Does your Client need Managed Care E&O Coverage?

You may be asking yourself what is Managed Care and does my client need Managed Care E&O Coverage?

Managed Care describes the activity of organizing doctors, hospitals, dental and vision plans as well as other healthcare-related providers into groups to enhance the quality and cost-effectiveness of health care to its enrolled members. There are many different types of Managed Care Organizations (MCO). A health Insurance plan is any system of health payment or delivery arrangements where the plan attempts to control or coordinate use of health services. Health insurance plan entities generate most of their revenues from both underwriting and managing risk. They act as an efficient gatekeeper between providers and patients.

For example, health insurance plans objective is to manage two key aspects of healthcare: cost of services and quality of care. With a health insurance plan, the insurer will sign a contract with a specific group of healthcare providers to coordinate health services for their members in the most cost-effective manner. There are many different types of contracts that the health plan will use with the providers. One of the most common is Fee for Service. One type that is becoming more common is value-based. This type of contract between the insurer and provider is when the provider is incentivized to provide the best care and keep the cost low and is financially rewarded when they reduce the cost of care.  

Any organization with these exposures needs a Managed Care E&O policy in today’s litigious environment. The managed care industry has unique needs within the insurance market, no one understands these needs like Chatham Insurance Services (CIS). With CIS’s specialized knowledge, expertise and focus on the Managed Care Industry you are guaranteed to have exceptional coverage for your client. With the managed care market evolving it is vital for Managed Care Organizations to have Managed Care E&O Insurance.

Is Managed Care E&O Right for Your Client?

Managed Care E&O policy provides coverage for errors and omissions in of the performance managed care activities (defined term). When MCOs lack proper managed care coverage, they open themselves up to potential vicarious bodily injury claims, regulatory claims, and anti-trust claims, to name a few.

CIS targets all sizes of private and non-profit organizations or publicly traded companies in the Managed Care Industry. Organizations with great management, experience and expertise in the Managed Care space, effective risk management, and consistent profitable results are candidates for managed care errors & omissions coverage.

Is a Health plan the only type of MCO’s that need this coverage?

In addition to health insurance companies, there are also ancillary managed care organizations that are part of a health system as well as all of the administrative and specialized organizations that contract with health plans for outsourced services. These entities are independent physician Associations (IPA’s) Physician Hospital Organizations (PHO’s), Clinically integrated Networks (CIN’s) and Accountable Care organizations (ACO’s). While many of these organizations are owned by health systems, the professional liability insurance purchased by the health system typically does not protect these types of organizations. By implementing a managed care policy to cover these organizations the health system’s will be protected.  As the quality of services provided goes up, along with balance sheet protections, the cost and liability goes down.  Other types of organizations supporting health plans include: Dental, Vision and Prescription Drug Plans, Credentialing, Peer Review and Utilization Review Organization, and Case and Disease Management Companies.  Other types of organizations with Managed Care exposures include, Self-funded Health Plans and Trusts, Third Party Administrators of Self-funded Health Plans and Medical groups that manage a Network or have direct contracts with Health Plans.

What other coverage can CIS offer?

Within the unique needs of the managed care industry, Managed Care Organizations need a program specific to the needs of the industry. Chatham can offer Managed Care E&O, D&O, EPL, Crime, ID Fraud, Fiduciary, Cyber, and Kidnap and Ransom. Many entities overlook the importance of all-around coverage.

Agent’s Role?

As an agent you understand how lack of protection can lead to increased costs for your clients in the healthcare industry. Chatham can help your client meet these needs by offering a suite of management Liability coverages including Managed Care E&O coverages. Helping MCO set up an effective program can help with coordination, quality and cost containment. As an agent it is your responsibility to your client to protect their interest so they can focus on what matters most, enhancing quality and cost effectiveness to its enrolled members. 

About Chatham

Since its founding in 2002, Chatham Insurance Services has been providing excellent service to clients and pride themselves on their long-term relationships with their clients through their vast knowledge of the Managed Care Industry. As one of the largest Management Liability Insurance Program Managers, Chatham offers unparalleled knowledge in the industry. With the ability to offer Managed Care E&O, Cyber, D&O, EPL, Crime, Id Fraud and Kidnap and Ransom and Cyber, Chatham will ensure all your clients’ needs are covered.

Does your Client need Managed Care E&O Coverage?