Insurtech making your head spin? Perhaps it’s because of the confusion whether insurtech is a “there and back again” project or more of a paradigm shift? No one can deny the great impact that J.R.R. Tolkien’s books and movies have had on our culture. He’s been called the father of modern high fantasy literature. Not that money has the final say on one’s success and impact, but in 2009 he was ranked by Forbes as the fifth top-earning dead celebrity. From my perspective, Tolkien’s books are fabulous and intensely engaging. I was listening to a literature professor talk about Tolkien, and he made a most interesting observation on how very different his books were. He described "The Hobbit" as an adventure, while "The Lord of the Rings" was a quest. He went on to say that "The Hobbit" is a “there and back again” adventure story, where you go out, experience thrilling events and then come home again. But "The Lord of the Rings" was a quest; you leave home and are fundamentally changed by the events you experience. In a quest, you may physically return home, but you are so altered that in a real sense you never return home. I had never thought of the books in this way before. As a matter of fact, "The Hobbit’s" official title is “The Hobbit, or There and Back Again.” At the end of "The Lord of the Rings – The Return of the King," Frodo Baggins returns to the Shire but never quite feels at home and eventually leaves Middle Earth with the elves and Gandalf. See also: Core Systems and Insurtech (Part 3)  Insurtech can be looked at in a similar way. Do we view insurtech as a journey, or is it a quest? Is insurtech a “there and back again” project that has a start, middle and end, or a more fundamental paradigm shift in our thinking? Is insurtech to be bandied about as yet another consult-speak hype-phrase added to web pages, slide decks, articles, polls and white papers so we can be 100% buzzword-compliant? Is it hurriedly tacked on as yet another topic on an already bloated agenda of items to be covered? Or is it something substantially more? There are more insurtech lists, companies, conferences, accelerators and analysts than you can shake a stick at. There are more than 1.2 million results when you Google "insurtech." You could make it your life’s work just tracking insurtech. Using the “there and back again” definition, the vast preponderance of what is labeled today as insurtech is a journey, and there is nothing wrong with that. Within the insurance industry, we definitely need incremental new products, ideas and solutions that gradually move the needle when it comes to process streamlining, reducing costs and greater customer engagement. We applaud their efforts and wish them all success. But the number of insurtechs that can earn the quest moniker is much smaller. While many web sites and brochures purport to be a game-changing quest, most are actually a journey in quest’s clothing. So, how do we make sense of it all? First, figure out if the insurtechs you are working with are on a journey or a quest. Here are six marks of an insurtech that is on a quest. You don’t have to exhibit all six to be on a quest, but four is a minimum:

• Big Audacious Dream – Sometimes referred to as the BAD idea, this visionary and emotionally compelling future state is dramatically different than anything yet proposed.
• Multiple Directors – There are not only numerous users that employ the solution, but it directs multiple stakeholders both inside and outside multiple organizations.
• Revenue Diversity – Income comes from numerous different users, stakeholders and sources; the quest is not tied to traditional license/use fee revenue streams.
• Elongated Delivery – Because the quest is by nature long and complicated, quick deployment is not possible; delivery will take time and significant investments.
• Lots of Data – While functionality is important, large amounts of data from various sources are brought together in new and compelling ways that transform traditional tasks into new opportunities for customer satisfaction, additional sales and revenue opportunities.
• Numerous Detractors – Few will understand or initially identify with an insurtech quest, thinking it outlandish and outrageous; most will immediately dismiss it or continually poke fun at it.

Second, it’s more than OK to be engaged with multiple insurtechs that are on an adventure. As a matter of fact, it’s wise not to put all your insurtech eggs in a single basket. Some will make it, others will not, so hedging your bets is a good thing. Third, an insurtech on a quest is not for everyone. You can probably only deal with one at a time. They will take longer to develop and deploy than an adventure insurtech. Fourth, you should periodically reevaluate the insurtechs you’re involved with, eliminating some, adding others. P.S – if you are an insurtech that is on a quest, welcome to the club! See also: Why #Insurtech Doesn’t Matter   It’s easy to become discouraged and think you will never succeed. Take heart. Here are five encouraging Tolkien quotes from "The Lord of the Rings":

• “The quest stands upon the edge of a knife. Stray but a little, and it will fail, to the ruin of all. Yet hope remains while the company is true.” Galadriel, "The Lord of the Rings: The Fellowship of the Ring"
  • There will be days when you are convinced that your quest is teetering on the edge of failure. It’s at times like this that you need to seek encouragement from your team and supporters.

• “The Ring-Bearer is setting out on the quest of Mount Doom.” Elrond, "The Lord of the Rings: The Fellowship of the Ring"
  • There will be days when your quest seems destined for financial failure and industry embarrassment. Listening to your detractors is a recipe for certain defeat. If necessary, recalibrate your goals and move forward with your team and supporters.

• “This quest may be attempted by the weak with as much hope as the strong. Yet such is oft the course of deeds that move the wheels of the world: Small hands do them because they must, while the eyes of the great are elsewhere.” Elrond, "The Lord of the Rings: The Fellowship of the Ring"
  • Leadership is vital on a quest, but more is accomplished not by the great or brilliant, but by average people. Do not overlook their value or contributions.

• "What is to be my quest? Bilbo went to find a treasure, there and back again; but I go to lose one, and not return, as far as I can see." Frodo, "The Lord of the Rings: The Fellowship of the Ring"
  • To succeed in your quest, you need to have an attitude of abandonment, willing to lose to win. You will need to hold loosely those traditional things that have given you stability and success.

• "But do you remember Gandalf's words: Even Gollum may have something yet to do? But for him, Sam, I could not have destroyed the Ring. The quest would have been in vain, even at the bitter end. So let us forgive him! For the quest is achieved and now all is over. I am glad you are here with me. Here at the end of all things, Sam." Frodo, "The Lord of the Rings: The Return of the King"
  • When you have succeeded, you will look back and remember people whom you thought were your supporters and friends but turned out to be your enemies. Don’t harbor anger and bitterness.

Work hard and enjoy the quest.

This morning, I was reading a new article essentially about how insurtech disrupters were going to destroy the insurance industry. As is often the case, these startups were compared to Amazon, something I’ve blogged about on several occasions, including in the article “Insurance and Paper Towels.” Among the predictions of this article were: “And you’re going to get disrupted in a way that’s staggering in its infinite nature, with infinitely more data points, infinitely greater opportunities and, as a result, infinitely more options amid a sea of competition, which makes you feel infinitesimally small. Suddenly. This competitive force has built such a commanding, unexpected lead. Yes, a good, old KO before you even heard the bell go off. You will likely default, and it will be too late to pivot. “For the lucky, the ability to slip into obsolescence and appreciate the nostalgia of the past will do. (Of course, not the positive vibe-nostalgia, the punch-drunk love of sentimental warmth. Nope, as you become a relic of history, the nostalgia will be more like the Greek word root for nostalgia, which translates to pain, or more specifically the debilitating and often fatal medical condition expressing extreme homesickness).” See also: How to Respond to Industry Disruption   Yikes! Gadzooks! Godfrey Daniel! (and other “old-timey” expressions of fear and terror used by industry fossils like me). Or, better yet, he “blathers like a bubbly-jock,” an 18th century expression that means to prattle like a gobbling turkey or “to talk rubbish.” The article concluded with: “…you’re about to be disrupted. Amazon ring any bells?” Yep, so does Google Compare. And Airbnb Insurance and Guevara and Guild and Health Republic and Risk Genie and Tribe Cover and Zensure and RiskGone and…. Amazon sells products with a known cost. Insurance involves parties entering into complex, legal, highly regulated indemnification contracts where the costs are not fully known and one event can be financially catastrophic for either or both insurer and insured. Insurance is more process than product. It begins with an individual risk exposure analysis, continues with matching the results of that detailed survey with the proper risk management technique (one of which is “insurance”), then moves to interpreting a complex legal contract IF a loss event occurs. Insurance in its present form does not lend itself to an Amazon-like “1-Click” purchase. Insurance contracts are not commodities distinguished only by price. If I buy three pairs of crew socks on Amazon and they don’t fit or I don’t like them, at worst I’m out a few bucks or the inconvenience of a return. If I choose the wrong insurance product, I may almost literally lose everything I own, and, in the particular case of liability claims, I may have my income garnished for the next 20 years. Insurance is a complex process, not a single event where all that matters is a fast/easy/cheap convenient and pleasant customer buying experience. The true test of the insurance product is whether it covers a claim. Again, in the particular case of liability exposures, the value of the purchase may not be known for years. See also: Why Insurance Is Ripe for Disruption   Those who think they can disrupt a centuries-old industry with a phone app and an AI bot that extracts bad data from a county tax database without human intervention aren’t being innovative. They simply lack a valid historical perspective of the industry and a fundamental misunderstanding of what the industry is all about. What the insurance industry is all about is assisting individuals, families and organizations in identifying their exposures to loss and implementing the most appropriate risk management techniques to minimize the potential for serious or catastrophic financial loss. How many insurtech startups will figure this out before they run out of venture capital or ruin the lives of an unsuspecting public?

“Alexa, can you tell me the impact of the wholesale shift to voice search and voice communication over the internet?” Amazon’s wildly popular personal assistant, Alexa, probably cannot answer that question for you. And even she doesn’t perceive how she is making us dumber and taking our choices away. The world is surely moving from text to voice as the primary interface on the internet. The rapid rise of Amazon’s Echo (and its smaller version, the Echo Dot) personal assistant device was the biggest story of the 2016 holiday shopping season. As of September 2017, Amazon had sold 15 million Echos, and Google had sold five million of its own personal assistant device, the Google Home. This is impressive, for a category that just a year earlier had not existed. Even more significantly, we are switching to voice as the means of communicating with our smartphones. More than 20% of mobile searches were conducted via voice in 2016, according to Google: a roughly a 35-fold increase in voice search since 2008. Google also found that about two-thirds of its users conduct voice search via mobile phone several times per day and that roughly half of its users use voice and text search interchangeably. See also: Could Alexa Testify Against You?   Such growth has been enabled by dramatic improvements in voice recognition, through use of powerful artificial intelligence systems that use machine learning. We are now in a positive feedback loop for voice: As more people talk to their smartphones or home assistants, more data become available to companies such as Amazon, Google and Apple to feed to their personal assistant systems. As of May 2017, Google’s speech recognition error rate was 4.9%, down from 23% in 2013. Businesses have recognized the shift in accuracy and customer engagement, and are piling in. Amazon now boasts more than 15,000 Alexa “skills,” which are capabilities that allow customers to make personalized requests. For example, travel search providers let you plan vacations via Alexa using voice commands; Pizza Hut lets you order pizza; Nissan and Hyundai let Alexa owners start their cars’ engines and set their temperatures; Capital One lets customers check their bank balances; and Campbell Soup Company supplies recipe ideas. The shift to voice search and voice communication will surely make many things more convenient for us but will dramatically reduce our online choices. The reason for this is simple: When results are spoken back to us, we will receive only a few options, because humans cannot absorb 10 results in succession and adequately choose between them. We can’t remember them all. This switch in information density has profound implications, and voice search can subvert our purchasing choices in subtle ways. Prior to the advent of the internet, when we looked at the Yellow Pages, we had many pages of options. When we searched online, we had even more options but tended to only react to those on the first page. Increasingly, those first-page results are sold to the highest bidder. On mobile phones, the searches mean even fewer options, and the paid ones utterly dominate the screen. In the results of a voice search, we are usually down to only two or three options. People just can’t remember more information presented to them vocally. So your search for “best hotel in San Francisco” will yield only a few results. The response to “I want to find a pizza place in Palo Alto” might not show the pizza joint that is the best in town, because it has not bought its spot in the search results. Most worryingly, the shift to voice will further consolidate power in the hands of the big providers, such as Amazon, Google and Apple. When we ask Alexa to add olive oil to our shopping cart, we are ceding our choice to Amazon. Maybe we prefer Californian olive oil, because we know it is less likely to be adulterated. Or maybe we would rather buy the lower-priced of two favorite brands. With voice, which olive oil goes into the cart becomes Amazon’s decision. Unsurprisingly, research firm L2 found that Amazon is more likely to put its own proprietary products into your shopping cart. In theory, we could ask for more voice results to get richer searches. Or perhaps voice assistant systems will eventually be improved to include capacities such as following up to ask us whether we want, for example, a particular type of pizza. See also: ‘Alexa, What Is My Deductible?’   But even if that happens, the world of voice is taking us back a century in terms of information density. Talking to a voice assistant is a lot like asking a friend for restaurant recommendations, except that friend is a giant technology company that makes its money from the recommendations it provides us. That doesn’t sound very friendly. This article was written by Vivek Wadhwa and Alex Salkever.

For over eight years, the Democrats and now the Republicans have struggled with the politics (and business) of healthcare in America. More accurately, the topic has been health insurance in America, and nothing has been done to address the actual cause of high insurance costs. The real problem with healthcare in America starts with the root of the issue, namely health. This article is short and simple -- because the problem is extremely simple, and the solution is short. Eat right, don’t smoke and exercise. I can see you sitting behind your computer screens laughing – ha! You’re saying, “Troy, if was that simple to get people to put down the cheeseburger, throw away their cigarette and actually do those workout videos they're watching on YouTube, why hasn’t it happened yet?” Perhaps the root of the problem is all the dialogue around other ways to motivate Americans rather than address these very easy, tangible solutions to improve American health. If we can get back to basics and repeat (over and over again), “Eat right, don’t smoke and exercise,” we can move the needle. It’s Expensive to Ignore Prevention We all know health insurance is expensive because healthcare is expensive. Healthcare is expensive because as a nation we don’t eat right, we don’t exercise and some people still smoke. The fiscal impact of poor diet and exercise in America is staggering. The Center for Science in Public Interest reported that in the last 30 years obesity rates have doubled in adults, tripled in children and quadrupled in adolescents. What were the two leading causes of premature death in 2010? Diet and tobacco. See also: Healthcare: Need for Transparency   If we ate better and exercised, our nation’s financial problems would be solved. We spend a cool $245 billion on treating cardiovascular disease and Type II diabetes. This expense is almost always associated with bad lifestyle choices (diet and inactivity) made by the individual. Freedom is great, but people should pay for their decisions. If a car driver received multiple speeding tickets, his insurance premium would go up. This is common sense, but health insurance premiums (for the most part) do not follow this logic. Two single people of the same age, living in the same Zipcode will likely pay the same medical insurance premium even if one chooses to smoke, eat poorly and never exercise. The person who chooses to take care of his or her body is in no way rewarded with a lower insurance premium. Incentives, eh? Some companies choose to reward their employees with lower insurance premiums for weight loss, smoking cessation, etc. Those companies should be applauded, but there is no real incentive for better health at the national level. The Affordable Care Act tries (operative word: "tries") to cultivate a nation of better health with provisions such as the “smoker’s premium penalty.” It’s designed to enforce higher medical insurance premiums for smokers relative to non-smokers. On the surface, this approach appears to make common economic sense: Associate the risk cost with the price. The approach fails because it’s simply a band-aid and an act of showmanship. In its first of year of implementation, a Yale School of Public Health study found that “tobacco surcharge resulted in lower enrollment among smokers, without an increase in smoking cessation.” The ACA smoker’s premium penalty will have no impact on saving lives or money. Without significant support and incentive, many states simply opted out of the smoker’s premium penalty or capped the 50% surcharges substantially lower (between 10% and 40%). Other options allow a smoker to say he or she is trying to quit, thereby avoiding the premium increase altogether. The Government Is Making Us Fat The U.S. government is a major contributor to the obesity and poor health of today’s Americans. By offering subsidies on tobacco, dairy and meat products, the government offers a window of opportunity for these producers to lower their prices and increase consumption. As a result, they’re perpetuating a generational cycle of poor health and increasing the damage with every generation. The government launched national dietary guidelines and the food pyramid in the 1980s – an attempt to stabilize and grow the economy. In an article on the government’s role in our nation’s health crisis, Dr. Wolfson writes, “Despite overwhelming evidence, the food pyramid advised Americans to eat the things that made them sick and to avoid the things that made them healthy. On what planet of delusion could the creators of this pyramid be from? The grain category is twice the size of the vegetable category! This planet could only be controlled by food manufacturers.” This cycle shows no sign of changing. Our policies on scientific studies continually “allow studies concerning practices and health impacts to be funded and conducted by the very corporations that created them and profit from their sales.” Within the last eight years, the most prominent and political voice on better health is Michelle Obama. When the former First Lady suggested we occasionally skip dessert or eat more carrots, she was told by Republicans to “Stay out of my kitchen” and “Don’t you have something better to spend your time on?” The Republicans should have embraced some, but not all, of her ideas. The Republicans should have distanced themselves from some of the misguided school meal programs but totally embraced her core message of better diet and exercise. Education or Marketing? Diet education is also a problem. For decades, most television and print ads for food and drink have pushed extremely unhealthy choices. Milk doesn’t do a body good. Beef should not be what’s for dinner. Do not hanker for a hunk or a slab or chunk of cheese. In “How Big Government helps Big Dairy sell Milk,” the dairy industry has spent billions of dollars to convince consumers that milk is the only way to get their best recommendations of calcium, potassium and protein – even though you can get the same amount from fruits and vegetables. See also: U.S. Healthcare: No Simple Insurtech Fix   Positive, popular TV shows are making attempts to debunk this misinformation and take jabs at America’s poor diet. In a "Family Guy" episode, Peter Griffin’s solution to cooking is to consume obscene amounts of butter, and he’s met with an instant stroke, followed by a heart attack, stroke, another stroke, heart attack – you get the picture. Small Steps Forward We have a reactive healthcare delivery system in America. When health savings accounts (HSAs) were introduced, they were slow to be accepted. Most private insurance in America is sold through health insurance brokers. Initially, brokers offering HSAs were asked to do twice as much work and make half as much money. Now, HSAs are more commonplace and have some excellent features. A free annual checkup is always part of the plan. If people improve their health and don’t spend as much on medical care, they pocket the savings. There is no fountain of youth, and there is no magic pill. As Dr. Leonard McCoy said in "Star Trek: The Omega Glory": "It might eventually cure the common cold but lengthen lives? Poppycock! I can do more for you if you just eat right and exercise regularly.” When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need. Ayurvedic proverb

The enthusiasm for insurtech seems to have hit a bit of a lull. Now that some have fallen by the wayside, while others are taking longer than hoped to deliver on their promise, there seems to be less buzz in the air.

But the failures and sometimes longer time horizons shouldn't be a surprise. Not all seedlings take root, and trees don't grow overnight. We know from history that some 90% of startups fail, and insurance will be no different.

Maybe the thinking is just maturing as we all see that, as an old boss of mine liked to say, "We're in a marathon, not a sprint." In any case, I can assure you that our monitoring of  thousands of insurtechs as part of our Innovator's Edge platform shows that innovation continues apace. 

As just a bit of evidence, here are our six Innovators to Watch for November. (Honorees from prior months can be found here.) Onward!

AOC Insurance Broker

Paris-based AOC Insurance Broker helps individuals and companies to evaluate and find international private medical insurance plans for expats, meeting their coverage needs while on international work assignments. In addition to comparison tools to find the best coverage options from 30 multinational insurers, AOC also offers an mHealth solution to provide medical advice, guide preventive care and healthy behavior and provide rewards for user engagement that can result in a premium discount. Leveraging such technologies as machine learning, chatbots and wearables, AOC delivers a robust solution for a growing niche market. The company also recently launched its solution via a mobile app. Learn more about AOC Insurance Broker.

Gain Compliance

Gain Compliance, based in Des Moines, Iowa, is a cloud software company focused on making it easier for the insurance industry to gather and organize information for compliance. The company’s solution aims to help insurers that struggle with outdated processes and technologies to gather and report the massive amount of information required for statutory reporting. The result is a dramatically more efficient process and higher-quality data. The initial focus of Gain Compliance is helping carriers comply with the notes section of a company’s annual statutory financial report, which entails following a package of instructions, data requirements and formatting guides that typically runs to more than 100 pages for companies. Learn more about Gain Compliance.

Hello Zum

Hello Zum aims to make insurance more efficient by digitally restructuring how information is collected, shared and analyzed by brokers, carriers and policyholders, with the needs of the customer as the focus. In the process, the Lima, Peru-based insurtech sees significant savings for the insurance market over existing workflows, which today can involve managing multiple carrier requirements as well as a wide variety of information and document formats.  Hello Zum is a Saas platform that sits in the middle of all stakeholders, organizing the information digitally. Its solution currently is live in Peru, and it is working with local and international insurance distributors—not only brokers, but also banks and department stores that sell insurance—carriers and regulators. Learn more about Hello Zum.

Insurance Agent App

Helping customers stay connected to their independent agents and helping agents get  connected to the digital channel is the focus of Insurance Agent App. The Charlotte, N.C.-based company aims to put the insurance agent at the center of communication between policyholders and their insurers and, in the process, make independent agents more competitive with direct writers and captive agents. Insurance Agent App recently was named  winner of the 2017 ACORD Insurance Innovation Challenge for Startups/Disruptors. Judges recognized the company for a pilot program with Selective Insurance that allows a policyholder to transmit to its insurer directly via the app a first notice of loss that automatically keeps the independent agent in the loop on the claim, using ACORD data and real-time messaging standards. Providing claims notification will join a suite of services that policyholders can access with the app. Agents using the app also gain software tools to better communicate and manage customer relationships and integrate with agency management systems. Learn more about Insurance Agent App.

Neosurance

Neosurance hopes to make insurance more relevant to the lives of consumers by presenting coverage offers at the right time and right place using push notifications in a mobile app. The initial focus of Milan, Italy-based Neosurance is on-demand protection for travel-related risks, including lost baggage protection and medical coverage while traveling abroad. The company applies behavioral science and machine learning technology, along with smartphone sensors and contextual data, to identify when to present an offer, such as when a user is at an airport, not when a ticket is purchased months earlier. Neosurance uses a B2B2C model, aiming to serve digital communities of users, such as associations, rather than directly sign up individuals. Additional use cases for its solution beyond travel are in development. Learn more about Neosurance.

Pindrop

Pindrop provides anti-fraud and authentication solutions that help insurance call centers reduce the risk of false claims and fraud attacks originating in the call center. Atlanta-based Pindrop technology goes beyond caller ID and knowledge-based answers that call centers typically use to authenticate customers. Pindrop multi-factor technology can pinpoint where callers are coming from and what device they are using and generate risk scores to authenticate callers and reduce potential fraud. For insurers, the solution minimizes the risk of someone using a phone to, for example, make fraudulent claims, cancel policies or take over accounts. It also improves efficiency and satisfaction by reducing the time it takes to authenticate and serve customers. Learn more about Pindrop.

The Innovators to Watch honorees are drawn from among the thousands of insurtech companies that are featured in Innovator’s Edge, a technology platform created by ITL to drive strategic connections between insurance providers and insurtech innovators. From this growing pool, only those companies that have completed their Market Maturity Review—a series of modules designed to help insurers conduct baseline due diligence on the innovator and make a more informed connection—are eligible to be considered for Innovators to Watch, helping them to stand out in this crowded diverse field.

If you are insurtech innovator that has not yet taken advantage of Innovator’s Edge to boost your company’s visibility to the insurance market, we encourage you to get started today. Contact us at info@insurancethoughtleadership.com if you have any questions.

Commercial insurers have every reason to be optimistic. Thanks to the gig economy and the sharing economy, business launches are on the rise. And even though not every business launch is the next Fortune 500 company, insurers that are poised to take advantage of volume may find themselves with impressive market share. Here are five quick reasons that commercial insurers in every line of insurance can be excited.

1. Demographics are pointing to short-term and long-term growth because growth fuel will be coming from two separate sets of entrepreneurs with separate timelines for business maturity.
2. Technology is supporting new channels for acquiring business that were not feasible before. Commercial insurers, in many cases, can look at current direct-to-consumer trends for real insights. Improved data use will provide better custom-fit insurance solutions for small and medium-sized businesses (SMBs).
3. Product development opportunities for commercial insurers are growing out of gig-related business trends and lifestyle and purchase trends.
4. Modern affinity groups will become more prevalent and important the more that people pursue gig-type employment. Insurers that traditionally offer voluntary benefits through employers will find that thousands of new types of business groups will become interested in both traditional and non-traditional products.
5. More sharing, less disruption. As the sharing economy grows (and with it, a new type of commercial product need) commercial insurers will also be the beneficiaries of fewer negative disruptive trends, such as vehicle autonomy.

The further we dig into the gig economy, the more we find that small efforts by commercial and specialty insurers could yield big results. If an insurer is looking to build a case for preparation, some of the following points may be excellent support. Gig workers, millennial entrepreneurs and senior entrepreneurs Demographics are painting a clear picture of the new economy from the ground level. As we pointed out in our report, Future Trends 2017: The Shift Gains Momentum, project-based work and new businesses are on the rise. The emergence of the “gig” or “on demand” economy is made up of individuals who work as freelancers, independent contractors for themselves or independent contractors for on-demand service providers. The gig economy has increased the number of small businesses. The 2016 version of Upwork and the Freelancers Union’s annual survey, Freelancing in America, estimated that 55 million people, or 35% of the U.S. workforce, have chosen freelancing as their means of work. See also: Commercial Insurers Face Tough Times   While freelancer and independent contractor work arrangements are not new, the relatively recent trend of on-demand workers, where workers and clients are typically connected through a digital platform, have caused state regulators and insurance companies to wrestle with questions of worker safety, liability and employee benefits. A growing list of insurers are providing products for the fluid dual coverage needs of people working through ride-hailing services like Uber and Lyft and home-sharing services like Airbnb. Insurers are also providing for the unique coverage needs of workers and companies engaging in contract-driven work. Many of these independent jobs turn into larger businesses, and insurers can find relevant business launch trends among two separate groups — aging millennials and retiring boomers. The Kauffmann Foundation’s statistics on entrepreneurship indicate that the “peak age” for starting a business in the U.S. is around 40. Millennials are on the cusp of mass entry into the “peak age” bracket for entrepreneurship. They show a strong desire to start businesses. By 2020, more than 60% of small businesses in the U.S. will be owned by millennials and Gen-Xers. Baby Boomers are reaching retirement age in ever greater numbers. As they move to retirement, some will seek “gig economy” businesses and jobs to supplement their income. Many will start their own businesses. For those who already own their businesses, they will potentially pass them to the next generation. For those starting a business, this represents a growing segment. In either case, the trends will cause growth in the need for commercial insurance. For more information on how demographics is shedding light on growth opportunities, read A New Age of Insurance: Growth Opportunities for Commercial and Specialty Insurance in a Time of Market Disruption. Greater access to small businesses Traditionally, commercial insurance was sold and serviced by agents and brokers. Smaller businesses were often underserved because they were simply difficult or expensive to reach. For the underwriter, they were also a bit cumbersome. Was it worth the time spent in research to underwrite the business? With small businesses, cookie-cutter products were an effective solution. But today’s small businesses are too varied for effective low-volume underwriting. Digital sales and service will effectively fill a void for millennial and Gen X business owners, who prefer that kind of service for most every other transaction. Our research, The Rise of the New Insurance Customer, showed that all generations use multiple methods to research insurance prior to buying or renewal, but Gen X, Millennials and Gen Z use the widest variety of options, including digital channels like e-mail, texting/messaging/chatting and social media. Like personal lines, commercial lines have historically relied on macro segments for classification and pricing purposes. With the advent of more data sources and sophisticated analytics, commercial lines have developed new segments for insurance like professional liability for specific businesses, all-terrain vehicles, yachts and pleasure boats, wineries, country clubs and numerous others. In many cases, the business sales and service model for gig individuals and SMBs will be patterned off of modern direct-to-consumer models. Some insurers have already been capitalizing on the similarities. Berkshire Hathaway, Hiscox and Homesite are all examples of successful small business coverage direct writers that have found a formula that works. Group purchasing and commercial and specialty product development The gig economy is naturally isolating individuals who used to be covered under employers for standard health, life and other core employee benefits and voluntary benefits. Those who leave their jobs for gig-type employment will often take portable benefits with them, switched into individual coverage. They will be assuming a larger load of their core benefit costs or going uncovered. This will create a natural pooling. New potential “affinity” groups will arise with insurance opportunities for both group carriers and commercial insurers. New work habits and preferences will also create new needs. For example, there is growth in demand for temporary work spaces, temporary storage spaces and occasional use of vehicles and equipment. Commercial insurers will be filling the insurance gaps for these types of policies. In many cases, the lines between insurance types may begin to get fuzzy as commercial insurers create risk products that go beyond personal lines but that still contain some of their attributes. See also: Gig Economy: Newest Tool for Insurance   As some personal lines business is lost due to vehicle autonomy and manufacturer liability (such as at Volvo) or sharing liability (such as at ZipCar and Maven), commercial insurers will be on the flip side of receiving additional pooled business. Many commercial insurers, already adept at handling fleet dynamics and logistics liabilities, will be extremely comfortable shifting gears and accepting other types of pooled risk. If commercial insurers are truly interested in expanding into gig-created space, they should prepare their systems to handle not just large groupings of risk but individualized data contained within the risk pool. They should also keep tabs on mobile and insurTech developments, keeping their eyes on apps that cater to group sharing of any type of resources. Mobile apps may open commercial doors to unique product development. For example, an insurer may find that only one app is traditionally used by commuting cyclists or bike couriers. One unique product offering may help that insurer corner the market on a nationwide community.

Practical tips and thoughts on travel for the new insurance broker, underwriter, risk manager; or someone who is new to business travel. Pre-Trip -- Plan, Plan, Plan

• Understand that there are risks associated with travel. As an employee and representative of your firm, your responsibility is to take necessary steps to mitigate them.
• Read and understand your organization’s travel policies. Follow the policies on travel authorization, approved vendors and rates. The organization will only pay for the travel that it authorizes, and only at an approve rate. Check for spending guidelines or limits per diem on personal meals, etc. Do not expect to be reimbursed for failure to follow the written guidelines.
• Use the company travel agent and the company credit card if one exists. This is not just for financial information for your company, but often additional protections and insurances built into these resources should something go wrong.
• Get your travel documents in order. If your state-issued drivers license does not meet the ID requirements, you will need to have an alternative document such as your passport with you to travel beginning in 2018. For more information on compliant states, use the Homeland Security website: https://www.dhs.gov/real-id.
• If you are traveling alone, leave an itinerary with an immediate family member. Leave a copy with your manager if your company does not have a central travel agent. Ensure that your contact information is current at all times with your HR department and with your travel agent.
• If you are traveling with a group, put together an itinerary. The itinerary should include, who is traveling with you, their cell phone numbers; the flight information (airline and flight number); ground-transportation information (local phone contact); the hotel name, address, telephone number, and reservation number; meeting times and places — with telephone numbers, of host names, telephone and fax numbers, and e-mail addresses; meal arrangements; and scheduled entertainment.
• If traveling as a group, appoint a central coordinator to double check to make sure you are all on the same flights and staying at the same hotel.
• Travel costs escalate the closer to your date of travel. Wherever possible, make your travel and accommodation arrangements as soon as you know when you will be traveling. Follow your company travel policy on non-refundable tickets.
• As an employee traveling, you should always manage travel expenses as part of your overall budget.
• If an airline is checking your bag, always doublecheck the tag to ensure that it goes through to the right location. (There are a lot of San Juan and San Jose cities out there)
• Always have a spare set of underclothes and a toothbrush in your carry-on luggage.
• List what you want to take and practice packing it. Consider bringing your laptop, cell phone, reports, contracts, brochures, clothes and shaving kit toothbrush medication and your lens prescriptions if you wear glasses or contact lenses. If visiting foreign countries, make sure that you have the proper electronic conversion to keep your laptop and phones alive. 220 volts can wreak havoc with your stuff if you are not careful.
• Have a list of your medications and lens prescriptions where you can access them quickly in the event you need to replace while traveling.

See also: The Insurer of the Future – Part 6   Airline Rules

• Be a smart flyer. You will have missed connections and missed meetings. In most cases, things will all work out. Anger does not help the situation. Do not stand in lines -– use your phone and call your travel agent or airline directly.
• If you park at the airport, take a photo of your parking space. It will save you from wandering around a parking lot following a long trip late at night when you are the most tired (especially if you return on a different airline than the one on which you left).
• Take a photo of your luggage with your phone. It will help you recover it if it is lost.
• Dehydration is caused by flying, and studies show that deep vein thrombosis (DVT) can be a risk for frequent flyers; drinking water on all flights and getting up to stretch are simple preventative measures that can be taken.
• Once you arrive at the airport, secure your car keys (other than on your person). Once you lock your car, you won’t need them again until you return. There usually are special pockets in backpacks or suitcases to use. That way, you always will know where they’ll be when you need them.
• Global Entry and TSA Pre work well. In time saved and travel friction reduced, the status is worth every penny. If traveling international, get Global Entry. It can take as much as six months to get an appointment for Global Entry.
• Enroll in every frequent flyer program whether or not you routinely fly a particular airline. Make sure that you have a spreadsheet of the programs and the security code to access them online.
• Check in early and review your seat selection. With equipment changes, the airlines may move you around without your knowledge.
• Determine if you are an aisle or a window person.
• There is a reason exit rows are premium seats. If there are upgrades to be had, it is likely that an “exit row” person will be moved to business class. Ask at the gate to get the open seat if one opens up.
• When things are blowing up at the airport, use the latest technology to re-schedule your flight and get a place where you can sleep for the night. Waiting in lines during these events can be a colossal waste of time.

Money, Money, Money

• The company credit card should not to be used for non-business expenses.
• Have the right currency on a foreign business trip. Take enough cash to cover your needs or to get you to the next cash machine. Some countries or places do not have cash machines.
• Watch when you are using the credit card to make sure it is not being used inappropriately. Keep it in sight whenever possible.
• Keep all of your receipts. Take a picture of them with your cell phone when you pay the bill. Document who was at the dinner. Be aware of what the company does and does not pay for. Submit your documented expenses as quickly as possible.

During the Trip - While There, You Are Not Here

• If you travel enough; you will eventually get a bug. They are not fun. Cancel your appointments. If necessary, go to a doctor or hospital. Do not be a dead hero.
• Drink lots of water. However, do it strategically. In inclement weather or remote locations, access to bathrooms can be problematic.
• Exercise upon arrival is a great way to “reset” your internal time-clock. Sunshine works wonders. Take a walk outside (no matter the time of year).
• Use the gym at the hotel unless the concierge has recommended a jogging route; running around in some cities is both dangerous and often a sign that a crime has been committed.
• If you are visiting an exotic location (such as Cleveland, Ohio) for business, take advantage of the experience. Tourist destinations are just that because there is usually something worth seeing. Avoiding tourist destinations usually results in not seeing the good things.
• Don’t be obnoxious, rude or inconsiderate; America has enough problems with our reputation in the world; in fact, lean the other way. Go out of your way to be polite, friendly and considerate. Learn enough of the local language to say “hello, good morning, good day, good evening, yes please, thank you, no thank you and two cappuccinos take away.”
• The Google translation program is amazingly helpful in reading menus and other written documents.
• Use the opportunity for international travel to open your eyes to how the rest of the world thinks, acts, lives and believes; Americans often think that choosing a latte is the toughest decision they make in a day.
• Take pictures (cell phone or full camera.) Anyone can get a picture of the Eiffel Tower. Get a picture of you in front of it.
• Follow the local signs concerning when not to take a picture. Do not take pictures of any military person or institution without permission.
• Never give money to panhandlers, beggars or street people; you are likely to be swarmed and possibly attacked. If you want to help the local poor, donate money to a religious institution.
• Always leave an extra donation in a church or museum that you have visited.
• Local guides are usually worth every penny.
• Carry 3x5 cards to PRINT the name and address of hotels and restaurants to give to taxi drivers who may not speak English or even the local language. NEVER leave a hotel in a new city without a card with the hotel’s name and address
• Try not to schlep your bags to all of your business meetings. Most times, you can leave them at the hotel even if you are checked out. If you do, always count the bags every time you move (in and out of taxi, in and out of business offices, etc.)
• Read up on the country you are visiting, and ask for advice from others who have been there. A little cultural knowledge goes a long way and can make the difference between a successful trip and failure.
• Embrace the culture of places that are different from the one you call home.
• Know how to dress for the culture and business you will be doing; most countries outside the U.S. tend to be a little more formal.
• Little things count. For example: Wearing a green hat in China means your wife is having an affair.
• Drink local wines and beer. Ask for advice from dinner guests or restaurant help. This could help avoid some weird stuff (cherry beer late at night with a sandwich at the Holiday Inn by the Brussels airport).
• In business situations, do not overdrink. Always be sober enough to get safely back to your hotel if you are somehow left alone.
• If you are with a group and get lost from that group, plan to meet back at the last place where everyone was aware that the group was together.
• When visiting certain countries, realize the potential for your technology to be hacked and any information you had in that computer to be used against you.
• If an alarm goes off, do not ignore it. Take stock and determine where you should be.

See also: Risk Exposed to Your Art Business   Lodging

• Try to stay above the first floor of a hotel or motel. Also try to stay low enough for the fire ladder to get to your window (usually seventh floor).
• If you forgot a personal item, the front desk has it. Don’t pay for one in the little store.
• Pick hotels that have in-house gyms. Exercise, even 30 minutes on a hotel stationary bike, can help with digestion, sleep and staying awake in meetings in a warm room.
• Stay at places that include breakfast in the price of the stay.
• During a power outage, your phone and laptop can provide you with needed light.
• Tip the concierge if you get help from him or her.

Ground Transportation - Do Not Get Ground Down

• No matter where you go, take identification that allows you to drive. Consider getting an international driver’s license - https://www.consumer.ftc.gov/articles/0050-international-drivers-license-scams
• Uber and Lyft are a non-regulated means of travel available in most cities. There are increasing reports of violence from passengers using these forms of travel. Be cautious when using non-regulated transport.
• Purchasing auto insurance for rental cars is usually determined by company policy.

Traveling Internationally

• Read the State Department warning on travel. If traveling overseas, enroll in the State Department’s STEP program and list all locations.
• Get your international travel documents in order. Passport should be current and not expiring in the next six months, or some countries will not allow you to enter.
• Keep your passport safe at all times. Keep a notarized photo copy of your passport separate from your passport and keep it safe, as well. This will allow you to get a replacement while traveling much faster.
• Use chip-enabled cards only while traveling overseas to prevent theft.
• Most international car rental locations may only have manual transmissions. Know ahead of time if you can’t use a stick.
• When you’re planning the dates of an international business trip, review local bank holidays and religious holidays, which could affect your ability to schedule meetings or access services that may be closed.
• Bring a full set of electronics (chargers, adapters, etc.) for the phone, laptop and tablet in your briefcase.
• Before travel, identify any recommended or required vaccinations in the countries where you are traveling. Ensure that your flu, pertussis and pneumonia vaccinations are up to date. Finally, in many countries of the world, TB is a common illness. If you travel frequently internationally, speak to your physician on whether he or she recommends an annual TB test.

International Communication Most of us travel with a laptop and cell phone at all times. Using your cell phone and getting Wi-Fi access worldwide is possible but can be expensive if you don’t pre-plan.

• You should download all local Google maps for where you will be visiting onto your cellphone. This will save you data fees and allow you to get information even if you have no signal.
• Before an international trip, you will need to activate international service on your phone.
• Data is VERY expensive overseas. You should turn off your roaming on your phone prior to your trip. Use Wi-Fi dialing and Wi-Fi access to get emails, texts, etc.
• Be very aware of the Wi-Fi provider and only use trusted sources.
• Make sure you are aware of your company’s international data and phone policy – it will be different from the normal usage.

Travel Resources: https://travel.state.gov/content/passports/en/go/checklist.html

In our previous post on Insurance Nexus Global Trend Map #3: Insurer Priorities, we explored where carriers are focusing their money, time, staff and training resources in their bid to stay relevant and competitive in today's fast-moving insurance market. Today we are continuing that theme, examining some bellwethers for the general health and future direction of the traditional industry:

1. Service-Area Round-Up (in which areas are services are being consumed?)
2. Investment Prognosis (how is investment in these areas changing?)
3. Job-Role Creation (recent job appointments within carriers)

This selection of statistics is drawn from the extensive survey we conducted as part of our Trend Map. If you'd like to see a full breakdown of our survey respondents and details of our methodology, please download the full Trend Map here. 1. Service-Area Round-Up It’s one thing to talk about general industry challenges (post #1) and priorities (post #3), but people’s money is often not where their mouth is. To provide some clarity here, we asked insurers and reinsurers where they are planning to use third-party services, selecting from a shortlist of 15 priority areas. The three most sought-after services among insurers and reinsurers globally were digital innovation (cited by 59% of respondents),-analytics (47%) and Internet of Things (34%). The high percentage of respondents seeking digital and analytics services is hardly a surprise, given that these were two of the top three global priorities for our insurer and reinsurer respondents, as we saw in our previous post on Insurer Priorities. The presence of Internet of Things in the top three is more noteworthy. In our previous post, we found IoT ranked 11th out of 15 on our global priorities list, yet here it appears to be one of the most-sought-after areas for third-party services. Unsurprisingly, and consistent again with our previous post on priorities, investment management is the least in-demand area for services.

"The importance carriers are attaching to analytics, digital and IoT is demonstrated by the numbers that are seeking third-party services in these areas." – Paolo Cuomo, principal at Boston Consulting Group (BCG) and co-founder at InsTech London

2. Investment Prognosis We asked our insurer and reinsurer respondents to indicate qualitatively, on a sliding scale, how much they expected investment to change in each of the priority/service areas we have been considering. Respondents saw investment increasing in almost all areas, which may indicate a bias toward bullishness. That said, the order of the different service areas should be a fair indication of which ones are most likely to attract whatever additional budget is available. In addition to being the key areas carriers are currently seeking services in, digital innovation and analytics are also due the largest increases in investment. Investment in IoT (3rd place among services sought) shows minimal increase. So, putting our two measures together, it would appear that digital innovation and analytics are attracting large and increasing investment from insurers and reinsurers, whereas Internet of Things is attracting large and steady investment. See also: Global Trend Map No. 2: Insurtech   As we saw in our first chart (under service-area round-up), product development was a relatively unimportant category when considering global demand for third-party services, with only 19% of carriers seeking services in this area – nonetheless, in the table above it displays one of the highest increases in investment (fourth place overall), suggesting that it may become a more significant category. The declining importance of investment management is most likely a reflection of globally low interest rates – this side of the insurance business, having become less lucrative, looks set to attract less spending on services.

"Insurers will invest in those areas that will support growth and differentiation or operational efficiency through innovation. These will range from delivering end-to-end innovative digital products to re-inventing the insurance value chain at the front end. A lot of these capabilities, though, rely on underwriting to achieve optimum results." – Sabine VanderLinden, managing director at Startupbootcamp

3. Job-Role Creation A key proxy for growth in any technology or business area is the creation of job roles relating to it. This is a useful measure for determining – beyond idle talk – which areas are genuine priorities or concerns for an industry. Based on our broader research, Insurance Nexus drew up a short list of emerging job roles within insurance companies, and asked insurer and reinsurer respondents to indicate whether these had recently been – or were soon due to be – created at their company. The results reflect the recent spike in importance of information security, which has doubtless been fueled by a series of high-profile cybersecurity incidents involving insurers, such as last summer’s data breach at U.S.-based Banner Health, in which as many as 3.7 million customers had personal data stolen. Thus, chief information security officer scores the highest out of the roles we considered in all the geographies we assessed (Europe, North America and Asia-Pacific). Comparing across regions, we see that chief customer officer assumes a higher relative importance in Asia-Pacific. As we noted in our earlier post Insurance Nexus Global Trend Map #2: Insurtech Perspectives, the real or perceived threat from new market entrants and disruptors was deemed highest in Asia-Pacific, and we speculated that this might be due to a larger proportion of the population being un- or underinsured, lacking ties to the traditional insurance model and thus representing an appetizing target for dynamic new players aiming to cut traditional carriers out. If this is true, it makes perfect sense for insurers in Asia-Pacific to place a special emphasis – including a whole new job role – on the customer. Sometimes, the relative prominence of different job roles may reflect variations in naming conventions rather than real differences on the ground. For example, we see that chief digital officer is relatively insignificant in North America compared with Europe and Asia-Pacific. On the other hand, these two regions both trail North America when it comes to the recent or forthcoming appointment of the chief analytics officer role. We know from the stats we have already presented in our previous posts, covering everything from challenges and priorities to investment and spending, that analytics and digital are both highly important in all three of these regions, so this disparity (with the job roles) is probably no more than apparent.

"Marketing/sales, human resources, underwriting, finance and claims are all being impacted by the growing focus on analytics. New roles are rapidly emerging — from a chief analytics officer to data scientists and engineers." – Margaret Milkint, manager partner at the Jacobson Group

We asked our carrier respondents to name any other significant roles of recent creation that we had missed. Our most significant omissions were, in no particular order:

• Chief risk officer
• Head of transformation
• Titles around "customer experience" and "customer engagement"
• Chief strategy officer
• Chief innovation officer
• Head of disruptive innovation
• Head of blockchain

Emerging job roles fall, it would appear, into one of two camps. We see that holistic strategy roles (also framed in terms of "transformation" and "customer-centricity") are becoming more and more important; indeed, one respondent lamented the lack of a "thought leadership officer" position. Then we have roles related to specific emerging technologies, such as blockchain – and we can expect the same with machine learning and AI. This spectrum reflects a major issue that insurers are likely to face from a staffing and organizational-structure perspective: Complex emerging technologies invite and often outright require specialization, yet the dependencies between divisions, technologies and initiatives within carriers become larger and larger every year. See also: Global Trend Map No. 3: Priorities   The ability to strike the right balance between these two camps – deep technical expertise on the one hand and a capacity to conceive and coordinate the big picture on the other – will be one of the key factors that separate the insurance wheat from the insurance chaff over the coming years. This concludes our exploration of the Global Trends. Tune in next time as we break into the Trend Map's 11 Key Themes, bringing you stats and perspectives on: We kick off with Insurance Nexus Global Trend Map #5: Analytics and AI. If you'd like to access all 11 Key Themes straightaway, though, simply download the full Trend Map whenever you like (it's free!). Download your complimentary copy of the full Trend Map here.

As I indicated in Part 10, I’m expecting the future role of the broker or agent to be severely curtailed. But that’s not to say there’s no role for intermediaries of a different type. In commercial lines, I expect to see an expansion of the push that some of the brokers have already made into broader risk management. The Risk Manager of the Future will provide a holistic risk management service to its biggest corporate clients – drawing heavily on IoT and big data analytics to predict risks real-time and prevent them from crystallizing. Only a small part of the risk manager’s service will involve insurance, but the risk placement process will be highly efficient. The risk manager will be seamlessly integrated with a wide network of insurers that, together, can meet all of the insurance needs of clients. See also: The Insurer of the Future – Part 10   The risk manager will place business in two ways: standard and bespoke. However, those terms describe the relationship not with clients, but with partner insurers. If a risk is standard, such as marine or aircraft cover, the Risk Manager of the Future will already have made arrangements to place pre-agreed percentages or exposure bands with a range of different insurers. And those business rules will be built into a “risk placement hub” linked directly into those insurers' core systems. This means that the risk can be underwritten in accordance with those pre-agreed arrangements, and policy documents generated, in a matter of seconds. If, on the other hand, the risk doesn't match previously agreed arrangements, the Risk Manager of the Future's “cognitive placement engine” will swing into action. This will pull together all the information it can on the risk, trawling multiple internal and external sources. It will then automatically pass that data to the underwriting systems of multiple different insurers, negotiating pricing with the AI engines of those individual Insurers and constructing the optimum cover for a client -- making trade-offs between the different insurers as appropriate. Again, once the cover package has been designed and placed, policy documents will be generated automatically and issued to the client. See also: Innovation: ‘Where Do We Start?’   Using the power of data analytics and AI, this entire process, end-to-end, will take no more than a couple of minutes.

You know those "three biggest lie" jokes? The third biggest lie would be: "I'm from Interactive Health, and I'm here to help you." Hilarious... unless you are one of those unfortunate souls who are:

1. paying their bills;
2. believing their outcomes; or
3. taking their advice.

The first and third are closely related in the sense that one would think, with their fees – which rank among the wellness industry’s highest due to their industry-leading embrace of hyperdiagnosis — they could afford to train their employees in wellness. See also: Healthcare: Need for Transparency   However, because they apparently forgot to check that box, I’ll do it for them. I owe them this favor, having recently made unflattering observations regarding their botched cover-up of their invalid outcomes reporting. First the good news No one can accuse Interactive Health of wasting money on excessively silly, excessively gimmicky, excessively readable user interfaces. Here is the advice they give to employees, all 1,350 words of it, starting with Page 1: But wait…there’s more. Page 2: And for all those employees who simply have too much free time on their hands at work, Page 3: More good news. They do tell this employee, after informing her that she has metabolic syndrome, to “avoid sugar.” Credit the law of averages with that — if you write 1,350 words, it is likely that two of them —  0.14% — will be correct. These two words are in the middle of the second page, so I’m sure she saw them. Who wouldn’t? Next, the bad news To prevent that metabolic syndrome from progressing to diabetes, the letter also recommends “lowfat or nonfat dairy” in the diet. However, according to the the journal Circulation, people with the most dairy fat in their diets had a 50% lower risk of diabetes. Likewise, a study of 18,000 women showed lower obesity among those who consumed full-fat dairy. Journal articles are likely beyond Interactive Health’s grade level, so here are two lay summaries and two lay books:

1. The Skim Milk Scam: Words of Wisdom from a Doctor Dairy Farmer
2. Lowfat Dairy: Zombie Guidance
3. The Big Fat Surprise
4. The Bad Food Bible

It’s not just dairy fat, where the science, though perhaps not definitive, is settled enough that even the dumbest wellness vendor should know not to tell diabetics to switch to skim milk. It’s also saturated fat in general, where the change in scientific understanding over the last 10 years has caught many wellness vendors by surprise, and they haven’t had time to react. If consumed in large quantities, perhaps saturated fat may be a heart disease risk factor nonetheless.  Who are we to say? However, if it were a culprit of any significance — like trans fats or cigarettes or family history — that conclusion would be definitive by now, given the massive amount of research that’s been thrown at this question.  Even if saturated fat were a minor risk factor, there is still one overriding reason that Interactive Health shouldn’t be telling people with metabolic syndrome to eat less fat: What the he** do they think people will eat instead? There is a whole body of literature on how telling people to eat less fat helped create the obesity epidemic. In all fairness to Interactive Health, they recommend eating only less dairy and other saturated fat, not less total fat. However, that is a subtlety that can get lost in those 1,350 words brimming with all sorts of random advice. For instance, on the subject of abnormal thyroid function, the letter says: “Talk with your healthcare provider about possible treatment options for this condition.” Sound advice indeed — if in fact the person in question had abnormal thyroid function, but according to this report (bottom of Page 2), her “thyroid was normal.” More bad news Even though this person does not have high blood pressure, the letter also recommends eating less salt. For people without high blood pressure and especially people like her who have other diabetes and cardiac risk factors, avoiding salt is likely a bad idea. Other than the answer being different for different people and different ethnicities (subtleties overlooked by almost all wellness vendors, which prefer to give blanket advice), the science is unsettled. It does, however, increasingly point to the importance of salt — something humans have been consuming in large quantities ever since way before the Roman empire paid its soldiers in salt — in the diet. This is especially the case for people with, or at risk for, diabetes or heart disease (which this person is). In particular, for people without hypertension, reducing salt intake to a level much below the U.S. average:

• is associated with higher risk of death among diabetics
• may increase insulin resistance
• may increase risk of death from heart disease
• may increase total and “bad” cholesterol

Among other limitations,  most of these studies are correlative, not causative, and rely on self-reporting rather than controlled environments.  So we can’t conclude with certainty that avoiding salt is a bad idea. Nonetheless, my suspicion is that companies paying Interactive Health millions of dollars — and basically forcing their employees to choose between submitting to them or losing money — have assumed that the advice they are giving employees is settled and likely correct, rather than controversial and likely incorrect. Other studies, generally older ones, recommend low-salt diets to prevent high blood pressure, so it is still at least arguably fair to say salt science is conflicted. But the overriding reason for Interactive Health to stop telling employees at risk for diabetes to eat less salt and less saturated fat is, what the he** do you think they are going to eat instead? Because most proteins come with saturated fat (and salt), there is only one thing left to eat: carbohydrates. The bottom line is that anyone who actually takes Interactive Health’s advice on how to avoid diabetes is likely to increase their odds of getting diabetes. See also: Wellness Isn’t the Only Scam in Healthcare  Fortunately, most employees will have the good sense to ignore their advice, if for no other reason than it is quite a Herculean task to plow through it all. How do I know this? By definition, any employee reading this blog is more health-conscious than average. And yet the particular employee who, after reading my blog post on them, sent me this letter originally sent me only the first and third pages. She hadn’t even realized there was a second page, because Interactive Health printed it on the back of the first page. Ironically, that was the page where it said “avoid sugar.” The “coaching” call In addition to the letter, this employee did receive a coaching call, described as follows: When they called to offer me advice, they simply said, “ Do you know you have high cholesterol?” I said, “Yes.” Then she proceeded to ask me what I was going to do about it. I said: “I thought you would tell me what to do.” She had nothing to say. Then I received another call a few weeks later as a follow-up, and I wanted nothing to do with them as they had already discredited themselves with the first call.   In yet another installment (which will have to wait until 2018 because December is devoted to highlighting the best-in-shows of the wellness industry and, of course, the Deplorables Awards) we’ll explain how Interactive Health translates ignorance of clinical guidelines, bad dietary advice and massive hyperdiagnosis into quite literally the most inflated savings in the wellness industry this side of Wellsteps.