Download

A Practical Launch Framework for Insurance Startup Programs

Unclear roles and weak project discipline—not talent shortages—cause most insurance program launches to stall or fail.

Organization

If we could restart many insurance program launches we have worked on or observed over the last decade, we would not begin by hiring more people or buying more technology.

We would begin with a better operating structure.

Insurance startups, MGAs, carriers, wholesalers, and brokers often struggle to launch new programs because the work is not organized clearly. Strategy, underwriting, technology, compliance, vendor management, operations, testing, and distribution move at different speeds, and too often, no one owns the launch end-to-end.

The result is predictable. Decisions stall. Vendors wait for answers. Testing starts late. Carrier requirements are only partly translated into operations. Founders and executives get pulled into work that should sit elsewhere.

Most launch problems are caused not by a lack of talent but by unclear roles, weak project discipline, and too much execution work falling on senior leaders.

If we had to do it over again, we would start with a lean core team, add project management early, build operations alongside product, use technology selectively, and rely on flexible staffing before permanent headcount.

The Problem With Unstructured Launches

Launching an insurance program is complex. A new program has to align underwriting rules, rating, forms, state requirements, claims intake, billing, payments, document generation, reporting, compliance, and customer service. Every part depends on the others.

Without clear ownership, launch work gets spread across people who already have full-time jobs. Underwriting leaders support the new program while managing an existing book. Technology teams juggle configuration, integrations, and internal priorities. Operations teams are often pulled in after major product or system decisions are made.

Invisible delays then become visible problems. UAT credentials are not ready. Vendor tasks remain incomplete. Endorsements, cancellations, reinstatements, and payment processes are not fully documented or tested. Small gaps become launch issues, and senior leaders spend their time solving coordination problems instead of making strategic decisions.

Start With a Lean Core Team

A launch needs a lean core team, but that team should own strategy, not every task. In most cases, the right group includes the CEO or founder, an underwriting lead, a technology lead, and one or two strategic operators.

That team must understand both insurance and implementation. Modern programs depend on systems, data flows, APIs, rating engines, billing workflows, document production, claims processes, compliance controls, and reporting. Insurance knowledge alone is not enough, and technology knowledge without an insurance context is not enough, either.

The core team should own the product and underwriting strategy, carrier and capacity relationships, distribution, vendor selection, financial targets, launch priorities, and major issue resolution. It should not spend its time chasing vendor updates, forwarding credentials, or collecting test results.

Add Project Management Early

The most important execution role in many insurance launches is the project manager, and that role should be added at the beginning, not after the timeline slips.

A strong launch PM understands both insurance and technology and can translate across underwriting, operations, compliance, claims, billing, vendors, and distribution partners.

The PM builds the launch plan, tracks owners and deadlines, manages dependencies, runs status meetings, documents decisions, escalates blockers, coordinates UAT, and keeps vendors accountable. This is not a light administrative job.

Without a dedicated PM, coordination usually happens through side conversations, email threads, and status meetings that generate more noise than progress. The PM gives the launch one operating rhythm.

Build an Operations Function

Project management is not the same as operations design. A launch also needs someone responsible for process detail, usually a business analyst or operations lead.

That person handles workflow design, process documentation, user requirements, operational handoffs, exception handling, billing and payment procedures, cancellation and nonrenewal processes, customer service routines, and claims intake coordination. These may look secondary next to underwriting or technology, but they determine whether the program can function at real volume.

Too many MGAs focus on product and platform configuration first, then discover near launch that service workflows are incomplete. Policy issuance may work while endorsements, claims notices, and payment exceptions do not. Operations has to be a launch workstream from day one.

Use Technology to Reduce Manual Work

Technology should support the operating model, not complicate it. Project management tools should track owners, milestones, dependencies, defects, and decisions. Contract tools and shared repositories should reduce friction and make current materials easy to find.

AI and automation can help with work that is repeatable: drafting process documents, summarizing vendor calls, reviewing checklists for missing items, organizing compliance requirements, and creating first drafts of operational materials.

But every tool needs an owner and a defined workflow. If it does not reduce work, improve quality, or increase visibility, it is probably adding another layer to manage.

Avoid the Headcount Trap

One common startup mistake is hiring too much permanent staff before revenue supports it. A better approach is elastic staffing: use experienced fractional resources for launch coordination, UAT, claims setup, documentation, or LOB or state expansion. The advantages of the elastic staffing model are the ability to fractionalize many positions at once, move the risk to a trusted BPO partner, which then allows you to keep expanding (assuming success) or contract the positions (assuming product failure).

Put the Framework Into Practice

A disciplined launch still needs a written plan, a soft launch, and clear ownership. The lesson is simple: insurance launches need structure before scale. Build the operating model first. Then launch the product.


Nick Lamparelli

Profile picture for user NickLamparelli

Nick Lamparelli

Nick Lamparelli is the managing partner of Insurance Nerds and chief program officer for Latin International Reinsurance Group. 

He is also CEO of the Insurance Advocacy Forum of Florida.

Lamparelli is a three-decade insurance executive, starting as a local agent and evolving to middle market broker, wholesaler, underwriter and catastrophe insurance expert.


Peter Crowe

Profile picture for user PeterCrowe

Peter Crowe

Peter Crowe is president of Focus.

Previously, he was senior vice president of marketing, communications and investor relations, and executive vice president of business and product strategy at RE/MAX. He was also chief revenue officer at We Insure.

Crowe holds a bachelor of business administration degree from Indiana University and an MBA from the University of Denver, Daniels College of Business.

P&C Insurers Shift to Precision Underwriting

Softening pricing and returning competition force carriers to replace broad underwriting discipline with surgical precision.

Market Volatility

The P&C industry has spent the last several years fighting its way back to profitability through aggressive rate action, tighter underwriting discipline, and reduced exposure across volatile segments. Many carriers are finally reporting some of the strongest underwriting results the industry has seen in over a decade.

But the environment that made broad underwriting discipline effective is beginning to change, and the question becomes, which carriers are ready to pivot?

Competition is returning across major lines, commercial property pricing is softening, and personal auto is becoming increasingly aggressive. As new capital enters the market, growth conversations are reappearing in boardrooms and executive planning sessions throughout the industry. This is a natural progression, but it creates an inflection point.

Much of the discipline that defined the hard market was supported by favorable pricing conditions. Strong rate environments gave carriers more flexibility to absorb imperfect underwriting decisions while still maintaining acceptable results.

However, this cushion will begin to disappear as pricing pressure intensifies. When this happens, underwriting precision will be far more important than underwriting restriction.

Historically, many carriers have responded to volatility through broad corrective measures such as tightening appetite across entire segments, reducing exposure in specific geographic areas, or pulling back from markets altogether. These decisions can improve portfolio-level performance quickly, but they also create collateral damage.

The truth is that blunt underwriting actions frequently remove profitable risks alongside unprofitable ones. Carriers leave large sums of money on the table as well as thousands of insureds without proper coverage.

In softer, more competitive markets, growth opportunities become harder to replace and retention becomes more valuable. Traditional segmentation methods are becoming less effective in an environment where risk volatility is increasingly fragmented and dynamic.

Aggregate assumptions no longer tell the full story they once did. For example, two policyholders with similar demographic profiles can produce very different outcomes. Two businesses operating in the same industry and geography may present entirely different levels of operational risk. Yet most segmentation frameworks still treat them as interchangeable. This is where underwriting and pricing precision become strategic advantages rather than operational enhancements.

The carriers best positioned for the next phase of the market are ones that have a much deeper understanding of risk behavior at the individual policy level. Organizations that can identify where profitable growth actually exists, rather than those that push for growth based on broader assumptions.

Modern AI and predictive analytics are allowing for carriers to move beyond static underwriting frameworks toward more dynamic forms of risk differentiation. Insurers can increasingly evaluate nuanced behavioral, operational, and contextual signals that correlate more directly with loss propensity and profitability. This level of granularity changes decision-making.

With this precision, carriers are able to maintain confidence in markets others may retreat from. Precision enables more surgical pricing adjustments that are easier for insureds to bear rather than broad rate reactions that prove untenable. The technology enables carriers to preserve access to profitable business that might otherwise be excluded through blunt segmentation strategies.

We need to face the reality that the levels of volatility we are facing are unlikely to recede. Economic uncertainty, climate change, litigation trends, supply chain instability, and rapidly shifting consumer behaviors will continue introducing complexity into underwriting performance.

We can't depend on broad market hardening to protect margins like we have in the past.

Will your organization be able to separate the signals from the noise? Does your organization operate with surgical precision or blunt demolition?

Historical information is rapidly becoming less useful and the time for precision underwriting is already here. Carriers that can price and select risk with greater confidence will be able to remain active in challenging regions and segments without sacrificing discipline. Those that cannot may continue relying on broader strategies that limit growth and long-term competitiveness.

The long-term winners will be the carriers capable of navigating the volatility we are facing with greater precision than those who avoid it entirely.


Scott Ham

Profile picture for user ScottHam

Scott Ham

Scott Ham is the CEO of Pinpoint, an insurtech company helping carriers make fairer, more accurate underwriting and pricing decisions through data-driven insights.

He has held executive leadership roles at large insurance carriers and advised financial services organizations at McKinsey.

Wildfire Smoke Complicates Winery Insurance

Smoke taint claims turn on whether wineries can document when grapes were exposed during increasingly overlapping wildfire and harvest seasons.

Winery and Vineyard

Across many wine-producing regions, wildfire seasons are increasingly overlapping with key points in the growing and harvest cycle, creating a broader category of risk for wineries and their insurers. A vineyard or winery may avoid direct fire damage and still face critical economic loss if smoke exposure affects grape quality during harvest operations or while harvested fruit is awaiting processing. As a result, smoke exposure is becoming a growing risk issue not only for viticulture and winemaking teams but also for insurance brokers, adjusters, and coverage counsel evaluating when a claimed loss occurred and how the condition of the product can be established.

Wildfire season often overlaps with harvest, which can create a heightened risk of smoke exposure for wineries. When smoke taint is suspected after grapes are picked but before fermentation, first-party property coverage questions tend to revolve around timing, documentation, and the quality of the testing record as much as they do the winemaking science. Wineries can put themselves in a stronger position by keeping their focus on objective facts that show when the fruit was harvested, how it was handled, and what the available data indicates about the condition of the product.

One common issue that often leads to disagreements between a winery and its property insurer is whether smoke taint occurred. A winery may believe smoke exposure or absorption took place after harvest during transport, staging, or short-term storage, while the insurer may contend the impact occurred while grapes were still on the vine. This distinction can matter under many property policies because coverage for growing crops and harvested stock can be treated differently depending on the policy language. The most practical way to reduce timing disputes is to treat post-harvest handling like a chain of custody process and maintain clear records that match how the fruit moved through the winery's system.

Helpful documentation typically includes harvest dates, vineyard block identifiers, bin or tote identifiers, weigh tags, receiving logs, transport routes and times, staging locations and conditions, crush and press schedules, and tank or barrel assignments by lot. Notes about observable conditions, such as smoke density, odors, or ash deposition, can also provide useful context when paired with the operational timeline. The goal is not to turn harvest into a dispute, but to present a coherent lot-specific narrative that reflects the winery's real-world handling and supports a clear understanding of when the condition likely developed.

Another recurring issue is an insurer's position that testing does not support taint. Differences can arise based on what was tested, when it was tested, how representative the samples were, and how results were interpreted in light of varietal and site conditions. Wineries can help by using reputable laboratories, documenting sampling methods, preserving samples where feasible, and combining analytical results with consistent sensory evaluation and controlled comparisons across lots. When results are mixed or early results are non-detect, follow-up testing at later stages may be appropriate because smoke impacts can evolve during fermentation and aging.

In the United States, smoke taint testing historically leaned heavily on guaiacol as a primary marker associated with smoky and ashy aromas. Today, many wineries are increasingly focused on panels that include phenols and, in particular, phenolic glycosides, because smoke compounds can be present in a bound form that may not show up clearly in early volatile testing and may become more apparent later as the wine develops. Another practical reason to avoid relying on guaiacol alone is that it can appear for reasons unrelated to wildfire smoke in certain production contexts, which can complicate interpretation. For wineries, a balanced and practical approach is staged testing tied to how the fruit and lots are handled: test representative samples by block and lot at harvest or receiving, consider additional testing after pressing and during or after fermentation when warranted, and keep the testing record aligned with lot segregation and production decisions. That combination of good science and good records helps the winery make better operational choices and, if an insurance claim arises, supports a clear and fair discussion of what the data shows.

Considering everything above, smoke taint claims are easier to evaluate and resolve when the winery can present a clear timeline, a consistent testing plan, and organized lot-level records that connect the science to real operational decisions. By documenting post-harvest handling with a heightened level of care and by using staged testing that includes both traditional markers and phenolic glycosides when appropriate, wineries can create a straightforward record for any coverage discussion.


Victor Jacobellis

Profile picture for user VictorJacobellis

Victor Jacobellis

Victor Jacobellis is an attorney with Merlin Law Group.

Herepresents policyholders throughout California in complex commercial property, homeowners and insurance bad faith matters. He has additional experience in general liability, builder's risk, professional liability, marine and pollution coverage disputes.

How to Handle Homeowners Affordability Conversations

As insurance costs strain homeownership dreams, agents must navigate affordability discussions with empathy rather than industry-focused explanations.

Home Affordability

According to data published in February 2026 by the National Association of Home Builders, more than 65% of households are unable to afford the median-priced new home in 39 states and the District of Columbia.

As the costs of owning a home increase, insurance is becoming a more significant part of the overall homeownership affordability puzzle. While insurance agents are typically not the first call in determining what home a client can afford or when the best time to buy is, they are often tapped to help buyers understand the full financial framework of homeownership.

Therefore, conversations about insurance coverage can quickly shift into broader topics about costs, risks, and the long-term financial outlook of ownership.

What affordability means

It is crucial to navigate these conversations with both skill and empathy. First, it's important to recognize that homeownership has long been ingrained in U.S. society and is widely regarded as an important part of the American way of life.

Consumers are deeply concerned that homes and homeownership are becoming increasingly unaffordable for the average person and, therefore, that the traditional American Dream lifestyle enjoyed by generations before them is becoming impossible to reach.

Before discussing costs, ground the discussion with a shared understanding of what affordability means. The most common definition comes from the U.S. Department of Housing and Urban Development (HUD), which defines it as a home in which the occupant pays no more than 30% of their gross income for housing costs, such as utilities, mortgage payments, and property taxes. Yet, according to a December 2025 report by Bankrate, U.S. workers who earn the median income will find themselves priced out of three in four homes on the market.

Why homeownership isn't affordable

There are several reasons why homeownership is not affordable today:

  • Inflation and macroeconomic pressure are two driving factors that have been top of mind for many since prices spiked initially in the post-pandemic years. According to data from the U.S. Census and HUD, in Q1 of 2020, the median home price was $329,000, and in Q1 of 2025, it was $423,100, a 29% increase over five years. In recent months, inflation has elevated due to tariffs, the war in Iran, and other factors.
  • Elevated mortgage interest rates have made it difficult both for first-time homebuyers and existing homeowners who want to move.
  • Rising property taxes also affect affordability. To help offset rising costs, states and local municipalities will raise property taxes, making owning a home more expensive.
  • Insurance premiums are increasing due to a rising frequency of extreme weather-related claims involving floods, hurricanes, tornadoes and hailstorms.
  • Legal system abuse, such as unwarranted lawsuits, excessive jury awards, false and inflated claims, and third parties investing in legal actions, also inflates insurance costs.
What's driving monthly costs

Discuss with clients what expenses they are responsible for when it comes to owning a home, including:

  • Mortgage payment, including the interest rate.
  • Property taxes.
  • Insurance premiums.
  • Utilities.
  • Maintenance and construction costs.

It's important to frame these costs as variables that can change over time, rather than just making a blanket statement that owning a home is "expensive," which can leave clients feeling frustrated and the discussion futile.

The dos: how to navigate affordability conversations with clients

Lead with empathy and shared values. Starting from a place of mutual understanding builds trust between you and your clients and keeps the conversation from feeling cold and transactional.

Ground the conversation in a shared definition of affordability. Before diving into the specifics of costs, establish a common framework for what constitutes an affordable home. The HUD benchmark of 30% of gross income helps put into perspective what affordable actually means.

Discuss the true cost of homeownership. Owning a home requires more than just paying a mortgage bill every month. It's important to frame the true cost of owning a home as comprising several components, such as mortgage and interest rates, property taxes, insurance premiums, utilities, and maintenance. Your client will respond better when they understand that insurance is just one piece of the larger financial picture when it comes to owning a home.

Connect costs and use concrete examples. While discussing insurance premium increases isn't always comfortable, it's a necessity. You'll want to reference what aligns with what your clients are already seeing in the news and their own communities, such as rising repair costs, more frequent severe weather events, and increased rebuilding expenses.

Clients are also more receptive to these conversations when agents use real-life examples to explain factors that may affect the cost of coverage. As an agent, you may want to reference natural disasters like hurricanes, severe winter storms, and wildfires, which have led to higher claim costs and, in turn, increased premiums.

The don'ts: what to avoid in affordability conversations

Don't downplay the impact of rising insurance premiums. Although insurance is just one financial factor of homeownership affordability, it's important not to minimize its impact. Homeowners insurance is one of the most visible for consumers, and those living in high-risk areas may face premium increases that affect affordability. Downplaying these costs can make agents seem out of touch. As their insurance agent, it's better to acknowledge the impact of insurance costs on households and help clients to better understand the factors that affect their policies. Independent insurance agents, in particular, are uniquely positioned to help consumers navigate these issues by offering them a choice in insurance carriers, coverage options specific to their needs and budgets, and local knowledge about what risks are more likely to affect their community. The combination of personalization, flexibility and community insight allows consumers to be more informed and confident about their insurance decisions.

Don't seek sympathy for the insurance industry. As an insurance agent, you may be well-versed in the affordability challenges around insurer losses, capital constraints, or market exits. However, it doesn't mean this messaging will translate well with clients.

Despite the recognition that inflation has increased costs for the sector, most clients perceive the industry as financially well-off. For this reason, they may be skeptical of this messaging and perceive it as agents trying to seek sympathy and justify increases simply to cover industry costs. Instead, center the conversation around external cost drivers like severe weather events, inflation and increases in repair costs that the client can relate to.

Don't rely on new technology as a replacement for human decision-making. In the last several years, there has been a surge in the adoption and reliance on AI technology and data across business sectors, including insurance. Agents should avoid overemphasizing the role of AI, predictive analytics, and data-driven technology in setting premiums or assessing risk, as some consumers may see these tools as impersonal, unreliable, or inequitable. This may be especially true if they believe the technology reduces transparency in the process or completely replaces human decision-making. Framing affordability issues too narrowly through algorithms and risk models can make these conversations feel disconnected from the real financial pressures consumers face today.

Instead, agents should take a more empathetic approach to these discussions, focusing on providing clear explanations and practical guidance. Remember, agents often serve as trusted advisors, and these conversations provide the opportunity to help people better understand their coverage options, navigate changes in the market, and make informed decisions based on their individual circumstances and localized needs.

Conversations centering on being able to afford a home in today's economic climate can be complex and personal. As their trusted advisors, insurance agents can help their clients navigate homeownership discussions with clarity and confidence. By starting with a shared definition of affordability, clearly explaining the factors and events that can cause premiums to rise, and approaching these conversations with empathy, agents can build greater trust and credibility with their clients. It is just as important to know what not to say as it is what to say.

As finances remain top of mind for U.S. families, thoughtful, well-informed discussions are essential for reinforcing strong client relationships and helping clients make confident decisions about protecting their homes.


Nancy Germond

Profile picture for user NancyGermond

Nancy Germond

Nancy Germond is executive director, risk management and education for the Big "I." 

Drawing on almost three decades of insurance experience, Germond has written scores of risk-management related articles and white papers and has presented for organizations like the Public Risk Management Association (PRIMA) and the Society for Human Resources.

Drug Cost Spiral Breaks Employer Benefit Plans

Rising drug costs and opaque PBM practices are forcing employers to treat prescription benefits as enterprise risk.

Rising Costs Medical

In 2026, U.S. employers are staring down another year of healthcare inflation with fewer tools to absorb it. Drugmakers plan to raise prices on at least 350 branded medications this year, with a median increase of about 4%. At the same time, the three largest pharmacy benefit managers now control nearly 80% of prescriptions filled in the United States, giving them enormous influence over pricing, access, and reimbursement. The result is that many employers are being asked to fund a benefits system they cannot fully see, audit, or predict. For corporate leadership, this is no longer just a benefits issue. It is a financial governance issue, a workforce issue, and increasingly, a business continuity issue.

The Prescription Benefit Is Becoming an Enterprise Risk Problem

For years, rising healthcare costs were treated as a slow-moving pressure that could be managed through annual renewals, modest plan design changes, and cost-sharing adjustments. That approach is no longer enough. Specialty medications, biologics, and other high-cost therapies are now driving a disproportionate share of total pharmacy spending, and even one catastrophic claim can materially disrupt an employer's annual forecast.

This pressure is not only coming from manufacturers' list prices. It is compounded by the internal mechanics of the pharmacy supply chain. Pharmacy benefit managers were originally designed to simplify claims adjudication. Over time, however, consolidation and vertical integration have transformed them into powerful gatekeepers that influence which drugs are covered, where prescriptions are filled, how rebates are structured, and what patients pay at the counter.

That structure creates a serious visibility problem for employers. When pricing is shaped by confidential rebate arrangements, affiliated specialty pharmacy requirements, spread pricing, and opaque network rules, employers are left trying to manage a major corporate expense without a clear line of sight into how their dollars are being used. The Federal Trade Commission's recent reporting on specialty generic markups and excess PBM revenue only deepens concerns that employers may be underwriting profits embedded in a system they cannot fully govern.

The practical consequence is that financial risk has shifted. The vendors and intermediaries operating within the pharmacy ecosystem continue to collect revenue through administrative and contractual mechanisms, while employers absorb rising trends and employees face growing out-of-pocket exposure. As costs continue climbing, many organizations will continue to respond the only way they believe they can: by increasing deductibles, narrowing coverage, or pushing more expenses onto the workforce. That may protect the short-term budget, but it weakens trust and puts employee retention at risk.

The Cost Problem Is Not Just Pricing, It Is Pricing Without Accountability.

There is a tendency in public debate to focus narrowly on manufacturers as solely responsible for high list prices. Drug prices are set by manufacturers, but that does not tell the whole story. In many cases, manufacturers are unable to lower the list price because the system is still built around rebates, formulary placement economics, and access controls that sit between the manufacturer and the patient.

This is especially true in specialty pharmacy. Specialty labeling can function as a control mechanism, routing prescriptions to PBM-affiliated pharmacies and reinforcing a closed ecosystem where one organization may influence pricing, approval, dispensing, and reimbursement. From the employer's perspective, that is a deeply unstable arrangement. It combines concentrated financial risk with limited transparency and weak accountability.

It also creates a false sense of value. Higher spending is often framed as the unavoidable cost of innovation, but there is too little connection between the price of a medication and the value it delivers to the patient. In a functioning market, buyers can assess cost against alternatives, outcomes, and real-world impact. In the current system, that relationship is often obscured by layers of contractual complexity that make rational purchasing nearly impossible.

For executives responsible for enterprise planning, that opacity should be unacceptable. Healthcare may be complicated, but complexity does not excuse a lack of auditability. When a major line item cannot be traced clearly, forecasted reliably, or evaluated against measurable value, it becomes a risk management problem.

What Forward-Looking Employers Are Doing Differently

The organizations best positioned to weather the next phase of healthcare inflation are not waiting for policy reform to solve their budgeting problems. They are rethinking prescription benefits as a supply chain and financial design issue, not just an insurance issue.

They are asking more basic questions. Who is being paid, and for what? Which incentives reward higher spending rather than lower net cost? What percentage of spending is truly tied to clinical value? Where does the employer's fiduciary responsibility begin when plan assets are flowing through multiple opaque intermediaries?

That shift in mindset is leading some employers toward more transparent procurement and pricing structures that restore accountability and predictability.

  • Demand auditable pricing: Executives should expect the same financial clarity in pharmacy benefits that they would demand in any other major vendor relationship. That means rejecting models that depend on hidden fees, undefined spread, or opaque rebate retention. Every dollar spent should be attributable, visible, and understandable.
  • Separate insurance from predictable specialty purchasing: Traditional insurance is built for the risk of unknown loss, not recurring predictable expenses. When a known category of high-cost medications is folded into a structure designed for broad risk pooling, distortion follows. Employers are increasingly evaluating whether specialty purchasing should be managed through a more deliberate, transparent framework rather than left inside a black box.
  • Use fixed, member-first pass-through models to restore predictability: One of the most important advantages of pass-through pricing is not simply lower cost. It is budget stability. A fixed model that aligns incentives around actual acquisition cost, rather than inflated list price and rebate volume, gives employers a clearer basis for forecasting and helps reduce the pressure to shift costs onto employees.
  • Evaluate global sourcing pathways responsibly: When domestic pricing becomes detached from any rational benchmark, employers are increasingly examining compliant international sourcing options. In some cases, individuals may choose to obtain medications from English-speaking countries with regulatory frameworks and manufacturing standards aligned with the U.S. FDA regulation. When coordinated through reputable pharmacy partners and clinical advocacy programs, this approach can provide access to the same high-quality medications sold globally while aligning costs more closely to international benchmarks.
The Employers That Adapt First Will Be Better Positioned for What Comes Next

The prescription benefit crisis is not a temporary spike. It is a structural challenge shaped by consolidation, misaligned incentives, and a growing disconnect between price and value. Specialty therapies will continue to expand. Administrative controls will continue to grow. Financial pressure will continue to move downstream unless employers take a more active role in how pharmacy benefits are designed and purchased.

That is why this moment matters for the C-suite. A benefits strategy built on opacity is no longer sustainable in an era of rising drug costs and concentrated specialty risk. Employers that continue to rely on opaque renewals and inherited contracting structures may find themselves financing a system that grows more expensive while offering less control each year.

The better path is one built on transparency, accountability, and clear alignment between cost and value. In 2026, the employers that treat prescription benefits as a strategic enterprise issue, rather than a passive administrative function, will be the ones best equipped to protect both their balance sheets and their workforce.


Paul Pruitt

Profile picture for user PaulPruitt

Paul Pruitt

Paul Pruitt  is chief growth officer at SHARx.

He works with benefit advisers to lower the cost of medications for employers and their members.

The Nature of Insurance Pricing Is Changing

Modern market pressures force insurers to transform pricing from fragmented relay race into cohesive and strategic enterprise capability.

Dollar Sign

For decades, insurance pricing resembled a relay race, with actuaries generating insights from data, technology teams translating those insights into rating systems, and business leaders awaiting results. This sequential process separated key players, creating risky hand-offs and hindering cohesion in developing and executing pricing strategies.

In today's property and casualty insurance market, that model is increasingly out of step with reality. Climate-driven volatility, economic pressures, evolving customer expectations, and competitive market dynamics demand faster responses than traditional pricing processes were designed to deliver. Pricing decisions that once moved through long analytical and operational cycles now need to adapt rapidly to changing conditions.

With intensifying market pressures, insurers increasingly view pricing as a strategic enterprise capability, extending far beyond a purely technical or actuarial function. True agility requires breaking down silos so that pricing becomes a bridge between risk insight and business execution. This alignment enables organizations to respond rapidly to risks and achieve sustained profitability.

Successful insurance pricing transformation depends on treating it as a strategic discipline, a theme that becomes even more critical at the executive level.

Why Pricing Matters at the Executive Level

Historically, pricing was largely considered a technical discipline. Actuarial teams analyzed historical loss data, built pricing models, and recommended rate adjustments. These adjustments then flowed through regulatory review and operational implementation before reaching customers.

Today, a range of business forces is driving a significant shift. Climate risk is reshaping patterns of catastrophe exposure across geographies. Inflation and supply chain disruptions are altering the cost structure of claims. At the same time, competitive dynamics are accelerating as digital distribution and comparison platforms make pricing more transparent and heighten customer expectations for speed, simplicity, and personalization.

Regulators and consumers are also placing greater emphasis on fairness, transparency, and responsiveness in pricing decisions.

As a result, pricing shouldn't be treated as a narrow actuarial exercise. Its impact spans financial performance, competitive positioning, and customer outcomes. This expanded role requires insurers to reassess how pricing processes are structured and where legacy approaches may be holding them back.

The Legacy "Relay Race" Model

Despite the growing importance of pricing as a strategic capability, many insurers still operate with workflows designed decades ago.

In the traditional model, actuarial teams analyze historical experience and produce pricing models. These models are often documented in spreadsheets and technical specifications. The analysis is then handed off to IT teams responsible for translating the business logic into rating engines or policy administration systems. Quality assurance teams test the implementation, and pricing actuaries prepare documentation before the rates can be deployed.

Each step in this process introduces delays, interpretation challenges, and operational risk.

This sequential handoff model, once valued for clarity and governance, now creates friction and slows pricing decisions, preventing the swift responses required today.

Consequently, pricing insights may take months to reach production, by which time market conditions could have already shifted.

The Real Pricing Challenge Isn't the Math

One of the most common misconceptions about insurance pricing is that the biggest challenges lie in analytical sophistication.

In reality, the actuarial science behind pricing has matured significantly over the past several decades. Modern actuarial teams employ advanced statistical models, machine learning techniques, and increasingly powerful computing resources. Tools such as generalized linear models and gradient boosting models have become widely understood across the industry.

The challenge is not the lack of analytical methods.

The fundamental challenge is that, while analytical capabilities have rapidly improved, most organizations still struggle to operationalize pricing insights. Organizational fragmentation, rather than analytical sophistication, is the main bottleneck to achieving effective pricing.

Actuaries, data scientists, IT teams, underwriting leaders, and business executives frequently operate in separate environments with different tools, timelines, and objectives. Even when analytical insights are clear, translating them into operational systems can be lengthy and complex.

Recognizing the organizational nature of these bottlenecks reveals a deeper issue: a persistent gap between risk insight and effective business action.

The Gap Between Risk Insight and Business Action

In practice, this gap is where pricing efforts begin to break down.

Actuarial teams may identify changes in loss trends or emerging exposure patterns. However, those insights often lose momentum as they move through multiple organizational layers. Specifications must be documented, translated into system logic, validated, and approved before changes reach customers.

Each translation step adds friction, slowing progress and making the process harder to manage.

This gap between insight and execution has a direct business impact. Slow pricing adjustments can leave insurers operating with outdated assumptions, causing real financial risk, especially when market conditions shift rapidly.

Overcoming this organizational challenge requires identifying additional alignment issues within pricing operations.

Diagnosing Pricing Bottlenecks

When insurers examine their pricing processes more closely, bottlenecks typically fall into several categories.

The first category involves analytical pace. Some organizations struggle to produce pricing models quickly enough due to data accessibility challenges or outdated analytical tools.

The second category involves decision-making workflows. Even when models are available, pricing decisions may require coordination across multiple departments, slowing internal approval cycles.

The third category involves implementation and deployment. Traditional rating engines were designed primarily to calculate premiums quickly during quoting, not to support rapid updates to pricing logic. As a result, even small changes may require extensive development and testing.

Across these categories, pricing challenges often reflect two competing objectives: speed and accuracy. Insurers must balance the need to respond quickly to market changes with the need to maintain confidence in pricing integrity.

The Business Cost of Fragmentation

The operational consequences of fragmented pricing processes can be significant. Slow pricing adjustments can reduce an insurer's ability to respond to emerging market trends. Delays in deploying new rates may cause loss ratios to deteriorate before corrective actions take effect. Fragmented workflows also increase operational costs through manual coordination, duplication of efforts, and testing. In some cases, errors in approved pricing can make their way into production, potentially costing insurers millions to identify, correct, and remediate.

Beyond operational inefficiencies, pricing fragmentation can create governance challenges. Regulators increasingly expect transparency in how pricing decisions are developed and implemented. When pricing logic moves through multiple disconnected systems, maintaining a clear audit trail becomes more challenging.

In sum, fragmented pricing processes undermine both financial results and operational effectiveness, making it crucial to address this core organizational barrier to competitiveness.

The Emergence of Intelligent Pricing

To address these challenges, many insurers are beginning to adopt a new approach sometimes described as "intelligent pricing."

This approach focuses on integrating analytics, implementation, and operational decision-making within a cohesive platform environment. Rather than separating pricing analytics from rating execution, intelligent pricing environments allow pricing teams to move more seamlessly from insight to implementation.

Platform-based pricing environments can provide a range of benefits. They make it easier for teams to collaborate on pricing models while offering the flexibility and tools needed to analyze business impacts effectively. More importantly, rather than resorting to "spec documents", they enable pricing logic to move more directly from analysis into operational systems without requiring an intermediate translation layer.

By reducing the friction between analytics and execution, insurers can significantly improve the speed and agility of pricing decisions.

New Data and Intelligence Inputs

Another important development shaping the future of pricing is the rapid expansion of available data sources.

Telematics systems in vehicles can provide direct insight into driving behavior. Sensors embedded in commercial equipment and infrastructure can offer real-time information about operational risks. Advances in geospatial analytics allow insurers to evaluate property exposures with far greater granularity than traditional location-based models.

At the same time, emerging artificial intelligence technologies are beginning to unlock new forms of unstructured data. Text, images, and inspection reports can increasingly be analyzed to generate structured insights relevant to risk assessment.

These developments create opportunities to move beyond traditional proxy variables toward more direct risk measurements. As data becomes richer and more granular, pricing models can become both more accurate and more responsive to real-world conditions.

From Silos to Coordinated Teams

Achieving faster pricing execution also requires changes in organizational structure.

In traditional environments, actuarial, technology, and business teams operate in separate silos with distinct responsibilities. Modern pricing capabilities increasingly rely on cross-functional collaboration.

Some insurers are experimenting with multidisciplinary teams that bring together actuaries, data scientists, technology specialists, and underwriters to work on pricing initiatives together. These coordinated teams can reduce communication barriers and accelerate decision-making.

When pricing teams operate collaboratively rather than sequentially, the organization can move more quickly from analytical insight to operational deployment.

Technology as the Enabler

Technology plays a big role in modern pricing, but it's only part of the picture. Success comes from closing the gap between insight and action. Modern pricing platforms make this possible by letting teams define, test, and apply pricing decisions within a single, integrated environment.

These platforms can also support governance by giving teams clear visibility into how models perform and how pricing strategies are applied, while ensuring compliance with regulations.

Ultimately, technology serves as an enabler of organizational alignment rather than a standalone solution.

Executive Takeaway

The property and casualty insurance industry is entering a period in which pricing agility will increasingly differentiate leading organizations from competitors.

The insurers that succeed will not necessarily be those with the most sophisticated models, but those who can move fastest from understanding risk to acting on it.

By treating pricing as an enterprise capability, one that unifies analytics, technology, and operational decision-making, insurers can transform pricing from an operational constraint into a strategic advantage.

As risks shift and markets move faster than ever, the ability to connect pricing insight directly to action may become one of the most important capabilities an insurer can develop.

Moving to a 'Platform Economy'

As generating traffic becomes a commodity capability, competitive advantage shifts from managing customer relationships to participating in their decisions.

Futuristic 3-D Squares

The creator economy was once seen as a new form of independence. Individuals could publish articles, videos, courses, communities, or other forms of content, build their own audiences, and turn that relationship into income and influence. They no longer had to rely entirely on publishers, media organizations, academic institutions, or large companies. They could face the market directly, build their own voice, establish trust, and create their own business model.

But that promise has changed.

Today, much of the creator economy looks less like an ecosystem that supports genuine creativity and professional expertise, and more like a content production machine driven by platforms, algorithms, and monetization mechanisms. It encourages creators to chase exposure, trigger emotion, manufacture anxiety, and convert content into traffic and income as quickly as possible. More and more content is no longer built around understanding, knowledge, judgment, aesthetics, or responsibility. It is built around clicks, engagement, conversion rates, and repeatable monetization routines.

So, when people say the creator economy is becoming a "junk economy," the statement should not be dismissed as an emotional complaint. It is a criticism of the platform economy on which the creator economy depends, especially its traffic mechanisms and monetization structure.

The creator economy is not an isolated phenomenon. It is a visible sample of a broader platform economy. It deserves attention not only because creators are being shaped by algorithms, traffic, and monetization rules, but also because this process reveals a common structure across many platform-based industries.

Whether we are looking at e-commerce, food delivery, ride-hailing, short-form video, financial services, or insurance distribution, platforms do more than provide connection. They use connection as a means to redistribute visibility, trust, and value.

This is why the issue is not that creation itself has lost value, nor that all creators are becoming low-quality producers. The deeper issue is that platforms control traffic and use distribution rules to establish evaluation standards that benefit themselves. Content, products, and services are forced to adapt to algorithmic preferences. The participants on the platform are gradually reduced to suppliers of traffic, data, or transaction opportunities.

In this structure, people with real experience, expertise, and responsibility may not be the ones most easily seen. Instead, those who are skilled at stirring emotion, amplifying anxiety, copying and pasting content, and selling shortcuts often receive greater platform rewards. The original ideal of the creator economy is then swallowed by platforms, traffic, and arbitrage.

This is not merely a moral question about whether platforms are "good" or "bad." It is a question of concentrated power, market-driven dependence, distorted business models, and long-term sustainability.

Platforms Are Rule-Makers, Not Neutral Infrastructure

When discussing platforms, a common, soft explanation is that platforms do not necessarily intend to do harm; their business models simply lead to certain negative outcomes.

But this explanation weakens platform responsibility.

Platforms are not innocent carriers of rules. They are designers, modifiers, and primary beneficiaries of those rules. They decide which content is recommended, which voices are suppressed, which formats receive traffic, and which participants are easier to monetize. Platforms use seemingly neutral language such as algorithms, customer preference, and market efficiency to package their power. But such language does not make the power neutral.

When platforms control visibility, creators no longer truly own their audiences. When platforms dominate distribution paths, content value becomes a measurable traffic resource. When platforms define monetization rules, creators' income and survival depend on the platform's decisions.

The same logic applies beyond creators. A merchant may believe it owns customer relationships, when it owns access granted by a marketplace. A service provider may believe it is competing on quality, when visibility is determined by ranking rules. A financial or insurance intermediary may believe it is managing customer relationships, when leads, timing, evaluation, and conversion tools are increasingly shaped by the platform.

Therefore, platforms do not merely control entry points. They reshape the entire relationship structure through which participants and customers meet, trust, and transact.

The key question is not whether platforms intend to do harm. The real question is this: when a platform controls the rules, profits from those rules, and refuses to take responsibility for the degradation of content quality, professional expertise, and trust that results from them, then harm is no longer just an unintended side effect. It becomes part of the structure.

Why Moving from Public Traffic to Private Relationships Is Not Enough

A common response to platform dependence is to move from public traffic to private-domain operations. The idea is to reduce dependence on platform algorithms by building more direct relationships through communities, email lists, membership systems, subscription content, messaging tools, or other private channels.

This approach has value. But it does not fundamentally change the logic of the traffic economy.

In many cases, private-domain operations simply move people from a large traffic pool into a smaller one. On the surface, creators or companies appear to regain some direct access to users. In practice, however, the logic often remains focused on retention, activity, conversion, repurchase, and referral. The relationship structure between the participant and the customer has not been fundamentally changed.

This is one reason many private-domain strategies fail to deliver lasting results. They require long-term investment, continuous content supply, frequent interaction, manpower, funding, and management capacity. Even when they work in the short term, they often struggle to become a high-leverage, sustainable, and replicable system of value creation.

More importantly, private-domain operations are still mainly relationship maintenance. They can increase familiarity, strengthen trust, and improve conversion probability. But unless they help the company understand the customer's real needs and enter the customer's decision process when opportunities arise, they remain a low-efficiency form of relationship management.

The real shift is not from public traffic to private traffic. It is from managing relationships to understanding needs and participating in decisions.

This distinction is particularly important for insurance.

Insurance has always been a business that depends on trust, timing, context, and decision support. Yet many digital strategies still treat insurance customers as traffic to be acquired, segmented, nurtured, and converted. The problem is that buying insurance is rarely a simple transaction. It often involves family responsibility, health anxiety, risk perception, financial constraints, and a person's willingness to face uncertainty.

If insurers continue to look at customers only through the old lens of leads, conversion, product matching, and campaign response, they may miss the deeper question: why does a person decide to think about protection now, and what kind of support does that person need before making a decision?

Sometimes, the insurance industry cannot solve new problems by staying entirely inside its old mental framework. Looking at creator platforms, e-commerce, and other platform economies may help insurers see their own problem more clearly: the challenge is not only how to get more traffic, but how to enter the customer's decision moment with understanding, trust, and responsibility.

From Relationship Management to Decision Participation

There is a fundamental difference between managing relationships and participating in decisions.

Relationship management asks: how do we keep the customer, increase interaction, maintain contact, build trust, and improve conversion?

Decision participation asks a different set of questions: why does the customer have this need? What situation is the customer really facing? What problem is the customer trying to solve? Which factors are shaping judgment? What is causing hesitation? Is the customer looking for a product, or looking for a reason to make a difficult decision?

From a methodological perspective, relationship management deals with how to move along a path. Decision participation asks why the path exists, and whether it is the right one.

This means a new methodology cannot be centered only on traffic, private-domain operations, content frequency, or community activity. It must be centered on causality.

The question is no longer simply how to convert customers. The question is how customer needs and decisions arise. How is a need formed? How is trust established? How is a decision triggered? How is value realized?

The focus is not messaging or content. The focus is understanding the causal structure behind customer decisions.

A person does not buy insurance simply because they understand policy terms. They may be responding to family responsibility, health anxiety, risk imagination, or a life event. A company does not adopt AI simply because its leaders understand the technology. It may be responding to competitive pressure, management anxiety, cost reduction needs, strategic signaling, or a transformation challenge. A reader does not follow a creator simply because the content is good. The reader may be looking for a framework to understand the world, a way to judge problems, or language to clarify confusion that has not yet been expressed.

The true value, therefore, lies in the insurance adviser's insight into customer needs, the executive's understanding of organizational pain points, and the creator's ability to help readers reconstruct problems and form judgment.

What these roles share is not merely that they are good at managing relationships. It is that they can enter the process through which needs are formed and decisions are made.

That is what decision participation really means.

In this diagram, "distribution causality" refers to how platforms shape visibility and distribution rules, while "decision causality" refers to how customer needs, trust, judgment, and choices are formed.

Figure 1: The shift from traffic operations to decision participation.

From Companionship to Demand Inquiry

If the core of this new methodology is causal thinking, then the supporting technology cannot stop at generative AI in the usual sense. It must move toward causal AI.

Generative AI is powerful at producing content, organizing information, answering questions, and simulating conversation. But if it relies only on correlation-based generation, it is not enough to support true decision scenarios. In decision scenarios, the key is not only how to answer or what to answer. The key is why a need has appeared, which factors are influencing judgment, and what conditions might change the decision.

This also means the human-AI relationship must change.

In the past, AI often functioned like a companion, assistant, or customer service representative. It answered questions and provided information. Its interaction model was mainly responsive.

But in decision scenarios, AI cannot only respond. It must be able to ask follow-up questions based on causal logic. It should help people see problems they cannot yet clearly express, identify the motives behind stated needs, uncover causal factors beneath surface answers, and, when necessary, reframe the problem itself.

Companion-style interaction makes people feel heard. It is closer to emotional support and information provision.

Demand-inquiry interaction helps people better understand their own problems. It is closer to causal analysis and decision support.

This is not simply an improvement in customer experience. It is a change in role.

For AI to move from a content tool to a decision-support capability, it cannot rely on the model alone. It needs a causal methodology as an analytical framework, concrete business scenarios as sources of problems, contextual data that can support judgment, and human experts who can correct, interpret, and take responsibility for the results.

Only in such an environment can AI truly participate in need formation and decision construction.

Decision Participation Is Harder Than Relationship Management

There is an unavoidable reality: participating in decisions is harder than managing relationships.

Relationship management already requires substantial investment. Without effective automation, many participants eventually fail because they cannot sustain the required content, interaction, and service effort. Decision participation is more demanding. It requires understanding context, identifying needs, interpreting motives, reframing problems, offering recommendations, and, to some extent, taking responsibility for the consequences of advice.

This is not work that individuals or companies can sustain through enthusiasm and diligence alone.

A sustainable approach requires three supports.

The first is methodology. A causal framework is needed to rethink needs, trust, decisions, and value, rather than staying within the language of traffic, retention, conversion, and repurchase.

The second is technology. Causal AI can support demand inquiry, motive identification, problem reframing, and decision recommendations, reducing excessive dependence on individual experience and manual labor.

The third is a business model. Professional judgment must be reasonably priced. Otherwise, it will be forced back into free content for attracting traffic or low-priced services for conversion.

Only when these three supports work together can decision participation move beyond a high-cost service provided by a small number of experts and become a value creation model that more individuals and companies can adopt.

For insurance, this matters because the industry often describes itself as a trust business, but still operates many customer processes as traffic and conversion systems. If AI is used only to generate scripts, summarize conversations, or automate follow-ups, it may improve efficiency but not change the underlying relationship. The more important opportunity is to use AI to help advisers and insurers understand why a customer is hesitating, what responsibility or fear is shaping the decision, and how to support the customer's decision-making process instead of reducing the conversation to a sales script.

The Real Moat Is Decision Position

In the platform environment, content alone is no longer enough to create lasting differentiation. Opinions can be rewritten, articles summarized, videos edited, courses imitated, and even personal style learned and regenerated by AI. When the threshold and cost of content generation continue to fall, low-level homogeneous competition becomes unavoidable.

For customers, the true source of irreplaceability is not whether you can produce more content. It is whether you can enter their decision position.

This is the key for the creator economy to move beyond junk content. It is also a strategic question for e-commerce merchants, insurers, enterprise service providers, professional advisers, and AI solution companies trying to break through platform dependence.

In scenarios where transactions require long-term relationship building, if we treat content push merely as a tool to collect customer tags and build customer profiles, while ignoring the essence of customer management, we are still playing a game of "guess what you like." We are competing on statistical probability, not understanding.

The essence of customer management is to enter the customer's mind and wallet at the critical moment of decision. That does not mean manipulation. It means being present with relevant understanding when the customer actually needs help.

A platform may reduce your exposure, but it cannot easily replace your position in the customer's decision process. A platform can decide what content is distributed, but it cannot bear judgment and consequences on behalf of the customer. Even the most precise algorithmic recommendation can only infer preferences from past behavior. It cannot fully understand the customer's present context, constraints, hesitation, and responsibility. Trust, especially in insurance and financial services, cannot be created for an individual customer simply by scaling traffic.

Therefore, the answer to platform dependence is not to flee platforms. Nor is it merely to move traffic into private channels. The answer is to reposition one's value role: from traffic operations to decision participation.

Conclusion: Being Present When Customers Need Help Most

In the platform economy, what individuals and companies need to build is the ability to understand customer needs and enter the customer's decision process. The purpose is simple: to be present when customers need help most.

Platforms are powerful because they control traffic, distribution, and visibility. But the key to breaking through is not to fight platforms directly. It is to build another path of value. Instead of waiting to be distributed by platforms, companies should ask how they can become truly needed by customers. Instead of chasing exposure, they should learn how to enter the process through which customers form judgment and make choices.

When platforms control the distribution of content, products, and services, individuals and companies need to build a closed loop of capability: from need formation, trust building, problem reframing, and judgment formation to value realization. Once this chain is established, participants are no longer merely units of content, products, or services to be distributed. They become structural roles in the customer's decision process.

What we should oppose is not the platform economy itself, but the junk economy that emerges when platforms use traffic and algorithms to capture value from participants across industries. The part of the platform economy worth preserving is its ability to improve connection efficiency and reduce transaction costs. If that capability helps truly valuable people and companies become visible, understood, and trusted, then it deserves to be expanded.

What we should support is not everything that platforms amplify, but the individuals and companies that sincerely provide knowledge, experience, judgment, and responsibility. By understanding causality, reconstructing needs, and participating in decisions, they are the true creators of future value.

Individuals and companies may not be able to change platforms, and they do not need to. What they need is an upgrade in customer management: to rely less on traffic and content production, and gradually build their own loop of demand inquiry and decision influence.

For B2B service providers, this is also a reminder. Customers should stay because of value, not because of lock-in. This is not easy. But it should be a basic value principle for technology companies entering enterprise scenarios.


David Lien

Profile picture for user DavidLien

David Lien

David Lien is a partner at Lingxi (Beijing) Technology. 

He wrote “Decoding New Insurance” (2020), which ranked among JD.com’s top books. Lien has held leadership roles at Sino-US MetLife, Sunshine Insurance and Prudential Taiwan, leading digital transformations and multi-channel marketing. A 2018 e27 Asia New Startup Taiwan Top 100 nominee, he holds a patent for the "Intelligent Insurance Financial Management System." 

The Wasted Insurance Opportunity in AI Subscriptions

Fifty million AI subscribers are generating new exposures daily, yet insurers are writing exclusions instead of embedding coverage.

Shield with Arrows stuck in it

Every few years, the insurance industry watches a new distribution channel open up and takes too long to walk through it.

It happened with auto telematics. It happened with embedded travel coverage. It happened, most painfully, with cyber — a line we hesitated on for a decade while insurtechs and specialist managing general agents built the playbook we now have to license back.

A similar window is opening right now. And almost no one in traditional insurance is talking about it.

OpenAI confirmed 50 million paying subscribers across all tiers in its April 2026 announcement. Anthropic confirmed that paid subscriptions to its Claude AI platform more than doubled in 2026. Google's Gemini is scaling through Android, Workspace, and Search. Microsoft Copilot is being purchased seat-by-seat across enterprises of every size. Add Perplexity, Grok, Mistral, and a long tail of specialist AI tools, and you have something the insurance industry has not seen in a generation: a brand-new category of paying users — most of them business users — being created at unprecedented speed.

The question I keep coming back to is simple. These users are taking on real, novel professional and digital exposure every time they use these tools. Who is going to insure them, and how?

I think the answer is embedded insurance — sold at the same moment they click "Subscribe to Pro."

Why This Moment Is Different

Embedded insurance is not a new idea. We've discussed it for years in the context of auto OEMs, travel platforms, and e-commerce. What's different about AI platforms is the intensity of the exposure being created relative to the price of the underlying product.

A small business owner who subscribes to ChatGPT Plus or Claude Pro and uses it to draft client deliverables, write production code, advise customers, or build autonomous agents is generating a brand-new risk surface every day — one that no existing policy was priced for.

The industry has already started reacting defensively, by introducing new AI-related exclusions.

But that standalone market is being built the traditional way — broker-led, application-heavy, aimed at mid-market and up. Meanwhile, the actual users of AI tools — millions of freelancers, consultants, small firms, and individual professionals — are buying their subscription in 30 seconds and getting straight to work. They will never call a broker. But they would absolutely tick a box for $10–$15 a month that protects them against the very tool they are using.

That is the embedded insurance opportunity.

What an Embedded AI Coverage Could Look Like

Imagine a world where:

  • A user upgrading to a paid AI plan sees a single optional add-on: AI Use Protection.
  • For an individual professional, the coverage bundles AI errors and omissions, cyber and privacy protection, deepfake and reputational harm response, and IP infringement defense.
  • For a small business, the same product scales up by seat, with broader limits and incident response services.
  • For an enterprise, the embedded layer feeds into an existing master policy with usage-based premium adjustments at renewal.
  • Underwriting signals come directly from the platform: account type, industry, usage volume, integrations enabled, agent autonomy level, and governance controls.
  • Pricing, binding, and endorsement happen instantly, through the same checkout flow as the subscription itself.

This is not a futuristic sketch. The pieces already exist. With AI-driven underwriting and instant pricing, carriers can now confidently offer coverage in context — at the point of need, and for the duration required. What is missing is the partnership — a carrier or insurtech sitting down with a foundation model company and building it.

Why Insurers Tend to Miss These Windows

There are three patterns that explain why insurance keeps arriving late to opportunities like this one, and they are worth naming honestly.

The first is that we wait for credible loss data before we move. Underwriters want triangles. Actuaries want credibility. By the time we have either, the insurtechs and specialist MGAs have already built the wordings, the distribution, and the brand recognition. Cyber between roughly 2010 and 2018 is the case study every carrier should re-read this year.

The second is that we instinctively treat new technology as a risk to exclude rather than a customer base to serve. Look at the carrier behavior above — exclusions, carve-outs, regulatory filings to remove coverage. These are all defensive moves. Very few carriers are asking the offensive question: if 50 million people are now generating new exposure every day, who is selling them an appropriate product?

The third is that we are not yet good at partnering with non-insurance platforms. Carriers know how to work with brokers, agents, and program administrators. Partnering with a foundation model company — meeting their API standards, their UX expectations, their speed of iteration — is a different operating muscle, and most carriers have not built it.

The Window Is Narrower Than It Looks

Embedded auto insurance took roughly a decade to mature. Embedded travel coverage, similar. But the AI subscription market is growing at a pace neither category ever saw. The platforms that will define the next decade of distribution are being chosen right now, in 2026.

The next great embedded insurance product is unlikely to come from an automaker or an airline. It is more likely to appear next to a "Subscribe to Pro" button, sold to a freelancer who never knew they needed it until the moment it was offered.

The risk is here. The exposure is here. The customers are here. The only real question is which insurers stop excluding the future and start underwriting it.

Every great distribution channel in insurance was obvious in hindsight and invisible in the moment. AI subscriptions are simply the next one.


Manjunath Krishna

Profile picture for user ManjunathKrishna

Manjunath Krishna

Manjunath Krishna is a property and casualty underwriting consultant at Accenture.

He has nearly a decade of experience supporting global underwriters and carriers. He holds CPCU, AU, AINS, and AIS designations.

Machine Learning Transforms Insurers' Portfolio Optimization

Insurers are turning to scenario-based machine learning for portfolio optimization as traditional methods falter under regulatory and economic complexity.

Human Brain

The investment landscape is becoming ever more unpredictable, driven by economic uncertainty, geopolitical risks and evolving regulations putting a strain on traditional asset portfolio optimization techniques.

These techniques are becoming less effective in addressing the rapidly evolving financial environment, and insurers are facing the challenge of struggling to balance complex regulatory and financial objectives using tools and techniques that were designed for a simpler, more stable era.

Shortcomings of traditional portfolio optimization

For decades, investors have relied on techniques rooted in linear relationships such as mean-variance optimization, which seeks to balance expected return against risk. These closed form approaches offer clear frameworks for decision-making but require simplified approximations of insurer-specific objectives.

Insurance companies face objectives far more complex than simply maximizing return for a given level of risk. They must also account for objectives such as solvency capital requirements, regulatory compliance and liquidity management. Traditional optimization approaches struggle to accommodate these objectives, particularly when constraints are non-linear and when conflicting goals must be considered simultaneously.

To overcome this challenge, insurers had to resort to trial-and-error or brute-force methods, manually generating portfolios until one fits the desired criteria. While this approach can work, it is inefficient and offers no assurance of optimality. The time and resources expended in this process can be considerable and the resulting portfolios may still fall short of meeting the required objectives.

Scenario-based machine learning - a new approach

Scenario-based machine learning (SBML) represents a paradigm shift in portfolio optimization, enabling users to evaluate any combination of objectives within a stochastic scenario framework. Unlike traditional methods, SBML embraces the full complexity of the real world, allowing for non-linear objectives and the simultaneous optimization of multiple competing goals.

The key to SBML is its ability to learn from vast data sets of generated balance sheet projections driven by a stochastic real-world scenario generator. Machine learning algorithms train on these projections, identifying patterns and relationships between the complex objectives and constraints. This learning process identifies asset portfolios that best meet the objectives and constraints defined in the optimization exercise creating an efficient frontier of suitable portfolios.

Targeting balance sheet metrics

One of the defining features of using SBML tools for strategic asset allocation (SAA) optimization is the capacity to target the balance sheet metrics that matter most to insurers, leading to a targeted SAA approach.

Let's take solvency capital as an example. By and large, for all insurance regulatory frameworks globally, the amount of capital held is directly influenced by the risk profile of the investments held. Regulatory frameworks, such as Solvency II in Europe, impose strict standards on insurers, requiring them to maintain sufficient capital to cover the risks of running asset portfolios. SBML enables insurers to directly incorporate these considerations into the optimization process maximizing returns or surplus while minimizing solvency capital and imposing a constraint on the amount of capital required.

Insurers that embrace tools that use AI and machine learning for portfolio optimization will be best positioned to achieve their goals, adapt to new challenges, and secure their place in the evolving landscape of global finance.


Ashish Doshi

Profile picture for user AshishDoshi

Ashish Doshi

Ashish Doshi leads the insurance strategy team in the U.K. for Ortec.

He has over 15 years of experience within the investment industry, holds a first class degree in actuarial science and is a qualified actuary.

When Operations Becomes Marketing

The AIs deciding whether to recommend your company aren't reading your brand guidelines. They're evaluating your operational reality.

AI Bot

While graduates recently booed the mere mention of AI at commencement ceremonies in Florida and Arizona, to wild applause, Google's head of search unveiled "the biggest upgrade to our search box in over 25 years."

In a nutshell: Google has moved from being a search engine — a tool that helps humans find links — to being a search agent: an autonomous system that researches, synthesizes, and concludes on behalf of the human, often without the human ever visiting a website.

They even introduced a feature called "Human Not Present" payments — which is, if you squint, the most honest branding in Silicon Valley history.

Here's the thing about technology revolutions that people keep forgetting: Consumer sentiment and consumer behavior are two entirely different animals. People hated ATMs and used them. People hated self-checkout and used it. People write long X and Reddit screeds about how AI is destroying everything, then ask ChatGPT to fix their cover letter 20 minutes later. The outrage and the adoption happen simultaneously, in the same brain, without apparent contradiction.

Google's AI Overviews are already used by more than 2.5 billion monthly users, and AI Mode has more than 1 billion monthly users. What percentage of those booing graduates are among them? Let's set the line at 80% — and I'll take the over.

The hard business reality is this: Whether you decide to use AI in your operations is up to you. Whether AI is used to evaluate your business for marketing purposes is up to them.

The existential question isn't whether to participate in an AI-mediated marketplace. The question is whether your business is legible to the machines that will increasingly decide who gets recommended, who gets trusted, and who gets the transaction.

Most businesses, if they're honest, are not legible.

They're running on claims systems from 2009, CRM platforms that don't talk to each other, PDFs that contain institutional memory no one has ever indexed, and tribal knowledge sitting in the heads of people who are 18 months from retirement.

For decades, this created internal inefficiency — higher costs, more escalations, customers on hold listening to music they didn't choose. Annoying, expensive, but survivable.

Now businesses face a more fundamental issue: discoverability itself.

Google is explicitly trying to turn Gemini from a chatbot into a distributed agent runtime — a system that doesn't just answer questions but routes decisions, recommends vendors, and executes multi-step commercial transactions.

An AI agent deciding which carrier to recommend, which doctor to surface, or which vendor to integrate is going to favor organizations whose operations are coherent, structured, and machine-readable. It has no patience for ambiguity. It won't retry. It won't call customer service. It will simply move on to the competitor whose data makes sense.

Which means a structured operational model isn't just an IT project anymore. It's the difference between being findable and being invisible in a world where the searcher is a machine with no tolerance for mess.

Operations and marketing have spent decades pretending to be separate disciplines. AI is about to collapse that distinction. Every fragmented workflow, every ambiguous data state, every avoidable customer complaint — all of it now has a marketing consequence.

The machines experiencing your company aren't reading your brand guidelines. They're reading your operational reality.

That was the announcement that got lost in the recent hoopla — the quiet, structural truth beneath it all: In the agentic era, your operations are your marketing. Operational excellence is marketing excellence.


Riv Arthur

Profile picture for user RivArthur

Riv Arthur

Riv Arthur is a business leader and technologist working in insurance, healthcare, and private equity.