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Innovation & Progress: ProAssurance’s MPL Division
In 2023 we shared our standards with you, our partners, for the first time, telling you what we are going to do and holding ourselves accountable to do it. Meeting expectations is critical. Our theme from last year, Beat the Standard, called on us to set, communicate, meet, and then beat service standards for our policyholders and agents. In 2024 we are further developing our systems to facilitate achievement of these standards and better monitor our performance. We are also improving expectations for standards between our teams and services that can be leveraged across lines of business and segments within ProAssurance Group.
We understand that we must be a leading underwriter in the MPL markets we choose to serve and strive to be the Carrier of Choice for our distribution partners and insureds. We will lead our industry by differentiating service and providing diverse products. We plan to reduce and mitigate our insureds’ risks and aggressively adjudicate claims against them. Our efforts over the next three years will revolve around innovation, consistency, ease-of-doing-business, accountability, and growth as we pursue and achieve target levels of profitability.
Innovation is the foremost business strategy of the current era given the rapid advances in technology and the greater tools those advances provide. We are employing technological innovation using data and the pursuit of greater automation to advance our efficiency and effectiveness—but innovation is not limited to technological change. It also allows us to evolve our business models and processes. The former can disrupt markets or launch us into new ones, while the latter suggests continuous improvement of how we work to achieve our goals, creating new value.
One part of our innovation strategy is ongoing product expansion, creation, and refinement. Product and program innovation not only helps us meet the evolving needs of the healthcare industry, it keeps us front of mind for distribution partners who are always looking for something new to offer. A steady pipeline of new or improved offerings is necessary for engagement and market relevance. Presently we have several initiatives underway, including a full revision of the MPL physician form and underwriting manuals that cover approximately $400 million of our business, specialty-specific underwriting pilots challenging older methodologies in favor of new data and analytics, and consideration of new products either in the market overall or to ProAssurance.
As we develop new tools to enhance our capabilities and assist in underwriting decisions, we will employ these tools to deliver in a consistent manner. While our regional segmentation allows us to make decisions that are best for the specific circumstances related to distribution, insured, or environment, we must continually improve tools and processes to assure consistency in the way that we make decisions. Consistency, responsiveness, and customer experience are core elements of being your Carrier of Choice. Our commitment to continuous improvement in that regard infuses everything we do. Continuous improvement through incremental enhancements to our processes, services, and products—over time—lead to significant advancements.
We will continue to expand efforts to make it as easy as possible for you and your clients to do business with us. We must provide the service, expertise, products, and value that are expected from a top-tier MPL carrier.
We believe agents and brokers specializing in medical liability value the breadth of our appetite and product offering across nearly all sectors of healthcare. Our new business submission pipeline has been robust and, from this vantage point, we clearly see that our competition is experiencing severity trends in both expected and unexpected venues.
Claims: Challenges, Trends, & Future Plans
Current MPL Claims Challenges
Claims faces significant challenges in the MPL market in 2024, including an increase in claim severity due to social and economic inflation, tort reform erosion (with deterioration of certain laws governing civil cases), and juror anger influencing verdicts. The replacement of retiring defense trial attorneys with less experienced successors adds to these challenges. So do the incidence of highly publicized aberrant verdicts and the prevalence of cyberattacks on health systems, which cause delays in medical treatment and expose healthcare providers to claims.
Addressing MPL Severity Trends
We have responded to increasing severity trends by implementing a series of proactive measures:
- Using high-low agreements
- Conducting liability investigations early on (can lead to early resolution on cases of obvious liability in lieu of trials)
- Analyzing and investigating the facts and circumstances of each claim, including venue; judge; plaintiff counsel’s experience; parties, witnesses, and experts; liability; causation; damages; damages caps
- Monitoring and assessing appealable issues
- Using focus groups to hone defense strategies
- Retaining damage experts before and during trial to mitigate damage claims
- Evaluating each case on its merits in the defense of good medicine
- Extensively preparing witnesses for depositions and trial testimony
- Engaging in appropriate motion practice to mitigate claims, preserve issues for appeal, and ensure only appropriate plaintiff expert opinions are allowed to proceed
2024 Claims Accomplishments
The numerous accomplishments the Claims team has achieved this year include:
- Regional defense attorney conferences
- Trial victories
- Favorable appellate results
- Preferred vendor partnerships and pricing
- Favorable impact on indemnity payments through the effective use of high-low agreements
- Legal expense reductions due to efficiencies
- Use of artificial intelligence (AI) or other innovations to assist with medical record tabbing, medical record chronologies, and deposition summaries
Our team has also played a pivotal role in retaining and acquiring profitable business through exceptional customer service and targeted marketing initiatives, supported by ongoing collaboration with key departments like Underwriting, Business Development, and Risk Management.
Claims Projects for 2024
We are continuing to utilize AI to assist with medical record tabbing, medical record chronologies, deposition summaries, and correspondence. We are also continuing to train Claims personnel on our claims management system, Claims Workspace (CWS), and on its upgrades.
Collaborating with other teams within ProAssurance to develop workflows, processes, and procedures to facilitate Claims’ transition to a new document management system remains a priority. We are also continuing management of indemnity and expenses on files. This includes honing preferred defense counsel lists to include only efficient and effective counsel. This also involves vetting vendors to ensure retention of efficient and effective vendors with secure products and services.
Strengthening Our Partnerships: Business Development Update
In 2023, ProAssurance made progress in its quest to become your Carrier of Choice, achieving remarkable growth and progressing on strategic initiatives. The company recorded $54 million in new business production, surpassing expectations by 56% and marking a notable 92% increase year-over-year.
Particularly impressive was the 72% year-over-year surge in new business from our Elite Partners, attributed to the successful launch of a redesigned Elite Partner program. This revamped program—which now evaluates partners based on various performance metrics including premium volume, partnership performance, broker ROI, and book trending—contributed to our strengthening relationships with top-tier partners.
Moreover, ProAssurance established Advisory Councils to foster open communication channels with partners, soliciting feedback to enhance our position as your Carrier of Choice. With seven councils led by Elite Partners, including five Regional Councils, one National Advisory Council, and one President’s Council, ProAssurance demonstrated its commitment to collaborative improvement.
Moving into 2024, ProAssurance is poised to leverage the insights gathered from its Advisory Councils. Key focus areas include enhancing submission efficiency by providing comprehensive submission requirements and templates, improving change communication to partners regarding product or process alterations, and implementing Global Service Level Agreements (GSLAs) to further standardize service expectations.
ProAssurance has also embarked on establishing the Automated Business Unit (ABU), which aims to streamline operations through a fully automated rate-quote-bind system. Initially launching with two classes of business—general dentistry and the MDVIP concierge medicine program—the ABU will continually expand to accommodate additional classes and products. The launch is scheduled for November.
In the broader market landscape, ProAssurance maintains its position as one of the top five medical professional liability carriers by premium volume. However, market dynamics indicate a shifting landscape characterized by evolving challenges. While the top carriers continue to dominate, overall market growth has slowed, prompting larger carriers to respond with rate adjustments and tighter terms. Conversely, smaller and regional carriers are seizing opportunities to gain market share amid the changing landscape. That being said, through the first five months of 2024, we remain on track to match our new business production from 2023, suggesting that with the right partners, opportunities are there to produce good quality business.
The industry's response to deteriorating results, coupled with regulatory changes and capital dynamics, has led to a “lumpy” market characterized by regional disparities and product segment variations. Nevertheless, ProAssurance remains steadfast in its commitment to innovation, collaboration, and strategic adaptation, positioning itself for continued success in this evolving marketplace.
MPL Marketing: Impacts & Goals
The objectives of ProAssurance’s MPL Marketing & Communications team are to create awareness for those unaware of our brand or, if already familiar, to improve sentiment. Our agency partners are our primary constituency for our marketing efforts, as you are the ones presenting ProAssurance to our customers. The MPL Marketing team took on several major initiatives specific to our agency partners in 2023.
Significant Accomplishments in 2023
We published a full calendar year of this monthly magazine, ProVisions. Each issue highlights a specific trend or theme impacting the MPL line of business. The magazine is designed to give agents actionable insights to better prepare you for discussions with customers and prospects. Some of our most popular issues in 2023 included our overview of the claims severity crisis, cannabis liability, and our annual “The Difference” issue.
It's our understanding that no other MPL carrier produces a piece similar to ProVisions. We hope you find value in it, and we are always open to your advice or ideas about themes of interest in future issues.
The Marketing team also began redesigning several ProAssurance websites. One major initiative was the creation of the ProAssurance Group site, which provides a digital platform to share information and resources for ProAssurance Group and our corporate identity. Some of the resources include information on multiple ProAssurance lines of business, ProAssurance careers, and our company culture as well as history. This addition also frees up the main ProAssurance.com URL to focus on medical professional liability. The Marketing Digital team also launched and strives to improve Agents.ProAssurance.com as a home for ProVisions and other content specifically relevant to our agency partners.
Since the agents site inception, we have added information to our Elite Partners Program and Regional Councils pages, and to our initial batch of state profiles—quick hits to help you get a feel for the MPL environment in a state you may not regularly do business in. We will continue to expand that library and launch new items such as a fully digital Producer Guide and marketing materials library through 2024.
As with ProVisions, our ultimate goal for the agents site is to provide you with whatever is useful to help you sell or renew more business with ProAssurance. We welcome any suggestions or requests that would allow us to better serve your needs.
Key Goals for the Remainder of 2024
Marketing supports the change in organization through different communication channels. Some of the new communications initiatives we support include the launch of the new web portal, the unified policy forms project, and support for Business Development initiatives to help agency partners understand the venues and specialties where we can find mutual success.
Marketing also works closely with Risk Management to produce and support their work. Some of those efforts include the deployment of the new Risk Management website, support of the Annual Baseline Self-Assessment rollout, and improvements on written publications focused on case studies and the claims severity crisis. Marketing is working to use data intelligently to tell Risk Management’s story and continue to demonstrate value to our insureds.
Preview the New ProAssurance Website
The new version of ProAssurance.com is scheduled to go live August 5, but we are offering our agency partners the opportunity to see the updated site in advance of our official launch.
Get a preview of the site here.
This launch concludes a year-long project to update our main websites.
Phase 1 – Launched ProAssuranceGroup.com (August 2023) to house all information about ProAssurance at the holding company (or corporate) level.
Phase 2 – Pair down the existing ProAssurance.com to focus exclusively on our MPL business and customers.
Phase 3 – Launched RiskManagement.ProAssurance.com (February 2024) to house all insured-facing tools and resources from our MPL Risk Management department.
Phase 4 – Launch the new ProAssurance.com with the updated look and structure with an MPL focus.
We will continue to expand the agent website that preceded this project and update our program sites (Certitude and the Ob-Gyn Risk Alliance) following the conclusion of our August 5 launch.
One of the most significant changes implemented in 2024 was the announcement of a two-option program where insureds can take advantage of our traditional Loss Prevention Seminar or participate in our newly released ABSA (Annual Baseline Self-Assessment) for premium discount. The combined announcement and mailing reached both our agency partners and insureds and offered an easy way to showcase the benefits of each option. Some insureds have opted for the traditional 2024 Loss Prevention Seminar titled “Opioid Treatment: Guidelines, Research, and Prescribing,” while others chose to participate in our new ABSA to obtain premium discount. This inaugural campaign allows insureds to participate in the option that best suits them.
The ABSA is a valuable tool to benchmark a clinical practice and gain insight into not only physicians but staff members by asking relevant risk management questions. Once a group completes the survey, a risk consultant develops a personalized report to share with the practice regarding areas of potential improvement. Participation in both activities is an option, but premium discount is only awarded for one activity.
Agents and brokers can request the Annual Baseline Self-Assessment with the ABSA Request Form.
The first half of 2024 was marked by staffing changes due to several well-deserved retirements. Risk Management underwent leadership changes that have enabled both internal promotions to management and new hiring. I was grateful to be promoted to Director of Risk Management and now lead the five regional Risk Management teams as well as the ACCME program. My promotion opened an opportunity for the Southeast Regional Manager position to which Bradley Byrne was named.
Risk Management continues to align with our regional model by moving consultants into their home regions. As such, Wendy Alderman has moved from the Southwest over to the Southeast to service customers in her home state of Florida. Barbara Hunyady was named Risk Management’s Midwest Regional Manager. She has been with the company for six years and brings claims handling experience to the team. The Midwest also welcomed Barb Linder as a Senior Risk Management Consultant, and Gerryann Whalen was added to the Northeast team as a Senior Risk Management Consultant. Finally, Aaron Hamming was named Director of Data Analytics and Technology for Risk Management in charge of the Risk Management Data and Admin teams.
One of the most exciting announcements for Risk Management is the release of our easy-to-navigate website. This much-needed change has been an added benefit to insureds, agency partners, and potential customers alike. Whether you are seeking our helpline to call in with a question or perusing our newest publications, the accessibility and ease of use on this site are of the highest caliber. Our educational seminars, two-minute videos, medical malpractice case studies, and other resources can be found here along with monthly additions.
Risk Management has been focusing on areas of emerging risks, such as regulatory updates, artificial intelligence, staffing shortages, and claim severity. It is also looking at disclosure and the risks of working with Advanced Practice Providers. With advances in technology and the changing healthcare landscape, attention to communication and documentation can bring positive changes to any practice. The team maintains a commitment to thought leadership in the industry through speaking engagements and interdepartmental meetings, and by supporting state and local societies. New releases like our enduring online seminars and the new 2024 Practice Administrator Seminar, “Opioid Prescribing: Minimize the Risks to Patients and Physicians,” are easy to locate and participate in online.
One of the defined metrics Risk Management holds at the highest priority is our customer service and response time. With improved technology and processes, the team can now measure not only the type of helpline calls we receive but how we are performing. With nearly every call or email answered within 24 hours—and more than two-thirds immediately—the customer service provided to insureds, agency partners, and internal callers is unmatched.
The Risk Management team aims to develop and grow our relationships with our insureds and agency partners by understanding their challenges and providing practical solutions to their needs. By collecting and maintaining Risk Management data, the team can produce education and resources in specific areas of need for insureds and assist customers in a more efficient and timely manner. Whether it is answering a call on our helpline or reviewing an ABSA report with a practice manager, Risk Management staff are committed to serving as a resource to our customers. Simultaneously, we strive for continuous improvement and innovative solutions to mitigate current industry risks.
BOLT: Past, Present, & Future
Significant Accomplishments in 2023
Business Operations, Logistics, and Transportation (BOLT) focused on improving foundational systems and processes in 2023. BOLT facilitated the integration of NORCAL systems into core ProAssurance systems, resulting in faster service, increased visibility, and improved accountability with documented service standards. The team worked closely with Claims and IT to deploy a new claims management system (known as the Claims Workspace), reimagining an end-to-end workflow for claims handling with a focus on standardization to set a foundation for future automation and service improvements. The new workflows created by BOLT helped streamline processes, increase visibility, and improve accountability for our internal and external partners.
Key Goals for the Remainder of 2024
BOLT anticipates releasing a new portal toward the end of the year, which will provide the foundation for efficient and simple self-service. BOLT will continue to manage and support filing and prepare for the implementation of a nationwide unified policy and policy manual. The new policy will be rolled out by region beginning in mid-year 2025. The team will continue managing system, process, and workflow enhancements to improve service and visibility to our partners and insureds.
Key Opportunities and Threats in the Marketplace
Generative artificial intelligence is both an opportunity and a threat for BOLT, ProAssurance, and the entire insurance industry. We are working to assess how and where to use the rapidly developing technology.
PICA: Accomplishments & Goals
Significant Accomplishments in 2023
ProAssurance Insurance Company of America (PICA) accomplished several strategic goals in 2023. From a sales and marketing perspective, PICA’s podiatry business exceeded annual new business targets by increasing new business initiatives, as well as launching innovative social media campaigns.
Operationally, PICA increased efficiency significantly by completing automation and data-related projects; for example, we began utilizing artificial intelligence capabilities to process select inbound customer requests. Also of note, PICA hired a new Chief Medical Director, Luke Cicchinelli, DPM, who has expanded upon risk awareness programs to engage with podiatric medical students and residents around the country. Additionally, PICA received the Middle Tennessee Top Workplace Award for the eighth consecutive year, as well as a Tennessee Top Workplace recognition.
Key Goals for the Remainder of 2024
PICA remains focused on maintaining profitability while providing an excellent customer experience and defending the livelihoods of our insured healthcare professionals. The PICA team is also undergoing internal systems migrations to increase efficiencies within the ProAssurance family of companies, which will make doing business more streamlined. PICA is focused on making these migrations as minimally disruptive for teams, agency partners, and policyholders as possible.
Key Opportunities and Threats in the Marketplace
There is quite a bit of private equity acquisition activity in the marketplace, which is both an opportunity and a potential threat. PICA has been successful in insuring large medical groups backed by private equity because of the team’s deep expertise regarding the complex coverage needs of these practices. Collaboration with agency partners and brokers was crucial in accomplishing this and will continue to play an important role as the marketplace evolves.
The trend toward larger verdicts is a potential challenge for PICA and our insureds. PICA is focused on how to impact the frequency and severity of claims by educating insureds about the potential risks they face as healthcare practitioners in today’s litigious environment. With the financial compensation awarded in malpractice lawsuits on the rise, it’s even more important for insureds to be informed on risk mitigation.
The pace at which technology is evolving proves both a challenge and an opportunity. The impact is far-reaching and is already changing how insureds practice medicine, as well as how business is done within the medical malpractice insurance space. PICA is focused on automation and how to best utilize technology like artificial intelligence, machine learning, and large language models. These advancements will inevitably change how insureds care for patients, as well as how the medical malpractice insurance industry operates.
AM Best Affirms ProAssurance Group and ProAssurance Corporation Credit Ratings
On June 20, 2024, AM Best reaffirmed ProAssurance Group and its subsidiaries Financial Strength Rating (FSR) of “A” (Excellent).
Concurrently, AM Best has affirmed the Long-Term Issuer Credit Ratings (Long-Term ICR) of ProAssurance Group as “a+” (Excellent). Financial strength is crucial for a healthcare liability insurer: Part of ProAssurance’s pledge is maintaining stability and sound investments for agency partners and insureds. The rating of ProAssurance Group represents our balance sheet strength, which AM Best assesses as strongest, as well as its adequate operating performance, favorable business profile, and appropriate enterprise risk management (ERM).
The rating considered ProAssurance Group’s operating performance, which remained stable despite the challenging market conditions over the last five years. However, the stable outlooks for ProAssurance Group and ProAssurance Corporation reflect AM Best’s expectation that the Group will maintain its strongest level of balance sheet strength assessment, supported by effective capital management, while ongoing initiatives implemented by management will maintain stable operating performance, supported by its favorable profile.
The FSR of “A” (Excellent) and the Long-Term ICRs of “a+” (Excellent) have been affirmed, with stable outlooks for the following members of ProAssurance Group:
- ProAssurance Indemnity Company, Inc.
- ProAssurance Specialty Insurance Company
- Medmarc Casualty Insurance Company
- ProAssurance Insurance Company of America
- ProAssurance American Mutual, A Risk Retention Group
- Allied Eastern Indemnity Company
- Eastern Advantage Assurance Company
- Eastern Alliance Insurance Company
- NORCAL Insurance Company
- NORCAL Specialty Insurance Company
- Medicus Insurance Company
- FD Insurance Company
- Preferred Physicians Medical Risk Retention Group, a Mutual Insurance Company
Handling the Heat of a Medical Malpractice Trial: Sound Advice from ProAssurance’s Experts
Mary-Lynn Ryan and Barbara Hunyady of ProAssurance share their insights on the challenges physicians face during medical malpractice trials, the resources available to them, and the role of risk management in maintaining their professional standing.
Dan Reynolds, editor-in-chief of Risk & Insurance, recently caught up with ProAssurance’s Mary-Lynn Ryan, JD, senior risk management consultant, and Barbara Hunyady, JD, Midwest regional risk manager.
They discussed the challenges and considerations involved in preparing physicians for medical malpractice trials, the resources available for stress management, and the role of the risk management team in these situations.
Updated Rate Strategy: Illinois & Kentucky
We are committed to responsible pricing that reflects the current risk environment. After recent review of our rate plan and rating factors, we have decided to update our rate strategy for new and renewal accounts in Illinois and Kentucky. The following changes, which have been filed and approved, may impact insureds:
ILLINOIS (ProAssurance)
- Base Rate: No meaningful change (decreased $1)
- Revised Rating Factors for Advanced Practice Providers (formerly Allied Health Professionals)
KENTUCKY (NORCAL)
- Base Rate: No change
- Revised Territory 2 Factor
- Revised Class Factors
- Revised Specialty Class Assignments: Administrative Medicine, Bariatric Surgery, Cardiovascular Surgery, Emergency Medicine, Emergency Medicine (With Trauma), Gastroenterology (Minor Surgery), Hospitalist (Including ER), Internal Medicine (Major Surgery), Pain Management (Interventional), Podiatry (Surgery), Pulmonary Medicine (Minor Surgery), Thoracic Surgery, Urology (Major Surgery), Vascular Surgery, Nurse Practitioner, Physician Assistant, Radiology Assistant, Surgeon Assistant
These changes, which have been filed and approved, go into effect August 1, 2024, and are applicable to new and renewal accounts.
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The Contextual Imperative: Making Healthcare Data Meaningful
When you have data that supports ProAssurance's strong position in the marketplace, you're likely to include it in discussions with clients and prospects. After all, it's data that ultimately drives buying decisions in healthcare, right?
Not so fast. The data itself doesn't tell enough of the story the prospect needs to hear. Healthcare providers work in a world where existing workflows, products, and habits that serve them and their patients can become sacred. Your data may suggest a comparative advantage, but why should they care when their current MPL coverage seems adequate?
Anyone who sells has a strong confirmation bias. We love data that supports what we believe to be true (such as our product is the best!). We instantly recognize the data's relevance and think, 'Wait until the doctors see this!' But will they care?
A better question is, 'How can you make them care?'
The answer lies in Their Story.
Data Without Personalized Relevance Is Easily Ignored
The beginning of the 21st century saw a surge in minimally invasive surgery (MIS). As a sales rep in the highly competitive orthopedic implant industry, I craved anything that gave me an edge. Several orthopedic companies developed specialized instrumentation to perform total knee and total hip replacements through a smaller incision than was traditionally used. The data were compelling: patients recovered faster from the surgery and reported better functional outcomes earlier. They would also have a smaller surgical scar, which seemed a big plus. Armed with the data, I took MIS to my territory, expecting surgeons to be drawn to it like moths to a flame.
They weren't.
Not only were surgeons unimpressed, but many thought the idea of trying to perform relatively complex surgery through a smaller incision was irresponsible. More than one surgeon invoked the Three Golden Rules of Surgery: Exposure, Exposure, and Exposure. The more the surgical site is visible to a surgeon, the better. They also defended their reluctance by informing me that their patients were getting good results even at the cost of a larger incision and a slightly longer recovery time.
Connecting The Dots: The Power of Context
Within a short time, new data emerged revealing something surgeons couldn’t ignore: surgeons who didn't offer MIS procedures were losing patients to those who did. I started sharing a narrative to grab surgeons’ attention regarding MIS:
Increasingly, patients are migrating to surgical practices offering minimally invasive surgical options. Patients are learning that MIS results in an earlier return to full function, less pain, and better cosmetic results. Many surgeons have been reluctant to adopt MIS because of a perceived compromise with surgical principles, specifically exposure. Can I take a moment to share with you how surgeons are growing their total joint practice by offering MIS without compromising surgical principles or taking unnecessary risks?
The solution was simple: Offer MIS surgery with the caveat that the incision would be as small as possible and as large as necessary.
Wrapping data with context proved effective. The data on improved outcomes and patient preferences had little meaning unless surgeons could see themselves in the story.
Place the Client in the Narrative
ProAssurance's robust strength may not be immediately apparent to healthcare professionals until they envision themselves in a medical liability scenario. Help them see how MPL coverage with ProAssurance increases the likelihood of a favorable outcome. It's all about helping current and future clients understand how ProAssurance fits into their story.
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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. |
