CHICAGO — The Patient Protection and Affordable Care Act and the subsequent health care market changes present new threats for many risk retention groups.

Like insurers that cover health care professionals, risk-retention groups - the vast majority of which are in the health care industry — should re-evaluate their exposures as new ACA regulations are implemented and the market continues to change, said Patricia Marzella-Graubart, vice president and senior treaty underwriter at Swiss Reinsurance America Corp. in Armonk, New York.

“We're not telling people to raise rates or do anything,” Ms. Marzella-Graubart said. “We're just saying, "Are you looking at the exposure?' “

Ways in which ACA may affect risk retention groups was a featured topic during the National Risk Retention Association's conference earlier this month in Chicago.

Salvatore Samá, senior vice president and head of U.S. professional underwriting at Swiss Re in Armonk, New York, said the responsibilities of health care professionals, such as nurse practitioners and physician assistants, are expanding.

Liability insurance “rates could have been put together with the thought that a nurse practitioner does X, a physician assistant does Y,” Mr. Samá said.

“Now if they're doing more than that, have you revised rates or pursued an actuarial study to revise your rates to make sure that you're charging an adequate premium for the exposure you're taking on?”

Health reform and the already shifting health care market, such as physicians becoming employees of hospitals, could provide “opportunities and challenges” for risk retention groups, Ms. Marzella-Graubart said of issues such as electronic health records, the delay in implementing the employer mandate, opportunities to cross-sell coverage and new technology.

One example of new technology is MedFax, which provides “real time risk management” to insurers, said CEO Gemma Cunningham. She founded Glendale, California-based TruthMD L.L.C. three years ago and it provides the MedFax database to clients with information on physicians, hospitals medications and medical devices.

One of the biggest underwriting challenges is that physician information often is self-reported, Ms. Cunningham said.

“If the physician chooses not to reveal certain information, maybe a license (issue) in another state or a malpractice settlement ... the underwriter may never know,” she said. “By not knowing, it could greatly affect the level of risk.”

In a study of 485 physicians with malpractice coverage through an unnamed New York insurer, MedFax found that 32% failed to report at least one past claim, lawsuit or other matter of public interest.

Ms. Cunningham said 40 physicians cost the insurer at least $2.6 million in settlements.

Ms. Marzella-Graubart and Mr. Samá said there are several ways risk-retention groups can prepare for the unknown effects of ACA.

Risk retention groups can revise their applications for coverage to make sure they're getting the information they need, Ms. Marzella-Graubart said.

“Are your questions appropriate on your application, are you looking at the business and the way it's evolving, and keeping up with evolving exposures, accelerating technology and all of the changes that are going on at light speed?” she said.

Meanwhile, mandates associated with electronic health records have made it necessary for risk retention groups to consider cyber exposures, Mr. Samá said, adding that medical records are worth far more than credit card numbers on the black market.

“Once any of us call American Express or Visa and cancel the card, that number is essentially useless,” he said.

“Our health information doesn't really change.”