Putting the employee in charge of a consumer-driven health plan

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As co-owner and chief innovation officer for Borislow Insurance, Mark Gaunya is branching out his firm into the health captive market. Calling the division Captivated Health, this New England branch aims to mitigate the cost of health insurance for the small employer group.

“We’re based in Boston, Mass., but it is available in 25 states and growing,” Gaunya says. “We have six employees who are full-time dedicated to Captivated Health, but there are also shared resources between Borislow Insurance and Captivated Health.”

Gaunya says a captive insurance structure is best for small employers because it allows them to self-insure and share risk with likeminded organizations. To promote this strategy, his firm has created four principles that serve as a cornerstone for Captivated Health: Members first, consumerism, creating a culture of health and wellbeing, and governance.

Because he feels that brokers are experts in the benefits industry, Gaunya says they know the rules of the game and generally fall into categories that he calls “stadiums.”

“There’s the fully-insured stadium, the self-funded stadium and then there is this shiny new thing called the captive stadium,” he says.

Gaunya compared Captivated Health to the game of golf. Those employees and employers enrolled in a captive should be outfitted with the tools they need to be covered — similar to a golfer’s bag. They will also have the availability of a Captivated Health adviser to assist them with making the correct medical decisions.

The advice from the adviser should only be solicited if the employee chooses to contact the adviser, and not a series of unwanted and intrusive communications that will be ignored.

“Would you like someone calling you at home while you’re trying to have dinner with your family to talk about your diabetes? No, then why recommend it?” Gaunya says. “Employers want access to this information when it’s convenient for them.”

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The second principle of Captivated Health is consumerism and Gaunya says every employer involved in the captive must offer a consumer-driven health plan. This means a lower premium with a higher deductible plan with an HSA, an HRA or a combination of the two.

“The program principles require participating organizations to offer a consumer-driven health plan with an HRA or an HSA, preferably, because we want you engaged,” Gaunya says. “You will care more when it’s your money being spent.”

To create a culture of health and wellbeing, Captivated Health has developed an algorithm that allows its brokers to look at an employer’s demographic through their claim experience, the employer’s environments and by a survey of employee interest.

Captivated Health’s algorithm was created internally using the experience Gaunya had with clients over the course of his years in the benefits industry, and with the help of his company’s director of health and wellbeing.

“Through a collection of all of that data, we push it through that algorithm and creates a three to five-year road map for an employer to build a culture of health and wellbeing in your workplace,” Gaunya says. “That supports consumerism and supports the member.”

Finally, under governance, Gaunya and his colleagues are program managers for Captivated Health because they consider themselves to be experts in the market, but the risk of providing healthcare to employees is left to the employer and not to the service.

Gaunya likens the advisers’ role to that of a computer processor. “Our job is the strategic thinking part, the processing part, the identification of claim trends and behavior patterns,” he says. “We are solution providers focused on improving that member’s healthcare experience. Our mission is to help consumers build healthcare confidence.”

Captivated Health currently has 33 clients: 30 schools and three engineering businesses. Each member elects a chairman and vice chairman from their company to organize three committees within their organizations. These committees include finance committee, governance and membership.

“They provide organizational leadership and ensure that Captivated Health adheres to the bylaws,” he says.

Because the members for Captivated Health are in the education and engineering industries, Gaunya created two separate bylaws for the industries because of their different needs. In the stop loss contracts of insurance, for instance, schools need more help with cash flow. Meanwhile, engineering companies strictly handle employees and schools deal with faculty and staff.

“The bylaws set out what’s required in the program and they also provide for the election of a chair and a vice chair from the program participants, and then there are three committees — governance, finance and membership,” Gaunya says.

“Healthcare is a $3.5 trillion industry, there are entrepreneurs in every nook and cranny all across the country,” he says. “We are trying to find as many talented and capable entrepreneurs as we can to put more golf clubs in our golf store.”

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