More than 450 medical professional liability (MPL) industry professionals from across the country—and around the world—gathered in Philadelphia from May 13-15, deepening their knowledge, networking with industry insiders and exploring cutting-edge business solutions. The annual MPL Association Conference featured engaged learning sessions for hospital and health system writers, a powerful introductory keynote on disruptive technology trends, and a wide variety of sessions focused on specific areas of MPL risk, including reinsurance, patient handoffs, broker consolidation, and plaintiff attorney defense tactics.
In an engaging keynote, The Disruptive Trends Shaping Tomorrow, Futurist Sam Jordan challenged MPL industry stakeholders to imagine an AI-enabled healthcare future where robots, trained on millions of simulations, can potentially achieve improved surgical and healthcare outcomes over humans. Consider how different versions of an AI-enabled healthcare future might affect the underwriting function as AI systems gain the ability to take over more of the actual surgical function, with surgeons setting the goals for the surgery, rather than actually operating an AI-enabled surgical robot. Taking that potential future outcome a step further, what are the implications of a robot or robots becoming the most prolific provider in a hospital? Both healthcare system and MPL insurer executives need to continuously update their policies and procedures around how human healthcare providers and AI-enabled systems interface.
The real challenge with foresighting—the systematic process of exploring possible alterative futures to improve current decision making—is how the nature of human judgment and decisions are changing. Two-thirds of teenagers, who are the future healthcare and insurance workers, interact with chatbots, and as a result are becoming, at the same time, more confident and less accurate in their judgements. Now is the time for insurance and healthcare leaders to build systems in their organizations to infuse judgment into the employee development pipeline. At the executive level, creating a system that builds foresighting into the decision-making processes will provide healthcare or insurance organizations with a robust framework to think through uncertainty.
(L-R) Keynote Speaker Sam Jordan; International Healthcare Trends panelists Gerald Zarlengo, MD, Copic; Rashi Bansal, Avant Mutual; Jaco Van der Sandt, PPS Health Professions Indemnity, and Matthew Lee, BM, The Medical Defence Union.
At the session on International Healthcare Trends and MPL: A Look Around the Globe, international healthcare providers and insurance executives described health systems under strain. In the UK, four out of five physicians are experiencing stress, which points to the need for defense organizations, insurers, the NHS and private healthcare systems to boost support systems to prevent burnout and medical errors. In Australia, a shortage of physicians is creating openings for non-physicians to perform physician tasks, which leaves MPL gaps in terms of responsibility when something goes wrong. As more advanced practice providers practice at higher levels, insurers and health systems must ensure their policies and procedures around scope of practice and level of supervision are updated to reflect the reality on the hospital and clinic floor. MPL claims can involve multiple parties with different MPL coverage; carriers need to prepare for multi-defendant claim complexity at scale.
The session on Plaintiff Attorney Tactics in Today’s Hospital Professional Liability, featuring Daniel Ferhat, shareholder with Saxon and Stump, emphasized how plaintiff attorneys are conditioning jurors to believe that MPL victims deserve excessive compensation through simple, emotional messaging. Defense attorneys and insurance executives need to understand the importance of mounting a defense that is less focused on technical matters of the standard of care and more emotional and personal. As part of the defense strategy, a focus on countering plaintiff claims of profits over patients will help counter these claims, which shouldn’t be left unopposed. When defense attorneys breathe life into the story behind the medical situation and humanize the physician and healthcare providers, they take control of the narrative rather than letting the plaintiff’s attorney define it. Ferhat encouraged defense lawyers to teach juries what modern medicine looks like through demonstrative exhibits, direct examination themes, and effective storytelling techniques. To counter the widespread distrust of the medical industry, Ferhat’s advice is to take time during the direct examination of the defendant to show why they became a doctor or nurse, have them talk about what keeps them in medicine, and describe what it’s like to care for a critically ill patient so the jury understands that the defendant is a person who has devoted their career to caring for people, not just a name on a chart.
The session Power Shift: The Impact of Broker Consolidation on MPL Market Access considered whether consolidation has negatively affected MPL market access. In a market where relationships are paramount, panelists said that insurers need to ensure that their agency representation is diversified so that no one broker has more than a third of their business. To ensure that physicians understand the value that insurers provide, they should focus on deepening and solidifying those direct relationships so that there is less potential for the relationship to be disrupted due to broker consolidation. Insurers should prepare for consolidation to continue because while it isn’t happening at the same velocity, it is still happening. That means insurers must be strategic in building and maintaining relationships with brokers and with their insured physicians.
(L-R) Panelist from the Broker Consolidation panel include Michael Roque, Positive Physicians Insurance Company, Scott Weber; Coverys, Kendra Heredia, The Doctors Company, Gabrielle Lamb, The Hilb Group, and Randall Nukk, Gallagher Healthcare; and Reinsurance speakers Tom Wagstaff, MedPro International, Michele Johns, Cleveland Clinic Foundation, Martha Jacobs, Guy Carpenter, and Giovanni Fanizza, Partner Re.
In an environment where MPL severity, insurer paid losses, and sexual abuse and misconduct cases are increasing, the stability of the reinsurance market is clearly a concern for hospitals and primary insurers as seen in the title of the reinsurance-focused panel, Is Reinsurance Keeping You Up at Night? While many unfavorable macro-economic trends remain in place, including rising severity, declining market profitability, and the increase in severity in the sexual abuse and misconduct area, rate changes are moderating, which creates more room for carriers and captives to negotiate their reinsurance rates than in prior years. Explore strategic co-participations in reinsurance, where multiple reinsurers collaborate to share premiums and financial risk through collaborative agreements. These can provide carriers and captives with additional leverage in their negotiations with reinsurers. Engaging in strategic risk management through active monitoring and forward-looking assumptions facilitates the ability of carriers and captives to manage inflation’s unpredictable impact on MPL reinsurance. Open, transparent and ongoing communication with reinsurance partners helps carriers and captives maintain capacity despite higher pricing and tighter terms from inflation.
Tom Mayer, MD, NFL Player’s Association Medical Director described in his session Leadership for Today’s MPL, HPL, and Healthcare Professionals the environment leaders should strive to create during times of crisis. Leaders must strive to feel deep joy in their role of guiding emerging leaders, healthcare providers, carriers, and health systems to meet the needs of their patients and stakeholders. In making hiring decisions, look for motivated people who you can educate, not just smart people. A culture of servant leadership creates the conditions for a healthy environment because servant leaders are committed to building up others. A culture of personal passion and resilience creates a great culture, lowering burnout rates. Great cultures in healthcare must include the patient as an active member of the team as well as physicians, nurses, aides, janitors—and more.
In the State of the MPL Insurance Market presentation, Art Randolph, principal and consulting actuary at Pinnacle Actuarial Resources, shared information about industry headwinds and reasons for optimism. Significant headwinds include questions around whether recent industry investment returns are sustainable. Carriers and captives need to carefully manage their investment portfolios and seek to balance the desire for additional alpha with risk management. Organizations that can leverage artificial intelligence have the potential to increase operational efficiency, improve risk management protocols, and reduce underwriting expense ratios.