There are rumblings of fear and nervousness about the long-term impact of artificial intelligence (AI). Are we ready? Have we thought through the potential consequences? More and more questions pop up, which is understandable considering AI’s capacity for profound change. But it doesn’t really matter if we’re ready for AI or not. Let’s consider what AI does and how it can work for all businesses as well as in specific industries. It’s Not a Replacement Artificial intelligence is, essentially, algorithm-based software that can “see,” “hear” and “think” in ways that often mimic human processes — but faster and more accurately. It is easy to see why business would not be ready for this. AI can teach you something by looking at your data more deeply and in a less biased way than you would ever be capable of otherwise, and this could sound ominous or threatening to human jobs. But it doesn’t mean a loss of value for humans. Rather, the innately human characteristics of higher-order thinking, of seeing what’s not on the page, and making decisions that account for intangibles, can be applied in far more strategic ways. This is a pretty incredible proposition, one that any business should want to embrace. AI informs and empowers people to do their jobs even better and with greater efficiency. It can also help bring a high degree of personalization to services and products. When fear creeps in, it is important to remember that AI is a tool that humans control. People have the final say. We’re not looking at a “machines will rule the world” scenario. How You Feed the Machine Matters If there is another knock on AI-based technologies, aside from questioning whether AI will replace humans (it won’t, although jobs in the future may look a little different), it’s the issue of bias. Some argue that data generated through AI is inherently biased because humans assign machines to look for and pull out specific elements, and, therefore, human biases have entered the equation. This is not necessarily true; it depends on how you set things up. Many companies feed data into systems and don’t “tell” the machine anything; they let it tell them. With this approach, all bias is eliminated because the data is clean. The human interpretation of resulting data is what then adds bias. See also: Untapped Potential of Artificial Intelligence   For example, if I input all of the addresses and relevant statistics in Chicago, a system will eventually learn which are the high-income areas all on its own, but if I feed the system data that I code as high-income, I’m making the choice. From this perspective, you can think of AI like the lab partner you always wanted who could conduct every experiment perfectly but let you determine how the findings should be applied. The Transformation Has Begun Perhaps the best way to conquer AI apprehension is to look at some of the exciting applications of AI-based software across industries. In healthcare, companies are using AI to match patients with the right doctors at the right time, doctors who, along with researchers and drug companies, are using AI to determine the best, most effective treatments for incredibly complex medical conditions. Faster, more efficient research capabilities powered by AI are saving people’s lives. Local, state and federal governments are using AI for everything from virtual assistants to controlling traffic lights to furthering policy initiatives. And AI is one issue that has received bipartisan support. In 2016, President Obama issued a report titled, “Preparing for the Future of Artificial Intelligence.” The White House stated: “Advances in AI technology hold incredible potential to help America stay on the cutting edge of innovation. Already, AI technologies have opened up new markets and new opportunities for progress in critical areas such as health, education, energy and the environment.” Earlier this year, President Trump unveiled his own American AI Initiative, directing federal agencies to conduct R&D on AI, work with outside researchers, set clear standards and more. As part of its rollout on Feb. 11, Trump noted, “Continued American leadership in artificial intelligence is of paramount importance to maintaining the economic and national security of the United States.” There is also tremendous promise for education, where AI is expected to help schools and teachers accomplish more than ever. With help from AI, schools can make better use of their resources and reduce admin time, while teachers can focus on teaching the way that their students need instead of prescribing to a one-size-fits-all curriculum. See also: 3 Steps to Demystify Artificial Intelligence  I could give even more examples, but you get the point. If even the sectors known to be among the slowest adopters of change are exhibiting a willingness and excitement to put AI to work, the train has left the station. You’re going to have to get on board. In part two of this series, I will dive deeper into why businesses must look beyond what’s happening in the world today when considering what to do about AI. You cannot plan successfully for tomorrow based solely on what is happening today. As first published in Dataversity.

The thought of a major insurance company, and its brand, disappearing from the market seems impossible to comprehend and more like the stuff of an attention-grabbing headline. But that’s probably what everyone once thought about Atari, Commodore, Kodak, Nokia, Polaroid, Blockbuster, The Sharper Image, Enron, Blackberry, DeLorean, Radio Shack, Motorola, Toys 'R' Us, Tower Records, HMV, Palm, AOL, Compaq, Borders, Circuit City, Pan Am, Netscape, Nortel – and now Sears. As I was reviewing the NAIC 2018 insurance industry rankings and market share, I could not help but notice that some significant trends were accelerating. In the private passenger auto insurance line of business, Geico has overtaken Allstate to take the #2 spot with a 13% market share and continues to close in on State Farm, whose share has dropped to 17%. In fact, Geico has publicly stated its intention to overtake State Farm soon. Now this does not mean that State Farm or Allstate is at risk of going out of business anytime soon, but it does underscore the power of market trends that could over the longer term displace carriers that are not paying attention. Consolidation among top tier insurers is one of the many ways that insurance brands will disappear. According to Deloitte’s 2019 Insurance M&A Outlook report, the aggregate deal value of P&C acquisitions grew by 316% to $34.1 billion in deal value, up from $8.2 billion in 2018. American Family, the 10th largest U.S. auto insurer, recently acquired a number of smaller competitors, including Ameriprise Auto & Home, Main Street America, the General and Homesite. And #13 Kemper recently acquired Infinity. Also, in 2018, #19 Hartford Insurance acquired specialty insurer Navigators. Just as Amazon’s direct-to-consumer model disrupted brick-and-mortar retailers, insurers that deliver and service consumer products and services digitally and on mobile devices will continue to outpace competitors that operate in a “middleman” distribution model. Auto insurance insurtechs such as Metromile, Root and now others will not displace tier 1 auto insurers but will further erode their customer base, particularly those in indirect distribution models. See also: Insurance 2030: Scenario Planning   The Internet of Things, consisting of an estimated 50 billion “always on” sensors in connected cars, property and factories and on people by 2030, is enabling the development of very different on-demand and other types of insurance products that lend themselves to fulfillment by smaller, technology-driven companies, further displacing traditional insurers. As if these threats were not enough, look for car manufacturers to pile on by leveraging connected cars to exert greater control over the sale and design of auto insurance as well as the collision repair claims process. And the potential nail in the coffin – autonomous (self-driving) cars will shift risk and responsibility from “drivers” to manufacturers and software developers – ultimately eliminating auto insurance as we know it. Insurance carriers that recognize the implications of all of these trends are already making strategic plans to defend themselves. State Farm is in the midst of a long-term restructuring plan that will see it shed thousands of jobs and consolidate its facilities into three major U.S. operational hubs and in 2015 sold its substantial Canadian business to Desjardins. But eliminating overhead alone will likely not be sufficient. Others are pursuing strategies to alter product offerings to focus on risk prevention and avoidance, to diversify out of traditional insurance into protection products, alternative transportation and travel services and to develop strategic partnerships with auto manufacturers. Others are restructuring and positioning their companies for eventual acquisition, merger or sale. See also: Innovation: ‘Where Do We Start?’   A historical side note: Sears founded Allstate in 1931 and sold its products in the Sears tire and battery department. Allstate was spun off as an independent company and went public in 1993. Major insurance brands may not disappear any time soon, but their dominance and longevity can no longer be taken for granted.

For nursing professionals, medical malpractice is the 200,000-pound monster in the room. If a nurse inadvertently commits an error and a patient is injured, and then the patient decides to sue the nurse for malpractice, the resulting settlement payments and legal expenses can cost, on average, a total of $201,916. In this article, we’ll discuss what nursing professionals need to know about medical malpractice, look at a legal claim study and offer some risk management recommendations on how you can reduce the chance of getting bitten by the malpractice monster. What Is Malpractice? When you pass your licensing exams, your state board of nursing provides you with a professional license that certifies that you have the knowledge necessary to provide treatment and care in your state. Malpractice is defined as the failure to provide the degree of care required under the scope of your license that results in an injury. Legally, four elements must exist for malpractice to occur:

1. Duty: A nurse-patient relationship is present. The nurse has the duty to treat the patient according to the standards of care recognized by the nursing profession.
2. Breach: A breach of that standard has been established. Examples: Failure to notify the attending physician of a change in the patient’s condition; failure to properly complete a patient assessment; or failure to administer the correct dose of a medication.
3. Cause: The patient sustained an injury caused by the nurse’s error.
4. Harm: The injury resulted in damages, such as pain, medical bills or loss of income.

Patients tend to define malpractice more loosely. They may initiate a lawsuit because of the perception of wrongdoing. Real or perceived, win or lose, an allegation of malpractice can be devastating and typically results in an investigation by your state board of nursing. Depending on the outcome of that investigation, action may be taken against your license. For these reasons, making good risk management habits routine can help increase the likelihood of positive patient outcomes, reducing the chances of a lawsuit alleging malpractice. See also: What Shapes Malpractice Coverage?   Who Can Allege Malpractice? The injured patient can allege malpractice, as can legal counsel or, in the case of a minor, it could be the parents or guardian. In the event of a death claim, it could be the estate of the deceased party. Examples of Damages When a malpractice lawsuit is initiated, injured parties will seek damages to “make them whole.” Tangible losses are called economic damages. Intangible losses are called non-economic damages.

• Economic Damages
  • Medical expenses
  • Loss of income
  • Funeral expenses
• Non-Economic Damages
  • Mental anguish
  • Pain and suffering
  • Loss of consortium

Notice of Claim A notice of a claim informs you of legal proceedings against you. The notice outlines the allegations that caused the injury and will include a demand for services or money. A claim notice can also mean the filing of a suit or the starting of arbitration proceedings. Notice of a claim may include any of the following:

• Summons/complaint
• Letter demanding free services or money
• Oral threat or complaint
• Notice of arbitration

Act Early: Spotting and Reporting Incidents Recognizing potential incidents, acting quickly and reporting them to your supervisor or employer’s risk manager and to your professional liability insurance carrier may help reduce the likelihood of a claim. If a patient sustained an injury as a result of any of the following scenarios, report it immediately to document the incident. Such incidents may include:

• Slip and fall accidents
• Treatment-related injuries such as burns or fractures
• Complaints about unusual pain or discomfort
• Concerns over adverse treatment results
• Medication-related injuries

Malpractice Claim Dos and Don’ts

• Do
  • Contact your manager or supervisor
  • Contact your organization’s risk manager
  • Contact your malpractice liability insurer
• Don’t
  • Add or delete information in the patient’s chart
  • Try to resolve the situation on your own
  • Discuss the matter with anyone other than your defense attorney or your insurer


Legal Case Study This case study involving an ER nurse illustrates how easy it is to get drawn into a malpractice lawsuit—and how following good risk management procedures can help avoid a guilty verdict. Situation A patient was brought to the ER where he was well-known to the department staff. He was intoxicated, agitated and aggressive. For the patient’s safety, four point physical restraints were ordered. Per hospital protocol, security staff applied the restraints and checked the patient’s person for contraband. The ER nurse performed patient monitoring and assessment checks every 15 minutes as ordered, missing only one check to care for a critically ill patient. The missed check, along with the ER nurse’s monitoring and assessment findings, were fully documented. Shortly after the ER nurse performed a 15-minute check, the patient attempted to burn off his restraints with a cigarette lighter, igniting his bed linens and clothing. The patient suffered severe burns over 25% of his body, including both hands, causing him to lose his fingers on one hand. Allegations The patient sued the attending physician, the hospital and ER nurse. The allegations against the nurse included failure to properly assess and monitor the patient and failure to provide proper care in a safe environment. Results Although the patient suffered life-changing injuries, it was determined that the ER nurse acted within the standard of care. The nurse’s documentation of events made an aggressive defense possible and ultimately successful. While this was a favorable outcome for the ER nurse, the resulting malpractice claim took 12 years and two trials to resolve, and the total cost to defend the ER nurse was $500,000. Nurse Practice Act To understand the standard of care required, know the Nurse Practice Act in your state. You can find your state’s Nurse Practice Act and keep abreast of changes to the law by visiting the National Council of State Boards of Nursing website. The Importance of Good Documentation The ER nurse’s documentation was key to successfully defending her case. A patient’s record is a legal document. Your notes can provide evidence of the treatment you provided, as well as acts against any miscommunication with that care. As a general rule, if it wasn’t documented, it wasn’t done. Your legal team can prove you provided specific treatment and care if it is found in the patient’s record.

• Document your patient care assessments, observations, communications and actions in a timely, accurate and complete manner.
• Never alter a record for any reason unless it is necessary for the patient’s care.
• If it is essential to add information to the record, properly label the delayed entry.
• Never add any documentation to a record for any reason after a claim has been made.

Dos and Don’ts of Documentation

• Do • Read and act on progress notes of previous shift • Be specific and objective when you document your observations • Document complete assessment data • Document interventions and status of patient following any intervention • Communicate any changes in the patient’s condition in a timely manner
• Don’t
  • Use vague expressions
  • Record a symptom without including what you did about it
  • Use shorthand or abbreviations unless they are approved
  • Give excuses
  • Record for someone else
  • Record care ahead of time

Policies and Procedures Wherever you work, the facility will be engaged in patient safety measures. Make sure you know and understand your facility’s policies and procedures for preventing errors and ensuring positive outcomes. Learn the documentation standard in your facility for how to chart, correct errors, make late entries and copy/paste in the electronic record. See also: Empathy Transforms Health Insurance   Should a malpractice claim occur, your defense team will analyze your documentation, and when complete records are available can use it to build a strong defense. It can also weaken a defense if it looks like the entries were copied and pasted from a previous patient. Lastly, know your facility policy on incident reporting and chain of command. Key Takeaways for Protecting Your Career

• Know and comply with your state scope of practice requirements, Nurse Practice Act and facility policies, procedures and protocols.
• Follow documentation standards established by nurse professional organizations and comply with your employer’s standards.
• Develop, maintain and practice professional written and spoken communication skills.
• Emphasize continuing patient assessment and monitoring.
• Maintain clinical competencies aligned with the relevant patient population and healthcare specialty.
• Invoke the chain of command when necessary to focus attention on the patient’s status and any change in condition.

While no healthcare professional is immune to the 200,000-pound malpractice monster, you keep it from affecting your career by making sound risk management procedures a part of your practice. Following the recommendations outlined in this article is a good place to start.

By now, most of us are so familiar with McDonald’s “do you want fries with that?” strategy that it’s easy to forget how brilliant it is. Let me refresh your memory. In 1993, McDonald’s implemented a new policy: Every time a customer placed an order that didn’t include fries, the cashier would ask if the customer wanted fries with that. The result: an added 15% to 40% in annual revenue. Just as important: The boost didn’t require any expensive training or investments from the company. So how does all of this apply to insurance sellers? Turns out, many insurance companies can implement a similar point-of-sale upselling strategy to increase market penetration and revenue. Here, I’ll offer examples of several other companies doing this successfully and offer takeaways for those in the insurance industry. 1: Partner to Be Present at the Point of Sale One of the biggest struggles for insurance sellers is getting customers to come to us. Even when they want and need insurance, it’s easy to forget to make the purchase, which isn’t good for anyone. The solution is to be present at the point of sale for the item that needs to be insured. One company that’s been doing this for a long time is Expedia, an online travel agency. The site helps you search, compare and purchase your plane tickets, rental car and hotel stay. At several points during the checkout process, you’re offered the opportunity to add travel insurance to back up your trip. As you approach the “Complete Purchase” button, this coverage only seems to make more sense. This strategy is brilliant because it makes life easier for everyone: the customers who are about to make a big purchase (which could be derailed by bad weather); the airlines, which want to make sure their customers have a great experience; and the insurance provider, for obvious reasons. Of course, not everyone will buy right away. To make this strategy as effective as possible…

• Ask for contact information from those who don’t buy so you can follow up later.
• Be explicit about your plans for contacting people; otherwise, they may ignore your communications or mark them as spam.
• Remind customers of your connection when you contact them. Mention the company you partnered with in your first communication.

Of course, many insurable purchases are still made in person. When it’s not possible to integrate via an app, it’s time to… See also: How to Keep Humanity in Online Sales   2: Unite Disconnected Systems The classic example here (and one that my company, BriteCo, addresses) is buying an engagement ring. In a typical transaction, the seller may be able to offer an appraisal, which buyers must then take to their homeowners or renters insurance provider to see if they can get the ring scheduled. That’s not ideal for a number of reasons, chief of which is that the purchaser is likely to forget to follow up (and may even lose track of the appraisal), meaning that the valuable asset goes uninsured. We’ve found success by creating a software system to handle the entire appraisal and insurance flow. First, our jeweler partner logs in to a simple-to-use, cloud-based platform to create an appraisal in minutes. That appraisal triggers an insurance engine, which generates a customized insurance quote. A customer who buys from a BriteCo jeweler partner will get a digital copy of the appraisal via email or text, immediately followed by a separate message with the insurance quote for the appraised piece(s). The customer can purchase insurance right then and there, on a smartphone, and leave the store fully covered. Many buyers won’t immediately be ready to purchase insurance, but with the ability to access a policy in their pocket (literally!), they can easily follow up later. This removes much of the confusion about the insurance process that can cause customer dropoff and, of course, helps prevent valuable jewelry from going uninsured. 3: Add Value for All Parties As you cultivate partners who can help you connect with customers, it helps to be able to offer tangible benefits to everyone involved. For example, human resources software giant ADP has a partnership with the small business insurance agency Insureon that lets ADP customers easily apply for business insurance, which nearly every business needs and which tends to be difficult for small-business owners to find. Everyone wins in this partnership: Business owners get access to essential coverage that can prevent major financial losses, ADP manages its risks by helping its customers get insured (including for professional liabilities such as workplace discrimination), and Insureon gets an opportunity to sell to those in ADP’s large customer database. Just as important, the partnership offers business owners a third-party vote of confidence as they make a decision about commercial insurance, a product that many have little or no experience with and so often feel uncomfortable evaluating independently. 4: Aim to Be Subtle and Persistent Once you start looking for masterful upselling, you’ll see it everywhere. Apple gently offers AppleCare as an add-on throughout its checkout process, without ever shifting into a hard sell. Amazon and Office Depot surface additional warranty coverage for higher-ticket and tech products in checkout as you complete your purchase. See also: Bold Prediction on Customer Experience Think about these experiences from a customer point of view: There aren’t obnoxious pop-up windows you have to click past. Instead, the add-ons are part of the array of available support being offered as a part of an extremely fluid sales process. That’s an important model to follow for an industry that hasn’t always had the friendliest reputation. The Worst They Can Say Is “No” Remember: McDonald’s managed to increase revenue by at least 15% by asking a simple question at checkout. Part of this strategy’s brilliance is that not everyone has to buy fries – or insurance – for it to work. Even if many customers decline the offer, the ones who accept it will make a difference. As hockey legend Wayne Gretsky once famously quipped, “You miss 100% of the shots you don’t take.” Questionable statistical analysis aside, the man has a point.

Long-term care (LTC) insurance is no stranger to large amounts of data. However, in my 10-plus years in an LTC claim operations role, there is a piece of data I’m surprised continues to be shared without the proper context – claim terminations for people labeled “recovered.” Across the industry, this piece of data is used in actuarial assumptions and operational processes -- but not just for claims where the insured has recovered. Before I explain further, a little background: Claims data is a crucial piece of the overall risk management puzzle, especially for LTC insurers. The reserves associated with future claims represent a huge amount of the liability they are holding separate. Claim termination rates are closely watched. Insurers generally have three main designations for terminations for closed claims: 1. Death This one is pretty easy to understand; the insureds stopped receiving benefits because they are now deceased. This occurs 73% of the time based on the recent study conducted by the American Association of Long Term Care Insurance. 2. Exhaustion of Benefits Again, another simple concept. The insureds ran out of benefits before they died. This occurs 14% of the time, according to the AALTCI study. 3. Recovery Here is where we find the complexity. The very nature of the word implies the claimant in this category is now healthier and no longer needs to receive benefits. According to the same study, this occurs 14% of the time. See also: Using Data to Improve Long-Term Care   The problem with this category lies not with the study, which accurately reflects what insurers report, but rather the context and consistency of how this data is classified. What’s suggested is not quite the reality. But it requires a little digging to understand what I mean. Now for the Context Insurers and the claim administration systems they use require their data be categorized into larger buckets. It’s much easier, after all, to analyze and predict variables when there are fewer varieties of those variables. Instead of having many claim termination reasons, let’s find a way to just have three. Sounds simpler, right? Unfortunately, this approach changes the recovery designation into more of an “Other” category. Any claim that is closed where the insured isn’t deceased and still has benefits remaining ends up in this classification. Some examples: Preservation of Benefits Some insureds have limited benefits (and thus can run out of them). These claimants tend to be in their 60s, 70s and lower 80s. Given they’ll potentially fall short of benefits, they sometimes choose to stop receiving benefits to save them for future needs. Respite Care Most policies allow for several weeks of respite care per year. This benefit is independent of the elimination period and allows families to open a claim for a short time while the primary caregiver takes a much deserved break. Again, when these short claims close, they are coded as recovery. Moving Abroad Many policies do not cover care received outside the country. So, when insureds move overseas at the end of their life, the claims unfortunately must be closed, and their policy then lapses by their choice. Spouse Retires/Family Member Becomes Caregiver This one is close to the preservation of benefits status. Some policies exclude family members from providing the care. When the claim is initially filed, the spouse is still working or family members are unavailable to assist. These factors can change and cause a family to close the claim while the family member is able to care for the insured and save the rest of the money for later. Lack of Contact As odd as it sounds, sometimes claimants just stop sending in bills. The company attempts to contact them over several months, they search online databases for proof of their passing and they contact every phone number and e-mail address they have in connection to the claimant. At a certain point, they have to stop trying and close the claim. Unreported Death Related to lack of contact are deaths that are not reported to the insurance company and don’t get picked up by the search techniques most insurers use. Even if the companies later find out that the insured passed away and close the policy as a death, they generally don’t go back and change the termination status of the claim, so it remains, a recovery. Less than $100 left on the policy This one adds a final bit of humor to the list. The benefits available on an LTC policy are often not used in the exact amounts intended, so the policy is not exactly exhausted by the final benefit payment. I have seen situations where the amount left on the policy is so small, the insured (or the family) doesn’t send an invoice to request the final amount. All of these examples have something in common. The claimant didn’t die, and there were benefits remaining on the policies. So every one of these situations would be reported as a recovery. So what? So what am I trying to say here? All data is inaccurate? No, the data isn’t inaccurate, it just requires the proper context before it is used for analysis. Without the proper context, statistics could be used to suggest that, 14% of the time, an insured who qualifies for long-term care benefits will improve enough to regain independence and no longer require assistance. See also: Time for a ‘Nudge’ on Long-Term Care   The reality is much harder to know. While you would expect some recovery on acute conditions (think hip replacements), would it surprise you to know that as many as 25% of these recoveries are claims where the insured has been certified with cognitive impairment? Did those claimants really get better and no longer require care? Another 25% of the recoveries most likely fall into one of the categories above. So that means about half the recoveries reported, aren’t really recoveries. Recommendations:

• Talk to your internal claims team to get their input. Involve them in the collection and analysis phases, not just at the read-out of the final product. By working together with some of the key claims experts, you will gain better context around the data.
• Understand your internal processes and procedures. Learn the details of your company’s processes associated with opening, approving, paying and closing claims.
• Be careful when using industry-wide data. Not every company’s processes are the same, and data elements may have different definitions. Only rely on and draw conclusions when you understand the contextual factors surrounding the data.

Forrester’s “The U.S. Health Insurers Customer Experience Index, 2018” found that the consumer experience with health insurance companies is among the lowest-ranked in the industry. The cause, according to Forrester: Insurers don't engage with emotion. Making an empathetic, emotional connection with consumers should be a top priority for health plans that want to differentiate themselves from competitors in an increasingly crowded market.

Why Customer Experience Is Essential — and Difficult

A positive customer experience can set a health insurance organization apart from others. With more choices available than ever, members are ready to switch health plans if they feel you’re not meeting expectations. Not only that, they’ll share stories with each other, and these stories and reviews matter more than you think.

I saw this play out with my company’s recent open enrollment process. My colleagues and I were deciding which insurance company we would choose. A couple of employees mentioned how difficult it was to work with one of the companies on the docket, while another woman said that one option was more collaborative and seemed like it cared about her health. She said she wouldn’t mind paying more for a trustworthy company, and, just like that, eight of us were swayed to go with the more expensive option because of the experience it delivers.

To be fair, the industry faces significant hurdles in its quest to improve customer experience. Health is a personal and sensitive area, so healthcare is an emotional field. When dealing with intimate, frightening medical issues, it’s easy for consumers to transfer their fears and frustrations to something as complicated as insurance. And it doesn’t help that consumers often don’t know exactly what they’ve bought until they need to use it, which sometimes causes unpleasant surprises.

See also: Thought Experiment on Life Insurance

Communication between members and health plan representatives is another barrier to connection. Because many member-payer interactions happen over the phone or via email, it’s difficult for health plan representatives to empathize with consumers. Add to that the high turnover rate within this field. A lack of trained, experienced staff makes it difficult to build trust and long-term relationships with consumers.

A Simple, Human Approach to Customer Experience

Despite these challenges, focusing on the human element of health insurance will improve the consumer experience — if you make empathy and top-notch communication the driving forces. Getting in front of new members is crucial. Because they probably don’t have a full understanding of what they’ve bought until they need it, you have an opportunity to give them more information and build trust.

Consider it a preemptive strike: As soon as they sign on as members, welcome them with communications that outline just what they’re getting from you, and explain how they can best communicate with your organization. When questions arise down the line, they’ll feel prepared instead of frustrated.

Using plain language is crucial because the industry’s jargon confuses many. In a Policygenius survey of more than 2,000 Americans, plenty of health insurance consumers were confident they understood basic health insurance terms like co-pay, deductible, out-of-pocket maximum and co-insurance. But when asked to provide definitions, far fewer respondents — 4%, to be exact — could correctly define those terms. Being able to communicate insurance terminology so the everyday consumer can understand will be essential to forming member relationships and offering an excellent experience.

Empathy is equally important. Again, health insurance is an inherently emotional field, and you have the opportunity to interact with members with the kind of sensitivity, empathy and emotional intelligence they crave. 60% of consumers will cut ties with a company if they feel staff members are apathetic. From copywriters to customer service team members on the front lines, train people on how to empathize with others and how to communicate with empathy. This isn’t a skill that can be taken for granted.

See also: 4 Trends to Expect in Health Insurance

Finally, don’t forget about your own employees. If you take care of them as you would your members, you’ll empower them to provide the best possible service and experiences. Research shows that recognition is employees’ No. 1 desire, and it can inspire them to do their best work. Everyday affirmations and formal acknowledgment that they’re doing great work can help encourage employees to maintain the highest standards when it comes to customer service.

Customers need to trust their health plans if they’re to build an enduring relationship that lasts through a turbulent, competitive market. That trust is best established through authentic human connection. A focus on clear, empathetic communication and emotional intelligence can be transformative, giving even the most frightened, confused member a feeling of comfort and support.

Recent drone attacks in Saudi Arabia dramatically illustrate several key issues relevant to terrorist and security risk assessment. This should be enough to cause private entities, governments and insurers to reassess their prior risk assessments and security planning around important infrastructure, iconic buildings and large scale events. According to Aljazeera, the drone used in the Saudi pipeline attack “flew more than 800km into Saudi Arabia to successfully attack its target . . . [and] was guided using satellite technology.” As Aljazeera further noted, “This implies increasingly sophisticated levels of training." Couple the foregoing with a recent U.N. report indicating that Houthi drones can fly up to 1,500km with a 40-pound warhead and a statement by the FAA that anti-drone security technology is still developing, and it should be apparent that a risk that may have been only theoretically considered now seems to be very real. Anyone with even a cursory knowledge of risk assessment can readily see the potential dangers posed by a 40-pound bomb capable of traveling up to 1,500km with GPS targeting capability. But should we be surprised? I think not. See also: New Applications for Drones   Terrorist innovation and tactical learning are not new. Almost 25 years ago, Ramzi Yousef hid liquid explosives in contact lens solution containers and coupled that with a timer made from an inexpensive Casio watch to hatch a plot that resulted in the death of one person. Fortunately, the plot was disrupted before 12 airliners were destroyed over the Pacific. Terrorists and other malevolent actors have long used their technical expertise to transform technology that is intended to better our lives into a means for destroying life and societal bonds. For more than 40 years, cars and trucks have been loaded with explosives or just used as a direct means of killing innocent persons all over the world. And 9/11 illustrates how aircraft that serve to bring the world closer together can be used to kill thousands and make the world move a little further apart. The point is that terrorists innovate and learn from prior attacks. We underestimate them at our peril and increase the attractiveness of a target when we fail to implement measures to deal with the potential disruption and damage that they intend to cause. There are readily available measures that can be taken to minimize both the damage and disruption to critical infrastructure. First-party damage and disruption can be the subject of insurance coverage that will allow rapid repair and minimize disruption. Third-party damage and liability claims can also be addressed by insurance, as well as by implementing or cooperating in the deployment of defensive measures that will assist government actors fulfill their role as providers of a national defense. See also: Insuring Drones – A Growing Opportunity   Recognizing and respecting the governmental role in defending persons and property is also of critical import. My own experience in this area has long convinced me that terrorist attacks by truck, plane or drone are akin to acts of war and that these attacks target government policies far, far more than individual businesses interests. The long-established role of governments is to defend their people and infrastructure. And, cooperation with government defense efforts is what responsible citizenship demands. When private parties and government actors recognize and fulfill their respective roles, they not only help minimize their vulnerability but also lay the cornerstone for defending their actions should they ever be targeted. Insurers, insureds and government actors working together not only minimize the pre-attack risk but also the post-attack disruption that oftentimes proves more destructive than the physical damage caused by the attack itself. Indeed, when it is considered that the ultimate goal of terrorism is to destroy societal bonds, strengthening those bonds both before and after an attack takes place may prove to be the most effective deterrent and antidote to the terrorist disease that plagues the world today. That process starts with a rational and realistic risk assessment and then continues with the implementation of the mitigation measures deemed appropriate. It’s never too late to start that process but far too late to consider these rapidly emerging risks as something that can be dealt with in the far-off future.

Customer satisfaction requires sending relevant communications, but how do you sort through what's relevant when you have multiple relationships with so many customers? A customer may carry health and disability insurance, as well as long-term care and life insurance coverage with a single insurance company. When it comes to producing documents, issues arise as to how to coordinate multiple, separate applications, systems and processes. In our uber-connected world, every customer expects organizations to have a single, unified view of their relationship that includes all their interactions. Unfortunately, that’s not what typically happens. Although companies most likely have a plethora of information on each customer, they often face a challenge when it comes to accessing that information to deliver more consistent communications. Technology issues include: incompatible legacy systems, non-integrated lines of business, dispersed customer information and uncoordinated delivery channels. Understanding whether your technology can take information from disparate systems and work from a single, coordinated platform to create more customer-centric content is important. Being able to take full advantage of software that allows for easy integration with existing systems, data and content sources is critical. See also: How Technology Breaks Down Silos   A first step is to have a system that can support multiple platforms, packages and legacy systems. In many companies, by contrast, communications are silos built around specialized business groups, back-end systems and processes and output types. Remember that it is not only critical to communicate relevant messages to your customer, it is also just as critical (if not more) to listen to what they are saying back to you. Implementing two-way communication means being ready to use all available and emerging communication channels—email, web, social and mobile—and being ready to capture the feedback that your customers give you across these channels. Every customer has preferences, and having the ability to capture and respond to them is the real value of omni-channel communication. Preferences can mean many things, from where to send information, to how customers want to see their documents, to paying attention to concerns they may have expressed. Knowing these preferences, and responding to them, allows each document output cycle to be more and more targeted, making the customer feel like you are having a compelling conversation, and providing one more avenue to a deeper relationship. The right use of your system can provide the foundation for strengthening relationships with your customers across all contact points—print, electronic and interactive. With the ability to access a whole view of the customer, companies can use mission-critical documents—like statements, bills, enrollment kits and correspondence—to cross-sell and up-sell additional products and services, and lines of business (LOBs) can reinforce brand identity and representation of the organization. See also: Touching Customers in the Insurtech Era   Customer communication management (CCM) technologies can be complex. Reaping the rewards and earning ROI on your investment requires the ability to operate and manage CCM effectively. Companies that have implemented a successful strategy for breaking down silos and seeing the entire customer journey have reaped the benefits of reduced cost and customer churn, stronger brand identity and delivering customer communications to a customer more willing to buy.

True, a great deal has been written about the importance of inculcating a positive risk culture if an organization is serious about managing its enterprise risk. Yet, when it comes to discussions about organizational culture, many executives’ eyes glaze over because the topic is too nebulous or because they have no idea how to influence or develop a particular type of culture. Underwriters, considering an application from a commercial customer, generally do not look too deeply into the company’s risk culture. Given that risk is growing in magnitude and variety and with increasing speed of onset, it behooves leaders to take concrete actions to establish a sound risk culture or to maintain one if it already exists. And underwriters should also be interested in the risk culture of accounts they write for the same reasons. Often, I am inspired to write about something because of some news I hear or read about. In this case, something on the law360 website caught my attention: A woman slipped and fell near a collapsed "wet floor" sign at a casino. This person, Ms. Sadowski, suffered serious injuries and was awarded $3 million by an Ohio jury. “The sign lay flat on the floor that day in September 2016, and a Jack Cincinnati Casino employee even walked around it but did not pick it up," Sadowski’s attorney, Matt Nakajima, said, according to the Cincinnati Enquirer. He said that, moments later, Sadowski tripped over it and broke one of her knee caps. There were no safety measures in place for floor inspections or fall prevention, he said, and the employee who walked around the collapsed sign was not reprimanded. So, despite the use of "wet floor" signs, other aspects of risk management were purportedly absent. It seems the jury believed Nakajima’s description. If the description is accurate, the part about an employee walking around a collapsed "wet floor" sign is very troubling, as is the fact that there were no consequences for the employee. These kinds of actions point to a lack of a risk aware culture at various levels. See also: Building a Risk Culture Is Simple–Really   So, how do leaders build a risk culture and how do underwriters probe to see what kind of risk culture exists in their prospective insureds’ organizations. Three Basic Steps to Build Risk Culture

• Articulate the organization’s position on managing risk at key communication junctures and through different media with employees: 1) hiring interview, 2) orientation, 3) staff meetings, 4) webcasts, newsletters, bulletin boards.
• Include a risk culture criterion in all performance reviews; e.g., does the employee perform duties safely and address or report hazards/risks when they are identified? Evaluate positively or negatively, as warranted. Celebrate exemplary cases of risk awareness or risk mitigation.
• Ensure that policies, procedures and work instructions all describe what is expected in terms of safety, precaution and risk reporting

Three Basic Data Points for Underwriters to Ascertain

• Does the organization have any losses in the loss history that show an egregious lack of risk awareness?
• Does the organization practice ERM or, at least, have policies around required safety measures, risk/hazard reporting, training on avoiding cyber and other risks, etc.?
• Does the organization discuss or evaluate risk awareness as part of normal performance management?

At a time when every insurer is streamlining the information it requests from potential insureds, adding more requests for data seems antithetical. However, in light of the thousands of ways that employees can create, increase or decrease risk in an organization, the culture they embrace is very important. For example, an HR staffer who delays inputting an employee termination to the appropriate systems can create huge data and physical security risks. Likewise, a factory worker who leaves equipment running while going on break, when it should be turned off, can create safety and property risk. Or, consider a finance employee who thinks a spoofed email is actually from the CEO and sends a payroll check to the hacker’s account because there was no secondary control or it was not adhered to. The questions above will help underwriters to get a glimpse of the risk culture at the company they are evaluating. See also: Thinking Differently: Building a Risk Culture   A risk aware culture plays a role regardless of the category of risk: financial, operational, legal, cyber, human resource, strategic, etc. Everyone from the top to the bottom of the organization needs to have an automatic and quickfire gut check regarding their actions – am I creating a risk by taking this action; have I recognized the risks in the situation that is leading me to action; do I need to vet a recognized risk with others? When an organization reaches the point where this type of thinking is natural, and almost universal, then it can be said that a positive risk culture has been embedded. Her latest book, "Enterprise Risk Management: Straight Talk for Nonprofits," can be found here.

As we wait to see what exactly happens because of the executive order that the Trump administration promises to use to cut drug prices in the U.S. (while keeping our fingers firmly crossed), let's spend a minute understanding just how dysfunctional the system for pharmaceuticals is.

If you want full-on fury, read this article, which likens Big Pharma to organized crime. But, even if you don't want to go nearly that far, it's hard to argue that the system isn't broken. 

Pramod John, probably the smartest person I know on the subject of drug prices, contends that the U.S. Food and Drug Administration focuses on safety but not enough on the effectiveness of pharmaceuticals.

And, once approval is secured, Big Pharma is free to do pretty much whatever it wants in terms of pricing. By law, Medicare has to cover every drug approved by the FDA at whatever price the drug companies want to charge. As this editorial in the New York Times notes, Medicaid likewise has to cover every approved drug; "the program receives an across-the-board discount from drug makers, but, as critics note, that discount has not kept pace with the changing drug market." Private insurers and the Department of Veterans Affairs can negotiate, but separately, diminishing their power to bargain with Big Pharma.

By contrast, Britain and Germany, among others, tie price to value: The government will only pay for new drugs if they represent a clear improvement over old drugs.  

The situation in the United States is made worse by a trend toward speedy approval for drugs. A system set up to fast track drugs that could help desperate patients has been turned on its head: Now, as the Wall Street Journal reported last week, at least 60% of drugs approved in the past five years have been handled on an expedited basis.

Increasingly, drugs don't have to demonstrate actual improvement in patients; the drugs just have to show progress on some interim measure. So, a drug company doesn't have to show that a cancer drug increases patients' lifespans or improves their quality of life, merely that, say, the drug shrinks tumors.

Improvement on interim measures, no matter how logical, often doesn't translate into benefits for patients—yet, if no safety problems are found, a drug finds its way into the market, often at a startling price. 

In short, oversight of the pharmaceutical industry has become ineffective and medicine has become wildly expensive. 

Let's hope we—the patients, insurance clients and taxpayers—get some relief. But it won't be easy, even if the coming executive order is everything that can be hoped. It's taken us decades to create the pharmaceutical mess; it'll take time for us to get out of it.

Cheers,

Paul Carroll
Editor-in-Chief