Preverity, a provider of clinical risk analytics and patient safety solutions to better assess physician and surgeon risk factors, was the first Insurtech Company to provide analytics to medical malpractice carriers like Positive Physicians Insurance Company (PPIC).
Founded in 2016, the Nashville, Tenn.-based business also partners with health systems and large physician practice groups to help those entities manage risk and improve patient outcomes.
“We have information on over 80% of all U.S. physicians and physician groups,” said Gene Boerger, president and chief operating officer of Preverity. “We provide underwriting analytics to professional liability insurers based on clinical practice patterns, including where the practice is located, if a provider is following recommended prescribing patterns, what type of procedures are being performed and patient population, as examples.”
The one piece of data that is not utilized in the calculation is malpractice claim information, he said.
“For example, based on our medical specialty models, we know that an orthopedic surgeon who does fracture work is at a higher risk of a malpractice claim than one who strictly does hip and knee replacements,” Boerger said. “A general surgeon who does bariatric surgery faces a 50% increase in risk compared to a general surgeon who does not perform the procedures.”
Boerger said the company also monitors shifting trends in procedures, notifying its customers of the changes.
“Since 2019, there has been a 5% increase in the number of general surgeons performing bariatric surgeries, with 25% now performing the procedures,” he said.
Annie Matincheck, chief strategy officer at PPIC, said the analytics provided by companies like Preverity benefit not only high-performing physicians but also contribute to stabilizing the overall insurance market.
“When policyholders receive more accurate pricing based on their actual risk, the positive effects trickle down to the physician’s patients, as higher rates often translate into higher healthcare costs,” she said.
Although this data was available in the past, Matincheck said often it was not structured in a format that was useful to most stakeholders.
“While actuaries could use this information in their models, companies like Preverity are now presenting it in manageable and usable formats for many other insurance professionals as well,” she said. “This development allows us to leverage the data more effectively and make informed decisions that benefit both providers and patients.”
In addition to more accurately predicting risk and outcomes, there are positive implications for patients and future claims, Matincheck said.
“By partnering with companies like Preverity and being able to aggregate this data and deliver these insights to physicians, providers and healthcare systems, who often lack the time to analyze metrics, we empower them to identify areas for improving patient safety and mitigating potential claims,” she said. “This proactive approach not only enhances patient care and safety but also reduces costs for everyone involved. Healthier patients lead to lower healthcare expenses, benefiting the entire system.”
While previous loss experience will always play a role in pricing, Matincheck said the new data and technology provide the industry with the opportunity to reshape how risk is determined and historical data is used to predict future losses and correlate emerging risk profiles.
“Ultimately, when we prioritize data-driven decision-making, we create a win-win scenario that enhances patient well-being while ensuring financial sustainability for healthcare providers,” Matincheck said.
See Part 1 of this story: Using data to measure, analyze and predict medical liability risk
