There’s a Problem With Health Care Benefits: Transparency and Technology

How can an employer – especially a smaller employer – understand how to improve what health care services you pay for if you can't measure or manage anything? The health insurance companies have the money, and the data and the power. What do you have?

The problem with health care benefits is the legacy technology and processes.

  • They add to the cost of health care.
  • They enable the institutionalization of medicine.
  • They can’t give you the data – your data.
  • They have the control.

How can an employer – especially a small employer – fight back against the inefficiencies of legacy systems? The insurance companies control the money, and the data and the power. How can you take back control?

Self-funding is the solution that lets you take back control.

Self-funding gives employers like you direct control of the structure and delivery of health care benefits. With a traditional self-funding model, an insurance company or an independent third party administrator handles all the administrative tasks, while you cover the cost of participant claims. Vxtra does things differently, to protect you from shock claims and give you more control over the processes that contribute to the cost of your health care benefits.

But isn’t self-funding risky?

It can be. But Vxtra does things differently so that you have more protection. We help you self-fund safely.

Our three-tier model and process is called Destiny+ and it’s changing the power structure of health care benefits for smaller employers.

  • Tier 1 – Each employer member assumes the first layer of risk (up to a predetermined amount) for their own plan participants under the terms of your own custom health benefits plan design.
  • Tier 2 – Our members collectively contribute to what’s called a “captive layer.” The captive layer is a shock absorber that limits employers’ exposure (up to a second predefined amount). Tier 2 protects you from the volatility of claims that exceed Tier 1.
  • Tier 3 – A stop-loss contract with an A-rated reinsurance company covers claims costs that exceed the captive limits.
  • Overarching Tier – Vxtra leverages advanced claims surveillance technology so you never pay more than you should. We root out coding errors and questionable billing practices and advocate to resolve issues in your favor — before you pay for services.

Captive protection is on your side.

As a member of the Destiny+ captive, a portion of your stop-loss premium is dedicated to the funding the captive. We call it the “shock absorber.” When you incur a claim that exceeds your practice fund, it is covered by the captive. Members share risk through their collective contributions to the captive.

  • In years when claims are lower, any excess captive funds are returned to the members.
  • If claims exceed the funds available in the captive layer, those claims are covered by the stop-loss insurance. Your financial exposure is defined and limited.

Here’s how our 4-tier model works in the case of what we call a “shock” claim – one bigger than the limits of the captive layer.

Vxtra-Tiers-graphic-L2.2-072716

 

Superior Financial Performance

Destiny+ has consistently out-performed traditional fully insured and “stand alone” self-funded carrier-based offerings in terms of renewal rates and cost-controls. The reason why? Our cost-management technology and processes work for you, not the hospitals or insurance companies.

Profit Redistribution

When the captive layer isn’t used, we re-distribute 100% of the underwriting profits back to you. Since 2012, Vxtra has distributed more than $2.3 million in underwriting profits back to our members. That’s money that would have been lost forever to the insurance companies.

Reduced Volatility

Our four-tier structure reduces claims costs, volatility, and your financial exposure. The captive layer ensures that if you are hit with a high-dollar claim, we first make sure the claim is billed appropriately before the captive absorbs the impact – not you. That means your annual costs are more predictable.

Claims Transparency

Using sophisticated claims surveillance software, we identify questionable bills. When we spot legitimate concerns, we intercede on your behalf and advocate for you with the providers in question. The result? You save money, and so do your plan participants.

Population Management

When it comes to your employees and their health, our fully integrated technology platform collects more discrete data that enables us to leverage “big data” analytics to identify health risks and gaps in care. Our approach to process management keeps your participants healthy – and reduces your costs.

Minimized Regulatory Costs and Exposure

With self-funding, our members are able to leverage federal tax exemptions and avoid many costly Affordable Care Act and state mandates. In addition, members’ premium tax burden is significantly reduced.

1Superior Financial Performance
2Profit Redistribution
3Reduced Volatility
4Claims Transparency
5Population Management
6Minimized Regulatory Costs and Exposure