Insuring Physicians: Are commercial insurers competitors or partners? Charles Kolodkin Cleveland Clinic Jack Meyer The Doctors Company Larry Smith MedStar Health Dec. 3, 2014

Employed Physicians: Captive v. Carrier Traditional Liabilities  Cost  Claims Control  Risk Management  Regulatory Considerations  Risk Tolerance  Underwriting expertise  Claims Management  Educational offerings  Portability

Employed Physicians: Captive v. Carrier Tail Liabilities  Cost  Claims Control  Expectation of clinician  Wall off liabilities  Risk Tolerance  Claims Management  Operational Management / Control

Employed Physicians: Captive v. Carrier Prior Acts Liabilities  Cost  Recruiting Tool  Claims Control  Third Party Business  Linkage with Hospital  Risk Certainty  Claims Management

Insuring Independent Physicians: Captive v. Carrier Captive  Assures Availability  Assures Affordability  Linkage with Hospital  Claims Control  Lower Costs

Insuring Independent Physicians: Captive v. Carrier Carrier  Regulatory  Underwriting Expertise  Claims Management  Risk Management expertise  Time / Resource efficiencies  Broader Coverages  Linkage with Hospital

Insuring Independent Physicians: Captive v. Carrier Hybrid Captive as Reinsurer  Underwriting Expertise  Claims Management  Risk Management expertise  Promote issues  Time / Resource efficiencies  Broader Coverages  Linkage with Hospital

Insuring Independent Physicians: Captive v. Carrier Hybrid Carrier as Reinsurer  Underwriting Expertise  Claims Management  Risk Management expertise  Promote issues  Time / Resource efficiencies  Broader Coverages  Linkage with Hospital

WHAT DO PHYSICIANS WANT? Affordability Claims Management Flexibility Supplemental Coverages Physician Governance Dividends