Financial Analytical Tools that Identify and Remediate Insurance Coverage Gaps Will Play a Critical Role in Helping Healthcare Reform’s Accountable Care Organizations Succeed

Industry Experts Say ACOs Need to Prepare for New Sources of Liability and Litigation

BRIARCLIFF MANOR, N.Y.--()--Since the Patient Protection and Affordable Care Act (PPACA) raised the profile of Accountable Care Organizations (ACOs) in 2009, there has been rapid expansion among healthcare providers, but few have addressed ACOs’ unique liability issues until now. USI Insurance Services ("USI") has found that traditional insurance policies are not designed to address the complexities inherent in ACOs, and this could result in devastating coverage gaps from uncovered claims and significant litigation that could exhaust policy limits. As a result, unique financial analytical tools that can identify and remediate coverage gaps are quickly gaining traction in the marketplace.

Rob Meyers, USI’s senior vice president, property & casualty, said, “We understand there is no 'one size fits all policy', which is why USI created an enterprise risk management approach that places the issues for ACOs front and center. This includes discussing a breadth of relevant topics that other firms are not asking and evaluating each requirement in the context of which analytical tool can yield the most refined, accurate answer. Following this analysis and a rigorous exposure assessment, we present a depth of solutions that address those concerns and demonstrate how the solution translates into meaningful, measureable results.”

USI estimates there are more than 300 ACOs in the U.S., and many more on the drawing boards. Jeff Levy, vice president for the USI Southwest region, said, “The insurance industry has begun evaluating potential risk solutions for these healthcare organizations. However, for these tools to work, they need to be able to correctly identify those new exposures that may not be covered under a traditional insurance policy and then obtain adequate limits of liability – all while keeping the cost of coverage affordable. This is particularly crucial as most providers are struggling with assuming the additional financial risks associated with adopting the ACO model.”

USI’s ACO Shield is a suite of financial analytical tools supported by a consultative process that guides a leadership team to better understanding the exposures arising out of an ACO’s structure, plan and operation. The systematic approach that distinguishes ACO Shield is designed to fit multiple permutations of this healthcare delivery model, including ACOs organized around the Centers for Medicare and Medicaid Services model of integrated care delivery, and many other private sector models. In addition to creating greater transparency, this solution fine-tunes insurance coverages to address liability needs in management, employment, managed care and malpractice.

Phil Dyer, senior vice president of healthcare management services for the USI Northwest region, said, “The concept of ACOs is gaining a great deal of attention in the reshaping of American healthcare delivery, and traditional, off-the-shelf insurance products are limited in their ability to fully address these new risks. Whether an ACO relies on an open or closed architecture, is hospital-centric or physician group-centric, USI’s ACO Shield offers a meaningful solution for important risk issues impacting these healthcare organizations.”

About USI Insurance Services

Founded in 1994, USI is a leading distributor of property and casualty insurance, employee benefits and specialty products throughout the United States. Headquartered in Briarcliff Manor, NY, the Company operates out of nearly 100 offices in 26 states. As the third largest privately-held insurance broker in the nation, USI combines its client-centric culture at the local level with leading edge technical resources on the national level. Visit USI at www.usi.biz to learn more.

Contacts

USI Insurance Services
Cecile M. Locurto, 914-747-6331
cecile.locurto@usi.biz

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