Robert J. Dubraski is president and CEO of Dubraski & Associates Insurance Services L.L.C. in San Diego, an insurance brokerage that specializes in serving the health care industry across all lines of business. He spoke with Business Insurance Senior Editor Judy Greenwald about risk management issues facing the health care industry. Edited excerpts follow.

Q: How are health care reform and the changing economics affecting the health care industry?

A: The health care industry is facing significant, unprecedented change and challenges, particularly around the way they're being reimbursed, and the changes that are occurring around managed care and accountable care. As a result, there are two key exposures that risk managers need to be thinking about.

One is a comprehensive managed care/accountable care errors and omissions coverage, and making sure they understand all the various aspects that their organizations are involved in, and that the policies are worded appropriately and customized to cover all those liabilities.

The second area is around protecting the financial risk associated with managed care and accountable care, and there are various stop-loss insurance and reinsurance policies available that can address a variety of those needs.

As health care organizations move through this drastic change and are forming new entities and integrated delivery systems, in order for risk management to truly cover the risks of the enterprise, it's going to be important for risk management to coordinate with the other key leaders within the health care organization, i.e. finance, health care, contracting and human resources.

But many times, these various departments don't coordinate in an enterprise risk management strategy. Even with the right insurance in place, it's possible there could be gaps in coverage or risk management opportunities missed to address claims before they happen.

Q: What other risks are affecting the health care business?

A: Health care organizations must manage their traditional risks like medical malpractice and workers comp, but they also need to address some of the emerging risks as well. In addition, consolidation in the health care market continues, resulting in many hospitals acquiring physician practices or even forming health plans.

These consolidations expose health care organizations to extended reporting periods or tail issues; physician integration; maintaining adequate limits, retentions and coverages; and mitigating potential employment practice exposures. Additionally, there is increased regulatory scrutiny on fraud prevention. Government billings, regulatory compliance, fines and penalties, and medical billing errors and omissions are big concerns for health care organizations.

Q: What other trends are we seeing in the industry?

A: Increased claims severity, i.e. higher jury verdicts; significant batch claims in medical malpractice; data privacy and security breaches, and increased costs associated with those breaches; and frequency and severity of billings.

As consolidation in the industry continues, antitrust claims activity is on the rise. However, overall, the insurance and reinsurance markets remain relatively soft, which is good for our health care clients.

Q: How should health care organizations deal with Ebola?

A: Obviously, Ebola is a very complex issue facing the health care industry today, and it's clearly much more than risk management. But clearly risk management has a role in two ways: One is in making sure that risk management has the appropriate protocols in place, or preparedness, to avoid these situations to begin with; and secondly, making sure that they have all the right insurance coverages to deal with such a claim should one arise. Brokers can have a role in consulting with their clients to assure the proper coverages are in place.

Q: How are data privacy and security issues affecting the industry?

A: Data privacy and security liability may be the most underinsured liability in the health care business today. Costs are increasing, incidents are more frequent, and fines and penalties and regulatory oversight are increasing dramatically.

There are really two key issues there for risk management, and that is to work with a competent broker to, No. 1, make sure they have the appropriate coverage and limits in place and, No. 2, to make sure that they have all services and protocols in place to address a breach when it happens. We do find that many health care organizations are either underinsured and/or are not prepared to really address a breach in all the various aspects should a breach occur.