Hospital and health system leadership should examine levels of risk retained within property and casualty insurance programs to ensure the right fit for the organization, rather than simply relying on past experience or basing decisions on a desire to reduce excess premiums. Leadership should determine the maximum cost of risk that can be absorbed by the organization without violating key financial performance targets. Also important is using predictive models to identify expected losses or claims costs, which factor into cost-benefit analysis of retaining risk at various levels.