Traditionally, healthcare reinsurers offered a robust model to customers, with additional services including claims analysis, access to vendor contracts in high-cost, specialty areas like organ transplant or dialysis, nurse hotlines, pre-natal teams and general expertise on "who to call" regarding specific claimant issues. Low loss ratios — around 65-75 percent — and high levels of client retention not only enabled, but also justified, those auxiliary services and let them take on a high expense load while maintaining a profitable business, according to Phillip Barker, Managing Director, Healthcare Practice, Guy Carpenter. That was before the implementation of the Affordable Care Act (ACA) began to bring attention to the healthcare insurance space.