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Systemic approach needed to ‘demystify’ malpractice data, experts say

World Captive Forum

MIAMI – The captive industry has access to reams of medical malpractice data that if properly mobilized could help reduce claims across the country and address societal challenges such as the opioids epidemic, experts say.

But the data is collected and managed in a fragmented manner, which prevents it from being deployed to its full potential, according to experts speaking on Thursday at the World Captive Forum in Miami, which is sponsored by Business Insurance.

“Everybody holds the malpractice data close to their chests and even within their own organization, malpractice data is not widely shared,” said Robert Hanscom, vice president of business analytics for Boston-based medical professional liability insurer Coverys Inc. “Most health care systems look at all of this data in fragments and it’s a real problem.”

Malpractice data can sometimes send strong signals back to the health care system to help identify and assess where vulnerabilities continue to exist, he said.

“Most of the time they discover (serious problems) by accident,” he said. “It should not have to be by accident. It should be a systemic approach to bring these data sets together.”

Coverys has committed to publicly sharing its malpractice data, including average indemnity and claims frequency in particular specialties, Mr. Hanscom said.

“Part of what we are trying to do is demystify the malpractice data,” he said. “Malpractice data has been held close to the chest. There’s no reason for it. If it’s aggregated, it’s safe and it ought to be put out there as a compelling factor in how people are understanding where the patient safety vulnerabilities are. I wish all commercial carriers and captives would start joining forces in doing the same because we really have to unite around understanding what these common themes are across the country.”

For example, Coverys released a report this month showing that obstetric-related events are its fifth-largest category of medical professional liability claims and the fourth-highest category of indemnity payments. The insurer’s analysis of 472 OB closed claims across the 2013-2017 period revealed that 80% of OB cases are high-severity cases, and 24% result in death of the baby, mother or both.

“We’ve been capturing the data for decades,” said Michael Maglaras, Ashford, Connecticut-based principal with insurance and risk management consultancy Michael Maglaras & Co. “What do Slovenia and Cuba and Italy and France and Costa Rica know about delivering babies that we don’t. Our maternal and fetal death rate is higher than theirs. We have the data. It’s in captives. We’re just not using it.”

One of the obstacles to breaking data out of these silos for captives is simply “trying to get their data straightened out,” Mr. Hanscom said. “The ability to organize claims data is something that’s often hampered by the fact that there isn’t real good management of the claims files. You have some claims files that are not infrequently in disarray, so that’s the first step: Get those claim files standardized and organized.”

Captive boards have tended to focus more of their attention on investment returns rather than claims, but social media is changing that dynamic because complaints about the health care being provided become public, Mr. Maglaras said.

“The pressure of social media is extreme,” he said. “I don’t care how we get better at mining data as long as we do.”

Opioids are not a new problem for the health care sector, but “press attention is fanning the flames of suits and claims,” Mr. Hanscom said. While those lawsuits have been directed at big pharma to date, health care providers are starting to be included in such actions, so this warrants more underwriting attention and data analysis to understand when physicians are “falling into the traps” in terms of overprescribing, he said.

Captives can allocate resources to mine data to help address the opioids issue, Mr. Maglaras said.

“You need to allocate resources to it because there’s a direct societal benefit to a captive being involved,” he said. “This is the second straight year that our longevity in the United States has dropped because of the opioid crisis. Use the data that we’ve already got to the advantage of everybody else.”







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