I have gone through a few product implementations using analytics and have come to realize that there is a simple success mantra: the human brain. Humans have an amazing inherent capability to comprehend patterns and apply what we learn. It all starts with how our senses respond and make the IoT within us (which has been designed so meticulously and flawlessly) the most powerful among all IoT applications. So what do we need to be able to mimic the same “sense and respond” mechanism when it comes to our business growth and analytics? How can we predict the success rate before we embark on an analytics journey to grow our business? How much failure should we tolerate before calling our analytics engagements a total disaster? See also: Applied Analytics Are Key for Progress   There are three keys to remember as we start on this path so that there are no surprises along the way: 1. People: The right talent can bring silos within an organization together. Use your internal business experts or practitioners to define their everyday issues and try to find the origin and impact. What is keeping you up at night? Without a goal, analytics is the magic that will remain within the genie's oil lamp. Once you have a goal, prepare to make some changes based on the results of the analytics. If the analytics are not actionable at the end, your goals are inaccurate. If you are a person who says, “I will let analytics tell me what to do. Where do I start?,” I would advise you to start with hiring the right talent who can help you define those goals and underline the problems or establish strategies for product and company growth. Finding answers through analytics may seem less daunting. Internal and external collaboration and goals are the first milestones. 2. Process: If you are not intending to make business process changes based on feedback from analytics, you are not ready for analytics — whether it's predictive, AI, IoT, machine learning or blockchain. Once you identify your goals, you have established a destination. Now you need the right driver, vehicle, sufficient gas and the right path to get you there. But if you never intended to make that journey, then the effort behind it is fruitless to begin with. Analytics is just the fuel, so you need a driver who will make the journey. Without actionable outcomes, your analytics will sound like glorified expensive reporting. Management must be prepared for strategic changes based on what analytics reveals and must expect this to be a continuing effort. Analytics should run parallel to — and a little ahead of — your business so that you have time to put it into action and see if the results pivot or move ahead. 3. Technology: Questions such as “What can your system do?,” “Can you do social media?” and “When can I get predictions?” will confuse you on your analytics journey. Predictions should be the end product if you can claim success in automating data gathering, modeling, enrichment, pattern detection, deep learning and artificial intelligence. As a business owner, own the process. Own its deficiencies and its growth path so you can then forecast where you would like to be. Now rephrase the question, “Can ‘X’ technology help me solve my problem?” Try to focus on your process and on how the technology can help solve your problem. Solutions, technology and software should be the flexible part — the variant should be replaceable/enhanceable when your goals change. See also: Why Data Analytics Are Like Interest   Build or buy? If you are not a software or technology company, invest in business experts, people, process changes and customer engagement. Invest less on building something from scratch. Software companies can monetize by reusing their solutions and evolving their products, but core businesses must maintain, support and enhance everything they build. Technologies have limitations, which is why they evolve so frequently. To take advantage, buy technologies and find solutions that will give you immediate ROI. But if you like to build from scratch, be prepared to fail, detect missing ingredient, replace and move on!

Reality is tough to capture. It keeps moving. But somehow we’re growing faster and better at capturing it. Consider visual reality. In 200 years, we’ve moved from illustrations and paintings, through still photography and into motion pictures. We then created technologies to transport the motion pictures across space to the places we wanted it. We’re now looking at 4K televisions and talking to family with FaceTime or Skype on displays that have the same or greater resolution than our eyes. Data’s reality is no different. Back in the late 1980s, I did work for a paint manufacturer, trying to monitor the real-time operating conditions in one of its paint plants. We connected some PCs to the plant’s programmable logic controllers and then asked the controllers every 30 seconds, “How are things going? What are you working on?” The controllers spit out lots of data on operating conditions. We charted, we graphed (in real time!), and the plant operators had new insights on how things were going with paint production. We were augmenting the physical instrumentation of the plant with virtual instrumentation. Instrumentation — Data’s Virtual Reality   So how is your insurance company instrumented? Are things running a little hot? Do you find yourself running short on any raw materials? How full is the pipeline? When do you find that out? Is it tucked into a spreadsheet a few weeks after the end of the month? Could you make more money if you found out in five minutes instead of five weeks? Are “modern” insurers still living on static pictures of data’s reality? Insurance leaders are creating real-time instrumentation for their companies, allowing them to open and close everything from granular geographies to wind risk and monitor premium production compared with last week, last month, last quarter, last year, as of today or any day. To better instrument our companies we need to think about: acquisition and transportation; accuracy; presentation timing and type; automation and cognitive capabilities; and actions and reactions. When you finish this post, I think you’ll agree with me that instrumentation should carry a high priority in insurance’s digital agenda. See also: How Virtual Reality Reimagines Data   Acquisition and Transportation of Data How do we monitor the data in a flow of information in constant motion, not just the discrete sets that are static and in place? First, our goal is to NOT be another weigh station in a step-by-step process. We need to be tapped into the flow without impeding it. To do this, we set up measurement devices that allow us to peek into the flow and draw of our information, then shuttle it to where we need it. This is not unlike the earliest “vampire” network connectors, feeding on Ethernet cables as opposed to a light socket sitting within a circuit. There are any number of tools that one can use for real-time streaming and visualization, but the key to having any of them working properly is the setup of the data acquisition. A vampire approach will allow for real-time monitoring, as opposed to relying on continual requests and responses from data sources. Accuracy of Data One of the challenges in looking at continuous data is that spurious results may throw off the averages, so we need to be careful about outlier events. When looking at real-time data, it is far more likely that outliers will appear. For example, as I was driving the other day, one of the “Your speed is...” signs I passed registered 110 mph. (I’ve driven 110 mph before, but not this day.) It quickly corrected itself to 55 mph. Data “in flight” like that needs the right periodicity to make sure that it is capturing the 55s, not the spurious 110s. And data obviously needs to be trained on what to notice and what to ignore. Automated removal of outliers helps keep the data pure. Keeping a concrete set of rules regarding data’s use will be very important in allowing people to trust the data when it is presented. Presentation Timing and Type In 2007 and 2008, Starbucks began opening stores as an undisciplined growth strategy. Eighteen months later, many of them were shuttered in a massive restructuring. In 2011 and 2012, Starbucks was adding stores again, but this time based on GIS traffic-flow data and demographics. Real-time reporting had become a more valued part of the business structure. Former Starbucks CEO Howard Schultz reportedly received store performance numbers as frequently as four times each day. How often an insurer needs data and how it wishes to have information presented is a matter of need and preference, but it can clearly be tied to business strategy. For one client we worked with, they realized that continual data visualization in public locations, such as lobbies and meeting areas, helped the whole community see how important data was to the decision process. Others may wish to keep their data tucked out of sight but still available via tablet or cell phone. Depending on the insurer and the insurer’s reactive capability, they may want feedback every day, every hour or every few minutes. Whether you choose to use dashboards, standard reports or e-mailed updates will also depend on your role and your need to know. Automation and Cognitive Use One of the drawbacks to data visuals of any kind is that they are subject to perspective. Trends and movements can be hard to spot over time. Anyone familiar with Excel line graphs will understand what I’m talking about. The graph below looks fairly flat.  But it shows a 5% move from start to finish.  Identifying that size movement will be important. Here is where automation in data’s motion pictures plays an important role. If the system can “learn” what good performance looks like, then it can also improve its ability to communicate vital information in a timely manner. I was just on a call where we discussed facial recognition in insurance. The use case was that there are teams working to identify faces and emotions on faces. If we have tools that can tell if someone is unhappy, surely we can use those tools to recognize a hidden pattern in our data. Data’s flow won’t just represent current trends, it will also identify oft-hidden patterns. What we think we know from our common snapshot approach to data may be overturned when cognitive capabilities start to bring new insights to our eyes. Once again, data’s motion pictures aren’t just for our own amusement, but they greatly enhance our strategies and decisions. Actions and Reactions If I run a chemical plant, I’m deeply concerned with monitoring real-time flow. Every action I take to tune that plant has a reaction. As insurers, we should also be concerned with real-time flow, capturing our understanding of reality. But there is also a historical component to data’s adjustments. In the chemical plant, if I change the mixture of a certain compound based on my data and the new mixture works, then I need to capture that moment in time as well. It is equally important for insurers to capture the timing of their corrective actions to make sure that we can see the relationship between action and reaction. See also: Your Data Strategies: #Same or #Goals?   Overlaying notes to explain that “we reduced available capacity in less profitable zip codes in June” should show some point of inflection in our results. Having that as a part of our reporting is critical to creating the positive action, a reaction cycle that we want to reinforce. We have an embarrassment of riches when it comes to data, and we are only going to get richer in the coming years. By instrumenting our organizations and realizing that we need some new tools and techniques to turn that information into actions that create the right reactions in our organizations, we can improve our results every day, week and month — not just when we close the books.

Backed with new capital, powered by digital technology and using decentralized administration, a new model for transparent, simple and customer-focused life insurance couldn’t be easier to visualize. And competition from newcomers means existing providers must innovate. But what can traditional insurers do specifically to -- to paraphrase management theorist Peter Drucker -- predict the future by creating it? Today’s insurance market is a customer-centric, buyer’s arena that reflects a palpable shift in power from the producer to the consumer. Insurers’ service offerings need enhancement. If it is felt little value is added to consumers’ daily lives, customers often fail to see the relevance of the importance of cover. Technology can help insurers to innovate and address this gap and deliver enhanced services. By striving for simplicity, insurers can also increase transparency. That said, no matter how simple the front end is made for the customer, acquiring cover remains an intricate process. Advice, compliance and regulation can clog the process but offer important protection to consumers. There is a delicate balance to achieve. See also: 7 Steps for Inventing the Future   Letting people engage in the ways they want is crucial. Trust and advice seem somehow less important to people than before. Today, people make emotional decisions with far fewer facts, and for many a community-based recommendation will do. This combination suggests that social brokering will only grow in importance and that demand for automation with robo-advice will increase. Consider the disintermediation -- the reduction in intermediaries - that transformed High Street banking. An appointment with the manager is no longer needed to set straight one's personal financial affairs. We fend for ourselves by banking online and using mobile-first apps to view statements, to set up transactions and to move money about. Customers now have similar expectations of life insurance. To provide more flexibility, insurers can offer products that work in a completely modular way -- products that can be built up or down and switched on and off to reflect much better how life’s risks ebb and flow. It’s likely the silo-based approach to the design and sale of line-of-business products is not sustainable. Product fragmentation with more diverse offerings will offer tailored products that fit with the way people live their lives. Personalization gives insurers the opportunity to transform the services they offer and take a real stake in the future health of their policyholders. One way is to shift from risk identification to risk prevention that is based on knowledge of behavioral change. While using data from wearables is a start, more support can be provided -- not just to the fittest customers -- by developing apps and technology that engage their unique health needs. Data from health apps, for example, is just one source that will give insurers access to a real-time view from which to assess risk, instead of relying on past data. However, continual engagement requires transformational change in the industry. To achieve this, insurers can -- and are -- engaging with experts and companies outside the sector. As the boundaries between insurance and adjacent businesses fade, roles and skill sets within insurance will also change, resulting in a need for more diverse recruitment. See also: How to Build ‘Cities of the Future’   Much is being said about big data, in particular how better use of the insights can make insurers' operations leaner. But analysis of large datasets gives established corporates and newcomers to the industry identical insight. While agility of execution may favor startups, it’s industry knowledge that puts insurers in a strong position to turn data into actionable insights. For more perspective on how technology is changing life insurance, click here.

It’s likely that when people hear about the growing opioid addiction problem in America, the face that comes to mind is the one commonly shown on TV and in the movies, which is a very broad generalization : the young, strung-out heroin addict living on the streets. Or dying of an overdose. Heroin abuse is definitely a growing problem in America. But it’s not the only opioid-related issue we’re facing. In 2012, an estimated 2.1 million people were suffering from substance abuse disorders from prescription opioid use, and deaths from accidental overdoses of prescription pain relievers quadrupled between 1999 and 2015. Sales of prescription opioids also quadrupled during this period. While prescription pain killers are often seen as a gateway drug to heroin among the young, the issue is much broader than just one demographic group. The reality is that the face of opioid addiction could be the soccer mom down the block who has been experiencing back pain. It could be the marathon runner who is trying to come back after knee surgery. It could be your grandmother baking cookies as she works on recovering from hip replacement surgery. In fact, it could be anyone. And that diversity is what has made prescription opioid addiction so difficult to manage. Drivers of addiction What is driving this explosive growth of such a potentially dangerous substance? Part of it, quite frankly, has been the incredible improvements in healthcare over the last 20-some years. Hip replacements, knee replacements, spinal surgery and other procedures that were once rare are now fairly common. More surgeries mean more patients who need pain relievers to help them with recovery. The greater focus on patient satisfaction, especially as the healthcare industry shifts from fee-for-service to value-based care, has also had some unintended consequences. Physicians concerned about patient feedback from Healthcare Effectiveness Data and Information Set (HEDIS) measures or Medicare Star ratings have additional incentive to ensure patients leave the hospital pain-free. Physicians may prescribe opioids, particularly if patients request them, rather than relying on less addictive forms of pain management. See also: In Opioid Guidelines We Trust?   Here’s how that translates to real numbers. An analysis of 800,000 Medicaid patients in a reasonably affluent state showed that 10,000 of them were taking a medication used to wean patients off a dependency on opiates. This particular medication is very expensive and difficult to obtain – physicians need a specific certification to prescribe it. So it is safe to assume that the actual number of patients using prescription opiates is two to three times higher. Those numbers aren’t always obvious, however, because the prescriptions may be obscured under diagnoses for other conditions such as depression. Indeed, more than half of uninsured nonelderly adults with opioid addiction had a mental illness in the prior year and more than 20% had a serious mental illness, such as depression, bipolar disorder or schizophrenia, according to the Kaiser Family Foundation. The result is that, without sophisticated behavioral analytics, it can be difficult to determine all the patients who are addicted to opioids. And what you don’t know can have a significant impact on care, costs and risk. Complications, risk, and prioritization Opioid addiction tends to interfere with the treatment of other concerns, especially chronic conditions such as depression, congestive heart failure, blindness/eye impairment and diabetes. As a result, physicians must first take care of the addiction before they can effectively treat these other conditions. That is what makes identifying patients with an addiction, and prioritizing their care, so critical. Failure to do so can be devastating, not just clinically but financially – especially as healthcare organizations take on more risk in the shift to value-based care. Take two patients with an opioid addiction who are on a withdrawal medication. Patient A also has eye impairment while Patient B is a diabetic. If the baseline for cost is 1, analytics have shown that Patient A will typically have a risk factor of 1.5 times the norm while Patient B, the diabetic, will have a risk factor of 5 times. Under value-based care, especially an Accountable Care Organization (ACO) where the payment is fixed, the organization can lose a significant amount of money on patients who are costing five times the contracted amount. For example, if the per member per month (PMPM) reimbursement for the year is $2,000, this patient -- who is using this medication for withdrawal from an opiate dependency and is a diabetic -- will end up costing $10,000. It is easy to see why that is unsustainable, especially when multiplied across hundreds or thousands of patients. Yet the underlying reason for failure to treat the diabetes effectively – the opioid addiction – may not be obvious. Healthcare organizations that can use behavioral analytics to uncover patients with hidden opioid dependencies, including those on withdrawal medications, will know they need to address the addiction first, removing it as a barrier to treating other chronic conditions. That will make patients more receptive to managing conditions such as diabetes, helping lower the total cost of care. They can also use the analytics to demonstrate to funding sources why they need more money to manage these higher-risk patients successfully. They can demonstrate why an investment in treating the addiction first will pay dividends in the long term with a variety of chronic conditions. See also: How to Attack the Opioid Crisis   Many faces It’s easy to see that opioid abuse in all forms has reached epidemic levels within the U.S. What is not so easy to see at face value is who the addicts are -- or could be. Despite popular media images, the reality is that opioid addition in America has many faces. Some of them may be closer to us than we think. Behavioral analytics can help us identify with much greater clarity who the likely candidates are so we can reverse the trend more effectively.

Artificial intelligence (AI) is advancing so rapidly that even its developers are being caught off guard. Google co-founder Sergey Brin said in Davos, Switzerland, in January that it “touches every single one of our main projects, ranging from search to photos to ads … everything we do … it definitely surprised me, even though I was sitting right there.” The long-promised AI, the stuff we’ve seen in science fiction, is coming, and we need to be prepared. Today, AI is powering voice assistants such as Google Home, Amazon Alexa and Apple Siri, allowing them to have increasingly natural conversations with us and manage our lights, order food and schedule meetings. Businesses are infusing AI into their products to analyze the vast amounts of data and improve decision-making. In a decade or two, we will have robotic assistants that remind us of Rosie from “The Jetsons” and R2-D2 of “Star Wars.” See also: Seriously? Artificial Intelligence?   This has profound implications for how we live and work, for better and worse. AI is going to become our guide and companion — and take millions of jobs away from people. We can deny this is happening, be angry or simply ignore it. But, if we do, we will be the losers. As I discussed in my new book, “Driver in the Driverless Car,” technology is now advancing on an exponential curve and making science fiction a reality. We can’t stop it. All we can do is to understand it and use it to better ourselves — and humanity. Rosie and R2-D2 may be on their way, but AI is still very limited in its capability, and will be for a long time. The voice assistants are examples of what technologists call narrow AI: systems that are useful, can interact with humans and bear some of the hallmarks of intelligence — but would never be mistaken for a human.  They can, however, do a better job on a very specific range of tasks than humans can. I couldn’t, for example, recall the winning and losing pitcher in every baseball game of the major leagues from the previous night. Narrow-AI systems are much better than humans at accessing information stored in complex databases, but their capabilities exclude creative thought. If you asked Siri to find the perfect gift for your mother for Valentine’s Day, Siri might make a snarky comment but couldn’t venture an educated guess. If you asked her to write your term paper on the Napoleonic Wars, she couldn’t help. That is where the human element comes in and where the opportunities are for us to benefit from AI — and stay employed. In his book “Deep Thinking: Where Machine Intelligence Ends and Human Creativity Begins,” chess grandmaster Garry Kasparov tells of his shock and anger at being defeated by IBM’s Deep Blue supercomputer in 1997. He acknowledges that he is a sore loser but was clearly traumatized by having a machine outsmart him. He was aware of the evolution of the technology but never believed it would beat him at his own game. After coming to grips with his defeat, 20 years later, he says fail-safes are required … but so is courage. Kasparov wrote: “When I sat across from Deep Blue 20 years ago, I sensed something new, something unsettling. Perhaps you will experience a similar feeling the first time you ride in a driverless car, or the first time your new computer boss issues an order at work. We must face these fears in order to get the most out of our technology and to get the most out of ourselves. Intelligent machines will continue that process, taking over the more menial aspects of cognition and elevating our mental lives toward creativity, curiosity, beauty and joy. These are what truly make us human, not any particular activity or skill like swinging a hammer — or even playing chess.” In other words, we better get used to AI and ride the wave. Human superiority over animals is based on our ability to create and use tools. The mental capacity to make things that improved our chances of survival led to a natural selection of better toolmakers and tool users. Nearly everything a human does involves technology. For adding numbers, we used abacuses and mechanical calculators and now have spreadsheets. To improve our memory, we wrote on stones, parchment and paper, and now have disk drives and cloud storage. AI is the next step in improving our cognitive functions and decision-making. Think about it: When was the last time you tried memorizing your calendar or Rolodex or used a printed map? Just as we instinctively do everything on our smartphones, we will rely on AI. We may have forfeited skills such as the ability to add up the price of our groceries, but we are smarter and more productive. With the help of Google and Wikipedia, we can be experts on any topic, and these don’t make us any dumber than encyclopedias, phone books and librarians did. A valid concern is that dependence on AI may cause us to forfeit human creativity. As Kasparov observes, the chess games on our smartphones are many times more powerful than the supercomputers that defeated him, yet this didn’t cause human chess players to become less capable — the opposite happened. There are now stronger chess players all over the world, and the game is played in a better way. See also: Microinsurance? Let’s Try Macroinsurance   As Kasparov explains: “It used to be that young players might acquire the style of their early coaches. If you worked with a coach who preferred sharp openings and speculative attacking play himself, it would influence his pupils to play similarly. … What happens when the early influential coach is a computer? The machine doesn’t care about style or patterns or hundreds of years of established theory. It counts up the values of the chess pieces, analyzes a few billion moves, and counts them up again. It is entirely free of prejudice and doctrine. … The heavy use of computers for practice and analysis has contributed to the development of a generation of players who are almost as free of dogma as the machines with which they train.” Perhaps this is the greatest benefit that AI will bring — humanity can be free of dogma and historical bias; it can do more intelligent decision-making. And instead of doing repetitive data analysis and number crunching, human workers can focus on enhancing their knowledge and being more creative.

As policymakers inside the beltway negotiate the future of the American Health Care Act (AHCA), the focus appears to be on who will pay for healthcare, how it will be subsidized and whether the state insurance exchanges will remain viable. The assumption is being made that access to care is the same as access to high quality care, and the driving force for change to the AHCA are these cost issues. In this changing marketplace, it is imperative that insurers consider the quality of care being provided, in addition to the finances, because medical errors and poor care cost us all in the long run. There is good news for insurers in this battle of ideologies. Certified Physician Assistants (PA-Cs) deliver on both fronts, providing high-quality care in a cost-effective manner. A 2016 article in the Journal of Clinical Outcomes Management showed no significant difference over 18 months in patient mortality, hospital readmissions, lengths of stay and consults with specialists when care was led by PAs compared with doctors. Additionally, PA-Cs can help meet the new and still confusing performance metrics designated by the Centers for Medicare and Medicaid services, such as the new Medicare Access and CHIP Reauthorization Act (MACRA). For these reasons, it is important that insurers and all healthcare stakeholders understand the role and qualifications of Certified PAs in healthcare today, including: education and commitment to lifelong learning; rigorous certification; how PAs are compensated and reimbursed; and the demographics and distribution of PAs around the U.S. These insights will help insurers understand how PA-Cs can contribute to improved cost management and patient satisfaction metrics while meeting patient needs and regulatory demands. First, consider the credentials of Certified PAs. Certified PAs are prepared and proven to meet the needs of patients today through a combination of a graduate level education and a rigorous certification and certification maintenance process. PA-Cs are educated in the medical model. Like physicians, they maintain certification at the highest level in healthcare. They must earn substantial continuing medical education (CME) credits every two years and sit for a proctored exam that covers general medical knowledge every 10 years to remain certified. Certification is a hotly debated topic in healthcare today. There is an anti-maintenance of certification (MOC) movement — a belief that initial assessment by exam after graduating from school is sufficient and maintenance of certification should be through CME only. See also: What Physicians Say on Workers’ Comp   Periodic assessment helps to ensure that PAs maintain and objectively demonstrate a baseline fund of knowledge that is essential for practice across the health care spectrum. The combination of substantive, relevant CME and periodic assessments ensure that PA-Cs maintain relevant knowledge throughout their careers. The National Commission on Certification of Physician Assistants (NCCPA) believes this combined approach reinforces the public trust and assures employers and payers that PA-Cs provide the safe, quality care patients should expect and demand. Who we are; where we practice NCCPA has the most comprehensive source of workforce data for the PA profession, with input from 94% of the nation’s PA-Cs. From that, we publish four reports annually detailing statistics on: all Certified PAs; those in 22 specialties; PA demographics by state; and on those PAs who were newly certified in the previous year. Here are some key findings:

• More than 70% of Certified PAs now practice in specialties outside primary care. There are 103 Certified PAs for every 1,000 physicians in the U.S., with notably higher ratios in surgical subspecialties, emergency medicine and dermatology.
• The median age of Certified PAs is only 38, so they are not nearing retirement age like many physicians. Only 0.6% planned to retire in 2016.
• The states with the largest number of PAs are New York, California, Texas, Pennsylvania and Florida. However, three of the top five states with the largest number of PAs per capita are Alaska, South Dakota and Montana, indicating that Certified PAs often fill the void for healthcare in rural areas.
• Certified PAs make an average salary of more than $104,000, which is less than half of a physician, making them an affordable provider who can still meet the clear majority of patient needs.

PA-Cs are everywhere, in every specialty, clinical setting and state, with services running the gamut from providing core medical services to performing surgical procedures, to assisting in complex surgical procedures.

• Almost 19% practice in surgical specialties like cardiovascular and thoracic surgery and orthopedic surgery, handling pre-ops and post-ops but also performing procedures like vein harvesting, central IV-line placement, lumbar punctures and fracture reduction.
• More than 14% are employed in emergency medicine, working in every area from fast track to admitting patients to the hospital or referring for follow up to a community physician.
• Almost 1.5% practice in psychiatry, managing patients with the gamut of mental health issues from anxiety to schizophrenia, providing continuity of care for patients on long-term medications and helping to detoxify substance abuse patients and referring for counseling.
• They manage complex patients with multiple co-morbidities and conditions such as diabetes, HIV and hypertension.
• Certified PAs are also improving efficiency in work places across the country, working on task forces to develop telemedicine programs, observation units to reduce hospital admissions and processes to increase patient satisfaction.

How PAs are paid and reimbursed Most PAs are employed and salaried providers. In some states, Certified PAs can own their own business, with a physician as medical director. Medicare pays PAs at 85% of the physician fee to perform the same services. Medicare increases that to 100% if the service is “incident to” the physician’s care. To be considered as “incident to,” the physician must perform the full first visit, services must be rendered in the office/clinic and a physician must be onsite when PAs treat the patient. Hospitals that employ PAs bill for their clinical services under Medicare Part B. Most often, private insurers follow Medicare guidelines. Thus, Certified PAs represent immediate cost-savings for insurers. See also: Medicare Implements Value-Based Purchasing   Q. What do MACRA, HCHAPS, PCMH, ACO, ACA have in common? A. Value-based care! Whether the ACA is changed or repealed, the demand for quality and cost-effective care will not lessen. Every healthcare model is seeking data to back up its promises. As patients, we all want to see metrics that can be replicated so that we know we are getting the best value care for our money. Solutions need to be refined in everything from clinical setting to workflows. However, as in any business, staff is one of the most significant factors in success—what they do and how much it costs for them to do it. As Congress debates how we pay for this coverage, and wrangles about the details of exchanges and subsidies, insurers are being asked to reduce the cost of healthcare insurance, while at the same time being true to stakeholders, be they public or private, by remaining profitable. The simple answer is to reduce the cost of medical care. Employing Certified PAs is one way employers can do that. Knowing they maintain certification at the highest standards in healthcare provides a level of assurance that PAs are a quality solution, not just a lower-cost solution. That should boost confidence in reimbursing Certified PAs who, at the end of the day, are a bargain for payers.

With the federal government’s announcement that it is considering expanding its MSA review process to include up to 51,000 MSAs for liability insurance and no-fault settlements, the liability MSA issue should be front and center for all parties resolving liability insurance claims. Non-compliance in this area has been rampant over the years, and changing your habits now is critical to ensuring a closed file remains closed from the federal government’s perspective. Addressing MSA issues in liability claims: What are you waiting for? In 1980, Congress enacted the Medicare Secondary Payer (MSP) Act. 42 U.S.C. § 1395y(b)(2). From this law (and following administrative policy statements from the federal government), parties resolving workers’ compensation (WC) claims became concerned about the application of Medicare Set-Aside Arrangements (MSAs). Today, we see the MSA issue often grinding a WC settlement to a halt for a variety of reasons. Strangely, the same broad level of concern has never really existed for those resolving auto, liability or no-fault claims. This article explores why, historically, these MSA issues have only resonated in the WC community. By comparing the issue in the WC context versus the liability context, you will see that parties resolving liability claims without addressing the MSA issue (more accurately stated as the future medical issue) expose themselves needlessly to the federal government asserting recovery for future medical expenses it paid mistakenly on behalf of its beneficiary. This exposure could lead to the federal government pursuing recovery of double (or, perhaps, treble damages. Recently, the federal government announced it is considering expanding its MSA review process to include liability and no-fault cases. No one wants to be the ones the federal government targets for non-compliance. Perhaps the Chinese philosopher Sun Tzu said it best in “The Art of War”: “The greatest victory is that which requires no battle.” At this point, if you are not yet addressing liability MSA issues as standard operating procedure on every single case, what are you waiting for? Background In 1980, Congress enacted the MSP Act. With the goal of extending the life of the Medicare Trust Funds, the MSP Act provides that the federal government should not pay for a beneficiary’s medical expenses when payment has been made under a workers’ compensation policy or plan, an automobile policy or plan, a liability insurance policy or plan (including self-insurance) or a no-fault plan. When the federal government’s right of recovery under the MSP Act is triggered, the parties involved in the claim have the responsibility to make sure Medicare does not pay a bill prematurely that had been paid previously as part of the settlement, judgment or award. See also: Medical Liability Insurance (Video)   In 2001, the federal government — through what is now known as the Centers for Medicare and Medicaid Services (CMS) — first verbalized its statutory interpretation of the MSP Act as applying not only to past medical expenses but also to future medical expenses. In what became known as the “Patel Memo,” CMS described situations in WC claims where parties should consider funding an MSA to ensure that Medicare is not asked to pay a medical bill prematurely on behalf of one of its beneficiaries. Since 2001, CMS has provided ample guidance in the form of additional policy memoranda and a reference guide that incorporates that policy memoranda for those who wish to ask CMS to review and approve an MSA as part of resolving a WC claim. Today, MSA concerns are commonplace in the WC community but not in the liability insurance community. Why is that? Statutory and Regulatory Language As a launching point, it’s important to understand the MSA statutory and regulatory landscape. In short, there is none. That’s right — neither the MSP Act itself nor the regulations enacted by CMS to provide its official interpretation of the MSP Act discuss or even mention the terms “Medicare Set-Aside” or “MSA.” Further, the Medicare Act provides that “The Secretary shall prescribe such regulations as may be necessary to carry out the administration of the insurance programs under this subchapter. In situations where regulations are not enacted, the Medicare Act provides that “No rule, requirement or other statement of policy … that establishes or changes a substantive legal standard … shall take effect unless it is promulgated by the Secretary by regulation under paragraph (1).” 42 U.S.C. § 1395hh(a)(2). As the MSP Act is a subpart of the Medicare Act, this applies to the MSP Act as well. Plainly put, because no regulation exists about MSAs today, there is no substantive legal standard parties must meet with respect to MSAs themselves. However, parties focusing on the so-called “MSA requirement” have missed the forest for the trees. An MSA is one possible tool to comply with the obligation to make sure Medicare does not pay a medical bill that is someone else’s responsibility. That same broad prohibition has existed under the MSP Act since Dec. 5, 1980. "Medicare will not pay for a beneficiary’s medical expenses where payment has been made under a workers’ compensation plan, an automobile plan, a liability insurance plan (including self-insurance) or a no fault plan." 42 U.S.C. § 1395y(b)(2)(A)(ii). The same statute addresses future medical expenses that Medicare could potentially be asked to make post-settlement for liability insurance just as it does for WC. According to the law, Medicare is barred by statute (but for the conditional payment exception) to make that payment where payment has already been made for those same items, services and expenses. Presumably, that payment would have already been made by the liability insurance carrier or self-insured to the claimant as part of the settlement. While the statute does not address MSAs, it does address future medicals. The fact that parties resolving liability insurance claims miss this is troubling. What’s more troubling (for some) is that the statute has addressed future medicals in liability cases for 36 years. Future medicals in liability cases under the law is not a new development. Despite the clear statutory text of the MSP Act, parties resolving WC claims worry about MSA issues, while parties resolving liability insurance claims generally do not. Why is that? MSA Jurisprudence Maybe the distinction lies with the body of case law that has developed around the MSA issue in the liability insurance context. Specifically, at least two federal courts have concluded that liability MSAs are not “required,” while none (to the author’s knowledge) have concluded that liability MSAs are “required.” (See Sipler v. Trans Am Trucking Inc., 881 F. Supp. 2d 635 (2012) and Aranki v. Burwell, No. 2:15-cv-00668 (D. Ariz. Oct. 15, 2015).) This is not a surprising conclusion from the judiciary given the fact that neither the law nor the regulations interpreting the law “require” liability MSAs. Still, that same law does not differentiate between WC claims and liability insurance claims. In both, Medicare’s right to not pay certain future medical expenses ripens when payment has been made by a primary plan or payer to a claimant for those same expenses. The law itself provides no distinction. Without a distinction, one might think that concern for MSA issues would be the same in the liability insurance context as they are in the WC context. But, historically, they have not been. Why is that? Federal Administrative Guidance If it’s not the statute itself or the regulations enacted to interpret the statute or the case law rendered when parties have taken the MSA issue in front of the judiciary, perhaps it is administrative guidance in the form of policy memoranda that stoke the heightened concern in the WC community as compared to the liability insurance settlement community. While not active in drafting regulations about MSAs, CMS has been active in providing policy memoranda and other informal writings about MSAs in WC. Starting with the Patel Memo of 2001, CMS drafted approximately 16 policy memoranda about WCMSAs. Then, in 2013, CMS combined those policy memoranda into one comprehensive WCMSA Reference Guide. As of April 4, 2016, CMS issued Version 2.5 of its WCMSA Reference Guide, and it has become CMS’ one source of the truth when it comes to WCMSAs. By comparison, CMS has issued scarce guidance about liability MSAs. One can look to one policy memo in 2011, an Advanced Notice of Proposed Rulemaking (ANPRM) in 2012, and a Notice of Proposed Rulemaking (NPRM) in 2013. By the way, CMS voluntarily withdrew the NPRM in October 2014. So, perhaps the distinction lies in the existence of the policy memoranda and the WCMSA Reference Guide. And that might make sense but for one thing: Policy memoranda and reference guides issued by the federal government alone are not afforded Chevron deference. For the non-lawyers out there reading this, Chevron deference is an administrative law principle whereby courts will defer to a federal administrative agency (like CMS) and its statutory interpretation of a law unless such interpretations are unreasonable. According to the United States Supreme Court, “Interpretations such as those in opinions letters — like interpretations contained in policy statements, agency manuals and enforcement guidelines — all of which lack the force of law — do not warrant Chevron-style deference.” Christensen v. Harris County, 529 U.S. 576 (2000). Thus, the mere fact that CMS has issued policy memoranda and reference guides about MSAs in WC situations does not mean those statements have the force of law behind them. Despite this, WCMSAs remain an issue of high concern, while LMSA issues remain largely ignored. Why is that? CMS and its Current MSA Review Process Well, the only other possibility for the disparate treatment of the MSA issue in WC as compared to liability insurance is the existence of a formal review process for WCMSAs. CMS is willing, under certain circumstances, to review a WCMSA when the parties voluntarily submit that WCMSA to CMS for review. However, since it cannot review every single WCMSA because of resource constraints, CMS has established workload review thresholds to help manage its caseload. This workload review threshold is not a safe harbor, and CMS clearly states this in its WCMSA Reference Guide. This means cases that do not meet the threshold are not provided safe passage from CMS on the issue. Future medicals should still be considered in a WC settlement that does not meet the CMS review threshold. That goes for WCMSAs in cases where the threshold is not met — as well as liability cases for which CMS does not yet offer a formal review process. The mere lack of a formal review process does not mean Medicare relinquishes its right to not pay certain future medical expenses under the law. Nor does it mean that Medicare surrenders its right to pursue parties who have failed to address the future medical issue compliantly under the MSP Act. The MSP Act grants Medicare the right to recover up to double damages plus interest for any conditional payments it is not reimbursed. 42 U.S.C. § 1395y(b)(3). <<--- ?? See also: Data Breaches: Who Has Legal Liability?   Further, Medicare might be able to recover treble damages if it chooses to assert claims under the federal False Claims Act. It is the False Claims Act, in the author’s estimation, that parties should be concerned about most in this area — no matter whether you are a lawyer on either side of the “V,” a Fortune 500 company who self-insures liability claims or a liability insurance carrier. For a moment, think about the number of liability claims you have resolved over the past 10 years or so without addressing the MSA issue. Then, multiply that number by anywhere between $10,781.40 and $21,562.80 — and then triple that figure. That’s the future medical exposure facing parties not addressing the LMSA issue today. Claims brought by CMS under the False Claims Act represent the “nuclear” option, which would be the federal government’s most sensational way to enforce its rights in this area. But, as it currently stands, parties resolving liability insurance claims seem comfortable with this exposure, while the WC community is not. Why is that? CMS Considering Expanding Formal Review to LMSAs Given all that, perhaps you’re still comfortable with your LMSA exposure. You ignore the plain statutory text that places WC and liability insurance claims on level ground. You point to the lack of regulations directly on point. You cite the cases that state that LMSAs are not “required.” You cling to the fact that CMS withdrew the NPRM in 2014 and conclude that must mean that MSAs are a non-issue in liability insurance settlements. You’re the one who says that LMSAs will be an issue to be concerned about only when CMS provides an official review process. Well, get ready to be concerned because it appears that time is right in front of us. On June 8, 2016, CMS announced that it is considering expanding its formal MSA review process to include liability and no-fault cases. CMS doubled down on that announcement in December 2016. As part of its RFP for WCMSA review contractor services, CMS asked bidders to provide information about its ability to review up to 51,000 LMSAs annually starting in 2018. That represents a 258% increase in MSAs reviewed as compared with current WCMSA reviewed. Bids are due to CMS by February 15, 2017 with an anticipated contract-award date of June 30, 2017. If CMS is considering expanding the formal MSA review process, it must mean that CMS believes MSAs in those types of claims are a thing, right? Why else consider expanding its formal review process? If CMS believes liability MSAs are a thing, how long has it thought that, and how much work has been done internally to vet the LMSA issue and the parties resolving liability claims without addressing the issue? So many questions and so much exposure that could be remedied by one simple step. The greatest victory is that which requires no battle. Conclusion By this point, one certainly realizes the ostrich approach to the LMSA issue is ill-advised. The time is right to either 1) formalize your process for addressing the MSA issue on every one of your liability cases pre-settlement; or, 2) begin formulating your plan to defend yourself when CMS pursues you seeking double or treble damages for future medical payments it made for its beneficiary by mistake. As a lawyer, I prefer my clients choose the former, but I'm willing to be hired to help those who prefer the latter. Your goal should be to minimize — or even extinguish — your future medical exposure related to this issue. You should get comfortable with the idea that Medicare’s right to future medicals is not limited to WC, and steps need to be taken to ensure your future medical exposure is minimal or even non-existent in the future. If you’re interested in learning how you can devise internal protocols to address potential LMSA issues or you would like a legal opinion about an LMSA issue in a specific case, I’d be happy to speak with you. Call me at (704) 232-7297, email me at cattielawpllc@gmail.com, visit my website at www.cattielaw.com or tweet me @MSALawyer. Don’t wait until it’s too late and you can’t keep your file closed because the feds won't let you.

There are a lot of good reasons to attend an insurance industry conference: high-profile keynote speakers, in-depth educational sessions on emerging industry issues, exhibitors showcasing their products and networking opportunities galore. Those reasons are why as many as 40 million people attend industry conferences every year, according to Conference Hound. The conference/event industry is only getting bigger; the Bureau of Labor Statistics expects it to expand 44% by 2020. For our industry, one index of insurance conferences listed more than 100 events focused on some aspect of the industry that happened in 2016. That's a lot of conferences! The trouble is, you can't do it all. Conferences present a lot of competing objectives--take a long lunch to continue networking, and you sacrificing key learning time, and catching an afternoon panel may mean missing an exhibitor's demonstration. You're stuck guessing what will be most beneficial. It's a real challenge, especially if it's your first time attending a conference. See also: Are Conferences Still Worth the Effort?   But that doesn't mean that you can't hit the ground running and get a lot out of your first insurance conference. With some preparation and follow-through, plus a little gumption during the conference itself, first-time conference attendees can maximize their experience and get significant value from the event. Before the conference

1. Find the right conference. With nearly 100 conferences for our industry, you have a lot of options, but that doesn't mean that they're all worth your time. The Risk and Insurance Management Society (RIMS) Annual Conference & Exhibition is a popular choice. Attendees get the chance to hear some of the top minds in the risk management and insurance industry. There are plenty of more specific options available, too, addressing topics ranging from windstorm insurance to trucking telematics. Attending a more targeted conference, such as one designed for underwriters, claims or another job function, may be more beneficial to your career development if you're looking to specialize.
2. Do your research. Once you've registered for the conference and have travel and accommodation logistics figured out, it's time to start snooping. A little bit of preconference research can significantly improve your experience during the conference. Look up the speakers and topics of interest--you can sometimes even connect with presenters on social media before the conference. Outline a tentative schedule of the speakers you want to catch so that you can spend your time at the conference networking and learning rather than double-checking when the next session starts.
3. Update your professional persona. Before you head to the conference, make sure that your business cards are up to date. Take a big stack of them--more than you think you'll need--and commit to giving them all away. Also make sure that you update your LinkedIn profile. Most importantly: Prepare a few short elevator speeches for conversations you're anxious to have. If you're there to network, come up with a short introduction of yourself and your organization. If you're there to learn about a certain topic, prepare specific questions you can ask speakers and subject matter experts.

During the conference

1. Network, network, network. Conferences are designed for networking, but that isn't everyone's forte. A lot of us are uncomfortable meeting people in unfamiliar surroundings. But one of the most important benefits of attending conferences is the opportunity to hone your networking skills and try out those elevator speeches. Many find that they're more comfortable networking if they expand their scope a little bit. Think of yourself as representing your whole organization--what connections could benefit your employer? It shifts the focus from promoting yourself and gives you a broader purpose.
2. Use the app and the hashtag. More and more of the important conversations taking place at insurance conferences are held online. That said, in 2016 more than half of conference attendees were expected to download mobile conference apps. It's a good way to organize your schedule and keep up with hashtags and updates on social media. (And it's not a bad idea to check out the hashtag for conferences you aren't able to attend.) Just don't spend the whole conference buried in your phone--you're there to meet and learn from other industry professionals. In fact, almost half of conference attendees recently surveyed said that the face-to-face interactions they had were more valuable than they were two years ago, and the Center for Exhibition Industry Research expects them to become even more valuable in the future.
3. Get your money's worth. There's one thing many first-time conference-goers forget: They're paying money to be at the conference. Whether you paid out of pocket, your company is footing the bill or you're just offering your valuable time, you should work to get as much out of the conference as you can. If a speaker isn't providing the information you want, ask questions. If you're still not getting what you need, don't be afraid to leave and find a session that's a better fit. Fill your days with as much learning and activity as possible--attend every session you can, talk to as many people you can.

After the conference

1. Maintain your connections. The biggest challenge after an insurance conference is maintaining the momentum and enthusiasm you had during it. Start by staying in touch with the connections you made. Send follow-up notes, emails and messages to networking contacts and speakers you met.
2. Solidify your knowledge. You may have a left a keynote speaker's presentation or a particularly strong session energized and ready to put your new knowledge or perspective to work, but that enthusiasm fades fast. Take the time to organize your notes each night of the conference, or read more on a particular topic so that you're ready and excited to use the new information once you're back to day-to-day operations.
3. Demonstrate the value. Make sure that your employer sees that the time you spent away from your daily insurance gig was worthwhile. A specific thank-you email or follow-up is always good, but returning to work with a few practical ways to do your job better and improve your organization is even better.

See also: My Top Tips From EXEC InsurTech   Have you mastered the art of insurance industry conferences? Give us your best tip in the comments section below.

Thanks to Scott Brinker at chiefmartech.com for sharing the 2017 Marketing Technology Supergraphic above. I appreciate every year seeing the updated technology landscapes along with the insights and commentary provided by Luma Partners. If you are having trouble making out any of the details, it’s not your eyesight. More than 5,000 companies are included on the landscape, astoundingly up from 150 in 2011. Wow. Does the chief marketing officer really need 5,000 -- and growing -- choices? Even within the super-graphic’s sub-categories, any executive may find herself searching for just a few needles in the haystack. That short list will only include those needs that matter enough to command resources at the expense of some other priority: Software will be licensed, planned into the tech stack, fed by data to produce decisions and provide leverage for media selection, offer testing, user experience, servicing, personalization, team collaboration or any of the other demands of a modern marketing organization. The super-graphic conveys at least two messages:

• Lots of engineers see that marketing is a function continuing to live with daily disruption and want to help, or see an open window at least to build solutions.
• With so many solutions out there, it’s reasonable to question where the value and meaningful differences are among them. Where has tech product specialization become so deep that solutions are not relevant enough to be worth the CMO’s pursuit?

Direct marketers have long subscribed to the orthodoxy that choice depresses response. While not always the case, certainly when presented with an overwhelming number of choices buyers tend to shut down. Without a framework relevant to the CMO’s needs, having 5,000-plus options on one slide (while a remarkable feat of design, even organized into tech-based categories with add-on, zoom-in capability) will feed decision-making paralysis. See also: Insurtechs Are Pushing for Transparency   There is a way to not get swallowed by the mar-tech vortex, one that is remarkably low-tech and depends more on critical thinking, collaboration, customer focus and clear commercial goals. In this context, software is the enabler, the means but not the end. That way? Be clear on what the business strategy is. How does the business strategy translate into the short list of marketing priorities -- those that constitute a 20/110 effort-for-impact calculation? This means the 20% of activity that will make 110% of the difference. (I prefer 20/110 thinking to the more common 80/20 -- let’s admit that some of the decisions that marketers make end up dragging down results, and that the headlines that dominate team appraisals of progress tend to focus on a short list versus the totality). Strategy comes down to:

• The starting point: Where are you now?
• The destination: Where do you want to be?
• The route: How do you anticipate getting there?
• The rationale: Why does any of this matter?

The focus for any CMO trying to decide where to start and where to put her undoubtedly too-scarce resources is to be confident about:

• What customer problems the brand wants to solve that will allow standout status in the hearts and minds of our users.
• And, what marketing capabilities (technology and otherwise) are needed to ensure the brand gets to the solution(s) that widen competitive advantage and grow user preference.

See also: The Failures and Successes of Insurtech   Mar-tech along with all of the other advanced technologies available today should be chosen because they can help the brand enable remarkable differentiation -- in the hearts and minds of customers. With strategy in hand, it is possible to make smart decisions and tradeoffs for the right reasons, about how to prioritize mar-tech investments for business leverage. Then, frameworks such as this complex snapshot of what technology can do for marketing become incredibly useful places to start searching for the appropriate enablers.

A landmark study into the profits of businesses found that only 55% stemmed from factors they could control. A full 45% of a business’s earnings was determined by external factors – the growth rate of the economy, political changes, movement in oil prices, etc. That study was done 20 years ago, so the part of earnings now determined by uncontrollable factors may well be higher, given that technology, politics and other factors have added so much uncertainty to today’s business environment. Executives don’t like things they can’t control, so many focus 100% of their effort on that 55% (or less) of earnings that is in their hands. But focusing on only roughly half the sources of profitability leaves an enormous opportunity for those who are willing to embrace uncertainty and find better ways to sense and react to those external, uncontrollable factors. Because of regulation and capital requirements, financial services have been largely protected from the digital disruption that has rewritten the rules for retailing, music and so many other parts of the economy. But uncertainty is picking up because financial services firms are now having to confront new kinds of information, at much higher speed, and must learn how to quantify new types of risk. For instance, some fintech startups are granting loans based on analyses of social media -- one theory being that, if your friends are solid citizens, you’re likely to be a better risk than your credit score suggests. The jury is still out on how effective these startups will be, but they show the need to be able to analyze "unstructured" data such as that coming from social media and from the cameras and sensors that increasingly blanket the world. See also: Change Management Is Not About Change!   Meanwhile, although technology is typically described as addressing humanity’s problems, it also creates whole new types of risk. How do you figure out how to insure a driverless car? There’s never been one before. When the Internet of Things essentially connects every device to every other device in the world, what risks come along with the benefits? They won’t just relate to cybersecurity issues such as how to protect personal information either; people will also hack into systems to sabotage equipment, to make cars crash into each other and who knows what else. History shows that many companies will wait and watch to see how the business environment evolves and only then start to react, but research for our new book, "Accelerating Performance," found that the best firms have a fast, yet low-risk way of responding to change. We can summarize that approach as: "mobilize, execute and transform with agility." Our study of these factors is based on decades of work and years of research, included a survey of 20,000 global leaders, investigation into the performance of 3,000 teams and deep research into the FT 500, including interviews with senior executives at 23 top performers we call "superaccelerators." Here’s what they do – and do well. Mobilize Embracing uncertainty. Some 60% of the respondents in a major survey of ours said high-impact events had repeatedly blindsided their organization, and 97% said their organization lacked an adequate early-warning system. To avoid ugly surprises, companies need to embrace uncertainty. That means building a deep understanding of the highest-impact forces that are shaping the future of an industry and preparing for a range of alternatives, rather than just addressing operational pressures. Pressure-tested decision making. Often, context needs to be broadened so that new options can surface. What seems to be a harsh, either/or choice can become a much easier decision. Continually reframing business challenges must become a best practice. It is human nature to have mental filters – they help us to efficiently manage information overload and to make many routine decisions without hesitation -- but these shortcuts often lead people to see what they expect to see rather than what is actually there. Overconfidence can also cloud judgment. We need to constantly recognize and work to overcome our biases, while still making swift decisions. Shared vision. Uncertainty can lead to divisiveness, as everyone has his or her own opinion of how the business will develop. But extensive research shows that companies that have a shared vision of where they are going, and why, do remarkably better than those that do not. Most visions are incremental and stifling, limiting change to minor investments in new capabilities that support the core, existing business. But a bold vision is often a bridge too far, creating a state of paralysis by presenting the prospect of radical changes  to the business model. Most successful strategies find the elusive sweet spot between incremental and bold, balancing the familiar with a distinct "North Star" for the future. Execute Core competencies. Today’s winning capabilities may become tomorrow’s table stakes. Organizations must identify what capabilities world-class competitors will possess in the future and begin to invest in them now. Execution feasibility. Many attractive strategies exist. However, not all are possible for every organization. Investing in strategies with low feasibility is a sucker’s game. Leadership needs to recognize that how they will win may be different than the path for their competitors. Before making any moves, organizations should inventory the principal strategic decisions for the near term and long term, and then evaluate their readiness to execute. Adaptive playbook. Relentless testing of alternative strategies is imperative. Organizations need more than one strategy at the ready, as market conditions often change and new threats and opportunities emerge, and must be acted on quickly. Most firms plan as if the world were predictable, developing point forecasts, budgets and initiatives that will succeed as long as the external environment cooperates. Organizations must become intimately familiar with their competitors’ inner workings, regularly employing role-playing exercises to simulate the competition’s strategic intents. Transform  Balanced portfolio. A well-constructed portfolio balances investments with knowable return on investment (ROI) in the short term along with investments that have long-term potential and can’t be evaluated with such traditional financial metrics. Portfolios need to incorporate varying levels of risk and multiple time horizons. Failing fast. Every organization has limited resources, so it must objectively assess which strategies are working and which are not, pull the plug on those that are failing, double down on those that are working and invest in new ideas. A firm burdened with too many stagnant strategic initiatives quickly faces a drag on overall performance. Rapid response. Rapid response requires the ability to sense threats and opportunities in the market, while relentlessly pursuing improvement in how to respond when signals emerge. Responding to a threat or opportunity more quickly than competitors, based on less-than-perfect information, can make all the difference. Most organizations struggle to act swiftly and commit resources because the near-term risks of being wrong outweigh the long-term reward of being right. See also: Group Benefits: the Winds of Change   Agility Foresight. Most companies are skilled at sensitivity analyses of one issue in isolation, but few can conduct deeper-level examinations of how issues interact in a complex system. The current volatile, uncertain, complex and ambiguous environment demands that firms re-evaluate their strategies and strengths and improve the ability to anticipate. Learning. You must continuously test assumptions about yourself, your market, your customers and your competitors. It’s important to understand which assumptions might be vulnerable and to "unlearn" associated behaviors. Operational excellence is increasingly becoming commonplace in many industries, with true differentiation stemming from a learning culture that is externally focused, experimental and innovative, collaborative and comfortable with risk. Adaptability. Existing strategies and processes, even if successful in the past, might need to be changed dramatically to ensure continued performance in the future. Organizations must adjust to changing circumstances by applying existing resources to new purposes and modifying actions and behaviors accordingly. Resilience. Many companies have too narrow a view of the plausible range of outcomes, and often a disruptive event turns into something that is crippling rather than a small setback or even an opportunity. Organizations must surface and examine mental models. By considering which assumptions might be vulnerable and looking at a broader range of outcomes, leaders can combat overconfidence and prepare for challenging operating environments. Even addressing all 13 of these factors won’t guarantee that you’ll win. The business world will remain a harsh place full of formidable competitors. But becoming expert on these issues will give you a much better chance of mastering uncertainty, while your competitors continue to focus just on the factors they can control.