An Introduction to Self-Funding & Captives

Jul 1, 2025
26 mins

Episode Description

In this episode of Captivating Health Insights, host Maddison Bezdicek sits down with Dave Gillis, Head of Business Development for Health Solutions at Captive Resources, for a crash course in self-funding and group captives. They unpack how shifting from fully insured to stop-loss arrangements can allow employers to reclaim transparency and control over their second-largest P&L cost.

Dave debunks worries about catastrophic risk and administrative complexity, shows how analytics platforms turn raw claims data into action, and shares proven cost-containment plays—from pharmacy-rebate recapture and international drug sourcing to reference-based pricing, direct provider contracts, and expanded virtual care. He explains how captives pool risk, foster community learning, and create a long runway for strategic improvements, enabling employers to own their reinsurance vehicle, benchmark progress with peers, and reinvest the savings in richer benefits.

Chapters

  • (00:00:00) - Employers are becoming owners of their health insurance
  • (00:00:52) - Captive Resources CEO on the Challenges of the Industry
  • (00:02:08) - What is the Difference Between Being Self-Funded and Fully-
  • (00:04:28) - Self-Funding vs. Stop Loss
  • (00:07:20) - Anticipating Self-Funded Pharmacy Risk?
  • (00:09:27) - PBM and TPA: How important is it?
  • (00:10:25) - Are We Seeing More Innovation in the Healthcare Market?
  • (00:12:25) - International sourcing and cost-effective PBM
  • (00:14:07) - Group Captive vs. Network Access
  • (00:16:54) - Group Captive and Self-Funded Insurance
  • (00:22:09) - What are the cost containment strategies that employers are using?
  • (00:25:24) - Group Captivity
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