Despite widespread consolidation and a slow transition away from fee-for-service (FFS), the healthcare industry is still dominated by state-specific regulations, and a deeply-rooted tort system.
Providers can continue to navigate new payment models and assume new risk without increasing their exposure to old tort liability.
Toro Risk has access to the nation’s largest and most-respected medical professional liability insurers, as well as forward-thinking companies that can protect the downside risk associated with new value-based care models.
If your enterprise is lacking a consistent risk management platform and you want to take advantage of efficiencies, as well as cutting-edge new resources, contact us.
Palliative and end of life care has been the source of massive expenditure in the US. Recognizing the potential economic benefits via shared-savings agreements in this space, investments have been flowing into hospice and palliative care companies.
Companies moving into this area should tread lightly, and must first build a legal and bio-ethical infrastructure based on informed consent and compassion. Any connection between referrals (or the lack thereof) and financial gain could be devastating to a business.
To navigate these sensitive issues, Toro Risk has partnered with the pre-eminent patient-rights advocate, Hon. Paul W. Armstrong (Ret.), who argued the original “right-to-die” case before the NJ Supreme Court, argued amicus before the US Supreme Court, and presided over a woman’s right to refuse forced medical care.
For more information about developing your enterprise’s palliative care program, contact Toro Risk.
ACOs and other population health models have been plagued by failures, but new modifications and a lot of learning has convinced sophisticated companies that considerable shared-savings dollars are within reach. The bigger prize remains the “direct to employer” model, and the population health models help prepare groups for that next phase.
Meanwhile, bundled payment models have enjoyed near universal success, while equipping forward-thinking participants with the tools to thrive in under any value-based construct – including direct to employer.
Toro works with a large healthcare revenue cycle management company and helped it apply to be a “convener” under CMS’s BPCI-A program. We also serve as an advisor to a company that is a national leader in machine learning and block-chain technology. Its first use case: Bundled payments.
Because bundled payments are based on diagnosis, or “episodes,” they present a manageable means for providers to learn to thrive in value based care.
Success within this model requires collaboration. To learn more about bundled payments and building an analytic, care-coordination and risk management infrastructure necessary to approach the payor community, contact Toro Risk.
Private Equity / Management Companies
Historically, state-specific Corporate Practice of Medicine Laws, which prevent non-clinicians from owning medical practices, have in turn prevented great business minds from running medical practices.
Thanks to the creation of management services organizations (MSOs), which run all the non-clinical affairs of a provider group, executives and outside investments have poured into healthcare.
Private equity groups tend to be brilliant in creating efficiencies and building value. But risk management is rarely a top priority, as it is not only seen as an expense, but one with little if any return on investment.
New value-based care models have made “risk management” the means to securing highly specialized resources as a “value-add,” while providing a considerable an at times immediate ROI. Few specialists have the experience, specialization and access to secure this ROI for the PE community.
To learn more, contact Toro Risk.
Toro was contracted by a wholesale agency, HPSI, to build innovative insurance products for the healthcare industry.
The result of this collaboration was an exclusive product through IronShore to protect management service organizations (MSOs) when they get involved in managed care-type activity, such as negotiating shared-savings agreements.
By leveraging this exclusive product, Toro helped one retail agency land a la large MSO spanning throughout Arizona and Nevada that manages a 9-figure shared-savings contract. This helped the agency forged new client relationships with several other healthcare provider groups, and begin to build up a healthcare practice.
If you are a retail agency that is looking to compete with the consolidators, but lack the access and expertise, or if you are a wholesale agency looking to innovate in the healthcare space, contact Toro Risk.
Healthcare Start-up Companies
Do you have a great company with great tech and IP, and a ground-breaking product that can solve a specific problem in healthcare, but struggle with your sales and marketing strategy?
Toro has relationships with start-up companies and private equity funds throughout the US. We work with “disruptive” companies every day to position them for success.
Healthcare is hard, who knew? Toro did. With relationships that can make your product a success, contact us to learn more.
Toro’s expertise has help guide some of the nation’s largest medical professional liability insurers’ strategic plans. Risk management has been the umbrella for many innovative concepts: EHR Support, Aligning efforts with value-based care requirements - MIPS/ MACRA, quality metrics, patient satisfaction, ACO’s, etc. - and even building new risk purchasing groups. The med mal industry must continue to progress.
The evolution of the US healthcare system demands an evolution of the industries that support it. The companies that best innovate will thrive; others will perish.
Innovation is no longer about amending a filing with an insurance department though. It must begin with a vision, leadership, pilot programs, a proof of concept, hard work and diligence, partnerships and investments.
By the time carriers announce new innovative products and partnerships, their competitors can no longer declare “me too.” Thus, the time has never been better for leaders to press for new ideas to support the healthcare community without having these ideas copied overnight. By contrast, those that do not innovate now will not realize that their competition has left them behind until it is too late.
Toro is working with executives and thought-leaders throughout the insurance industry to keep it relevant for decades to come. To learn more, contact Toro Risk.