A Discussion With Today’s Leaders in Medical Professional Liability Coverage
CAP sat down with Stewart Shanfield, MD, Chair and President of the Cooperative of American Physicians, Inc. (CAP), and Chair of the Mutual Protection Trust (MPT), and Sarah Scher, JD, CAP CEO, to discuss their vision for the future and what the company’s success over the past 50 years means for California’s physicians.
Q: As the organization celebrates its 50th anniversary, what are its greatest achievements and milestones?
Ms. Scher: Our greatest achievement is, and always will be, supporting our physician members. CAP began with nearly 500 physician members, and 50 years later, that number is now 13,000. This growth is underscored by the organization’s ability to focus on our members’ needs and develop innovative solutions to support their well-being and success.
In the mid-1980s, MPT became the first medical malpractice coverage provider to establish an in-house law firm. Today, our dedicated attorneys work alongside the best consultants and legal specialists to provide exceptional litigation support. To further support excellence in medical malpractice defense, and understanding the hardships associated with litigation, we built personalized and compassionate claims management programs for which CAP is well known. We have also continually expanded our robust risk reduction programs, which include 24/7 immediate adverse event assistance.
Most recently, we have implemented initiatives focusing on the business of medicine and now provide free practice management benefits and education to help our members remain operationally sound and profitable.
CAP has achieved many milestones over the past 50 years, and the programs we have developed to support our members demonstrate CAP's steadfast commitment to ensuring physician success.
Q: What do you believe have been the most significant challenges, and how were they overcome to make CAP the leader it is today in the marketplace?
Dr. Shanfield: There have always been and always will be challenges. In the early years, there was great doubt whether a small group of physicians self-insuring would survive, but they persevered to help doctors remain viable in their practices. Keeping their legacy front and center, CAP’s dedicated physician leaders and experienced executives continue to provide solutions that focus on the best interests of the membership rather than market share or profit.
In recent years, CAP led efforts to oppose legislation threatening MICRA’s protections—the very piece of legislation that in 1975, helped enable CAP’s formation. In 2014, we helped defeat Proposition 46, which, among other harmful provisions, would have significantly increased costs by raising the cap on noneconomic damages in medical malpractice lawsuits. And in 2022, we mobilized thousands of physician members to oppose Assembly Bill 35 (AB 35). Although AB 35 was signed into law, altering many of the important protections provided by MICRA, CAP has since doubled down on efforts to help physicians reduce their risk and avoid lawsuits, as we always have.
During the pandemic, CAP provided physicians with resources and guidance to help them navigate the legislative and regulatory responses from state and federal officials, especially relating to telemedicine and support for small businesses offered through the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
For 50 years, CAP’s efficient and unique business model has provided stability and affordability during turbulent market shifts. Our financial structure has proven to be highly accurate and the most precise means of matching claims expenses with coverage costs.
Q: Since 2006, the Mutual Protection Trust has earned A.M. Best’s A+ Superior rating, which recognizes the exceptional financial strength and stability of the organization and its coverage. What do CAP and MPT do to maintain this stability as an enterprise and why is it important?
Ms. Scher: Financial stability is the cornerstone of our mission. We are proud that A.M. Best, a global credit rating agency focused exclusively on insurance, has rated MPT with an A+ (Superior) rating for nearly 20 years.
This rating is especially important to our physician members and any physician considering membership in CAP because it showcases our ability to pay claims, debts, and other financial obligations. It also signifies outstanding management, innovation, and member participation.
CAP and MPT have consistently strengthened our financial position year after year, ensuring the level of conservatism needed to support the organization's continued success while anticipating future needs and demands.
The A+ rating is a testament to the overall strength of the enterprise, and why 13,000 members can confidently rely on CAP and MPT to protect their practices and careers.
Q: What is CAP doing now to drive its record-breaking growth?
Dr. Shanfield: CAP has experienced remarkable growth in membership in recent years, which can be attributed to various factors.
We approach the market with flexibility and agility, especially as technology evolves to support our efforts. CAP has a highly effective membership development team that works closely with other departments to prioritize new methods of identifying the top physicians in California and building strong relationships with them. We consistently share resources and provide personalized attention to demonstrate our commitment to their success.
As a physician-centric organization that offers outstanding medical professional liability protection, CAP is unique in the marketplace for offering a multitude of services independent physicians need and rely on to manage their practices. We continue to explore new avenues of support, which inevitably attracts physicians to our organization.
Q: What key initiatives or strategies are being implemented to ensure the organization remains relevant, successful, and impactful within the community and industry over the next 50 years?
Ms. Scher: The healthcare landscape is constantly in flux because of economic pressures, new healthcare models, technology, and more. We must remain diligent on several fronts.
As CAP membership grows in the independent physician market, we recognize the opportunities within the large medical group space as well. CAP’s subsidiary, Cooperative of American Physicians Insurance Company (CAPIC), recently revamped and restructured its operations to directly offer and underwrite medical professional liability coverage tailored to large medical groups. With an A- (Excellent) rating by A.M. Best, CAPIC draws off CAP’s longstanding tradition of delivering outstanding coverage for its large group clients.
Additionally, the CAP and MPT boards have long maintained exceptionally high standards for operational excellence and disciplined oversight of our business. Finding smart solutions for improved efficiencies is always a key objective. We embraced AI early on to enhance our approach to risk management, underwriting, finance, and much more, all so we can remain more responsive to our membership.
From an advocacy perspective, CAP has always recognized the need to leverage the collective voice of our physician members to stay ahead of the challenges they face in their practices. And bold action is required when dramatic legislation, like AB 35, impacts our members. That’s why we allied with the newly established Physician Association of California (PAC), the only advocacy group in California solely focused on representing independent physicians and small practice groups. Their efforts among lawmakers to highlight the critical role of private practitioners in delivering quality healthcare are essential to our membership.
Partnerships with organizations who share our vision to help physicians succeed have always been a priority for CAP. We are proud to support physician/healthcare associations throughout the state and work with them to solve issues impacting their stakeholders.
CAP’s influence is well established in the medical community. We will continue to stay relevant and make a significant impact by leveraging avenues for new products and services, increasing our visibility, advocating for our members, and forging partnerships that benefit physicians and their patients.
Q: What is the organization focusing on to ensure that independent physicians can sustain successful practices in the coming years considering the challenges posed by reimbursements, insurance companies, consolidation, and administrative and regulatory intrusions?
Dr. Shanfield: Obstacles will persist. Waning reimbursements, legal and regulatory burdens, healthcare consolidation, and practice administration costs are issues many physicians are experiencing. CAP has proven to be a leader in addressing these challenges with effective solutions and genuine care for its members.
The services and benefits CAP offers are exclusive to our business. More importantly, the delivery of these services by superb, dedicated, and knowledgeable staff is one of our greatest assets. CAP’s risk management and patient safety specialists, practice management experts, claims professionals, and membership services staff offer unparalleled personalized support to understand and meet the needs of our physician members.
Member participation in CAP’s programs and services is what I see as the "secret sauce" of the organization and a driver for continued growth. It is the only way we can remain by physicians, for physicians. And we have seen the results of this participation that only continues to increase.
Nearly a quarter of the membership participates in CAP’s group purchasing program, which offers significant savings on everyday practice supplies. Our human resources team helps thousands of member practices annually with HR-related inquiries. We also offer free staff training programs that are required in the workplace or are beneficial to smooth operations. These include harassment avoidance training, HIPAA and cybersecurity programs, risk management training, and more. CAP presents free monthly webinars addressing topics like billing and coding, documentation, prior authorization, new healthcare legislation, and much more. Our four-year-old My Practice program is now growing to provide members with even more support managing their business operations.
Managing a private practice is difficult, but the rewards are immense. When CAP can provide support that is either missing in the marketplace, too costly, or too hard to find, then we’ve in part accomplished our objective.
Guided by an executive management team that works closely with our physician leadership, CAP is continually expanding its programs to help members in their practices.
Our mission to protect physicians goes well beyond exceptional medical professional liability coverage. CAP strives to protect every aspect of our members’ practices and well-being. We are driven by a mentality of innovation, inspired by a movement that began 50 years ago with our founding members. Drawing from their determination, CAP stands by our promise to California physicians to safeguard their medical careers and their ability to provide quality patient care.