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While the life-and-death business of health care has always been inherently fraught with peril, new challenges loom on the horizon that will test the skills of risk managers in this field as never before.

Of these impending changes, legal reform is of greatest concern among health-care providers (see chart).

For example, the Medical Loss Ratio provision of the Patient Protection and Affordable Care Act (PPACA) limits administrative costs to 15 percent of premiums for large insurance groups and 20 percent for small groups. And under PPACA, Medicare reimbursement for physicians  will move from fee-based to metrics based on treatment outcomes. Furthermore, the allowance of new physician-led Accountable Care Organizations (ACOs) to utilize Medicare will allow medical-service providers to offer insurance options to patients.

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