Costante believed that the root of MIIX Group's problems was her predecessors' decision to expand into states outside of New Jersey. Her vision for MDAdvantage—where she is board chair and CEO—is different, and includes three key tenets:
- Insure only physicians and only in New Jersey.
- Be 100% physician-owned with each insured physician owning one share. Costante and other executives don't own shares in the company.
- Provide educational programs, a peer-reviewed journal, group discounts on products and other means to help physicians practice high-quality medicine and, thus, avoid lawsuits.
“I feel very strongly that we are a healthcare company, which is different than being just an insurance company,” Costante says. “So we provide a lot of resources to physicians, our insureds, as well as the general healthcare community.”
For her accomplishments, Costante, 53, has been chosen as the 2011 Trustee of the Year representing a for-profit healthcare company.
Launching MDAdvantage, based in Lawrenceville, N.J., wasn't easy. New Jersey's Department of Banking and Insurance granted Costante permission to open MDAdvantage in May 2002. But the department's blessing came with a large caveat: To qualify for a license to write insurance policies, Costante had to raise $30 million by July 31 of that year.
Read profile of Michael Voisin, representing large hospitals
Read profile of Mark Mossman, representing small hospitals
Read profile of Sarah Evans Barker, representing not-for-profit healthcare systems
To meet that deadline, Costante worked from early morning until late at night presenting her vision for MDAdvantage to small groups of physicians at hospital medical staff and department meetings, county medical societies and other gatherings.
Costante described the process as “a little hair-raising.”
“I must confess I was a skeptic,” says Dr. Paul Hirsch, vice chairman of MDAdvantage and an orthopedic surgeon.
Despite his reservations, Hirsch became one of about 3,000 founding physicians—who all made capital contributions equal to one year's premiums in exchange for one share of stock. The average contribution was $15,000.
With the fundraising behind it, MDAdvantage wrote its first policy on Sept. 1, 2002, and has become financially stronger ever since. In 2009, MDAdvantage had $70.1 million in direct written premiums and $286.9 million in total assets, compared with $71.7 million in premiums and $106 million in assets in 2003.
MDAdvantage also has added new services. For example, the company last year began including coverage for business risks in its policies. The policies include coverage for costs arising from noncriminal personnel issues, billing irregularities and compliance with the Health Insurance Portability and Accountability Act of 1996.
“It is difficult to start an insurance company and build up the funds to keep it going, and she has been able to help the company to do that,” Hirsch says.
Costante's roles at MDAdvantage and MIIX Group aren't the only tough jobs she has held.
As a hospital-based social worker early in her career, Costante worked with patients who suffered from a traumatic injury to their brains or spinal cords.
After earning a master's in business administration at New York University in 1991, she took a job with a consulting firm based in California, even though she had to frequently commute from her home in New Jersey to meet with clients based on the West Coast.
Costante has always had a “great deal of enthusiasm, a great deal of energy, and behind everything, a strong sense not only of purposefulness but also a high level of integrity,” Hirsch says.