Much Higher Bar for Customer Service
“It’s all about the customer.” How often have we heard that statement? More times than we can count. Yet it is more relevant than ever.
“It’s all about the customer.” How often have we heard that statement? More times than we can count. Yet it is more relevant than ever.
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Terry Buechner is vice president for digital consulting at Majesco. Buechner has nearly 20 years of experience in insurance, healthcare and related fields. Prior to joining Majesco, he was an associate partner in IBM’s digital consulting practice for insurance.
Core systems used to be replaced once or twice in a career. No longer. The technology is too important and improving too fast.
The core systems replacement cycle is speeding up. Twenty years ago, even if you spent your entire career working at the same insurance company, you might expect to go through the implementation of a new core system once, maybe twice. Technology – and the speed of business that it enables – is changing that.
Technology is advancing at an exponential rate, and that includes the technology underlying the business of insurance. Moore’s Law predicts that processing power will double every two years. Other technologies exhibit similar exponential advances. Before solid-state drives emerged, the cost of hard-drive storage dropped by half annually. In 1997, 1 GB of memory would set you back about $100. Ten years later, the price had dropped to less than $.50 per GB.
See also: Finding Success in Core Systems
When processing power was limited and storage was expensive, we were constrained in how we used core systems. The exponential advancement of these and other technologies removes the obstacles that had previously restricted their use – which opens many, many new avenues of technological advancement and business innovation. In the next 10 years, we can expect similar advances in the technology that we are using today.
Ten years is a critical number in insurance technology. In 2007, new insurance core systems did not have a variety of capabilities that are necessary to deal with the challenges of today. Mobile and policyholder collaboration is now a mandate. Advanced use of data and analytics has become a base-level requirement. Insurers now need to be able to handle a wide variety of specialized lines of business such as cyber, as well as shared economy elements like hybrid products to provide coverage for UberX and Lyft drivers. Consequently, more insurers expect that a core system implemented today will be up for replacement in less than 10 years. In 2011, nine out of 10 insurers anticipated a new policy administration system would last for more than a decade. Today, only six out of 10 insurers agree.
This is a tremendous shift in the market’s perceptions among P&C and L&A insurers alike. It reflects the accelerating pace of change and the exponential advances in technology. Insurers looking to the future – at the changing business models and products in the market – are unsure that an older core system will be able to face the challenges brought by digital and greenfield insurers as well as other insurtech advances. At a minimum, the core systems of today must continue to improve in upgradability to keep up with the advancing capabilities insurers need to match the pace of market changes.
Shorter lifespans mean insurers are rethinking how they allocate resources for core systems modernization. When faced with obsolescence in less than 10 years, insurers are more attracted to options that require less up-front planning and capital. This has translated into a greater number of cloud-based core systems as well as a shift toward more subscription-based pricing models.
The speedy implementations and quick time to value possible with cloud-based core systems appeal to insurers for the same reasons. Quick time to value is essential for insurers to be able to take advantage of new market opportunities, and implementations that take months rather than years can increase insurers’ adaptability. These buying trend changes aren’t displacing insurers’ purchases and implementations of larger, enterprise-wide core systems. The new trends simply give insurers the quick wins they need while they continue to advance enterprise-wide core systems modernization projects.
See also: The Death of Core Systems
My recent report, Bridging to the Future With Core Systems Modernization, explores that trend and other ways that insurers are using modern core systems to increase the adaptability of their businesses. Core systems replacement and modernization is one of the seven SMA Bridges to the Future – and is critical for insurers to prepare for the opportunities and challenges of insurance in the coming years.
When we look at how quickly our world is changing, 10 years doesn’t seem so long. It reminds me of a prescient quote from Bill Gates: “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next 10.” And he said that more than 20 years ago.
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Karen Furtado, a partner at SMA, is a recognized industry expert in the core systems space. Given her exceptional knowledge of policy administration, rating, billing and claims, insurers seek her unparalleled knowledge in mapping solutions to business requirements and IT needs.
Auto telematics represents the most mature insurtech use case, as it has already passed the test and experimentation phase.
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Matteo Carbone is founder and director of the Connected Insurance Observatory and a global insurtech thought leader. He is an author and public speaker who is internationally recognized as an insurance industry strategist with a specialization in innovation.
Scrutiny on ERISA-regulated health plans' spending could create immense liability for both company directors and health insurers.
This overpayment makes ERISA plans an attractive target for operational efficiencies. Healthcare is the last major bucket of operational expenses that most companies haven’t actively optimized (they've already optimized operations, sales, marketing, etc.). For those that don’t get on top of this, it could also be a source of significant potential liability for companies and plan trustees. We are already aware of the ripple effect on benefits departments — one entire benefits department (with the exception of one person) was fired when the board realized the lack of proper management.
See also: ERISA Bonding Reminder
ERISA requires plan trustees to prudently manage health plan assets. Yet very few plans have the functional equivalent of an ERISA retirement plan administrator who actively manages and drives effective allocation of plan investments. This person (or team) would have deep actuarial and healthcare expertise to enable them to deeply understand and negotiate potential high-cost areas of care, something traditional human resource departments lack.
At the same time, it’s broadly estimated that there is enormous waste throughout the healthcare system. The Economist has reported that fraudulent healthcare claims alone consume $272 billion of spending each year across both private plans and public programs like Medicare and Medicaid. The Institute of Medicine conducted a study on waste in the U.S. healthcare system and concluded that $750 billion, or 25% of all spending, is waste. PwC went so far as to say that more than half of all spending adds no value. It's impossible to imagine any CEO/board allowing this in any other area of their company.
Increased outside scrutiny on how ERISA-regulated health plans spend their dollars could create immense potential liability for both company directors and health insurers across the country. Nationally prominent lawyers, auditors and others are catching on to this and are taking action to get ahead of it or are advancing potential new categories of litigation that could result in hundreds of billions in damages.
In just the last couple of months, we at the Health Rosetta Institute — a nonprofit focused on scaling adoption of practical, nonpartisan fixes to our healthcare system — have learned of some key events that will likely further increase scrutiny on ERISA fiduciary duties.
First, two Big Four accounting firms have refused to sign off on audits that don’t have allowances for ERISA fiduciary risk. A senior risk management practice leader at one of those firms told a room of healthcare entrepreneurs and experts that ERISA fiduciary risk was the largest undisclosed risk they'd seen in their career. As more accounting firms start to require this, it will change how employers manage ERISA health plan dollars.
Second, independent directors have quietly sounded the alarm to three company auditors about this growing issue, recognizing the potential for personal financial liability that director and officer insurance policies may not cover. We expect to see more of them focusing on this issue, given that healthcare spending is roughly 20% of payroll spending for most companies.
Third, attorneys are building litigation strategies around employers filing suits against their ERISA plan co-trustees (the plan administrators who actively manage the plan’s health dollars) alleging they breached their ERISA fiduciary duties by turning a blind eye to fraudulent claims. We expect the first of these cases to be brought this year and expect to see significantly more in the next couple years. One firm we’re aware of is working on cultivating dozens of these cases.
The implications of this third trend could be enormous. If boards and plan trustees know fraud could exist and don’t take action to rectify the issues, they could open themselves to liability from shareholders and plan beneficiaries. The scale of damages just for fraudulent claims could be on the magnitude of lawsuits over asbestos and tobacco. A very conservative estimate of what percentage of claims are fraudulent is 5% (many believe 10-15% is more accurate). Employers spend more than $1 trillion per year on healthcare. If you take the low-end estimate (5%) and extrapolate over the statutory lookback period for ERISA (six years), that would be $300 billion.
These legal threats could force employers to actively manage health spending the same way they manage other large operational expenses. We’ve already seen companies doing this, reducing their health benefits spending by 20-55% with superior benefits packages.
Employers use a variety of approaches, but most are relatively straightforward and focus on proven benefits-design solutions that make poor care decisions more costly and better care decisions less costly to encourage the right behavior. Most importantly, they don’t focus on shifting costs to employees. This cost-shift to the middle class has devastated the American Dream and was the backdrop for the populist campaigns that were badly misreported (in terms of their root cause).
See also: Solution to High-Cost Indemnity Payments?
Three high-potential areas for improvement include actively managing high-cost care to move it to high-quality, lower-cost care settings; directly addressing drug costs; and creating incentives for wise care decisions. Here are a few repercussions these changes may have for companies and investors:
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Dave has a unique blend of HealthIT and consumer Internet leadership experience that is well suited to the bridging the gap between Health IT systems and individuals receiving care. Besides his role as CEO of Avado, he is a regular contributor to Reuters, TechCrunch, Forbes, Huffington Post, Washington Post, KevinMD and others.
Often, new technologies and solutions are tried for personal lines first. Insurtechs are moving to small commercial.
At times, it seems like insurtech is around every corner, with new startups materializing every day, conferences emerging out of nowhere and accelerators doing their job of accelerating. Until recently, most of the activity and visibility in property/casualty has been related to personal lines. Sure, there have been commercial lines startups and partnerships in the distribution space for quite some time, but there has appeared to be much less activity than around personal lines. This has begun to change in the last six months.
See also: Insurtechs Are Pushing for Transparency
SMA’s recently released research report, InsurTech and Commercial Lines: A Surge of Activity and New Implications, analyzes the current state of the insurtech world, and there are approximately 400 startups that SMA has identified as relevant for commercial lines insurers. At this stage, the biggest areas of interest are small commercial (distribution) and workers’ comp (loss control and claims). This follows the natural path of technology adoption in the insurance industry. Insurtechs and emerging technologies will likely advance along this path. There are certainly some insurtechs that are applicable beyond small commercial today, but the complexity and uniqueness of other commercial lines have limited insurtech's penetration thus far.
Among the insurtechs with capabilities for commercial lines, almost half are either in the connected world or the distribution spaces. Distribution plays include digital agents/brokers, startup MGAs and tech companies with platforms or solutions for agents and brokers. Those with connected-world solutions have great potential for risk reduction and mitigation for fleets, properties, worksites and other areas that commercial lines insurers cover.
It is likely that insurtechs will continue to emerge with use cases for commercial lines. In the meantime, the existing body of insurtechs are maturing as they refine their solutions, pilot/partner with insurers and begin to roll out live implementations with customers.
See also: Leveraging AI in Commercial Insurance
From a commercial-lines standpoint, insurtech is no longer hidden in the shadows. As more and more insurtech activity sees the light of day, the potential to transform the industry increases.
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Mark Breading is a partner at Strategy Meets Action, a Resource Pro company that helps insurers develop and validate their IT strategies and plans, better understand how their investments measure up in today's highly competitive environment and gain clarity on solution options and vendor selection.
Given that two-thirds of insurance industry economics are tied up in losses, why are innovators so focused on other issues?
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Andrew Robinson is an insurance industry executive and thought leader. He is an executive in residence at Oak HC/FT, a premier venture growth equity fund investing in healthcare information and services and financial services technology.
But, of the total tech deals completed in 2016, more than 72% involved U.S.-based startups and only 12% involved ones in Asia.
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William Nobrega is the Managing Partner of DTN Venture Partners, a boutique-consulting firm that focuses on advising insurance and tech companies on disruptive strategies for emerging markets and the New Consumer. Services include: Strategic planning, Market Entry Strategies, Strategic Alliances and Venture Capital strategies.
We have seen the increasing anger of the electorate from both the right and the left in the U.S. elections -- and now in Europe, too.
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Vivek Wadhwa is a fellow at Arthur and Toni Rembe Rock Center for Corporate Governance, Stanford University; director of research at the Center for Entrepreneurship and Research Commercialization at the Pratt School of Engineering, Duke University; and distinguished fellow at Singularity University.
Many workers' comp cases are oh-so-close to settling but never get there. A "mediator's proposal" can try to bridge the gap, without risk.
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Teddy Snyder mediates workers' compensation cases throughout California through WCMediator.com. An attorney since 1977, she has concentrated on claim settlement for more than 19 years. Her motto is, "Stop fooling around and just settle the case."
Some insurers have combined the best strengths of our industry today with the best new ideas from insurtech and the digital world.
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Karen Furtado, a partner at SMA, is a recognized industry expert in the core systems space. Given her exceptional knowledge of policy administration, rating, billing and claims, insurers seek her unparalleled knowledge in mapping solutions to business requirements and IT needs.