The popularity of the 1993 Bill Murray movie rendered the phrase “Groundhog Day” with a common reference to a continually occurring unpleasant situation, according to Wikipedia. Workers’ compensation claims handling seems to be stuck in a time warp with the same unpleasantries year after year no matter how many attempts have been made to address these issues through various avenues, including legislation and technology. 2019 began with the same challenges reverberating: provider fraud; medical disputes arising from applying evidence-based medicine together with a pharmacy formulary; inefficient and ineffective reactive claims management practices; through to the methods used for outgoing payments. In California, the opportunity for providing high-quality, coordinated care as well as controlling medical costs and fraud has existed since the passing of SB1005 some 26 years ago, yet there are still complaints from dragged out-medical care and poor recovery through to unacceptably high medical costs and fraud levels never witnessed before in the history of workers’ compensation. See also: The State of Workers’ Compensation   Technology has always been touted as a means to improve claims handling. Programming languages available 50 years ago, like COBOL and PL/1, enabled computer programmers to code logic to address all the needs of claims handling processes, including disbursements over any number of payment methods. Coding languages allowing predictive analytics, such as SAS, also known as Statistical Analysis System, have been available for over 40 years, and data management through a relational database using the Structured Query Language is also almost 40 years old. At the same time as these technologies became available, technology entrepreneurs planted seeds to raise awareness for the next evolution of analytics: artificial intelligence. Little (if any) of this technology, however, has been harvested in claims handling over the past four decades. Why then have the legislation and technology paths been littered with failed promises for over the past three decades or so, or indeed almost a generation of workers? The answers are simple: mindset and execution. In any business enterprise, including P&C insurance, money is the bottom line in every decision made. The objective of the P&C claims administrator is to close claims quickly with minimum payouts, which can incite adversarial claims handling. Workers’ compensation, which in 2017 accounted for 16% of P&C's written premiums in California, is governed by statute requiring employees injured at work to receive all the necessary care, including medical treatment, to enable their prompt return to safe, sustainable and gainful employment. However, to fully undertake the management of an injured worker’s recovery process as well as develop a successful reintegration strategy is not in the P&C DNA. Hence, the insurers are required to operate through profit-making middlemen, enterprises that prosper by manufacturing crisis and creating chaos. Their excessive costs for services have resulted in the rationing of medical care by restricting access to both resources and therapies. For instance, California allows P&C companies to establish their own treater networks, combined with their utilization review program, with oversight through an independent medical review process. Unfortunately, this approach has fallen into disrepute because of countless allegations of delays and restricted access to treatments, as illustrated in IMR Case# CM18-0238095. In this case, an off-work, 54-year-old woman with a shoulder pain rating of nine out of 10 waited for 69 days just to be informed her medication costing 92 cents was medically unnecessary and inappropriate as per the California Medical Treatment Utilization Schedule (MTUS). In 2017, 2.8 million employees in private industries experienced a nonfatal injury or illness, according to the U.S. Bureau of Labor Statistics, of which 882,000 (or 31%) required time off work. Over three decades, this equates to 26,5 million families (assuming the same annual figure) whose lives most likely experienced upheaval and disruption caused by the failed promises. See also: 25 Axioms Of Medical Care In The Workers Compensation System   Workers’ compensation claims handling for injured employees has been a major and inexcusable fiasco and in urgent need of a new breed of claims administrator, one who is forward-thinking, using outside-the-box approaches to effect change and break through the Groundhog Day time warp. A longer version of this article is available here.

Acknowledgment: Thank you, Dr. Jodi Frey and Jon Kinning, for assisting in the preparation of this article. The employee assistance program (EAP) might be one of the best-kept secrets for many employers. Instead, EAPs should be resources widely publicized to help encourage managers, employees and often their family members so that support services for personal and workplace problems can mitigate risk and promote vibrant workers. Many employers simply “check the box” when signing up for the EAP benefit, figuring health insurance will cover the mental health needs of their employees; however, most employers really don’t know what the EAP services entail or the value the services can bring to a workplace. With that said, not all EAPs are created equal. EAP services vary greatly, including some or all of the following::

• biospsychosocial assessments, including substance use assessments
• individual and family counseling
• financial and legal coaching and referrals for counseling
• referrals for additional services, with follow-up
• psychoeducation through workshops, newsletters and other communication for personal and workplace concerns, including stress management, parenting, mental health literacy, relationships and organizational change and individual crisis prevention, crisis response and support
• mediation and team development
• leadership consultation, coaching and development
• fitness for duty evaluations
• suicide risk assessment, treatment and “postvention” (i.e. what to do after a suicide)
• staff training on best practices on how to support someone in distress
• and more

Sometimes, the services are cursory, such as a brief telephone assessment and referral by a contracted outside provider. Other EAPs provide robust and high-touch services like 24-hour support; on-line assessment and information; telephone and in-person assessment and counseling; on-demand crisis consultation; on-site workshops; mental wellness promotion; and much more. As with many things, you get what you pay for, so employers need to decide how much they are willing to invest in the mental wellbeing of their workers and conduct a cost-benefit analysis. However, EAPs, even more customized programs with onsite services, have been shown to be cost-effective to employers through the years. Are EAPs Effective? While the research on the effectiveness of EAPs is limited, studies have found that employees' use of EAPs enhanced outcomes, especially in "presenteeism" (how healthy and productive employees are), life satisfaction, functioning and often absenteeism (Joseph, et al., 2017; Frey, Pompe, Sharar, Imboden, & Bloom 2018; Attridge et al., 2018; Richmond, et al., 2017). In one longitudinal, controlled study, EAP participants were more likely than non-EAP participants to see a reduction in anxiety and depression (Richmond, et al, 2016). Another matched control study found that users of EAP services often reduced their absenteeism more quickly than non-EAP users experiencing similar challenges (Nunes, 2018). In another longitudinal study (Nakao, et al, 2007), 86% of people who were suicidal when they engaged with their EAP were no longer suicidal at two years follow-up. Researchers have concluded that, while not all EAPs are created equal, they often provide accessible services that are effective at improving employee mental health and well-being. See also: Impact on Mental Health in Work Comp   Are EAPs Prepared to Support an Employer Facing an Employee Crisis With Suicide? When it comes to the life-and-death issue of suicide, EAPs have the potential to provide evidence-based suicide prevention, intervention and postvention services to employers. The EAPs’ contribution to the comprehensive workplace suicide prevention strategy is essential, and many would benefit from annual state-of-the-art training in evidence-based methods of suicide risk formulation and treatment to help distressed employees get back on their feet. Social workers, who provide the majority of EAP clinical services in the U.S., often report having no formal training in suicide formulation, response and recovery (Feldman & Freedenthal, 2006; Jacobson et al., 2004), so annual continuing education on suicide intervention and suicide grief support is often helpful to providers. Once trustworthy and credentialed providers have been identified, they should be highlighted in the “suicide crisis” protocol, so that companies are not trying to do this leg work in the midst of a crisis. If one of the main messages in suicide prevention is “seek help,” we need to make sure the providers are confident and competent with best practices approaches to alleviating suicidal despair and getting people back on track to a life worth living. Thus, dedicated employers will evaluate and even challenge their EAP providers to demonstrate continuing education in the areas of suicide prevention, intervention and postvention skills. In fact, some states are mandating that all mental health professionals, including licensed providers of EAP services, have some sort of continuing training in suicide risk formulation and recovery. Do Employees Know About the Benefit of Their EAP? In addition to making sure the providers have the needed skills, companies need to make sure that their employees know when and how to access the care. Recently, the American Heart Association and CEO Roundtable worked with experts in the behavioral health field to develop a white paper for employers, which includes seven specific actions employers can take to improve the mental health of their employees (Center for Workplace Health, American Heart Association, 2019). The report can be viewed online here. Dr. Jodi Frey, expert panelist for the report and internationally recognized expert in the EAP and broader behavioral health field recommends that “employers need carefully consider their workplace’s needs when selecting an EAP, and then should work with their EAP as a strategic partner to develop programs and communications that encourage utilization of the program and continued evaluation to improve services over time.” (Dr. Jodi Frey, personal communication, March 18, 2019). Employers that are mindful of their workers’ well-being will continually promote well-vetted and employee-backed resources throughout the career of the workers. Leadership testimonials of the efficacy of the resources after the leaders have used them for their own mental health would bring credibility to the resources and model appropriate self-care to the employees. Bringing the resources on-site to the workers (and not waiting until the workers stumble upon the resources) is another way to break through the barriers to care. The Employee Assistance Society for North American (EASNA) developed a guide to help employers evaluate EAPs and determine appropriate vendors. The guide also can be used to help employers evaluate their current EAP and decide if needs are being met or if more attention to what services should be offered needs to be addressed. The guide can be downloaded free. Are There Different Types of EAPs? Much diversity exists in EAP structure and quality (Frey, et al, 2018). Some companies use internal EAPs, where providers are also employees of the company. This arrangement often provides the benefit of having an immediate resource that has clear knowledge of the company and industry culture. Evaluation of internal EAPs has found increased utilization, customization and supervisor referrals (Frey, et al, 2018); however, there are some drawbacks. Internal EAPs, because they are so closely connected to the company, run the risk of being perceived as having blurred lines of confidentiality and objectivity. By contrast, external EAPs are often more diverse and can respond 24/7 across a vast geography. Because of these benefits and consequences, many companies have moved to a hybrid model to get the best of both models. Hybrid EAPs often have an internal employee to manage the EAP and to work with managers and employees on critical incident response, strategic planning and organizational change, and to provide onsite assessment and problem resolution. They can be an important ally for the employer to understand the potential for an EAP and to help evaluate whether EAP providers are effective in their response and offering high-quality services (Frey, 2017). See also: What if They Say ‘Yes’ to Suicide Question?   EAPs are most effective when they understand the industry and organizational culture, have business acumen and can adapt to changes in organizational structure (Frey, et al., 2017; Frey, et al., 2018). Thus, employers seeking to find a best fit for their employees will interview mental health providers about their knowledge of the unique stressors and strengths in the industry. Some industries (e.g., emergency responders and aviation) have gone so far as to credential mental health providers as being specialists in their industry to avoid a mismatch. Case Study From the COO of a Construction Contractor "We had an issue where our EAP was referring counselors outside of our healthcare providers, so, after the three free sessions, the participant learned they could only continue with the suggested provider at $150 a session; so the employees would drop out. My understanding is that counseling often takes around seven sessions to have a sustained impact, so, I put in a mandate with our HR team to renegotiate our EAP to ONLY refer in-network counselors, or they would pay for the continued care. "We then incorporated our EAP into our safety program. When there is a serious accident, we deploy counselors and have our EAP involved for post-accident assistance to our employees. Accidents can bring up traumatic responses from our employees, and these experiences bring up memories from other accidents they may have been involved in or around. This cumulation of trauma can be highly distressing for them. "In the early years, we had to work through the skepticism that the EAP would notify management of anyone that used the service. Since HIPAA came into play, we have less of this skepticism. The employees thought they would get fired or laid off first if they had issues. "I’ve worked with our safety and wellness groups to actually pick up and call the EAP for someone in distress and get them on the phone. Once they lay the groundwork with the counselor, they hand the phone over and leave and let the employee get the help they need. This helps break down the stigma, and some people just don’t have the courage or have a mental block about picking up the phone for help. This has been VERY effective to get those in need the help they need. "We promote our EAP in our weekly newsletter, and we also have business cards with the information, and we utilize hard-hat stickers that have all the information. This helps it be available when they need it. "I’ve also encouraged our managers to use the system so they can promote it from their point of view. This also has helped remove the stigma around using the EAP. I also talk when in front of our employees about the program and educate them so they will use it. Our utilization rate is the highest in our EAP network, and I think this is the reason why." 15 Questions Workplaces Should Ask to Strengthen the Mental Health Safety Net Employers should remember they are the customers of their EAP, and they should do the due diligence to make sure they are getting the best benefit possible. Here are 15 questions employers should ask their EAP to get the best services possible:

1. What services does your EAP cover? Are these services available 24/7?
2. Who answers the calls of the EAP, and how are they trained and supervised? What professional and educational preparation and certifications do they have? Are they licensed?
3. How are counselors selected and trained? Are certain licenses and other credentials required to be a part of the EAP provider network?
4. What types of training have EAP providers received? Specifically, when was the last time they received training in suicide risk formulation and treatment?
5. How is your EAP reporting utilization? How does your workplace’s utilization rate compare with others in your industry and what can be done by the EAP and by you as the employer to encourage more utilization?
6. Do your employees know about your EAP services and how to access them?
7. For those who have used the EAP, how satisfied were they with the services? Did the services help with the problem for which they were seeking support?
8. When employees completed EAP services, did the EAP follow up (or attempt to follow up) with the employee to make sure all needs were met?
9. How does your EAP interact with health plans? Are EAP providers also providers of outpatient mental health, and, if not, are they well-versed in the benefits of employees to make effective and seamless referrals?
10. How is your EAP measuring outcomes? Can they also provide you with a return-on-investment (ROI) or other cost-benefit analysis?
11. How is the EAP promoting upstream mental health efforts like prevention, resilience, positive psychology and work-life integration?
12. Are there general mental health screening or other wellness tools the EAP can offer the workers to help them understand and monitor their mental wellness? Does the organization also assess its own culture of system-level mental wellness?
13. Does the EAP have experience serving clients in our industry? If yes, what are some recommendations to improve how EAP services are promoted and offered at our workplace?
14. Is the employer receiving regular reports (i.e., bi-annual, annual) from the EAP on utilization, presenting problems, satisfaction and other workplace outcomes?
15. Does the EAP provide manager or HR training on how best to support an employee experiencing a mental health or suicide crisis? Are there additional staff training on skills needed to identify and assist employees in distress?

As the wave of innovation in insurance has built over the past few years, incumbents have had a choice about whether to swim out and try to surf it or to stay in the shallow water and hope to not get knocked over. No longer.

Last week's announcement by A.M. Best that it will assess and score insurance companies on their ability to innovate means that incumbents either have to build robust capabilities or suffer consequences in the here and now.  Best has essentially taken the position that a company cannot do nothing, nor can it really follow the herd or adopt a slow-follower mentality.  Innovation is critical to long-term resiliency. 

This is great news—at least for the industry as a whole. While some companies will remain incapable of innovating, they will not be able to claim surprise.

With this new focus on innovation, A.M. Best has done the insurance industry a big favor by not only sounding a warning but also offering the industry focus, structure and direction to avoid the danger of inaction.

A.M. Best, which will look both at the innovation process and at the results, is going to peer deeply into what companies do and don't do, so the box-checking that I suspect is going on at many insurance companies will have to end. Companies can no longer go on innovation tours and claim they are "staying on top of insurtechs." Executives will no longer just be able to assure superiors and the board that, "Yeah, yeah, we have an innovation process in place and have X projects planned."

A.M. Best will be comparing companies against each other and will have access to so much data that raters will be hard to fool, and they will double back in subsequent years to see which efforts and which companies delivered the goods. A three-year effort at change management won't cut it with A.M. Best if real innovation doesn't follow. (You can learn more about the A.M. Best methodology here and can offer comments.)

As usually happens when an industry goes through a wave of change, many companies will decide to sell rather than innovate. Selling is the safe bet, if not necessarily the best one.

For those incumbents that opt to bet on their ability to innovate, the process will provide some guardrails. Innovation is, by definition, a step into the unknown. A.M. Best will give companies informed feedback on how they're doing, and there are best practices that can guide companies through the uncertain waters of the innovation process. 

A.M. Best at its annual Review and Preview conference this week is going to great lengths to explain its perspective and its proposed process, and is bringing in world-class speakers on innovation – encouraging insurance industry attendees that innovation is not only critical, it’s doable. Another encouraging message is that the size of the company does not matter to how well it can innovate. 

Thank you, A.M. Best, for planting the flag firmly.  Now it’s up to the insurance industry to get serious about doing what few really want to do, but we all know must be done. 

Cheers,

Paul Carroll
Editor-in-Chief 

For the last couple of years, I’ve shared a post recommending a system for setting goals and achieving them. However, a few conversations with insight leaders have reminded me that advice remains generic. What about which goals to set? As this blog aims to support customer insight leaders, I want to also offer more specific advice. Given the context of common challenges and potential future trends, which goals would I advise? Well, far be it from me to second guess your priorities and specific context, but I hope these thoughts help. They are intended to simply act as a checklist, to prompt your own thinking. Topics for your specific goals Business priorities My first encouragement is to be guided by your context. Do not start with fashionable technology trends or the most passionate speaker at that conference. What does your business need? What do your customers want? Start by taking some time out to consider the most important challenges for your business. Here are a few potential issues to seed your review:

• Do you need to address customer experience irritants?
• Do you need to improve your marketing effectiveness to reach more new customers?
• Do you need to retain your existing customers better and even deepen usage/trust?
• Do you need to differentiate from the competition by innovating products or services?
• Do you need to reimagine how technology could reinvent how to meet your customers’ “job to get done”?
• Do you need to clarify a customer strategy for your organization?

Identifying the highest business priority that customer insight can guide is a great place to start. As I advised when sharing experience of how to influence "top table" executive committees, start with their need. Even if other improvements are possible and more interesting, start with how analytics or research can help the wider business. That will build the firmest foundation for influence. Having said that, many of today’s insight leaders have to build a capability, whether it be improved data usage, analytics or data science. So, which goals make sense for them? Capability building goals Data Management First, because almost no business has yet achieved full compliance, I must stress the importance of GDPR compliance. To help identify which specific goals you need to set regarding GDPR, a review of these previous posts should help identify gaps:

• Aspects to consider when preparing for GDPR (part 1)
• Aspects to consider when preparing for GDPR (part 2)
• How to embed GDPR in your business by communication
• A set of helpful GDPR resources to identify potential gaps
• Data quality implications of GDPR
• Guidance for improving your data quality reporting

See also: How to Keep Goals From Blowing Up   For now, I would suggest that goals with regard to using more big data (unless it is to improve your data quality) should be postponed. Until you clearly understand how you will achieve compliance with GDPR and can evidence a plan, that should be your data priority, not least because, once you fully understand your responsibilities, less may be more, for data usage. Data science capability The single most popular capability that today’s leaders are piloting is data science (including AI). That makes sense, as even the more advanced leaders are still exploring potential applications. Some new products and services have been developed. Existing processes have been refined and automated. But the business case for most organization is still far from proven. My personal view is that is most companies do not yet need data scientists; rather, better analytics would add more value. However, as coding languages become simpler and the most popular algorithms prove their relevance, that may change. So, even if you are not a tech disruptor, if you can secure sufficient budget, now is a good time to experiment. I would simply caution to set a goal regarding proving business applications and ROI, at low cost and low risk for now. Here are some posts to help guide where you might focus a goal to pilot a data science capability in your business:

• How to approach betting on a data science capability?
• How to get the best out of your data science team?

Analytics capability For many businesses, the capability with greatest potential to change how they operate is analytics. Unfortunately, the term has too often been misunderstood and either watered down or hijacked. By watered down, I mean conflating business intelligence (BI) with analytics. Because of the widespread, vague use of the term, I come across many businesses that believe they have an analytics team. Upon closer inspection, I find this team are only skilled in producing BI reporting. If educating your business on the difference between analytics and BI is one of your challenges, consider presenting a continuum. I’ve used a number of infographics, over the years, to show a maturity journey from simple data reporting through to data science. This can help show the difference compared with descriptive, predictive or prescriptive analytics. Do you need to set a goal to expand your analytics capability toolkit? With so much hyperbole surrounding data science, it is all too often allowed to subsume all analytics. I’ve met a number of leaders who assume any statistical modeling is now part of a data science capability. For one goal, I’d suggest identifying where your analytics capability can most rapidly improve ROI. These posts may help guide your goal setting:

• Experience of where analytics delivers biggest bang for buck
• Tips for getting the most out of your analytics team
• Advice on why to design applied analytics projects

People capability People are key. Often, the biggest predictor of impact is not the sophistication or even the relevance of analytics work, but the analyst. All too often, I find that analysts lack any training beyond technical skills. It is as if they are simply to be programmed with coding/software/stats skills and left to get on with it. When I see what a difference strong softer skills can make to individual analysts and teams, this is such a missed opportunity. So, I encourage you, consider the people skills that you should target with relevant goals. For developing individual analysts, I suggest considering:

• Need for softer skills in analysts
• A nine-step model for softer skills in analysis process
• Storytelling skills for analysts

For designing and developing better teams, I suggest:

• Need for and use of competency framework
• Internal events for sharing analytics knowledge

Leadership capability Last, but definitely not least, don’t neglect yourself as a leader. Rather than letting a personal development plan be a burden or afterthought, how about seeing it as a chance to invest in yourself? I’ve written previously about the need for improved leadership capability among insight leaders. More organizations are waking up to this development need. See also: 3 Steps to Succeed at Open Innovation   Two regular conversations remind me of the continued importance of setting goals in this area. First, I meet (and sometimes coach) leaders who have technical expertise but lack experience operating at a senior level. Second, busy insight leaders tell me they cannot spare the time for coaching or mentoring despite obvious challenges. If you recognize that you’d benefit from more investment in your leadership development this year, here are some posts on leadership development that should prompt your thinking, to craft a goal that is right for you:

• Professional development resources for insight leaders (different types)
• Another list of resources
• How to improve the reputation of your team
• Why coaching can help you develop as a leader
• Which do you need, a coach or a mentor?

What will your specific goals be? Did you find those suggestions useful? Which were relevant to the goals you need to set? What specific goals are your top priorities?

Until recently, the insurance industry has very much viewed technology as a cost-saver as opposed to something that can help drive revenue. Instead of doing things like connecting back-end systems or developing a CRM system to store data on all customer and prospects, insurance companies have been streamlining time-intensive tasks. But the industry recently has begun to perk up its ears and start investing in technologies that other industries have been leveraging for years – in some cases almost a decade. Why now? Insurance companies are starting to realize just how big an impact the customer experience has on their business and their bottom line. Today, it is very easy for a customer to switch to another provider – whether it is to get better rates or better service. Technology can centralize disconnected systems and remove friction, ultimately allowing agents to provide better experiences for their customers. For instance, mobile apps are shifting how insurers interact with customers, resulting in improved customer service, customer experience and sales. Where should insurers start? The first step is to conduct an expert review of what their current experience looks like for consumers. This will provide a blueprint of what their systems look like and where improvements can be made. It helps to get an outside perspective on the assessment to remove bias. The process shouldn't be time-intensive. Oftentimes, larger companies will go overboard – with some companies taking months to conduct the evaluation. Carriers should monitor their digital landscape quarterly or at the very least annually, to avoid being surprised. See also: Future of Digital Transformation   By successfully incorporating innovative technologies into their pipeline and transforming their operations, insurance carriers can improve efficiency and customer satisfaction as well as realize new strategic opportunities.

The fastest way for insurers to lower healthcare costs is also the easiest way to improve how people care for themselves and others. In three words, the way forward—for insurers and individuals—is basic life support (BLS). In three letters, the way to save a life is through CPR. If insurers provide incentives to customers to learn CPR, if people take CPR certification courses, we will have reason to rejoice. We will have more people with the ability to respond to a life-threatening emergency with a life-saving procedure. Patients will, in turn, have fewer hospital stays and quicker recovery times. This invaluable procedure will yield valuable savings in time and money, too. Insurers must lead this effort, infusing the public with a sense of purpose by purposefully improving people’s confidence about what CPR can do. By explaining why CPR is a necessity, insurers can show people how to save lives. When every second counts, people can then count on themselves to not only be good Samaritans but to also deliver the goods, so to speak, when there is no time to wait for first responders to arrive on the scene or paramedics to provide additional help. People who can administer CPR possess the best insurance policy: life itself. That policy is portable. It transcends cities, counties, states, countries and continents. It is a policy for personal empowerment and public enrichment, offering what no amount of money can match and no measure of fame can equal. It is a policy to save lives and strengthen communities. It is also a policy to advance the interests of the insurance industry. It is a policy with no liabilities and many rewards, both professional and personal. The former is a reward that puts insurers at the forefront of innovation involving science, technology, and medicine. The latter rewards policyholders—and feels rewarding—because of what they alone can do: save lives. See also: The Science That Is Reinventing Healthcare   CPR is too important a skill not to learn. It is too vital to life and longevity for us not to recognize its benefits. It is too indispensable for a health-conscious citizenry not to know its advantages. It is too advantageous for insurers not to acknowledge its worth. It is too worthwhile for a community not to accept its virtues. By promoting CPR, insurers can convert their support of life-saving techniques into a lifetime of savings for their respective clients. Insurers can reinvest that money by expanding coverage or making coverage more accessible to those who need it but cannot afford it. Such is the ROI of CPR: a skill that works—a skill that every worker should study—for the good of all people. Too convenient a chance not to capture, now is the time to seize an opportunity that can secure the credibility of insurers and sustain the safety of policyholders—of people—nationwide. If insurers fulfill that mission, the dividends will accrue for generations to come. Together, insurers and individuals can accomplish that mission.

The intersection of workers’ compensation with laws on leave of absence and job accommodation has become increasingly challenging. With the expanding number of federal, state and municipal laws on the books, there is also confusion about how and when they overlap. There are many inconsistent approaches and far too many organizations forced to compensate for their errors. Fortunately, there are experts who can help increase our understanding of these laws and how to ensure we are implementing our leave and accommodation policies properly. Three of them agreed to explain and simplify this complex topic as guests on our most recent Out Front Ideas with Kimberly and Mark webinar:

• Jennifer Holland, senior manager, leave strategies at American Airlines
• Bryon Bass, senior vice president, workforce absence solutions at Sedgwick
• Jeff Nowak, attorney at Littler

The Challenges Workers’ compensation stakeholders face a variety of hurdles trying to navigate and implement leave and accommodation policies. The first hurdle that our panel addressed is the expanding number of such laws. According to the panel, more than 70 proposals introduced in state legislatures this year have a leave of absence component. Some seek to expand existing rights for unpaid leave; for example, covering relationships such as siblings or domestic partners. Others concern paid family leave. While it is unlikely that we will see the federal government adopt the idea, several jurisdictions are jumping on that bandwagon. New York, Washington, D.C., Washington and Massachusetts are in the process of developing regulations to implement such laws. Another challenge facing organizations is ensuring their policies correctly address the ways leave and accommodation laws affect one another. Workers’ compensation should generally run concurrent with other leave laws, yet many organizations do not do so. Or, they may not understand some aspects of workers’ compensation, such as allowing injured workers to take time off for medical appointments. Finally, the panel identified consistency as another problem area that can get employers in trouble. The Equal Employment Opportunities Commission, for example, has sued employers for failing to provide the same return-to-work opportunities to workers with occupational versus non-occupational injuries. Some states find themselves struggling to meet quick deadlines for implementing new laws. By the time the regulatory information is provided, there are just a few months to put the new rules in place to ensure they are fair to employees as well as businesses. Panelists observed that some of the challenges surrounding leave and accommodation laws can be directly attributed to problems at the employer level. Some organizations are resistant to change or fail to have internal discussions about why a particular accommodation cannot work and do not try to create alternative arrangements. In some instances, the employer does not even realize there is a request for a leave of absence or accommodation. These situations can end up being time-consuming and expensive. Two examples provided by our speakers demonstrated the need for organizations to recognize and respond appropriately to requests. In one example, a pregnant employee was prescribed bed rest and sought approval to work from home. When her request was denied and no discussion took place, she pursued the issue. That case is now headed to a jury to decide. See also: Absence Management: Work Comp’s Future?   In a second case, a store clerk with diabetes wanted permission to have orange juice available at her register. Again, the request was denied, and the employer failed to engage in the interactive process or offer any alternative. A jury’s finding in favor of the employee cost the company more than $750,000 in compensatory damages and attorneys’ fees, plus back pay. Accommodation Issues The interactive process is a vital, but very misunderstood, provision of the Americans with Disability Act (ADA). As we see from the two cases above, failure to adhere to the requirement can become a significant and costly problem. The interactive process simply means the process of engaging with the employee to determine:

• If there is a qualified disability, and, if so
• If a reasonable accommodation is possible.

The key word in the term, and the one that is often misunderstood, is "interactive." Both the employee and employer need to be part of the discussion. This can occur between the worker and supervisor, HR representative or, in some companies, an ADA coordinator or other specialist. According to the panel, the obligation to engage in the interactive process is triggered at any time the employer becomes aware of the need for accommodation. Stated a better way, it is triggered when the employer knows — or should have known — there was a disability affecting the employee’s ability to carry out the essential duties of the job. This is an area that can trip up employers because it means the employee does not have to make an actual request for accommodation for the interactive process to be triggered. It’s a common myth carried over from the early days of the ADA when the employee had a duty to ask for accommodation. That is no longer the case. The panelists pointed out that courts in recent years have found, based on observable behaviors of the employee, that there was a duty to begin a process to inquire if there is a disabling issue preventing the worker from effectively doing his job. Identifying "observable behaviors" can be difficult. Our speakers advise training front-line managers and supervisors to be familiar with such behaviors and understand when and to whom to raise the issue. Terms such as "interactive process" and "observable behaviors" are just two of many that can confound employers. Fortunately, there are excellent tools available to help, especially through the Job Accommodation Network (JAN). This is a service funded by the Department of Labor. The website is: www.askjan.org. Among its resources is one called the interactive process, in which JAN breaks it down into six steps to ensure compliance:

1. Recognize the request.
2. Gather information on restrictions and limits and how they are affecting the job.
3. Explore accommodation options with the employee.
4. Choose the accommodation that is most beneficial for both the employee and employer.
5. Implement the accommodation.
6. Monitor.

Panelists stressed that monitoring is especially important because the person’s situation can change, and employers need to ensure the accommodation is still effective. One piece of advice our speakers provided concerns transitional duty and how that affects ADA requirements. Transitional duty is not intended to be permanent. There should be a timeframe that triggers an assessment to determine what the next steps will be. More permanent restrictions may be imposed, and the employer should determine if essential job functions will be affected and, if so, what to do. This is also an area where consistency of policy is crucial. Similar options must be provided to workers, regardless of the nature of the injury. There are situations where employers have been sued for failing to offer similar opportunities to people with similar injuries. Finally, the panelists noted that employers need to understand what is meant by "reasonable accommodation." It is a change to the way a job is done, a change to the work environment that allows the person to perform all the essential functions of the job. It could be a change in schedule or a change in process, for example. It may involve a leave of absence. Leave of Absence "Reasonable" in terms of extended leaves of absence (LOAs) can be another confusing issue. In response, courts have generally said that employees have to show that whatever amount of time they are seeking will allow them to return to their jobs. They have sought to determine if the leave will be a factor in helping the person return. One problem area our panelists identified is that physicians’ notes seeking extended leaves often do not indicate whether or when the person will likely be able to return to work. Both the employee and physician need to indicate that an additional leave will have a reasonable estimation to return to work and that the extended leave will aid the process. Panelists commented that a major concern related to LOAs for employers is potential abuse, such as directly before or after holidays or other planned periods of time off. There can be a fine balance for employers trying to determine whether the leave is warranted, and erring on either side can be problematic. See also: The Key to Lower Health Care and Absence Costs   There are also situations of potential abuse when the employee takes off more time than suggested by the physician. These can be legitimate, as the physician’s time is an estimate, and the worker may need more time. But there can also be cases in which the worker is taking advantage of the system. The panelists stated that any situation that suggests possible abuse must be viewed carefully. Working closely with field supervisors and managers who have closer relationships with the employee than an HR representative can provide great insight. Also, employers can look for patterns (i.e., whether leave requests are occurring on a regular basis). Where states and municipalities are adopting new paid leave laws can be extremely challenging to incorporate them into existing rights laws. For example, newly adopted laws may involve new job protections. Bereavement for relationships not previously allowed may now be included. A trend panelists identified is leaves of more than 12 weeks. Layering on LOAs plus sick time and vacations in a way that meets a state’s requirements can be daunting. Our speakers are trying to encourage different states to adopt similar practices to make it easier for employers to navigate the complexities of the leave interactions. So far, however, that has not occurred. Our guest experts warn that employers need to be cautious about terminating workers who are on LOAs. The timing must be done with care to ensure their leave is not perceived as causing the termination. Employers can take steps to ensure they stay compliant with the myriad of leave laws. According to the panel:

• Use partners, such as in-house attorneys, or outside experts, such as a third-party administrator, who can guide and interpret the laws to determine if there will be an impact.
• Keep documentation for disciplinary decisions concerning a worker who is or has been out on leave. It is important to show that the decisions are well-supported. The documentation may also warrant an independent layer of decision-making so it shows a decision, such as termination, was not made solely by a manager. An HR representative or attorney should review such decisions to make sure they are legal.
• Avoid hasty decisions to deny accommodation. Instead, be guided by five simple words: How can I help you? Fully and carefully review the request, engage the worker, seek additional information, if needed, discuss the request with managers and, regardless of the decision, make sure it is defensible. If a requested accommodation cannot be implemented, tell the employee why it cannot and make sure the decision is backed up. Seek alternative solutions. Set a time limit, such as two weeks or one month, then reassess the situation to see if it is working. Put all of this in writing so you can defend any and all actions later if necessary.
• Consult free resources. In addition to the JAN website, the EEOC, Society for Human Resource Management and Disability Management Employer Coalition websites also have valuable resources available.

We are finally beginning to experience a long-awaited revolution in the insurance industry. Historically, insurance has been one of the last and slowest industries to embrace technology as a means of modernization and process innovation. The insurance industry is fragmented, without common standards, and until very recently did not attract many investment dollars, which exacerbated the general lack of incentive to modernize. However, in the past few years, we have seen signs of revitalization in the industry, and it is becoming an exciting time to be a part of the insurance community. According to a report published by the National Institutes of Health, "Healthcare costs in the U.S. now account for 16% of the country's gross domestic product, and per capita healthcare spending is approximately twice that of other major industrialized countries. Inefficiencies persist within the healthcare system because—in contrast to other economic sectors in which competition and other economic incentives act to reduce the level of waste—none of the healthcare system's players have strong incentives to economize." It has been said that 40 manual workflows make up 25% of an insurer’s cost of doing business. A recent report by Newsweek--sponsored by Salesforce and Deloitte, which included a survey of 300 C-level insurance IT executives--found that in the quote-to-enroll process, only 4.5% of new business is "mostly" or "extensively" low-touch. About 52% of the processes used are achieved manually. When taking time to dive deep into their process, John Hancock discovered that even for one line of coverage, 120 steps could be condensed to seven and turnaround time reduced from several days to a few minutes. See also: Key Technology Trends for Insurers in 2019   Those of us who have been in the industry for some time are all too familiar with the time-consuming processes that have been used for decades, and there are a variety of players who have decided to do something about it. The past few years have seen an unprecedented amount of investment money flowing into the insurtech industry, which is beginning to change the market outlook as well as boost competition, which in turn is motivating startups and established companies alike to embrace change. We are beginning to see new partnerships and the building of the infrastructure necessary to overhaul the industry, enabling a new focus on user experience and connecting APIs instead of the endless custom work typically required in this industry. There’s a new optimism in the insurance industry that is catching fire. According to a recent report by Accenture, “In five years, nearly all the insurance executives in our survey expect the industry to be transformed by digital technologies.” Further, the report found that 90% of insurance executives state they have a coherent, long-term plan for technology innovation in place. Quicker turnaround times, automated processes and good user experience translate to more new business, higher retention and lower employee frustration and, arguably, could help bring down the costs of healthcare overall. There are at least three areas that need to be addressed to help the insurance industry to modernize and innovate. Insurance professionals would agree that the most common problems in the old processes are the incessant need to copy and paste, the aggravating issue of double entry and the frustration of having to cross-reference multiple sources to get accurate information. We need to break down silos, open up data and replace legacy systems to get these processes running more smoothly and quickly. Breaking down silos In Accenture’s report, “47% of survey respondents also say lack of collaboration with the IT function is preventing them from realizing their technology investments’ value.” From our own experience and years working in the benefits industry, I cannot tell you how many hours, days and months have been lost simply copying and pasting information from one Excel file into another, having to log into multiple systems to manually log information or to simply verify that the information needed to accomplish the task at hand is indeed accurate. Unlike other industries, there are very few APIs available that allow systems to communicate and connect with each other. Because of this lack of connectivity, many employees at insurance companies end up using up to five to 10 systems simply to complete their everyday tasks. Automating Once there begins to be a focus on modernizing and upgrading core systems, a carrier can begin to think about real efficiencies, including automation. Automating even a few of the top 40 manual processes would increase productivity and performance. Imagine the ability to:

• Automate the confirmation of group information for a master data store to automatically verify its accuracy
• Auto-ingest census information by machine reading
• Consolidate account information into a single record
• Provide one point of entry to populate multiple systems

Automating these processes not only leads to quicker turnaround times and better efficiency, but it also enables insurance professionals to close more new business and gives them a competitive edge and a way to stand out from those companies that may be slower to adapt to new technologies. See also: 3 Steps to Succeed at Open Innovation   Partnerships Working with possible competitors, as well as vendors, is becoming increasingly important, and new levels of collaboration are necessary for companies that wish to thrive in the digital economy. There is no one system that does everything that an insurer needs; it simply does not exist at this point and may not exist for several years. McKinsey says that “ecosystems will account for 30% of global revenues by 2025” and that, “to succeed in ecosystems, insurers will have to take a hard look at their traditional roles and business models and to evaluate opportunities to partner with players in other industries.” We are still facing an uphill climb to transform the insurance industry from stodgy to streamlined, but there are signs of a renewed energy and drive that show promise. As more and more insurance companies and partners see the value of digitization, automation and collaboration, everyone will benefit from a more connected ecosystem, and the insurance industry will do its part to make healthcare a more manageable, and possibly even satisfying, experience for the consumer.

As we near the end of the first quarter of 2019, which trends are worth watching? Data Visualization 3.0 To kick us off, let me highlight an area that is a regular topic on this blog, data visualization. Progress in this area is always a combination of skilled people as well as technology. So, building on the positive examples from IIB Awards 2018, what is the trajectory for 2019? Well, I think this video from Elijah Meeks (senior data viz engineer at Netflix) highlights some important 2019 trends. He not only summarizes the history of data viz tool development, but also the changing expectations of users. He may well be right about the 2019 theme of convergence -- a third wave, not just of tool convergence but of developers and readers expecting one more flexible tool and communication medium. Self-Serve Analytics Tries Again There have been plenty of times when Gartner’s predictions of technology adoption have proven too ambitious, but they are always worth hearing. In a recent paper, Gartner predicted that by 2019 fully automated or semi-automated systems would be delivering more analytics than data scientists (or analysts). Now, I am old enough to have seen at least two other waves of analytics “self-service,” with many predicting the democratization of analytics, only to later find that business leaders would prefer an analyst to do the work for them. See also: 3 Skills Needed for Customer Insight   However, with the rise of machine learning improving the intelligence and personalization of report/visualization delivery, this time may be different. This article from Dataversity does a good job of considering how this might happen for business intelligence (BI). However, I think it stretches the term BI too far and misses the difference between the advanced analytics and data science work, where data scientists should focus. AI Applications Revitalize an Antiquated Trend We shared several posts on the state of AI during 2018, focusing on financial services applications and even the issues of AI ethics. However, when worrying about potential threats to your career, it has become clear that many applications are hyped. What we began to see in 2018 was a more mature production line to manage the delivery of AI products (including role of product manager). Several speakers at the Data Leaders Summit 2018 shared their practical experience in deploying AI models from lab to business lines. So, I was interested to read this post on the reliable customer experience (CX) hub “Customer Think,“ from Vince Jeffs of Pegasystems. He provides a useful summary of how AI applications will evolve to better meet the CX demands for 2019, including familiar topics like empathy, human-machine collaboration, data protection and ethics. Jeffs makes a good case for how AI applications will begin to demonstrate progress on all these fronts in 2019, an important milestone, if not yet the sci-fi destination of AI. NOT the Year That Blockchain Transforms Businesses This is a strange one for me to finish on, but I thought it worth including this (non) trend. Given that we have focused before on blockchain, and the outstanding questions if it is to help data science leaders, this caught my eye. The title is almost clickbait, which is rare for a great site like Datafloq. However, the thoughts are worth reading. In this short post, Steve Jones helpfully summarizes both the progress in business adoption and the problem of still over-promising. See also: Key Insurtech Trends to Watch   I hope wise businesses will continue to adopt blockchain technology only where it is a more appropriate data solution. That could achieve its status as a data source that begins to matter to data leaders for analytics, too. But more likely it will be 2020 before we see serious use. Which Waves Are You Preparing to Ride? I hope those trends were useful to share with you and help inform your planning. There are many more topics I could have covered, including wider developments in data science, IoT and virtual reality/augmented reality (VR/AR). Which technology waves will you be riding in 2019? Are any essential to you achieving your 2019 goals? I’d love to hear your priorities or forecasts.

In an insurance industry battling rising costs and losses, the struggle to attract and maintain customers is real. Fortunately, studies show that existing customers value good service and meaningful relationships even more than low rates. This means that, to maintain the customer relationships they already have, insurers must focus on customer experience and engagement. Here’s why customers leave after a closed deal, and what you can do to forge stronger, more profitable, long-term relationships. Why Customers Leave (and Why They Stay) New customers often shop on price, but even the best insurance rates don’t retain customers who experience poor customer service. In Gladly’s 2018 Customer Service Expectations Survey, 92% of customers polled said that they would stop doing business with a company after three or fewer bad customer service experiences — and 26% said it would take only one bad experience to make them leave, says Shep Hyken, chief amazement officer at Shepard Presentations. “Your customers no longer compare you just to your direct competition. You are being compared to the best service they have ever received - from any company or any person,” Hyken says. That’s a tall order for insurance companies, which continue to lag behind other sectors in customer service, the Actuary’s Chris Seekings writes. The insurance industry’s customer satisfaction index score fell in 2018 while the scores of a majority of sectors rose, says Affinion Vice President Karen Wheeler. Insurance customers’ needs are relatively simple: They want policies that meet their needs at prices they can afford, and they want good communication with their insurance company, says Bain's Darci Darnell. “They expect their insurers to help alleviate their anxiety, not add to it.” In practice, however, insurance companies aren’t delivering on these basic needs. Bain’s fourth annual Customer Behavior and Loyalty in Insurance report, written by Henrik Naujoks and fellow researchers, found that most insurers are not delivering the quality products or ease of use their customers demand. The study found that 80% of insurance customers ages 25 to 40 rated their insurer low on the items that mattered most to them. See also: How to Enhance Customer Service   The transition to a digitally based customer service world remains racked with growing pains. Mark Breading describes an attempt to cancel a magazine subscription that required three phone calls, two web forms and an online chat session. In the end, Breading says, he contacted his credit card company and blocked the transaction — a process that was simpler than contacting the magazine itself. Unlike magazine subscriptions, however, insurance coverage is often a requirement. Customers may already feel that dealing with their insurance company is a chore; when the available communication tools are tough to manage, the relationship can be damaged beyond repair. “The challenge (and opportunity) is to enable the smooth transfer of those interactions and the related information between different channels in real time, so that the customer is provided with choice, and the use of digital and human capabilities can be optimized,” Breading says. How Insurance Companies Respond to Customer Variability Emboldened by easy information access and driven by a desire to save money, insurance customers are quicker than ever to switch carriers when their policy anniversaries arrive. To combat the regular shift in customers, insurance companies have leveraged a number of tactics. These tactics include leveraging data to improve personalization and employing new tools and strategies to make it easier for customers to purchase property and casualty insurance, says Tom Super of J.D. Power. However, digitization and its corresponding personalization no longer make companies stand out from their competition. In fact, companies that don’t offer a simple, personalized on-demand experience stand out from the crowd by falling short of everyday customer expectations, says Kevin Haydon, who works at the digital insurance platform EIS Group. While customers understand that buying insurance isn’t as simple as ordering pizza, they expect the same relative level of ease and personalization from both transactions. When prices rise but communication doesn’t get easier, customers feel the pressure to switch insurers from two directions at once. That customers place such high value on ease of use sends a strong message: Insurers' understanding of value must also extend beyond the bottom line, says marketing automation manager Brandon Carter. “Value doesn’t necessarily equal cheaper prices or more stuff. It simply means enhancing the customer’s ability to solve problems and reach their goals,” Carter says. Customers have made it clear that they value insurers who help them solve problems and reach their goals — and who make it easy to do so. These two elements thus become a powerful focus area for insurers. Helping Customers Find Value in Their Insurance Relationship Understanding how different policy options will affect their lives is the biggest factor influencing customer satisfaction in insurance, says Mikaela Parrick at Brown & Joseph. Customers want to know how their coverage benefits them. Currently, only 67% of insurance consumers — about two in three — believe that their insurer helps them understand their policies thoroughly, Parrick adds. When insurance companies put effort into helping customers connect coverage to personal benefit, however, their overall customer satisfaction scores increase by an average of 9 percentage points. The process of learning how to communicate value to existing customers teaches insurance companies more about those customers, as well. This understanding helps insurance companies retain existing customers, attract new ones and boost their own bottom line, says David Pieffer, who works in property and casualty insurance at J.D. Power. “Since insurance is a ‘must-buy’ product for most customers, the reason they buy the product is straightforward; however, why they buy a particular insurance company’s product is not so obvious,” Pieffer says. Failing to understand a customer beyond their risk profile is a big mistake for insurers hoping to adapt to current demands. Think Big With Omni-Channel Omni-channel in insurance offers benefits to the insurer by enabling more streamlined service, and it offers benefits to customers in the form of easier communication and transactions with their insurance companies. Yet one of the biggest values of omni-channel for customer retention remains largely untapped: the power to leverage an omni-channel platform as a tool for customer engagement. “Companies with the strongest omnichannel customer engagement strategies retain an average of 89% of their customers,” says Kris Hackney of Applied Systems. Companies at the weak end of the spectrum, however, retain only 33% of their customers on average. Enabling customers to contact their insurer via their preferred channel is a form of personalizing the customer experience, and it doesn’t require investments in big data. See also: Building a Customer-Service Culture   Build Networks as an Insurer Insurance companies are busily building digital networks to improve the customer relationship. The value of human networks, however, should not be underestimated — particularly when today’s platforms offer the opportunity to add valuable perspectives to the relationship between insurers and the insured. An approach that incorporates insurance agents into the company’s overall de-siloing may have a stronger impact than merely improving technology, says Casey Gustus, CEO of Apliant. Agents remain the single best way to maintain the level of human personalization insurance customers want — and they make it easy for customers to get their questions answered, building a relationship customers want to maintain. Expanding beyond traditional relationships can help bring insurance customers into the fold and keep them there. For instance, insurance companies can partner with financial advisers to reach potential P&C customers who turn to their financial adviser for coverage assistance, says Brian O’Connell at Insurance News Network. Research from Chubb and Oliver Wyman reveals that 40% of customers who seek the help of financial advisers would consider switching to a financial adviser who also provides help with acquiring insurance, says Annmarie Camp, executive vice president of sales and distribution at Chubb Personal Risk Services. Partnerships like these, boosted by technology, help customers feel that their personal needs are met and that receiving the insurance assistance they need is easy. This sense of support provides significant value and strengthens the bond between insurers and their customers.