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Property & Casualty

Management Liability/Managed Care E&O

Management Liability for Health Care Organizations

A health care organization must ensure that its board of directors, senior management and the entity itself have the appropriate insurance coverages to address a variety of management liability exposures. This coverage takes many forms, including:

  • Directors & Officers Liability
  • Employment Practices Liability
  • Fiduciary Liability
  • Crime Coverage
  • Kidnap & Ransom

Risk Strategies has years of experience analyzing the corporate structure and management of health care providers and managed care companies, and can quickly and efficiently identify ways that those coverages can be enhanced.

Managed Care Errors & Omissions Liability

The number of organizations that need to purchase Managed Care Errors & Omissions (E&O) Liability insurance is growing based on the changing landscape of the health care industry. 

While this coverage has typically been purchased by managed care organizations such as Health Maintenance Organizations (HMOs), Independent Practice Associations (IPAs), and Management Services Organizations (MSOs), today many other companies are involved in managed care that have similar exposures to loss. These organizations include Accountable Care Organizations (ACOs) and Managed Long-Term Care (MLTC) plans as well as many hospitals and physician organizations.

As a health care specialty broker and consultant, Risk Strategies recognizes the need for broad coverage to address issues related to managed care activities such as utilization review, provider selection, claims services, triage for medical payments, protection of health information, coordination of care etc. Moreover, we are continually challenging the insurance marketplace and driving innovative solutions to address coverage needs as relates to health care reform and other regulatory challenges. In addition, we have access to all financially secure insurers globally that write Managed Care Errors & Omissions coverage.

Property, Casualty & Other Lines

Property & Casualty Coverages

At its core, a health care entity’s property and casualty insurance should provide full and comprehensive coverage for all of its physical assets as well as its workforce. As a health care specialty broker, Risk Strategies has dedicated expertise in structuring and placing the broad spectrum of Property & Casualty insurance coverages for all types of health care organizations with financially secure insurance companies.

Areas of chief interest with regard to Property and Casualty coverage include:

  • Property
  • General Liability
  • Workers Compensation and Employers Liability
  • Commercial Automobile

Package Policies

Package polices are particularly attractive for small to mid-sized health care and managed care organizations.

A package policy is a blended form that typically provides both property and general liability coverages. These policies may also include a variety of other coverages, including commercial automobile, crime, cyber liability, and employment practices liability among others. Package policies are critical for small and mid-sized businesses so they can take advantage of the flexibility and cost effectiveness of this policy structure.

Specialty Liability

Even the most comprehensive insurance plans can have gaps in coverage, and these often occur when a company has unique service lines or exposures that do not fall under traditional insurance coverages.

Health care providers and payers are at risk in several ways due to the unique nature of their operations. From financial exposures due to government billing to the high standards of data privacy and security due to HIPAA requirements, these organizations have exposures that can easily lie outside regular coverage.

Risk Strategies has the insurance industry background, combined with decades of health care-specific experience, to assess an organization’s unique needs, and then identify any coverage areas where more or better coverage may be required. These include:

  • Cyber Liability
  • Environmental Liability
  • Government Billing Errors & Omissions
  • Miscellaneous Errors & Omissions
  • Terrorism
  • Builders Risk
  • Bonds

Environmental Liability

Health care facilities house a wide variety of hazardous materials used for diagnosis, treatment and cleaning. These materials pose a significant exposure to health care organizations if they are not handled and disposed of properly. Specialized Environmental Liability insurance policies have been developed to help health care organizations manage their environmental exposures.

These policies protect a provider and facility against liability from the accidental release of:

  • Pollution conditions on, at or migrating from the health care organization against claims arising from: waste to offsite locations, and tendering waste to non-owned offsite disposal or recycling facilities
  • Fungal and legionella exposures
  • Decontamination costs resulting from facility-borne illness events
  • Emergency response costs
  • Catastrophe management costs
  • Business interruption losses

Not having this type of coverage in place leaves a gap that could cost a health care facility or provider millions of dollars in cleanup and related costs. Risk Strategies can look at your specific areas of risk, and recommend the proper type and balance of coverages necessary to provide full coverage.

Government Billing Errors & Omissions

Health care providers today face constant scrutiny over billing practices related to health care reimbursement. For example, CMS launched the Recovery Audit Program to identify and amend improper Medicare payments in order to prevent future errors and ensure payment compliance. These audits and the associated compliance are a significant administrative task and can ultimately lead to costly payment denials and other expenses.
Government Billing Errors & Omissions insurance was created to address the potentially significant exposure providers face with regards to defense expenses and audit/investigation costs related to regulatory violations of medical billings. This insurance not only provides affirmative coverage for these specific circumstances but also can fill gaps in other insurance policies, such as Directors & Officers Liability and Managed Care Errors & Omissions Liability.

Client Services

Dedicated Client Service

Providing proactive and highly-responsive service to our clients is a cornerstone of our organization. Our team is motivated, organized and we work tirelessly for our clients. A dedicated client team handles all aspects of an account and communicates with our clients every step of the way.

At Risk Strategies, we bring enthusiasm as well as expertise to our clients. Our energetic team takes service personally, providing:

  • Accountability
  • Continuity of service, thanks to low staff turnover
  • Responsiveness to customer needs and concerns

We are committed to remaining an industry leader. We work hard, and we keep on top of changes in the industry through education, interaction with our professional colleagues and more.

And finally, we don’t offer cookie-cutter solutions. As a health care specialty broker, we have the experience necessary to tailor our service delivery based on the unique needs of each client.

Financial Analysis

Financial analysis can play a key role in the design of an insurance program and the subsequent insurance placement strategy. Our goal is to provide our clients with information to help support their decision-making process when choosing the appropriate balance of self-insurance and risk transfer. 

Based on our clients’ objectives, we build customized reports such as retention analyses and loss projections that provide detailed insight into our clients’ insurance programs. In addition, these reports serve as valuable tools as we negotiate various program structure options with the marketplace. In addition, our loss analyses serve as the foundation for our claim reduction strategies. 

Whether it is an analysis of property losses by location or workers’ compensation claim frequency and severity, we provide meaningful data to assist our clients in their overall risk management programs and in identifying new strategies that have the greatest impact on total cost of risk.

Claims and Risk Control Services

We provide clients with valuable claim and risk control resources. Our team promotes increased communication and education within the organization which ultimately leads to an enhanced safety culture and a reduction in claim frequency and severity. 

Effective claims management begins with timely and accurately reporting of claims. Our associates work closely with our clients to ensure that there is a claim reporting process in place that is clearly communicated when coverage is bound. 

Additionally, a sound risk control program is essential to prevent and mitigate claims. Before analyzing the specific risk control needs of our clients, we make sure to outline the risk management services provided by the insurers included as part of the policies purchased. Subsequently, for any additional projects or services, we develop a strategy in order to identify the specific needs of each client and deliver the most appropriate resources available.

Moreover, throughout the claims and risk control process, we:

  • Serve as your advocate at all times
  • Listen to your specific needs and develop effective claim and risk control programs and procedures in partnership with you, your insurance carriers and claim administrator
  • Review coverage issues and negotiate with insurers/reinsurers to achieve satisfactory resolutions
  • Monitor the progress of claims and obtain periodic status reports from the appropriate insurers/reinsurers
  • Participate in claim reviews
  • Provide access to outside coverage counsel experts

Enterprise Risk Management (ERM)

Enterprise Risk Management is a strategic, long-term approach to identifying and addressing system-wide risks.  ERM programs:

  • Manage uncertainty
  • Encourage accountability
  • Address the total cost of risk
  • Promote safety and communication
  • Emphasize collaboration

Risk Strategies works closely with our health care clients to develop and implement effective ERM programs.  The ERM process begins with risk identification, followed by assignment of metrics to prioritize the risks.  Once the risks are identified and mapped by intensity, we assist our clients in developing a strategy for treatment of these risks which may include risk transfer, self-insurance or a combination of both.  A successful ERM plan is constantly evaluated and updated.    

Benchmarking

Benchmarking is a useful tool that can be applied in many different ways. When working with our clients, we first determine which areas they wish to explore based on their unique needs. Then, we utilize a combination of the tools outlined below to address benchmarking requests.

Risk Strategies has access to a benchmarking database which contains data for over 3 million insurance programs across all lines of property and casualty business. This database allows us to input our clients/prospects’ program information and compare it to industry peers which will help identify gaps in coverage, limit inadequacy, pricing discrepancies, retention levels, etc. In addition, we have the ability to provide informal benchmarking reports compiled through information from various health care underwriters as well as client-redacted data from our existing customer base.

Insurer Financial Security

While pricing and policy terms are critical in evaluating an insurer’s product, we believe the financial condition of an insurance company should be a significant factor when evaluating competing proposals. Insurance is essentially a “promise to pay” and the carriers participating on your programs need to be financially strong over the long-term in order to be there to pay claims when necessary.

Risk Strategies is in the market every day communicating with insurers from the local underwriters to senior management levels. In addition to changes in financial ratings, the markets readily inform us of any changes in product offerings, policy forms, and additional client resources. Our company also subscribes to several industry and data resource publications (i.e. A.M. Best and other rating agencies, Business Insurance, Advisen and others), through which we receive information in real time on a variety of topics, including industry trends, benchmarking data, insurers’ financial strength and stability, and more. We promptly communicate any applicable information regarding our clients’ current or prospective insurers and other noteworthy industry news.

Service Quality Assurance

Our dedication to superior client service is demonstrated in the form of Risk Strategies Service Standards. We use our Service Standards as the basis for executing quality service plans to all clients. Service Standards details the scope and timing of the continuous client service cycle, the use of our technology platforms in the delivery of client service, and internal operations protocols to ensure appropriate and accurate file maintenance, insurer knowledge management, and other items.

Outsourced Consulting Services

Health care providers and payers require outside advice in many areas. At Risk Strategies, we focus specifically on our core services so that we can deliver superior value to clients. We do not duplicate or charge clients for services that are performed more efficiently by others. This approach allows us to remain unbiased and independent in everything we do. It also encourages others to collaborate with us for the benefit of the client.

We will work with existing consultants and other outside experts at the client’s direction. We also maintain an extensive network of professionals who are available as a resource. Once we have determined the exact strategy and service needs that are right for the client, we will:

  • Coordinate with third parties as determined by our clients
  • Introduce clients to outside specialists where appropriate
  • Monitor and manage third-party services as necessary
  • Utilize outside specialized resources to save clients money

Examples of outsourced services include:

  • Actuarial Services
  • Captive Management
  • Health Care/Managed Care Contract Consulting
  • Third Party Administrators
  • Premium Finance Companies
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