Risk And Insurance - Power Broker®

Healthcare

2010 Power Broker^® Winners

Matthew B. Rice

Managing Director
Aon, Chicago

A Real Innovator
Not everyone thinks of the word "creativity" when they give their insurance brokers marching orders. But some insist on it. And when they do, they like what they see in Matthew Rice.

"Most brokers try to force-sell me something they've sold me before," one client said. "Matt is a real innovator. He figures out what the end game is for the customer. He doesn't do things the same old traditional way."

Rice managed to enlist a major market to assume the exposure of third-party medical malpractice insurance for U.S. and foreign medical tourism operators who seemed unable to get it because of the apparent lack of recourse for unsatisfactory treatment across international boundaries plus the confusing jurisdictional matters involved, HIPAA regulations, lack of loss experience and accreditation issues. Nevertheless, Rice succeeded; he managed to devise a viable solution for this immature market with huge potential.

For a large New York healthcare system that was at risk of losing its physicians to other providers because no fronting alternatives were available with approved status, Rice established a New York captive approved for Section 18 (excess) coverage purposes. Many believed it couldn't be done, but Rice did it. In addition, a cost-effective reinsurance treaty, using the healthcare provider's Cayman captive, was put into place for primary coverage. It remains today one of only two such programs in New York."Matt 'gets it,'" a client said. "That says it all."

Ethan Crain

Managing Principal
Integro, Boston

Making Things Happen

Many years ago, his mentor advised Ethan Crain always to act in his clients' best interests instead of his self-interest. His clients said that's just what Crain does.

Take the large teaching hospital system the offshore captive for which faced a significant financial challenge. Interpretations of new accounting rules limited the manner in which not-for-profit healthcare organizations could fund their captives. Although the healthcare client has one of the best balance sheets around and more than adequate funds to satisfy its liability, the interpretation of the rules caused it to face extreme fluctuations--one quarter it would have excess cash available and another not enough.

Crain went through the regulations with the proverbial fine-toothed comb and worked with client and government auditors to switch the client from statutory accounting to deposit accounting, saving the client upwards of $3 million and stabilizing the predictability of its funding.

"I credit Ethan for being the brains behind this," the client's CFO said.

Crain helped another client company, a hospital and nursing home health system, to self-insure. "Ethan was able to make a large number of stakeholders, physicians and board members feel comfortable with this. There was much trepidation but he was key to pulling it all together--in a remarkably short period of time," said the client's counsel.

"If every outside consultant we use were as effective and giving of his time and talents as Ethan," he adds, "we would be far better for it."

Larry Reback, ARM

Managing Principal
Integro, San Francisco

Laying Down the Law

Nine years as an insurance defense and coverage attorney gives Larry Reback not only unique insight into how insurance coverages apply in complex claim scenarios but also the ability to navigate around insurance company roadblocks.

And he uses this experience to benefit his clients.

"To me, he has the skills few have," said one client. "He leverages his knowledge of coverage law with the relationship he has with insurance companies with extraordinary results."

In the past year, Reback was successful in a number of areas that resulted in multiple six-figure recoveries for his clients.

For one large healthcare system, he accessed on-line legal databases to research the application of a common "other insurance" clause to an alternative risk-transfer product. The carrier had allocated a significant portion of its liability to another carrier, which brought its liability below the policy's retention. Reback got the carrier to reverse its position, allowing a significant recovery for Reback's client. And the client did not have to hire outside coverage counsel, thus avoiding extra costs that would have diminished the ultimate recovery.

In another instance, Reback successfully challenged carrier audits of defense invoices to obtain additional reimbursement for legal fees and costs.

"We have in-house counsel who can handle garden variety disputes," a client said. "By the time things get to Larry, they're cutting edge. If I had the funds, I'd recruit him in-house."

David Garrigus

Vice President
Marsh, Chicago

E Pluribus Unum

Talk about the whole being larger than the sum of its parts.

A large university with both a medical center and an academic research institution had been addressing its directors' and officers', employment practices and educators' legal liability exposures through separate policies with different carriers and different risk needs.

But an organizational change blurred the lines between the academic and medical operations and a new approach to insurance was needed.

David Garrigus rose to the challenge--and then some. He came up with a creative, blended policy to cover both entities while maintaining the unique coverage features present in the previous industry-specific forms. He even added new coverages to the blended form that are not commonly seen in other contracts within any industry segment.

"It was a major accomplishment," the university's risk manager said. "I credit Dave with providing us analyses and support to make sure our decision was based on real facts."

Other clients also cite Garrigus' depth of knowledge.

"We have been very impressed," said the vice president, risk management, for a large Catholic healthcare system. "He was one of the major reasons we selected Marsh--we were so impressed by his depth of knowledge and enthusiasm during the RFP process. He has delivered since we've been working with him and continues to deliver.

"I could hardly ask for more."

Cindy Lusignan, HRM

Senior Vice President
Marsh, Milwaukee

The Smooth Transitioner

Heads of organizations don't always know what goes on behind the scenes when it comes to insurance. They just know that they need it and they need it now. But when the organization changes brokers, there can be a steep learning curve that can result in stops and starts.

Not so for Cindy Lusignan's two large new healthcare accounts. She made seamless transitions and obtained renewal results that produced strategic coverage enhancements and significant premium savings for both.

Before becoming the brokers for a group of teaching hospitals and clinics, Lusignan and her team reviewed each of the provided policies and identified areas for rate and coverage improvements for nearly every coverage line.

Within six months, the client's total cost of risk had declined by more than 6 percent; this decrease is expected to continue. For a large, multi-state Catholic healthcare organization that delivers acute care, senior care and affordable housing, Lusignan developed a "Quick Start Plan" to execute the flawless transition the risk manager demanded.

Lusignan and her team identified significant coverage gaps, and developed and executed efficient and well-communicated workflow processes for the client's time-sensitive, critical functions.

Nearly $500,000 in savings was realized and a mission-critical coverage gap was eliminated.

"Cindy moved with key leaders in four regions to get everything in place," one risk manager said.

Kenneth W. Felton, CPHRM, FASHRM

Senior Vice President
Willis, Hartford, Conn.

Making Experience Count

Ken Felton has worked on both the risk management and brokerage side of the healthcare industry. He's a registered nurse, too.

This man knows the healthcare business every which way.

And it is just this broad range of knowledge and experience that stands him apart from others, his clients said.

"My basic complaint about consultants," said the president and CEO of a nonprofit social service agency, "is that they don't give you the benefit of their expertise. They tend to come in and say, 'What are the problems?' and everyone says, 'These are the problems' and then everyone says, 'These are the solutions.'

"I could have done a two-day retreat and come up with that myself."

"Ken uses that process," he said, "but that's only a piece of the work he does. He brings his expertise and insights from the last 30 years to help us refine and analyze, and to come up with better solutions."

Whether it's performing risk management assessments to more effectively identify, quantify, prioritize and mitigate risks across entire organizations so they can better manage risks, or attending underwriters' meetings both foreign and domestic to help clients market themselves as desirable in the insurance marketplace, Felton brings his varied and esoteric experience to the table.

"I realize we have our role to play," one client said. "But if I'm going to pay that money, I want you to give me something I hadn't thought of or wouldn't have known."