Top considerations for non-profit healthcare organizations

Top considerations for non-profit healthcare organizations

Mercer outlines top considerations for not-for-profit healthcare organizations for 2016

  • January 11, 2016
  • United States, New York

Mercer, a global consulting leader in advancing health, wealth and careers, and a wholly owned subsidiary of Marsh & McLennan Companies (NYSE: MMC) outlined  the top investment considerations for not-for-profit healthcare organizations for 2016.

“Though many providers experienced operating improvement in 2015 as patient volumes grew and cost adjustments were recognized, these organizations still need to focus on care delivery and how it is compensated as well as the effects of healthcare reform regulation,” said Michael Ancell, National Segment Leader for Mercer Investments.  “As healthcare organizations begin 2016, we believe their investment priorities will include assessing and consolidating retirement plans and taking an enterprise level view of their investment strategy and risk management.”

Mercer suggests that not-for-profit healthcare organizations consider the following actions in 2016 including:

·         Analyze retirement plans

Did your organization complete a merger during 2015? Some mergers result in multiple defined contribution (DC) and/or defined benefit (DB) plans, which present an opportunity to conduct a complete assessment of their retirement plan design. As the cost of maintaining a DB plan continues to rise, more plan sponsors are considering alternate funding strategies and potential risk transfer opportunities. The trend away from DB plans elevates the need to ensure that an organization’s DC plan is optimized to attract and retain talent.

·         Define DC investment governance

Recent regulatory attention has focused on DC plan fees and is likely to expand to other areas. Choosing a DC plan’s investment structure and fund lineup is an ongoing task, not a ‘set and forget’ initiative. Investments should be regularly monitored (at least annually), with attention paid to both performance and cost.

·         Review risk tolerance

Many not-for-profit health care organizations enjoyed solid operating results in the calendar year 2015. As financial metrics improve, the institution’s ability to take more risk may increase as well, so it is a good time to reevaluate risk tolerance and investment strategies.

·         Integrate investment strategy and financial plans

Most not-for-profit health care organizations are subject to debt covenants that may restrict the amount of investment risk they can take with their unrestricted reserves. Institutions should quantify their risk floor and address it in the investment policy. The risk floor should account for illiquid investment strategies that may be excluded from the day’s-cash-on-hand calculation.

·         Determine how M&A may affect investment strategy

Not-for-profit health systems who are currently engaged in or considering strategic actions such as M&A, operating agreements, or joint ventures should be aware that some of these actions may materially alter an organization’s balance sheet. Boards may be unwilling to tolerate a significant asset decline post-action. Finance and investment committees should consider how best to integrate investment strategy and whether these factors may necessitate a change in their investment risk profile.

·         Manage DB funded status volatility

Low interest rates have caused the funded status of many DB plans to remain low the past few years. Funded status is expected to continue to fluctuate based on interest rate activity, investment returns, and plan sponsor cash contributions. As the journey to achieving a fully funded DB plan typically takes years, it showcases the importance of developing a road map to de-risk a plan as funded status improves. This may include allocation adjustments based on preset triggers, plan design changes, fixed income composition changes, and risk transfer methods.

·         Assess global portfolios’ asset allocation

Investors have remained overwhelmingly invested in US indexes, such as the S&P 500, since the end of the global financial crisis. Those investors have typically been rewarded for riding along with the US Federal Reserve zero interest rate policy and multiple rounds of quantitative easing. The benefits of those policies may have been largely realized in the US, resulting in all-time highs for corporate profits as a percentage of GDP and above-average valuations. The accompanying strong US equity market returns have led many investors to question their diversified portfolio structure. Organizations should be asking where to look for return opportunities going forward. Additionally, organizations should begin to consider how to balance the more attractive valuations of Europe or emerging markets with the very real challenges faced by both. Healthcare organizations’ investment committees should think about the how the return on public market beta could potentially be below what is needed to support the mission of the organization.

·         Audit inflation-sensitive investments

Global quantitative easing has supported improved economic growth and market asset prices, but it has not engendered sufficient demand to generate inflation near the 2% target of most central banks. Active foreign currency devaluations have further reduced inflation expectations for US consumers as the stronger dollar drives down the cost of imported goods. Do these changes in global pricing dynamics deserve a policy response from investment committees? Nonprofit committees should think about how to balance the negative impact to inflation-sensitive investments in this low inflation or deflationary trend with the potential inflation surprises.

·         Review  governance structures

Transformation in the delivery of care, coupled with existing operating pressures, requires healthcare organizations to reduce costs while increasing the quality of care. Outsourcing certain elements of an organization’s investment function can potentially reduce investment expenses and free up staff and committee time to focus on strategy.

·         Calculate impact of investment grade bonds on returns

Healthcare organizations’ unrestricted reserves in investment portfolios are typically structured more conservatively than traditional endowments or foundations, that translate to a larger allocation to fixed income investments. Reducing the allocation to US investment grade bonds, while adding to riskier investments, increases a portfolio’s expected return. The tradeoff is that the portfolio’s risk also increases. Higher-rated hospitals with stronger operating margins are better able to absorb unexpected operating challenges and equity market volatility.

Mercer will host a webcast to expand on this topic on Wednesday, January 13, 2016, 2-3pm Eastern Standard Time. Register here:

About Mercer

Mercer is a global consulting leader in talent, health, retirement and investments. Mercer helps clients around the world advance the health, wealth and performance of their most vital asset – their people. Mercer’s more than 20,000 employees are based in more than 40 countries and the firm operates in over 130 countries. Mercer is a wholly owned subsidiary of Marsh & McLennan Companies (NYSE: MMC), a global professional services firm offering clients advice and solutions in the areas of risk, strategy and people. With 57,000 employees worldwide and annual revenue exceeding $13 billion, Marsh & McLennan Companies is also the parent company of Marsh, a leader in insurance broking and risk management; Guy Carpenter, a leader in providing risk and reinsurance intermediary services; and Oliver Wyman, a leader in management consulting. For more information, visit Follow Mercer on Twitter @Mercer.

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