Multihospital Group Owned Captive: Optimizing the Captive and Services in the New Landscape of...
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HCCI/HCCR
Multihospital Group Owned Captive: Optimizing the Captive and Services in the New Landscape of Healthcare
Reform in the USA
Cayman Captive ForumDecember 4, 2013
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Tim RicePresident and CEOCone HealthGreensboro, NC
Chairman• Health Care
Casualty Insurance Limited
• Health Care Casualty RRG, Inc.
Mark O’BryantPresident and CEOTallahassee Memorial HealthCareTallahassee, FL
Board Member• Health Care
Casualty Insurance Limited
• Health Care Casualty RRG, Inc.
Rick BeckerChairmanClarity Group, Inc.Chicago, IL
Secretary, Health Care Casualty Insurance LimitedAssistant Secretary, Health Care Casualty RRG, Inc.
Moderated by: Anna Marie Hajek, President and CEO, Clarity Group, Inc.
Panel
HCCI/HCCR
Cone HealthGreesboro, NC
Tim RicePresident and CEO
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NFP Healthcare System: Serves a 5 county region in central North Carolina, covering approximately 1,000,000 lives
6 Acute Care Hospitals, Behavioral Health Hospital, Regional Cancer Center
1273 beds 1176 physicians; 2799 RNs 100 locations including 3 urgent care and 71 physician
practices Net Patient Revenue: $1.4 billion (FY2013) Became an Accountable Care Organization- Triad
Healthcare Network – July 2013: 700 healthcare providers, covers 40,000 lives and 30,000 more in Medicare Advantage
Cone Health
HCCI/HCCR
Tallahassee Memorial HealthCareTallahassee, FL
Mark O’BryantPresident and CEO
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NFP Healthcare System: Serving 17 counties in North Florida and South Georgia
772 bed Acute Care Hospital; Behavioral Health Hospital, Rehabilitation Hospital, Regional Cancer Center
570+ physicians; 1200+ RNs Region’s only state designated Trauma Center;
Region’s first Freestanding Emergency Center Net Patient Revenue: $480,815,000 (FY2012) Expanding residency programs and research
with Florida State University College of Medicine
Tallahassee Memorial HealthCare
HCCI/HCCR
Health Care Casualty Insurance Limited
andHealth Care Casualty RRG, Inc.
Providing Financial Protection and
Enhanced Patient Safety For Member Healthcare Systems
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In 2002, a group of healthcare providers determined that it was strategically advantageous for them to take control of their medical malpractice insurance The IOM report on medical error was fresh and
activity to enhance patient safety was accelerating The insurance marketplace was expensive … and
services were minimal Moving from purchasing insurance to using an
insurance vehicle in concert with quality and safety efforts became important
Introduction
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Two companies have been formed … both owned by the Healthcare organizations A group owned captive insurance company for the
hospital excess coverage: Health Care Casualty Insurance Limited (HCCI)
A group owned RRG for the physician coverage, and hospital excess coverage: Health Care Casualty RRG, Inc. (HCCR)
Fast Forward to 2013
The Owners (Members)• Health First, Inc., Rockledge, FL• Cone Health, Greensboro, NC• Tallahassee Memorial HealthCare, Tallahassee, FL• Unity Health System, Rochester, NY
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Hospital Program Captive Insurance Company domiciled in the Cayman
Islands Provides a $20 Million excess layer of insurance Special coverages are endorsed onto the policy Each Member retains a minimum of $1Million in a self-
insured layer Policy is written as claims made coverage for professional
liability, and occurrence coverage for general liability Reimbursement policy … claims control remains with the
Member, supported by Clarity resources Reinsurance in place
How do the programs work?
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Physician and Physician Extender Program
Risk Retention Group domiciled in Washington, D.C.
Insures Employed, Contracted and Voluntary Medical Staff
Full underwriting, policyholder services and first dollar claims management are done by Clarity, the Company’s Operations Manager
Reinsurance in place
How do the programs work?
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Comprised of physician leadership, nursing and risk/quality/safety professionals from the Member organizations
Focus the RQS services agenda Drive the education agenda Support RQS initiatives within their
organizations
National RQS Advisory Committee
Helps assure RQS coordination among the Members’ healthcare systems and staff
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Risk – Quality – Safety Management Tailored on-site consultation Educational programming- webinars, in-person Continuous access to professional consultants Shared data Current focus on RQS in Ambulatory Settings –
Coordination with the hospital External Peer Review Program System – wide Data and Event Management
Web-based data collection system that penetrates all aspects of the organization … enables immediate consultation on events and in-depth knowledge to get to action quickly – All Members use this product system-wide
Services Enjoyed by the Members
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Claims Advisory and Management Services Continuous access to professional consultants for best
practices and consultation on difficult cases and full cooperation with on-site Risk Managers
First dollar claims management of physician cases Web-based state-of-the-art claims management system Annual Audit to review claims managed within the
Member’s self insured retention Quality and Safety Support and Data
Protection under the Patient Safety and Quality Improvement Act Patient Safety Organization – All Members participate in
Clarity PSO, A Division of Clarity Group, Inc.
Services Enjoyed by the Members
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Insurance Products that respond to the changing landscape of healthcare delivery … particularly with the advancement of the Affordable Care Act and ACO formations Flexible coverage options Ability to add service structures, for – profit entities and joint
ventures Flexible physician coverage options and insurance structure
optionsUseful for recruiting / acquisition of physician groups … no need to
purchase tail from prior carrierUseful for employed physician groupsFocus on coordination with hospital RQS programs
Cyberliability protection: Hospital network and physicians … including participation in HIEs
Services Enjoyed by the Members
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What have been the most significant changes to your organization in the last 5 years?
How has your ownership and participation in HCCI and HCCR supported the changes you made?
What impact does your ownership and participation in HCCI and HCCR have on how risk-quality and safety are managed in your organization?
How would describe the overall benefits to your organization of your ownership and participation in these group owned captive facilities?
Questions to the Panel
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Benefits of the programs go beyond insurance coverage … Leadership …like minded organizations and leaders who
focus on quality and community benefit Openness …ability to share issues and learn from each
other Controlled cost… reduced costs for hospital liability
insurance each year since inception Physician alignment … physician insurance program has
been a vehicle for both employed and non-employed physicians
Resource support … RQS, Claims, and PSO services have worked in concert with internal resources and are now being financed by the insurance companies
In Summary…
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Healthcare reform is creating new reimbursement structures and integrating resources… Hospital – physician alignment is essential … medical
malpractice insurance is a good tool to help seal the alignment Clinical integration requires incentives to do the right thing …
working through the services in both the hospital and physician insurance companies can support this process
As organizations get more extensive services to manage the population’s health … issues of consistency and evidenced based care across the organization will arise … the web-based event management system, the insurance products and the Patient Safety Organization are vehicles to help control cost and quality
Why is this a good strategy for the future?
Control and coordination of practices … leads to control of resources and management of potential medical error
HCCI/HCCR
Multihospital Group Owned Captive: Optimizing the Captive and Services in the New Landscape of Healthcare
Reform in the USA
Cayman Captive ForumDecember 4, 2013