Cayman Captive Forum
December 4, 2013
HCCI/HCCR
Tim Rice
President and CEO
Cone Health
Greensboro, NC
Mark O’Bryant
President and CEO
Tallahassee Memorial
HealthCare
Tallahassee, FL
Chairman
Board Member
•Health Care
•Health Care
Casualty Insurance
Casualty Insurance
Limited
Limited
•Health Care
•Health Care
Casualty RRG, Inc.
Casualty RRG, Inc.
Rick Becker
Chairman
Clarity Group, Inc.
Chicago, IL
Secretary, Health Care
Casualty Insurance
Limited
Assistant Secretary,
Health Care Casualty
RRG, Inc.
Moderated by: Anna Marie Hajek, President and CEO, Clarity Group, Inc.
HCCI/HCCR
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Tim Rice
President and CEO
HCCI/HCCR
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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
HCCI/HCCR
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Mark O’Bryant
President and CEO
HCCI/HCCR
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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
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Providing Financial Protection and
Enhanced Patient Safety For
Member Healthcare Systems
HCCI/HCCR
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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
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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)
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HCCI/HCCR
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
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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
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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
Helps assure RQS coordination among the
Members’ healthcare systems and staff
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Risk – Quality – Safety Management
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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 systemwide
HCCI/HCCR
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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
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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.
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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 options
 Useful for recruiting / acquisition of physician groups … no
need to purchase tail from prior carrier
 Useful for employed physician groups
 Focus on coordination with hospital RQS programs
 Cyberliability protection: Hospital network and
physicians … including participation in HIEs
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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?
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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
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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
Control and coordination of practices … leads to control of
resources and management of potential medical error
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Cayman Captive Forum
December 4, 2013
HCCI/HCCR