Michael McConnell is system vice president of insurance and claims management for Chicago-based Presence Health, a health care system that includes 12 hospitals, 27 long-term care and senior living facilities, and several other medical offices. He spoke with Business Insurance Associate Editor Sheena Harrison about how health care risk managers can get backing from their executive leadership, as well as trends in insurance pricing. Edited excerpts follow.
Q: What are the biggest challenges facing health care risk managers right now?
A: Adapting to the new service care models. Risk managers, like most health care providers, are primarily hospital-focused. As care becomes more diffuse, risk managers will need to adapt to a model where they are handling multiple sites and levels of care.
Q: How can health care risk managers prove their value to their organizations and get buy-in from senior managers?
A: Risk managers need to partner with insurance, claims and finance to develop a metric that translates their successes or failures to a dollar figure. While every person will sincerely say that patient safety is the paramount goal, you get people's attention when you put it in dollars. The pressures of an organization to survive and compete are immense. Being able to articulate savings will get buy-in from senior managers.
Q: Do you expect the increased patient load from the Patient Protection and Affordable Care Act to generate increased medical malpractice exposures for health care organizations?
A: No. The increased patient load should be primarily nonemergent, as the previously uninsured are given access to preventive care and primary care physicians. I believe that adverse events and bad outcomes are more likely to occur with patients that have no history with the health care organization outside the emergency department.
Q: Have you seen medical malpractice and other professional liability insurance rates falling or stabilizing in recent years?
A: Professional liability insurance continues to be profitable, and capacity is strong, as evidenced by the recent addition of Berkshire Hathaway Specialty Insurance. I believe professional liability insurance rates will continue to fall for systems that are adapting to the new environment of health care and continue to have good loss histories. I believe that a strong relationship with your insurers/reinsurers goes a long way. Maintaining communication outside of the renewal process and working with the companies throughout the year on risk mitigation programs shows a commitment that is reflected in pricing, in my opinion.
Q: Do you see hospitals and health care organizations moving toward self-insurance or captives to manage some of their risks?
A: I do not believe there will be a move toward self-insurance or captives for existing health care organizations. Existing organizations whose size and exposure make these options attractive have already made the decision. What may cause an increase, however, is the creation of larger health care organizations through mergers and acquisitions. As systems grow, self-insurance and captives make more sense.
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