My COVID Pandemic Reflection
The COVID pandemic warped my sense of time. I find it hard to believe that the first shutdowns began five years ago. As I look back, I am immensely proud of how ProAssurance responded to the pandemic, both on behalf of our team members and our insureds. We found tremendous resiliency in each other and in our ability to redefine, sustain, and build on in-person relationships. We found strength in our willingness to lean on one another for support and encouragement.
When I reflect on the outcomes of the pandemic, two topics come to mind.
First, unlike many who think the most lasting impact from the pandemic was the pivot to remote work, I think the most lasting impact has been an outcome of that transformation. Today, operating and communicating remotely have become a core component of how we do business.
When we first moved to remote work and the distance it put between us, I worried that our culture would suffer. Instead, while being in person remains important, I have seen a new culture emerge. This new culture embraces the freedom and flexibility of remote and hybrid work while simultaneously building relationships in new ways and developing new avenues of support. This embrace of new ways of doing things has, in my view, amplified our innovation efforts and ultimately made us a stronger company.
Second, I remain concerned about the lingering impact of COVID on our insureds in terms of an unfortunate distrust in our healthcare system. This distrust appears to be impacting the delivery of care and the provider-patient relationship while also negatively influencing the litigation environment.
Five years ago I said, “Our healthcare system is being tested in a way we have never seen before, and yet people show up day after day to serve others. It is truly inspiring, and we are grateful for the opportunity to support them and our communities whenever we can.”
In the early days of the pandemic, many referred to those in our healthcare community as heroes, and indeed, they are. This was especially seen in the early days of the pandemic when so little was known about the disease. The selflessness with which they responded was truly inspirational, and it is unfair that the tide turned against them so quickly.
The New Normal
Looking back at COVID-19, our society and business have changed dramatically. The most obvious from a business perspective is the “work from home” situation. We never envisioned an immediate 100% remote workforce and a largely remote workforce today. Our team members are located much more widely.
Relative to Underwriting and Claims, we have both returned to normal and will never be normal again. With Underwriting, we reduced premiums for many insureds whose practices were disrupted by COVID, affording them some relief as their revenues were dramatically reduced. We did not see a massive movement of insureds between carriers, as their insurance wasn’t at the forefront of their concerns. For Claims, the immediate and long-term effects were significant. First, the number of claims dropped as many types of care were delayed. For example, elective surgeries virtually ceased for a considerable length of time. Claims counts did rebound to pre-COVID levels after care patterns returned to normal, but those “missing” claims remained as such with very little in the way of a “catch up” spike.
The most material effects were in claims resolution. Claims closure patterns were materially disrupted, delaying our ability to clear claims from the rolls. This fact combined with the increasing cost of claims leading up to and following COVID-19 created uncertainty about ultimate results, making financial estimates much more difficult.
In some ways, our favorable MPL results from 2024 were the result of this difficulty in estimating appropriate reserve levels in prior years. Basically, resolution took longer and has worked out a bit better than the initial post-COVID estimates. Of course, the addition of NORCAL following COVID-19 increased the volume effects of that uncertainty. We are just now seeing claims closures back at pre-COVID normal levels.
Generally, the claims volume (frequency) has moderated since 2020 with a slight decrease from pre-COVID levels, which is a bit of a surprise but a good one. We know that some of that moderation resulted from our strong reunderwriting efforts during 2020–2021, but we have observed a general moderation as well. Frequency has remained flat since 2021, and severity has continued to increase materially.
While some physicians, indeed, chose early retirement, many did not quit medicine but joined larger groups that could take the administrative burdens from them. That continued and possibly slightly accelerated the trend of consolidation of physician practices. Today, many estimate that only 20% of physicians own their practices.
This is our “new normal.”
The Post-Pandemic Impact on Senior Care
One of the long-term impacts of COVID-19 in Senior Care is that it permanently changed the landscape for occupancy. Many nursing homes closed, and occupancy has not fully recovered.
According to KFF, a leading health policy organization in the U.S., the number of nursing home residents decreased by 10% between 2015 and 2024, with a big drop from 2020 to 2021 due to COVID-19. While the number of residents is slowly rising again, it is still lower than before the pandemic. More people are now receiving care at home or in other community-based settings instead of nursing homes.
The number of certified nursing homes also decreased by 5% from July 2015 to July 2024. During this time, the average amount of nursing care hours per day dropped by 8%. The number of deficiencies per facility went up, and the share of facilities with serious deficiencies grew from 17% to 28%.
The number of workers at long-term care facilities is still below pre-pandemic levels. To help address the high mortality rates in Senior Care during the COVID-19 pandemic and ongoing staffing shortages in facilities, the Centers for Medicare and Medicaid Services (CMS) created a new rule. It set minimum staffing requirements for nursing homes in an effort to improve Medicaid services and long-term care.
While the pandemic posed significant challenges for Senior Care facilities, it has also sparked important changes that will shape the future of long-term care.
Title: The Ghost Map: The Story of London's Most Terrifying Epidemic – and How It Changed Science, Cities, and the Modern World
Author: Steven Johnson
Year: 2006
Genre: Nonfiction
What's It About?: Dr. John Snow invents both modern epidemiology and visualization-based data analytics to stop London’s 1854 cholera epidemic.
One Takeaway: While it’s almost always teamwork that saves the day, every once in a while it’s also a lone hero with an innovative way of looking at a problem.
Title: The Great Influenza: The Story of the Deadliest Pandemic in History
Author: John M. Barry
Year: 2004
Genre: Nonfiction
What's It About?: The 1918 influenza pandemic (aka Spanish Flu), a global health crisis caused by an H1N1 strain of influenza A, is estimated to have infected 500 million people worldwide and led to the deaths of 50–100 million.
One Takeaway: Pandemic misinformation did not originate with COVID-19 … The “Spanish” flu originated on an army base in Kansas.
Title: Station Eleven
Author: Emily St. John Mandel
Year: 2014
Genre: Fiction
What's It About?: The story of a small group of traveling performers around the Great Lakes area in the aftermath of the “Georgia flu” decimating humanity.
One Takeaway: If a pandemic takes out 99% of the population, the lucky ones are not necessarily the survivors.
Title: World War Z: An Oral History of the Zombie War*
Author: Max Brooks
Year: 2006
Genre: Fiction
What's It About?: A virus causes a global zombie outbreak leading to a world war with nations fighting each other. This is an oral history with no central characters or plot line (aka ‘nothing like the movie’)
One Takeaway: In a zombie apocalypse, the value of sedentary knowledge workers (like us) drops to zero. Find at least one useful skill or nobody is going to let you into their compound.
*If you only pick one book on this list, make it this one!
Title: The Cobra Event
Author: Richard Preston
Year: 1998
Genre: Fiction
What's It About?: A fictional thriller about a bioterrorism attack in New York City involving a genetically engineered virus—a fusion of smallpox and the common cold.
One Takeaway: The Clinton story places this book at an interesting intersection of science, the arts, and government. A molecular biologist at a conference with Bill Clinton gave him the book, and his reading brought attention to the issue and ultimately changed public policy.
Title: The Demon in the Freezer: A True Story
Author: Richard Preston
Year: 2002
Genre: Nonfiction
What's It About?: This nonfiction book covers the potential for smallpox and anthrax to be used as bioterrorism weapons. It includes a history of the global smallpox eradication program.
One Takeaway: It turns out we did not actually eradicate smallpox from the planet, as there are at least two live samples (demons) waiting in the freezer—one in Atlanta at the CDC and the other in Moscow.
Title: The Hot Zone
Author: Richard Preston
Year: 1994
Genre: Nonfiction
What's It About?: The true story of an Ebola outbreak in a primate quarantine facility in suburban Washington, DC.
One Takeaway: If there is one silver lining in the gruesome way viral hemorrhagic fevers kill their hosts, it’s that they work so quickly they tend to burn out quickly so are hard to spread.
Title: The Stand
Author: Stephen King
Year: 1978
Genre: Fiction
What's It About?: A good versus evil horror story set in a post-apocalyptic world after a deadly virus, “Captain Trips,” kills 99.4% of the population.
One Takeaway: Good versus evil allegories aside, at a whopping 1,192 pages, having this book on the shelf will keep your brain occupied for long stretches during the next lockdown.
Do you have a favorite pandemic book to recommend? Email us at AskMarketing@ProAssurance.com and let us know why you recommend it.
Post-Pandemic Travel Budgeting Challenges
It was just over five years ago in March 2020; we huddled up in the Birmingham headquarters trying to make sense of the news—lockdown. Working from home, essential versus nonessential travel, unprecedented issues with many questions unanswered. One colleague said it'd last two weeks, another said June, but June seemed much too long; we quickly dismissed that. Whatever your prediction, ProAssurance continued to insure our physicians, hospitals, and others throughout the pandemic. We worked remotely, supported each other, and went through the next years with agility and resilience.
My team with the ProAssurance Medical Professional Liability division is responsible for financial planning and analysis (FP&A). While our division has many responsibilities, a critical one is the travel and entertainment (T&E) budget planning and expense management. While this has always been a bit of a moving target, the pandemic completely broke T&E planning, and five years later our “new normal” makes that a challenge.
In the first year of the remote working environment, we ‘beat the budget’ for T&E expenses by 77% with business travel coming to a complete stop. By ‘beat the budget’ we mean underspent the expected amount, so if the T&E expectation for 2020 was $100, we only spent $23. This was not a surprise for 2020; however, getting the right number in the past few years has remained challenging.
While we did achieve a gradual decrease in the favorable variance, the total period T&E expense during ‘The Blip’ is lower by 46%. Business travel remains an important part of our business; so why do we see this trend? What have we learned?
Leisure travel in our country came roaring back after the lockdown period but not business travel. To responsibly predict and manage expenses, we needed more understanding of how business travel changed. We can't tie actual dollars to root causes, but there are material changes in work culture and expectations.
- Technology – We all became a sort of subject-matter expert in online meeting software and suddenly realized what could be accomplished as a replacement to what previously was done in person.
- Decentralization – With the impacts of remote/hybrid environments, there is added friction to travel planning, i.e., an insurance company business development representative cannot visit an agency’s office if no one is there.
- Last-Minute Cancellations – With new waves of virus and shifting expectations about personal cost and risk, travelers today are more likely to cancel on short notice. While individuals may have previously shown up sneezing, a culture of public health sensitivity makes it more likely you’ll stay home.
- Competition – Leisure travel is booming, and there is a reduction in physical office space; the need to book third-party venues and find airline tickets is much tighter. Our event planners have us looking further into the future to simply find space.
- Demographics – New employees entering the job market have lower expectations and interest in work travel, while older generations who prized work travel are retiring.
A responsible FP&A means trying to understand practical cause and effect in order to help your organization best apply financial resources. As we head into the 2026 budget cycle, here are some things your agency planners can consider.
- Start by revisiting company policy and using the resources offered by your budget team like tracking tools, analysis of trends, and recommendations. Another starting point is the current budget and the upcoming trips you have lined up for the current year.
- Have a dialogue with your teams and understand how you can get the most value from in-person interactions with your business partners, suppliers, and stakeholders.
- Adjust to shifts in our industry or understand how the roles of your team members have changed in relation to business travel. Employ best practices, share knowledge, learn from each other, optimize available resources, and continue to evaluate the purpose of travel.
Our team members have done an excellent job of controlling company costs. However, the expense reduction alone will not help reduce the actual budget variance. It’s the refinement of the travel assumptions all of us employ in projecting next period’s expense. With every step we take toward more automation, there should be an equal step toward more valuable in-person interaction.
COVID-19 Impacts on Risk Management
COVID-19 significantly impacted the medical professional liability industry, including the Risk Management team at ProAssurance. Reflecting on the past five years since COVID-19, the role of the “Risk Management Consultant” has evolved. For Risk, the pivotal moment came when live Loss Prevention Seminars (LPS), onsite surveys, and in-person staff education were canceled. This was a significant change in direction for the many consultants who were hired to travel the country and deliver in-person education to physicians and practice managers.
Risk Management quickly adapted when live education was no longer an option due to canceled venue contracts, required social distancing, prohibited travel, and mandatory mask policies. The online version proved timely, convenient, and cost-effective. Even today, the 2025 LPS is a predominantly online-only offering, reflecting the long-lasting changes resulting from the COVID-19 pandemic.
At the same time education shifted to an online platform, onsite visits were also no longer an option, and the role of virtual surveys and assessments became essential.
Adaptations during the pandemic allowed Risk Management to rethink offerings and discover new ways to reach more insureds when there were no geographic limitations. In the early days of the pandemic, communications with practices were challenging due to limited in-person contact, but the creation of virtual tools ultimately led to the creation of the Annual Baseline Self-Assessment (ABSA) in 2023. This innovative solution then evolved to become the offering we have today that allows Risk to reach physicians, practice managers, and medical staff in a meaningful way. The ability to collect, aggregate, and analyze larger data sets, as well as provide actionable insights from a virtual platform, has led to a large-scale deployment of the ABSA nationwide.
During COVID-19, Risk prioritized supporting insureds on the front lines. The ProAssurance COVID-19 Resource Center provided real-time, state-specific information focused on patient safety concerns as well as deploying telemedicine for patient services at scale. The Risk Management Helpline became essential as doctors sought guidance on virus exposure and PPE shortages. Healthcare workers faced intense mental health strain due to infection fears, increased workloads, and the emotional toll of patient care. Patients and families became more demanding as hospitals struggled to provide timely and safe care. As a direct result of the challenges, Risk Management provided additional educational resources to address the new needs regarding burnout and communication.
I am proud of how Risk Management supported policyholders during this challenging time and how we continue to see the positive changes initiated by the pandemic.
Human Resources Weighs in Five Years After COVID-19
One could say ProAssurance was a little ahead of the curve when looking at remote work and hybrid work. Prior to COVID-19, a few areas of the company were working from home one to two days per week, and some were just beginning to test work from home. The move to full remote at the start of COVID-19 was dramatic.
ProAssurance offices remained remote only until early 2021, when buildings reopened for team members to have the option to return to an office, but it was not mandatory. Jumping to the present day, most teams work from home a majority of the time, if not fully. This move was in response to the hiring challenges ProAssurance, and other companies, faced in 2022. These challenges, coupled with the talent struggles the insurance industry was seeing, pushed ProAssurance to expand its geographic footprint to hire talent where we could find it. Out of more than 1,000 team members, approximately 45% of individuals are remote.
ProAssurance is among many companies that offer flexible work hours. In its February 2025 Insurance Labor Market Study, insurance talent The Jacobson Group reported that 83% of companies offer flexible work hours. The study found 78% of companies are anticipating most individuals to be in office at least one day a week in the next six months. Eighty-eight percent of the companies polled do not foresee a change in their current model, and 11% are expecting employees to be required in the office more often.
What about the next global pandemic? Human Resources Vice President Marcie Claas says, “We feel we are prepared to respond well if we find ourselves in a similar position again. So much of what we learned and how we changed through COVID-19 is in the fabric of our company and how we operate each day.” She touched on ProAssurance’s flexible structure being an asset, with minimal transition if team members had to work from home consistently. She said the current work structure and resources in place would help managers and their teams confidently transition to a fully remote work model.
Existing ProAssurance Office Space
The pandemic influenced ProAssurance to close 10 offices, or around 15% of the company’s rentable square footage (RSF). Through lease attrition over the past five years, we closed a total of 89,048 RSF of office space and reduced our lease obligations by 44,325 RSF by rightsizing leased office locations, resulting in a total 133,373 RSF decrease. For perspective, that amount is twice as much space as we have in Lancaster and exceeds square footage in the five floors we occupy in our Birmingham headquarters. We now rent office space totaling 153,050 RSF, which is a 47% decrease in rented office space since 2020.
As of late March 2025, we own 217,444 square feet of office space. This amount includes a 31% reduction with the recent sale of the Franklin, Tennessee, office.
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Overall, data compiled from many countries shows that in 2020, on average, around 1 in 140 people infected died from COVID-19. In this article, we review the key insights from global data on COVID-19. (Our World in Data)
Decades from now, the pandemic will be visible in the historical data of nearly anything measurable today: an unmistakable spike, dip, or jolt that officially began for Americans in March 2020. (New York Times)
A research group found the following regarding the effects of the COVID-19 pandemic:
- Cancer screening participation decreased by 39%.
- Diagnoses decreased by 23%.
- Diagnostic procedures decreased by 24%.
- Disease treatment decreased by 28%—ranging from a 15% decline for radiotherapy to a 35% decline for systemic treatment during the pandemic compared with the pre-pandemic period.
- Medium-human development index (HDI) category countries experienced greater reductions than high- and very-high-HDI countries. (The HDI is a summary measure of average achievement in key facets of human development, including a long and healthy life, being knowledgeable, and having a decent standard of living.)
(Science and Medicine Group)
Average hospital occupancy rates were up 11% in 2024 compared to 2019, due mostly to a declining supply of staffed beds rather than an increase in hospitalizations. The average supply of staffed beds fell from 802,000 beds between 2009 and 2019 to 674,000 beds between May 2023 and April 2024. (Healthcare Dive)
For the week ending on January 25, nearly 1.7% of all deaths nationwide were attributed to the flu, compared to roughly 1.5% being the result of COVID-19, according to CDC data. Rates of influenza hospitalizations are more than three times higher than COVID-19 hospitalizations amid this season's record wave of flu infections. (CBS)
The Blip that Became the Blueprint: A Five-Year Retrospective on Selling in the Post-Pandemic World
What started as “The Blip” has fundamentally transformed how salespeople approach healthcare providers. While it might feel as though things are back to normal, comparing the pre- and post-pandemic business landscape reveals things have changed. If you’re still trying to sell like you did in 2019, it might be working, but chances are, it’s not working as well. Let’s look at these changes and what’s required to remain competitive.
The New Gatekeeping Reality
If you ask medical sales reps what’s changed since the pandemic, they’ll likely tell you that healthcare providers are more protective of their time. Pre-pandemic, a sales rep could grab a few minutes of a provider’s time by dropping in with lunch or a new widget. Today, lunch needs to be served with a solution to an urgent priority, or you’re not getting past the front desk.
While liability risk is a subject that gets the attention of HCPs, generic presentations about “potential liability issues” don’t cut it anymore. Today’s providers need you to address precise concerns relevant to their specialty, patient population, or specific technologies they use, not your products’ general benefits.
What HCPs Care About Now
While sales calls previously focused mainly on product issues, conversations have shifted. Doctors and other HCPs are more open to discussing:
- Staffing volatility and the resulting liability concerns
- Achieving financial sustainability during an era of declining reimbursement
- Integrating technologies that introduce new layers of risk
- Patient expectations that are more focused on care access and communication
- Expanding regulatory compliance burdens that consume administrative resources
- Cybersecurity threats
- Practice consolidation pressures (for the diminishing number of independent providers remaining)
Agents who deeply understand these challenges stand out from the crowd. The most successful sales professionals have aligned their value propositions around these and other evolving concerns rather than just focusing on a product.
Information Is Your New Currency
Relationships still matter with HCPs, but the basis has shifted. Providers gravitate more toward partners who deliver meaningful insights than those who are merely friendly.
Outreach around relevant data, case studies, and trend analyses are more likely to capture attention. By sharing intelligence about emerging risks, regulatory changes, or litigation trends, you position yourself as a true consultant instead of just another vendor.
This information-first approach serves a dual purpose. It keeps you top-of-mind when clients aren’t actively considering renewals or exploring coverage changes. More importantly, it positions you as helping clients identify emerging risk areas and potential coverage needs before they become urgent problems requiring immediate attention.
Building Resilience Into Your Sales Approach
One lesson from the pandemic is the importance of adaptability in the sales process itself. The sales professionals who thrived during the peak of COVID-19 were those who quickly pivoted to digital. This shift didn’t just change how providers operated, it changed how providers expected to interact with partners.
Adapting requires something beyond mere technical skills; it requires emotional intelligence. HCPs are experiencing levels of fatigue and uncertainty like never before. Agents who acknowledge this reality and approach conversations with genuine empathy create connections beyond traditional business relationships.
The pandemic didn’t just move the goalposts—it built an entirely new playing field. Yet the game remains oddly familiar: deliver truly personalized value, and you’ll win. Only now, healthcare providers define the meaning of value, and they’re not accepting substitute definitions.
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Written by Mace Horoff of Medical Sales Performance. Mace Horoff is a representative of Sales Pilot. He helps sales teams and individual representatives who sell medical devices, pharmaceuticals, biotechnology, healthcare services, and other healthcare-related products to sell more and earn more by employing a specialized healthcare system. Have a topic you’d like to see covered? Email your suggestions to AskMarketing@ProAssurance.com. |
Notice of Rate Changes
We are committed to responsible pricing that reflects the current risk environment. A review of our rate plan and rating factors has resulted in an updated rate strategy for new and renewal accounts in the states listed below.
The following updates, which have been filed and approved, may impact insureds. Note the carrier and effective dates below:
DELAWARE (NORCAL, effective April 1, 2025)
A base rate increase of 8.0%. After revisions to some classes and specialties, the overall rate change is 11.9%.
DELAWARE (ProAssurance, effective May 1, 2025)
A base rate increase of 4.4%. After revisions to some classes and specialties, the overall rate change is 7.6%.
PENNSYLVANIA (NORCAL, effective May 1, 2025)
A base rate increase of 4.8%. After revisions to some classes, specialties, and territories, the overall rate change is 7.8%.
FLORIDA (NORCAL, effective May 1, 2025)
No base rate change. After revisions to territories, credit eligibility, and some classes, the overall rate change is 2.7%.
