more diverse population to reduce plan level and catastrophic risk, while delivering exceptional cost reduction strategies, increased underwriting credibility and long-term rate stability for employees.

Valenz partners with the industry’s top captive manager and advisors, insurance carriers and claims administrators to deliver market-leading results for Valenz CaptiV members.

Why it works: The Power of the Valenz Ecosystem

Valenz operates at the center of the MLS group captive, actively engaging the group of employers and their employees in the Valenz proprietary ecosystem of data and service solutions.

From the inception of work with captive members, Valenz reduces the potential of incurring high-cost claims, creating the best opportunity to transform health plan costs.

Valenz engages data and enables better decisions across the life of a claim, pinpointing employees at highest risk, exposing gaps in network designs and aligning care solutions to employee and employer needs. That’s the Power of the Valenz Ecosystem.

With Valenz, employers visualize – and realize – every opportunity under the Claim Cost Arc. From pre-claim loss to post-claim resolution, our suite of fully interactive solutions build on one another, uncovering actionable information at each step in the life cycle of a claim.

Before a claim is realized, Valenz data identify opportunities to improve network design, analyzes employee health risks and aligns solutions to drive down the cost of care while improving health outcomes.

As the patient journey into healthcare begins, the ecosystem delivers and facilitates services and solutions that expertly navigate member health, ensuring in-network care for improved outcomes at appropriate costs. Valenz drives the right care in the right setting at the right time – and moves from reactive care to proactive population health management. By engaging employees early and often in the ecosystem, Valenz delivers a 20-40 percent improvement in savings to employers. As the central hub for care coordination, Valenz  empowers employees to make better health decisions and enhances the patient experience.

The Valenz model analyzes millions of data points within the ecosystem and weaves analytics into claim workflow for efficiency in cost and process – identifying additional negotiation opportunities with the provider.

Even after a claim is complete, we continue harnessing the power of real-time data and predictive modeling to protect the plan and manage potential risk. As a result, employers gain insights for  better decisions in plan modeling and provider contracting that bring balance to the cost-quality equation.

Meet financial objectives and risk tolerances

MSL group captives effectively provide employers with enhanced ability to optimize their self-funded healthcare plans. Properly structured group captives have proven to reduce costs and increase plan stability by effectively managing, diversifying and broadly diffusing risk.

Under the MSL group captive model, organizations that effectively manage claim costs are rewarded and those that face unanticipated costs are protected. Valenz CaptiV positions group members to succeed in controlling costs while improving health outcomes.

Benefits of CaptiV

With Valenz MSL group captive, your health plan will benefit from:

  • Risk Distribution: Valenz CaptiV includes a wide range of employer types and a diverse employee base, allowing us to distribute risk for greater underwriting predictability and rate stability.
  • Benefit Plan Flexibility: Valenz CaptiV members structure a customized benefit plans and risk participation levels to meet employee benefit and financial objectives.
  • Enhanced Data Integrity: Powered by v-Lens, the Valenz ecosystem offers unparalleled data-driven collaboration among captive members. The result is more strategic, proactive risk control and cost reduction decision-making which leads to improved profitability for Valenz CaptiV members.
  • Profit Sharing: As Valenz CaptiV drives down costs and mitigates risk, members share in the profitability of the program. At the end of the policy year, if the stoploss premiums contributed exceed the claims paid by the captive, the surplus is returned to members based on their contribution.

Selective Membership Positions Group for Success

Success for a group captive is truly predicated on the quality and engagement levels of its membership. The increased collaboration and engagement among a grouping of like-minded employers provides the platform for leveraging innovation in plan design, proactive risk control, and cost mitigation initiatives.

By taking a more discerning approach to membership and enabling more active, data-driven risk management, Valenz CaptiV is positioned to yield superior performance results.

And by integrating data and information from the Valenz ecosystem, we create value for everyone. Our ever-expanding analytic and predictive capabilities uncover new strategies to target the 5-15% of claims that drive up to 70% of health plan spending.

Preferred Valenz CaptiV Participant Profile:

  • 50 to 1,000 active employees
  • Currently self-insured or fully-insured with claims experience
  • Financially strong with the ability and willingness to assume additional risk
  • Committed to actively participating in progressive risk control initiatives

Take the Next Step

Are you looking to gain more control of your health plan and reduce the risk of catastrophic claims? Let us show you what Valenz CaptiV can do for you. Call (866) 762-4455

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Experience the Synergy

When we say the Valenz ecosystem is comprehensive, we mean it. With a complete selection of fully integrated wraparound solutions to complement the core solutions featured below, we deliver benefits far greater than the sum of all these parts individually.

Vālenz Access

Combine a quality-first provider network or open solution with a range of customized, data-driven services from the Access Solutions Suite.

Vālenz Care

Guide members to better care and outcomes at lower costs, for you and for them, with RN-led, triple URAC-accredited care management.

Vālenz Claim

Reduce costs and ensure accurate payments with comprehensive bill reviews and repricing methodologies, integrated analytics, and more.

Vālenz Assurance

Improve coding, reimbursement assurance, auditing, claim accuracy and compliance monitoring, all while saving time and costs.

v-Lens

Use advanced, drill-down analytics and predictive modeling to continuously disrupt the cost curve without compromising quality.

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