Healthcare consulting

Many healthcare entities, including hospitals, physicians, and physician corporations and their insurers face challenges and uncertainties related to their medical malpractice and other insurance costs, including:

  • The impact of the Affordable Care Act (ACA);
  • The impact of hospital / physician groups alignments;
  • The impact of tort-reform measures and the potential they are overturned; and
  • The impact of a changing insurance rate environment.

PwC actuaries help these entities estimate balance sheet liabilities, budget costs for planning purposes, and measure performance by providing analyses and benchmarks that allow for a meaningful assessment relative to peers.

Potential issues

  • Understanding the key drivers of your self-insurance costs.
  • Understanding the current and future impact of tort-reform measures on your reserve estimates.
  • Evaluating if now is the time to cost effectively increase (or decrease) your self-insured retention level.
  • Accurately allocating self-insurance costs within your health system in order to promote accountability for controlling them.
  • Evaluating the costs and benefits of a potential acquisition.
  • Getting the most from your claims administrator and whether the claims handling function is integrated efficiently with your loss control initiatives.
  • Having or are considering forming a captive insurance company.
  • Understanding financial reporting issues, including proper recording of tail liabilities and insurance recoveries, and the impact of accounting standards changes on your balance sheet.

How we can help

  • We can help you address medical professional liability, workers' compensation, and other retained risk issues.
  • Our experience working with a broad cross-section of healthcare entities, as well as government agencies and insurance companies that specialize in medical professional liability exposures, enables us to provide meaningful insights into your liabilities and associated costs whether you self-insure, have a wholly-owned captive, participate in a group captive, or purchase guaranteed cost insurance.
  • We understand self-insurance related accounting and audit issues.
  • We can leverage related areas of expertise, such as PwC's claims, risk management, accounting and tax professionals, as well as research from our Health Research Institute, to address a variety of issues, including captive insurance.

Our services

  • Actuarial analysis to estimate your balance sheet liability for medical malpractice and workers' compensation exposures, whether retained on an occurrence or claims-made basis with associated tail liabilities.
  • Estimates of future self-insurance costs at different retention options to help with budgeting and evaluation of alternative insurance program structures, including retention levels and coverage form.
  • Allocation of self-insurance costs to operating unit.
  • Drilldown analysis to determine drivers of self-insurance costs, with the goal of better controlling costs.
  • Actuarial support to help you determine the feasibility of forming a captive, including coverage limits.
  • Recommendations to improve the design and function of your insurance program, including an assessment of your claims-handling function.
  • Benchmark comparisons of your costs and reserve position relative to peers.
  • Assistance with the grossing up of your liabilities to reflect insurance recoverables and compliance with relevant accounting standards.
  • Statements of actuarial opinion for captive insurance companies for U.S. and non-U.S. domiciles.
  • Review of your internal (or external) claims-handling procedures and processes, in order to assess the reasonableness of staffing, reserving, case management and loss control.