2008 Medical Professional 2008 Medical Professional Liability SymposiumLiability Symposium

Chicago, Illinois ~ March 11 & 12, 2008

Trends in Healthcare-The Who, Trends in Healthcare-The Who, What, Where, When and How of What, Where, When and How of Healthcare Delivery in the FutureHealthcare Delivery in the Future

Wednesday, March 12, 2008

2:00-3:15 p.m.

The Changing Landscape The Changing Landscape of Healthcare Delivery of Healthcare Delivery

• MODERATOR: Ron Rumin, Vice President, Healthcare, Worldwide Facilities Insurance Services, Inc.

• John S. Chace, CPCU, Vice President, Fireman's Fund

• Michael Ragan, DMD, JD, LLM, Partner, Boyd Mustelier, Smith &Parker

• Dale Van Demark, Esq., Member, Epstein, Becker & Green, P.C.

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Good Afternoon

• This session will explore recent trends in the delivery of healthcare such as concierge medicine and medical tourism. We will see how these trends impact Underwriting and the overall healthcare marketplace.

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Concierge Medicine

• What is Concierge Medicine?

• Overview of the trend?

• Growth since 2004

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Concierge Models

• 3 basic Models Overview of how the modeling was

developed

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The 3 Models

• Preferred Access

• Medical Services

• Access Fee

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Future of Concierge Medicine

• Growth

• Social Impact

• Affects on Traditional Delivery System

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Medical Tourism

• US Industry Overview

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Medical Tourism

• Foreign Providers Business models and quality

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Medical Tourism

• Limitations on patient medical malpractice recourse

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Medical Tourism

• Market Alternatives to medical malpractice Current status

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Underwriting View

• How does the delivery changes / point of contact affect Underwriting guidelines Know Foreign Countries - “Medical Tourism”

• Different laws for Medical PL or also known as “PI” (outside U.S.)

• Determine Product - Scope of Policy coverage – “Bringing Claim in U.S. versus anywhere in world”.

• Know the exposures - (type of practitioners?, how does practitioner practice his or her medicine, how does entity operate – like op clinic?)

Know The practitioner and practice “Concierge”• Determine Product• Know exposures

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Can you develop a Premium formula

• How do you develop a rating formula for the medical malpractice exposure of these evolving trends. How to price for future claims from present acts?

• We look to past experience and present exposures, loss activity / claims, and other factors to build a loss cost.

Non – Frequency driven risks• uses known “class rating models – Usual practice -

“Practitioners for Individual PL, OP Visits, OP Surgeries or percentage of PL for entity, per trips, receipts, beds

Frequency driven risks • Uses known “Loss rate” or “experience rate”

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Future of Healthcare Delivery Trends

(A few types of Facilities)

• Dialysis Centers• Drug Rehab• Home Health Care• Residential Group

Homes• Testing Labs• Hospice

• Surgical-centers• Urgent Care

Centers• Medical Clinics• Ambulance

Services

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Future of Healthcare Delivery Trends

• Emerging Exposures / Allegations (Is determined based on the type of risk and the caregivers at the facility)

• Failure to diagnosis/misdiagnosis – “All Allied Profess”• Improper treatment/standard of care – “All Allied Profess”• Improper line feeds related to dialysis treatments • Sexual misconduct/physical abuse• Instruments left in surgical spot• Death/gross negligence• Improperly cleaned equipment resulting in infections• Methadone use in drug rehab• Elopement/wandering• Slip/falls – “PT’s”• Improper supervision• Misfilled RX – “Pharmacy”• Failure to Monitor – “PT’s and RN’s”

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Future of Healthcare Delivery Trends

• New Markets & Capacity ($ 2 Billion Market – good for the buyer) Current Market Players – over 30 players not including

all Physician carriers today• Some Bigger players – AIG (Lex), Allianz (FFIC), C.N.A,

Zurich, etc In 2007 alone

• US Domestic Carriers – 4 new in last year• London Markets – 2 new carriers in last year• Bermuda – 2 new in last year

Physicians carriers and Hospital Carriers fall into these classes “naturally” – they are a spin off of physician outpatient clinics or hospital outpatient ventures.

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Proliferation of current “Known” Markets

(in U.S.)

U.S. Markets – building out• Allianz (FFIC), QBE, Red Mountain, UNG, James River,

Colony, Smith Bell, Landmark, The Doctors Company, Michigan Mutual, Evanston, CNA, Zurich, Lexington (AIG), Gen Star, Scottsdale, Western World, Norcal Mutual, Philadelphia Ins Co, Admiral (Berkley), Liberty Mutual, Hudson, Darwin, Chubb, Medical Protective (Berkshire), “Other PIAA Companies”

Off Shore (Bermuda / London) – “now onshore or coming onShore and building out”• Bermuda and London Based companies now in US market:

Examples - Beazley, Hiscox, Inc., ACE – USA, Arch, One Beacon, - other Companies

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Thank you

Special Thank You to the Panel Members