Healthcare Cost & Risk Management
Fully insured premiums for mid-market employers keep climbing year after year, and a funding model that worked last year may not hold up this year. HUB's healthcare cost management tests whether your funding model is still the right fit.
Stay Ahead of Business Challenges
Three gaps standing between you and a funding model that fits
Limited access to pooled risk-financing markets, a funding model nobody has re-tested in years and cost projections built without clinical data all quietly inflate what an employer pays. HUB addresses all three as one coordinated cost strategy.
Actuarial projections built without current clinical and pharmacy claims data can look precise while missing the specific drivers, like specialty drug trends, shaping a given employer's costs. Meanwhile, PEO, actuarial and analytics decisions often sit with three different owners.
When actuarial and underwriting projections are built without integrating current clinical and pharmacy claims data, cost forecasts miss the specific drivers (like specialty drug trends) shaping a given employer's plan, and when HR, finance and benefits each own a different piece of the PEO/actuarial/analytics decision, no one owns the coordinated cost strategy.
An integrated actuarial-clinical-pharmacy team approach builds cost projections directly from current claims and pharmacy data, and coordinates PEO, actuarial and analytics decisions under one strategy rather than leaving them with separate, disconnected owners who never compare notes.
A cost projection built without the clinical data behind it isn't wrong on purpose. It's just guessing with better formatting.
Employers' cost projections and funding decisions are built from integrated actuarial and clinical data under one coordinated strategy, rather than from separate, siloed inputs nobody ever compares.
After four consecutive years of elevated cost increases, the case for a fundamentally different funding model has never been stronger. Many employers are still fully insured by default, simply because nobody has re-tested whether that's still the right fit.
A funding model chosen years ago can remain in place long after an employer's size, claims data and risk tolerance would support a better-fitting alternative, simply because nobody evaluates the decision each year.
An annual funding-model review assessing claims data, risk tolerance and organizational readiness against self-funded, level-funded and captive alternatives, replaces default renewal with a deliberate, re-tested decision made on purpose, not by inertia carried forward year after year.
Most employers don't choose to stay fully insured. They just never had the conversation with their broker about whether to change and what options exist.
Employers' funding model reflects a deliberate, current-year decision rather than an untested default carried forward from years earlier, when conditions and costs looked nothing like they do today.
Group captives typically require 50 or more employees to participate, letting mid-sized employers pool risk with peer organizations. Employers below that scale, or without an existing broker relationship in the pool, are left with fully insured pricing by default.
An individual mid-sized employer, negotiating alone, typically can't access the pooled risk-financing markets (group captives, alternative funding structures) that would give it better control over healthcare costs — those markets require aggregation with peer organizations that only a broker with an existing captive program can provide.
A broker-sponsored group captive or alternative risk-financing program gives mid-sized employers pooled access to markets and structures they couldn't reach negotiating alone, while Professional Employer Organization's (PEO) consulting expertise helps employers evaluate whether a PEO's bundled market access is the right fit or worth exiting.
The employers who benefit most from a captive were never going to find their way into one alone. Pooling only works if someone is already running the pool.
Employers gain access to pooled risk-financing markets and PEO alternatives that were previously out of reach negotiating individually, no matter how large they think they are.
Our Areas of Expertise
One cost strategy spanning funding, data, and PEO evaluation
Traditional cost-cutting treats funding model, actuarial projections, and PEO evaluation as separate decisions, each revisited only at renewal. HUB structures health care cost & risk management as one co-ordinated strategy, so funding structure, data, and market access reinforce each other instead of being decided in isolation.
Group captives let mid-sized employers, typically 50 or more employees, pool risk with peer organizations and share in underwriting profits rather than paying fully insured premiums alone. HUB sponsors and administers group captive programs specifically for employee benefits, distinct from general property and casualty captives, giving employers access to a pooling structure they could not build or join on their own. Stop-loss insurance, self-insured and level-funded plan structures round out the alternative-financing toolkit, each evaluated against an employer's specific size, claims experience and risk tolerance rather than offered as a one-size-fits-all recommendation. For mid-sized employers who have never had a genuine alternative to fully insured coverage explained to them, this is where that alternative becomes a real, accessible option.
A funding model chosen years ago rarely gets revisited, even as an organization's size, claims experience and risk tolerance change year over year. HUB's annual funding-model review tests fully insured coverage against self-funded, level-funded and captive alternatives, using an organization's actual claims data rather than assumptions carried forward from the original decision. For organizations considering a PEO instead, HUB's dedicated PEO Consulting practice evaluates whether a PEO's bundled insurance and HR offering is genuinely the right fit and supports a structured exit strategy for organizations already inside a PEO that no longer serves them. For employers who have not seriously reconsidered their funding model in several years, this review is where an untested default gets replaced with a deliberate decision.
Cost projections built on actuarial modelling alone can look precise while still missing what is driving a specific employer's costs, especially fast-growing categories like specialty pharmacy. HUB's named actuarial and clinical pharmacy specialists work the same cost problems jointly, building projections directly from current claims and pharmacy data rather than historical trend lines alone. Benefits Analytics extends this integration further, giving employers one coordinated view instead of separate, disconnected reports from HR, finance and benefits stakeholders. For employers whose cost forecasts have historically come from actuarial modelling alone, without clinical data behind the numbers, this integrated approach is what makes a projection something to plan around rather than a rough estimate to brace for.
HUB's Impact
How testing your funding model changes
Employers who move into HUB's alternative risk financing structures, including group captives, have seen healthcare cost increases moderate and, in many cases, decline year over year. HUB's alternative risk financing and PEO consulting help employers achieve results like these.
Case studies
Insights for Your Business
Healthcare cost and risk management insights and research
