Managed Care Stop Loss

We have been managing capitated stop loss programs for 25 years.

There are many terms used to discuss managed care stop loss. Whether you are a physician group, hospital, ACO, PHO, MSO, or HMO, we have the experience and expertise to structure an insurance or reinsurance program that will protect your bottom line. It is important to work with a broker that understands the nuances of risk transfer in the managed care world. It is critical for the coverage to minimize the spikes and volatility affecting the profitability of a given membership.

Financial Review:

Prior to the placement of coverage, twentytwenty will perform a detailed risk analysis. One critical component of the review takes into consideration the amount of risk the entity can retain. This is critical to minimize the cost of coverage due to the market’s expected loss ratio. By understanding the risks, we focus on programs that blend retained risk with the purchase of insurance or reinsurance. Dollar for dollar credit is not provided within the market place; therefore the cost of coverage is expensive.

The twentytwenty financial review includes an analysis of how services should be valued. If the services are “over valued” too much will be spent on the insurance or reinsurance. What services are to be included in the coverage? We look at the risk components helping you determine if there are risks that should be retained. As an example within a physician group, does it make sense to include in house physicians in the insurance?

Deductibles, coinsurance and contract structures are important components that are a part of our thorough financial review. This is combined with a review your contracts and claims history to build a program that meets your needs from a risk transfer and risk retention perspective.

Program Management:

On an ongoing basis we monitor “at risk” claims tracking the trends of your population. Reports detailing the frequency, claim type, primary diagnosis areas, dollars paid, valuation of services and location of services. These reports are provided at the frequency based on the needs of our clients. Prior to the annual review and placement of coverage, the plan history is reviewed to determine any needed changes in the structure of the coverage. Custom packages are presented to underwriters each anniversary.