Your Health Plan Is Diverting Money From Your Mission

The Cost of Staying Put

Your organization exists to serve, to invest, and to make something better in the world. Yet year after year, one of the largest line items in your operating budget pulls resources away from that purpose.

Healthcare premiums keep rising. In a fully insured arrangement, claims visibility is limited, the renewal arrives with a number but rarely with the detail leadership needs to understand what is driving it, and organizations are left to absorb the increase, cut somewhere else, or both. This is not just a benefits problem. It is a financial strategy problem. And for nonprofit organizations operating on mission-driven margins, the cost of leaving it unaddressed compounds every single year.

Health insurance premiums have risen nearly 50% over the last decade. National health spending is projected to grow over 5% annually through 2030, reaching nearly $6.8 trillion. The fully insured model that anchors most nonprofit budgets was built for simplicity and predictability, not long-term cost control. For many organizations, it is the starting point. Too often, it also becomes the default they never revisit, even when the financial case for a different approach is right in front of them.

Your CFO would not accept this level of limited visibility in any other expense category of this size. Your board would not approve a major budget line that operated without usable data, without a strategy to improve performance, and without clear accountability to outcomes. Healthcare deserves the same scrutiny.

It Is Not Bad Luck. It Is a Structural Problem.

Healthcare costs have not risen because your workforce suddenly got sicker. They have risen because the underlying drivers of cost are real, accelerating, and largely invisible to organizations that do not have access to their own claims data.

Five forces are pushing costs higher right now, and none of them are easing:

• Medical inflation and hospital consolidation are driving underlying costs up at rates that outpace nearly every other operating expense.
• Catastrophic claims are growing in both frequency and severity, with claims exceeding $1 million rising 45% over a four-year period.
• Specialty drugs and gene therapies are reshaping pharmacy spend at a pace even sophisticated finance teams struggle to model, with the gene therapy now exceeding $3 million per treatment.
• Deferred care from the pandemic years is showing up as higher-acuity utilization, with people presenting later and sicker than historical actuarial models anticipated.
• Administrative complexity across billing, coding, pharmacy benefit management, and plan administration continues to add cost at multiple layers of the system.

The structural limitation of the fully insured model is that it offers limited visibility into these dynamics and very few practical levers to address them. There is little claims detail to analyze, limited flexibility to respond to what the data might reveal, and no built-in mechanism that rewards an organization for managing its population well over time. For a human services agency, a university, a foundation, a faith-based institution, or any organization whose reason for existing is not profit but purpose, passive cost absorption is not a neutral decision. It is a choice that slowly redirects resources away from the people you exist to serve.

Stop Absorbing Costs. Start Managing Them.

Enter the OneDigital PRO Captive. The OneDigital PRO Captive is a group healthcare captive, a community of like-minded employers that shares risk, pools purchasing power, and actively manages health plan costs together over the long term. It is not a benefits product. It is not a short-term fix. It is a financial strategy, and it has been delivering results for members since 2018.

The model rests on three foundations that work together. Self-funding gives your organization visibility into claims data, the ability to understand what is actually driving cost, and the flexibility to design a plan that reflects your workforce instead of simply accepting a standardized arrangement at renewal. Shared risk means you are not navigating cost volatility alone. The captive structure distributes catastrophic risk across member organizations and includes stop-loss protection so one difficult year does not dictate the next three. Purposeful, data-driven risk management means you are deploying targeted programs that address root causes, not just reacting to the invoice after the fact.

For nonprofit organizations, there is another advantage. The PRO Captive includes a nonprofit member cohort, a community of mission-driven organizations facing the same pressures, sharing the same commitment to their people, and building toward the same outcome. When you join, you are not starting from scratch. You are joining a group that has already been doing this work.

More Than 20 Levers. Real Savings. Proven Results.

The OneDigital PRO Captive is backed by a purposeful risk management framework with more than 20 proven cost-containment strategies, and the savings are not theoretical. High-impact approaches include reference-based pricing, which delivers 10 to 20% savings on medical spend; a carved-out, transparent pharmacy benefit manager, which can reduce pharmacy costs by 40 to 50%; high-performance and tiered provider networks, which generate 10 to 15% savings; and targeted programs for specialty Rx management, site-of-care optimization, and condition-specific interventions focused on cancer, cardiovascular disease, diabetes, and musculoskeletal conditions.

Over eight years, OneDigital PRO Captive members have achieved an average premium-equivalent renewal increase of just 3.7%, an average actual cost trend of 2.7%, and an average claim trend of 2.5%, all in an environment where the broader market has trended significantly higher. Captive layer surpluses have been returned to members in five of eight program years. Stop-loss renewal increases for PRO Captive members have averaged 10.3%, compared with 14.4% for stand-alone stop loss. That gap matters when you are trying to build a multi-year financial plan you can actually trust.

These are not projections built on favorable assumptions. They are eight years of documented, auditable results from real organizations.

When Healthcare Costs Come Down, People Benefit.

For the people leaders inside nonprofit organizations, a captive is not a benefits reduction strategy. It is a benefits investment strategy. That distinction matters, especially for organizations whose ability to recruit and retain talented people is already constrained by compensation structures that cannot always compete with the for-profit sector.

When healthcare spend is managed well, organizations can reinvest in plan richness, reduce employee cost shares, expand benefit options, and build the workforce wellness programs that attract and keep the people who power the mission. A OneDigital PRO Captive member was able to reintroduce a full PPO copay plan alongside a high-deductible option after years of offering only one choice because costs came down enough to make it possible. Their employees noticed. Their retention reflected it.

People who choose to work for mission-driven organizations are making a values-based decision. They deserve benefits that reflect the same commitment their employer asks of them. A captive makes that possible without forcing another annual conversation about what has to be cut just to absorb this year's renewal.

Every Dollar Saved in Healthcare Is a Dollar Returned to Your Cause.

For boards and executive leaders, the strategic case for a captive comes down to what happens to the savings. When a nonprofit organization reduces healthcare spend by $1 million, that is not just a favorable budget variance. It can be a program restored, a position preserved, a service extended to someone in the community who needs it, or a reserve fund strengthened against the uncertainty every nonprofit leader knows is always somewhere on the horizon.

Boards have a fiduciary responsibility to ensure organizational resources are stewarded well, and healthcare, which is often the second-largest line item in the operating budget, becomes harder to justify when it operates with limited visibility into cost drivers and without a strategy designed to bring spending under control over time. The organizations doing the most important work in our communities cannot afford to run one of their largest expenses on autopilot.

The OneDigital PRO Captive turns healthcare spend from a recurring cost pressure into a managed asset. And when it is managed well, the savings go back where they belong.

Is a Captive Right for Your Organization?

Not every organization is ready for a captive, and we will tell you that honestly from the first conversation. What we have found, over eight years and across dozens of member organizations, is that the ones that succeed in this model tend to share a few things in common.

They are frustrated with renewal increases that are difficult to explain or challenge without access to underlying data. They believe their workforce deserves a benefits strategy that is thoughtful, competitive, and built for the long term. They have leadership willing to take a multi-year view of healthcare rather than treating it like an annual transaction. And they understand that managing costs well is not separate from stewarding the mission. It is part of it.

Organizations that are a strong fit typically have 50 or more enrolled employees, have been with the same carrier for two or more years, are experiencing recurring premium increases they cannot fully explain or defend with the information available to them, want the flexibility to design a plan that reflects their workforce and organizational values, and are ready to redirect healthcare savings back into the programs and people at the center of their mission.

The Organizations Doing the Most Important Work Deserve the Most Thoughtful Strategy.

You chose this work because it matters. The communities you serve, the causes you champion, the people whose lives your organization touches every day, they are the reason the budget decisions you make in a conference room carry real weight in the world.

The last thing that should stand between your mission and the people you serve is a healthcare cost you cannot control, cannot fully explain, and cannot meaningfully reduce with the tools you currently have.

OneDigital and its Nonprofit Center of Excellence helps nonprofit leaders evaluate whether a captive is the right fit for their organization, and when it is, we build a plan designed to deliver real, measurable, multi-year results. We know what strong outcomes look like. And we know how to help organizations get there.

Let's find out what is possible for your organization. Reach out to your local OneDigital contact today!

The OneDigital PRO Captive is industry agnostic and includes a nonprofit member cohort that shares community experience, insights, and outcomes. Performance data reflects eight-year program results from 2018 to 2025. Past performance is not indicative of future results. Individual organization results may vary.