After several years of working with executives in large corporations to help them innovate, I have seen a distinction emerge that has really helped some teams get on the same page: innovative thinking vs. innovation. These might sound the same, but they are not. Both are very important for companies to remain relevant and successful for years into the future. However, one is pointed inward, and the other is pointed outward. See also: Insurance Innovation: No Longer Oxymoron   Innovative thinking means your teams are applying the principles of creativity, collaboration, problem-solving, risk-taking and customer focus to the business problems of today, including your current products, services and operating models. Some great applications of innovative thinking fall under the headers of improving customer experience; moving the needle on key business metrics such as sales, market share, retention or expense ratios; or even improving field satisfaction. These are important, daily challenges that deserve innovative thinking to come up with new ways to solve them, perhaps working within certain constraints. Constraints actually help drive innovative thinking vs. curtailing it. Many companies today have problems with innovative thinking because the organizations are not skilled in creative problem-solving; they don’t collaborate well; and they don’t know how to take calculated risks. These problems are solvable through the proper skill training and by providing the right data to help make decisions about what to focus on first and how much effort and money can be spent to solve it. Innovative thinking is an empowering competency for generating good business results. It also needs to be accompanied by innovation for long-term survival and relevance. Innovation, on the other hand, takes those same skills and points them toward unmet consumer needs. These could be consumers or needs you are not serving today. Additionally (and ideally), they could be needs that are not being served by anyone. When we discover large, unmet needs in the marketplace, these are significant opportunities for growth. However, it is difficult because a capability needs to be built that does not exist yet. We define innovation as the synchronized intersection between an unmet need, an idea that solves it and a great experience designed to bring it to market effectively. Innovation has all three of those elements correct. If one or more is incorrect, it is just an invention. Innovation is even more difficult than innovative thinking because teams are dealing with unknowns in the market as well as unknowns in the business. With innovative thinking, at least some things are familiar. This is why large corporations have such trouble launching game-changing ideas. See also: How to Turn ‘Inno-va-SHUN’ Into Innovation   The missing skillsets relative to innovation could be any of the same ones required for innovative thinking but also the skillsets of prototyping and effective piloting. These are skills the insurance industry generally does not have. But the good news is that these, too, can be trained in or brought in by outside partners. Startups are good for that, and some companies have taken that approach. However, it is not enough to just outsource. Your teams need to learn some of these skills so that innovations can eventually be integrated into the core business. When innovative thinking and innovation are confused, bad things happen. This is how “innovation” becomes a bad word. If various leaders or team members don’t see this distinction, innovation teams struggle to get traction. For example, the team is looking to create the next big thing, while the CEO just wants more sales. We’ve seen over and over again how companies establish innovation teams or centers and then shut them down because the organization did not make this distinction clear enough. If you are reading this and your team is struggling with gaining traction around innovation, this could be part of the problem. There are many ways to learn from mistakes of the past, and it takes a lot of wisdom and self-awareness not to repeat them.

As physicians and hospitals compete for the “under 65” patient -- whose payments are generally 150%-plus higher than for a Medicare patient -- they have to determine their pricing model. The traditional choice is to offer a low price per service based on a higher volume, or a high price per service based on a lower volume. But some are charging a higher price with the goal of generating higher volume, and their number may increase. Healthcare spending is already 17.5% of U.S. GDP and is expected to hit 20% by 2025. This high-price/high-volume approach could exacerbate the problem. See also: Healthcare: Time for Independence   Part of the reason for concern is a recent landmark decision, in which Cigna was ordered to pay an out-of-network provider more than $13 million to cover certain alleged underpaid claims and ERISA penalties. ERISA is the federal law governing large employers that self-insure their medical plans (generally those with more than 250 employees). In the lawsuit, Cigna alleged that the supplier was failing to collect the patients’ deductibles and coinsurance. The carriers’ intent is for the supplier to collect the deductible and coinsurance to make patients aware of the supplier’s charges and of their shared responsibility for the bill. Cigna took the position that, if the healthcare supplier does not collect any payment from the patient, the provider is accepting as “payment in full” the amount processed by Cigna on behalf of the employer. Cigna argued that, if the patient's portion under the Summary Plan Documents (the carrier’s contract with the employer and the employee) is waived, then the plan’s portion is waived, as well. When suppliers “forgive the patient liability,” these healthcare providers often have a revenue model of very high prices with the goal of higher volumes. They’ll entice the patient to use their more expensive services because the patient does not have to pay anything -- and the higher payment to the healthcare provider under the plan will more than cover the liability that the provider forgave for the patient, even though the average employee deductible is high, at $1,300. Most patients have not grasped that healthcare suppliers are running a business and that prices vary by as much as 300% within a network. As a result, while employees (the patients) may save money when the provider waives their financial responsibility, they lose in the end. That's because their employers’ costs increase, resulting in higher health insurance costs, with larger deductibles and payroll contributions for all employees. The court's decision to reject Cigna’s claims creates further risk to the affordability of healthcare for employers, as employees will be financially motivated to access care from suppliers with higher prices because the patient’s liability is forgiven. Can we expect other healthcare suppliers to implement a revenue model tied to high prices with no patient liability? See also: AI: The Next Stage in Healthcare   Conversations with a number of healthcare suppliers shows that many do not realize that most large employers self-insure their medical plans; the suppliers perceive that the insurance carriers covers the costs. The purchasers (the employers) have the opportunity to engage the healthcare suppliers (hospitals/physicians) in a discussion around supply chain management, quality and patient safety, so the providers fully comprehend that the one ultimately paying the bill is monitoring their performance. We’ll look forward to sharing the results of this type of collaboration, now underway in a major market. It’s time for employer-driven healthcare.

“It was the best of times, it was the worst of times…”  Charles Dickens, “A Tale of Two Cities” On Aug. 12, 2016, it was the best of times in Denham Springs, (Livingston Parish) LA. By Monday, Aug. 15, 2015, it was the worst of times. Denham Springs was a community of 10,000-plus people in a parish of 132,000. Driving your car through Main Street, you’d see small-town America. Driving through the suburbs, you’d discover a booming town. On Aug. 12, Denham Springs was a bedroom community for Baton Rouge, LA. It had it all — great schools, young families, new homes and commercial developments everywhere. You’d agree — it was the best of times. After three days and 30 inches of rain, you could still drive through the town — by boat. It was the worst of times. From the Livingston Parish News website: “The 30-inch downpour that has devastated nearly 90% of Denham Springs and flooded more than 70% of Livingston Parish has led NOAA [National Oceanic and Atmospheric Administration] to classify the rain event as a once-in-every 500-year flood. For Livingston Parish, it may have exceeded the statistics of even the 500-year event. In a parish in which an estimated 40,000 homes were flooded — and 90% of them considered possibly a "total loss" in Denham Springs — observers from NOAA believe the damage, based on population and statistics, could surpass the devastation New Orleans and the Mississippi Gulf Coast suffered in Hurricane Katrina.” See also: Is Flood Map Due for a Big Data Make-Over? If you can’t wrap your head around such devastation, remember the difference between New York City on Sept. 10, 2001, and on Sept. 11. Think about New Orleans, which was not destroyed by wind but rather by water. Think Flint, MI, where failed decision making and neglect resulted in destruction of the “water” and severe damage to the health and the future of her citizens. Drive through your town and imagine 70% of it wiped out. I could go on, but I won’t — I assume you get the picture. Now let’s leave the flood waters of Louisiana and move back to your reality. You are a successful professional or a business owner. Things are going great or, at least, good enough. You are in your comfort zone. If you’re in the business of risk or insurance, you talk constantly about risk management. In my simple mind, risk is uncertainty. Uncertainty is the difference between good things and bad things happening. Management is control. Risk management is control of uncertainty. This is all about maximizing the good and minimizing the bad in our clients' lives. Be selfish. Exercise this risk management process and discipline on your own shop and your own future. I’d ask you to do one thing differently: Over the next few paragraphs, measure your reality not as the wild-eyed, optimistic, successful entrepreneur you are but measure it in the hard reality of “misery.” Consider what would happen if you and your agency failed to open today because (like in Denham Springs) water has risen to the ceiling of your office and to the ceiling of 70% of the homes and offices in your city. Consider what would happen if the city and the state is on lockdown because terrorists have set off a dirty bomb. You’re driving away but are hearing rumors of the community being uninhabitable for at least three years (think Chernobyl). What do you do? How do you do it? Where’s your staff? Your future? Your value? See also: How to Make Flood Insurance Affordable   Draining the swamp is difficult when you’re up to your butt in alligators. Consider: “Job” and “job” are spelled the same way. Most often, when we think of “job” we are thinking of what we do (“a piece of work, especially a specific task done as part of the routine of one's occupation or for an agreed price.”) When we are going through the worst of times, some think of the other “Job,” “the central figure in an Old Testament parable of the righteous sufferer.” About 20 years ago, Dave Hamilton spoke at the IIAL convention. He was excellent. His theme was “No bad days.” His message was that we all have bad moments where bad stuff happens — but there are no bad days. He closed with the following, “The merchant of misery is either at your door, has just left or is soon to arrive. Still there are no bad days.” Dave is wise! If you’re enjoying the “best of times,” thank God. If you’re suffering through the “worst of times,” pray to God. Remember: Life is a streaming video, not a snapshot. Even after a 1,000-year flood, the sun shines again. Be prepared.

The phone rings in a company’s human resources department. The caller explains he is from the IRS and is conducting an audit of the company’s use of consultants. The company may have wrongly classified employees as consultants. If the company did misclassify, huge fines will be coming. To clear up this misunderstanding, the caller from the IRS needs historical W-2 data from all employees. An HR employee knows the company did nothing wrong, so he exports digital copies of all W-2 documents and sends them to the specified email address. By this point, alert readers should be horrified at both this obvious scam and the poor HR employee who will shortly be unemployed. Most people are familiar with the concept of phishing, which is targeting a specific person and using social tactics to elicit private information. From the clinical perspective of this article, it is easy to dismiss this approach as useful only against the unsophisticated. It would be much harder to dismiss if your phone rang from a Washington, D.C., number and the caller already had your company’s tax identification information. See also: Payoff From Great Customer Experience?   In other scenarios, there is no ill intent, only poor oversight. A health insurance company is preparing explanations of benefits (EOB) mailings, which include sensitive and private information about healthcare services. This company generates millions of EOBs each month and saves a copy in each member’s account on the company’s website. A batch process reads the member account number from the EOB and places the document into the correct website location. Recent regulatory changes forced the IT department to perform a series of last-minute adjustments to these documents, and the process updated the format of the account numbers. No one told the batch team, and the process that posts these documents was not updated. Millions of EOBs are posted to the wrong account, revealing everything from drug test results to cancer treatments. In both nightmare situations, digital communications have exposed a company to huge fines as well as public embarrassment and customer attrition. These dangers are not new. Traditional paper communications could have had the same effect. What is different in a digital environment is the speed with which a small mistake can reach millions of customers. With digital communications, no one can rush down to the mailroom and stop a stack of envelopes from going out. Automated processes massively increase efficiency, but these same processes, by their very nature, lack human oversight. This transition from traditional forms of communication to digital communication is critical for customer experience, but companies must update processes and procedures along with technology to avoid these dangerous situations. What can a company do to modernize communications processes while also remaining compliant with regulations? There are two considerations: prevention and recovery. Prevention is the more important approach. Recovery requires recognizing that, eventually, someone will make a mistake — and a proactive company will have the technology in place to minimize the impact of that mistake. See also: The Human Resources View Of Health Care Benefits Needs To Change   Prevention is not an exciting topic. Communications and customer experience professionals generally do not enjoy working with compliance departments. Compliance reviews can slow projects and sometimes prevent exciting new communications from even being launched. Because of this aversion, what often happens is that, at the end of a project, someone will remember to call compliance for a last-minute review. Compliance is upset because its schedule is disrupted; those responsible for customer experience are anxious because their project is delayed; and IT is angry because its work might have been wasted. The key to avoiding this situation is internal communication. Compliance should be an integral part of any new communications project, especially one that involves new technology or new delivery channels. Reviewing compliance challenges early keeps projects on schedule, and integrating compliance knowledge into communication design reduces the chances of an expensive mistake. Recovery is also an important consideration. In the first scenario above, every employee, current and past, was affected. Contacting current employees is easy; contacting former employees is not. Even with addresses on file, does the company have the technology in place to generate the appropriate notifications and follow-ups? Manual processes are slow and labor-intensive. Proof of notification is also critical to show that the company did everything in its power to inform the affected people. Creating this automated notification and auditing system after a breach has taken place is generally not feasible. Digital communications bring huge benefits to organizations, but they also bring new data privacy challenges. Any company that is in the midst of a digital transformation cannot afford to ignore these concerns. By focusing on prevention and recovery before a breach occurs, organizations can minimize the financial and legal effects and reputational risk. Spending the time and money now can prevent a much larger problem later.

“Reification” describes how people reorganize around new technologies. The Iron Age, Industrial Revolution, Information Revolution, etc., provide abundant evidence of the reification of society. Blockchain technology will likely have a similar impact. The insurance industry is currently optimized for the existing collection of risk pools, data inputs and price signals. If people reorganize, so, too, would their risk exposures — perhaps toward positive risk, or perhaps not. Understanding the implications of these emerging conditions requires a brief history lesson on database architecture. In the early days of computer networks, machines that performed computations were connected with wires to other machines that stored data on some physical medium such as magnetic tape. Humans interacted with these machines by using finger symbols on a keyboard and changing reels of magnetic tape. These activities had very little to do with the computation actually being performed, yet they caused the drive toward reification. While we may not realize it, those same functions are still often performed today in one form or another every time we interact with a computer database. Like the expression, “A fish has no word for water,” many activities that blockchain technology renders unnecessary remain difficult to identify. See also: Can Blockchains Be Insured?   Over time, databases became so incredibly useful that companies and institutions stored all of their data in proprietary silos where they could control access to financial records, product specs, trade secrets, personnel files, customer data, sales projections, etc. The database for an aircraft manufacturer was structured entirely differently than a coffee shop chain — or an insurance company. The specialized linkages that formed between the data and the operations became unique to the organization and, in many cases, proprietary. This was also convenient in sequestering people whose skills were adapted to a particular data structure. The purpose of management was to let nothing in or out of the database without appropriate permission. It has been widely written how institutions have become defined, or “reified,” by their data structures. The problems with legacy databases became apparent when the need arose for one database to communicate directly with another database. This was impossible without human administration. With the advent of the internet and social media, widespread networking capability between computer nodes became exponentially more valuable, while the ability for computers to communicate with each other remained linear. While electrons moved at the speed of light, many systems remained limited to the speed of bureaucracy. In the 1990s, organizations introduced legions of administrators, intermediaries and brokers to help databases communicate with each other. More recently, database engineers invented special interfaces (APIs) that allow, say, Amazon to provide access to parts of its database to wholesalers or partnered retailers. APIs allowed for a wave of innovation associated with the e-commerce movement and much more. However, even APIs had significant shortcomings with the more formal “titled” transactions. In 2016, with all the APIs in the world, a real estate broker must still wrestle with several databases to complete a transaction. The broker must lead the buyer and seller around the multiple listing service database (MLS), coordinate a financial lenders database, adjust for property inspection database, secure via a property insurance database,  use an escrow service and title insurance database — all under strict government database regulation and their own corporate management database oversight. The agents must deliver all of these databases in relative unison to a single point in time to receive archaic ink “signature” and a time stamp. A small mountain of paper “papers” is then registered in public archives. And, still, the deal can still be reversed by a legal challenge. The process can take weeks or months with unnerving risk, cost frictions and price volatility. “This is all very weird, only we’ve become accustomed to it” – Vinay Gupta Unfortunately, as the value of data increases, so, too, are the incentives, probability and consequences of cheating, especially where the ability to cheat has been equally enhanced by new technology. Reified society then reacts by adding additional laws and regulations that may thwart innovation to a greater degree than the protection that those laws may provide. Today, asymmetric information, blanket legislation and selective enforcement are considered among the scourges of modern-day commerce. Keep in mind, this complexity STILL has very little to do with the actual thing that people are trying to accomplish. See also: Why Insurers Caught the Blockchain Bug What if we can get rid of all the complexity? What if we can eliminate the brokers and intermediaries; the bureaucracy and the administration; the noise and the friction; and the risk? Actually, this is a popular idea that has been attempted throughout history in various forms of governance and marked by the willingness, ability and degree of control of information. Obviously, there are many methods for applying control (or not applying control); most lie on a spectrum between a fully centralized organizational system and a decentralized organizational system. Blockchain technology would allow data sources to communicate securely with each other directly with no central authority, administration or brokers. The insurance industry needs to take this technology seriously to enhance society’s ability to organize their own risk pools — or the insurance industry risks irrelevance. (Adapted from Insurance: The Highest and Best Use of Blockchain technology, July 2016 National Center for Insurance Policy and Research/National Association of Insurance Commissioners Newsletter)

If you’ve been involved in an accident, you file a claim with your insurance provider and assume that it will act in good faith and protect you. However, just because “good faith” exists doesn’t mean your claim won't be denied. Has Your Claim Been Denied? Nothing feels quite as disheartening as finding out your claim has been denied when you were sure your insurance company was on your side. If that happens you have the right to know why. See also: Power of ‘Claims Advocacy’   A car accident, for instance, might be denied because: the accident was avoidable; there was no complaint or treatment at the time of the injury; or there was a pre-existing condition. What’s Next? Often, a denied claim can be a simple mistake, so, before you settle for your insurance company’s decision, don’t be afraid to ask questions and get some clarification. If you have double-checked that the information you submitted is correct or have fixed some errors on your claim (and your claim is still denied), you have the right to dispute the denial. See also: Bad-Faith Claims: 4 Ways to Avoid Them   If you choose to appeal a denied claim, a common procedure for some insurance (such as health insurance) involves writing a letter explaining why you believe your claim should be covered. When explaining your claim, be as detailed and specific as possible and include any evidence or information the insurance company may not have asked for or considered. You should also keep copies of everything you send to the insurance company and keep detailed notes of when and whom you spoke with. Considering Legal Action If you don’t know how to proceed with a denied insurance claim, you may want to consult a lawyer who specializes in insurance cases. If your insurance company still refuses to accept your claim after your appeal, legal assistance may be your best course of action, as you may be able to file a “bad faith” case against your insurance company.

As we think about the changes that will inevitably happen within the insurance industry, we also have to recognize that these changes will be reflected in a transformation of the leadership function. Of course, we have to distinguish between leadership and organizational power. "Power" usually comes from the ability to influence and give direction to others and through hierarchy. The leadership role is often viewed as some form of organizational hero who has the ability to take an organization from a status of failure or inertia, to one of success. But is this hero model still valid, and will it be valid going forward? Isn’t one of the main problems that the pace and complexity of change is so dramatic that so-called leaders are no longer able to draw on their own experience to help create a compass for the organization? And without experience or adequate understanding, is there a risk that traditional leaders might simply revert to what they know, and create a drag on the business rather than provide the catalyst to drive it forward? In creating this drag, don’t the leaders themselves run the risk of personal criticism if their performance or ambition starts to dwindle? See also: Inventing Your Future: A 3 X 3 Approach   The paradox is that leadership can be both the cause of organizational weakness and also the cure if implemented effectively. Emerging theories of leadership point to a more devolved, flexible and decentralized model of leadership, a model that demands a shared, distributed and relation-based leadership ethos with the emphasis on collaboration – as opposed to the old hierarchical model. Has leadership become a process rather than a position? If that is the case, then does such an environment present us with the opportunity for a more fluid, richer leadership environment? No more Eureka moments, but rather that the leadership of an organization is constantly shifting and is a reflection of the culture and shared values of the business? And does it mean that anyone with the word "leader" in their job title – like mine – is toast? Yes, probably, unless as a leader you are personally prepared to change. If leadership is to exist in any form, then it will be by example. Leaders need to show how to collaborate, innovate and be agile. Leadership is no longer about holding the sword and shouting "follow me" or "do what I say." See also: The Future of Insurance [Infographic]   As we increasingly focus on a world of data and analytics, and the associated democratization of understanding and insight, we have to accept that this has the potential to create the collapse of organizational hierarchy. Maybe that’s not a bad thing. Data and democratized analytics inevitably force us to think about leadership in a different way. It might also force us to think about our own careers and professions in a different way, as well. How we communicate these very major issues is also critical. If we accept that the big data genie is out of the bottle, then we must also accept that the metaphorical Pandora’s Box has been opened. Classicists will know that as Pandora’s Box was opened, then all the evils of the world were allowed to escape from that box. Of course, it’s not quite so dramatic – but will big data and analytics provide the catalyst for a revolution in what we mean by leadership?

As an American and the de facto administrator of my family’s health insurance, I am reminded routinely of some of the complexities of the methods we employ to maximize health and pay for care in this country. Forces are driving individuals, providers, insurers and employers to change their approaches or suffer the consequences. InsurTech companies that take aim at the U.S. healthcare industry by using software and data to improve efficiency and outcomes can benefit from this opportunity. Depending on whether you are an optimist or pessimist, the healthcare sector is the land of endless opportunity or unsolvable problems. Because the scale is huge, even small steps forward, aimed at opportunity pockets, can translate into significant wins. Let’s view the situation through four lenses: the health of the American people, marketplace trends, the role of regulation and the players. You can unpack any one of these and understand why Venture Scanner has identified more than $26 billion in funding that is being poured into 1,300 health-technology companies across 21 categories and 48 countries. The issues and implications arising from any of these categories are intertwined, so even startups focusing on health insurers cannot disconnect from what is happening in the rest of the ecosystem. This post focuses on health insurance in the U.S., not the broader healthcare space or other geographies, because the U.S. is a) a massive market and b) a different structure from markets in Europe and Asia). Americans, overall, do not live a healthy lifestyle The U.S. came in last place in a 2013 ranking of affluent countries’ health in a Mayo Clinic Proceedings study that included four factors in its definition of “healthy lifestyle”: diet, exercise, weight and smoking. Americans are getting fatter. More than one-third of the adult population is obese. Every single state has an obesity rate of more than 20%, adding an estimated $200 billion to the national healthcare tab. A piece of good news from the Centers for Disease Control is that the percent of adult smokers has dropped steadily from 42% in 1965 to 17% in 2014. The trend among students has been less stable, but generally downward, peaking at 36% in 1997 and dropping to 16% in 2013. This is a huge and shifting marketplace Consider just a few dimensions:

• Healthcare spending represents 18% of the U.S. gross domestic product, $3.2 trillion, or about $10,000 per person. As the population ages, government spending in the sector is expected to increase. Also consider that 30% of Medicare dollars go toward the 5% of beneficiaries who become very ill and then die each year.
• Employers are taking action to shift costs to employees, and slow spending. Employers provide coverage to 150 million Americans. And, according to the 2015 Kaiser Family Foundation total average annual premium per employee has increased from $5,791 to $17,545 since 1999. Employees are being asked to pay more, or to avoid doing so by trading down to high-deductible plans. This creates near-term savings back to healthy families who don’t run into any medical surprises. What is rarely highlighted, however, is how many families are effectively assuming the financial risk of facing a large deductible in the event of, say, an unanticipated hospitalization. Because 62% of Americans have less than $1,000 in savings and 21% have no savings, the potential is real for individual families to face serious financial consequences as a result of this choice.
• Only one in seven Americans understand the insurance plans selected yet are held increasingly responsible to manage decisions that could have implications not only for cost, but also for quality of life.
• Insurance carriers have benefited from ACA (Affordable Care Act aka Obamacare, formally named the Patient Protection and Affordable Care Act) because of how the statute has expanded the market and provided premium subsidies for lower-income households. At the same time, insurance companies remain the least trusted of the healthcare subsectors.

Regulations focus on changing behavior, protecting patient data and stimulating innovation ACA, signed into law in 2010 and upheld by the Supreme Court in 2012, is watershed legislation that set the sector up for reinvention. ACA takes both a carrot and stick approach to increase coverage and care effectiveness while lowering costs, e.g.,

• If as a user you don’t purchase coverage, you face penalties.
• If as an employer of 50-plus people you don’t offer coverage, you face penalties.
• Health care providers are being given incentives to make "meaningful use" of electronic health records to create efficiencies and improve care decisions, and face penalties if they fail to use such tools
• Primary care providers and general surgeons are being given incentives to move to low-coverage geographies.

These are just a few examples of how ACA is attempting to get people to change how they select, use and administer healthcare payments and services. Two other regulations affect health insurers:

• The Health Information Privacy and Protection Act, better known as HIPAA, the privacy, portability and security rule designed to protect patient health information, while improving data portability. HIPAA affects how data is stored, protected, used and transferred.
• The HITECH Act (Health Information Technology for Economic and Clinical Health) was enacted to support the development of a nationwide health IT infrastructure, as well as define and maintain standards for health information technology products and how they interact with each other.

Any health care player -- incumbent, startup or investor -- must understand how the regulations work For those who question whether ACA might be repealed, consider that, while this year's election suggests anything can happen in politics, there have been more than 50 failed attempts by Republicans in Congress to undo the legislation. So, better to understand how the incentives and disincentives relate to any potential new business model, and appreciate how big a departure ACA’s core principles are from the traditional way in which the U.S. healthcare system has operated. The latter is vital to understand the dynamics of the new playing field and how individuals, providers, insurers and employers are responding. The winning business models will be those that exhibit four characteristics:

• Link to the regulatory levers – carrots and sticks for individuals and providers – and move them. This is where the commercial value lies.
• Prove they can deliver better outcomes at lower cost.
• Demonstrate potential to scale, by itself, via B2B partnerships, or via exit to a scale incumbent.
• Have a viable basis for underwriting and risk management.

Success will be a function of software + data + tactical knowledge of the levers – both the regulations and how to motivate behavioral change where people are being asked to make radical changes.

In the past, customers tended to ignore their insurance after they purchased it. They interacted with their agents only a couple of times a year — to purchase a policy or file a claim — and then they forgot about it. Now, technological advancements give consumers the ability to connect with their insurance products and services at all times, creating highly personalized services that are in high demand. In fact, 77% of consumers are willing to provide usage and behavior data in exchange for lower premiums, personalized coverage recommendations or faster claims settlements. The following five new technology trends will change the future of insurance for carriers and consumers alike. 1. Vehicle Telematics Vehicle telematics transmit real-time data directly to insurers through devices installed in vehicles. As a result, consumers receive more accurately priced premiums and better risk assessment that isn’t solely based on demographic information. Telematics can also help align your auto insurance premium with your driving usage. This is known as usage-based insurance (UBI). By 2020, it is projected that 70% of all auto insurance carriers will use telematics and some form of UBI. 2. Mobile Health Mobile health, or mHealth, refers to apps and wireless devices that can be used in healthcare for prevention, treatment and rehabilitation. Both insurers and consumers can benefit from mHealth, and its popularity is demonstrated by the fact that the industry’s revenue is expected to reach $26 billion by 2017. Mobile health allows insurance companies to sell policies that are specific to their consumers’ health data as well as their adherence to medications and treatment plans. Consumers can use mobile fitness apps to monitor and improve their health, ultimately reducing premium rates. See also: 4 Technology Trends to Watch for   3. Gamification Gamification incorporates different aspects of games to add some fun to the insurance consumer’s experience while solving real-life issues. Insurance companies recognized the lack of customer engagement and have sought to improve this through gamification. Though gamification techniques are fairly new to the insurance world, they are likely to benefit consumers. Gamification can turn formerly tedious activities — like tracking healthy habits or filling out a health risk assessment — into engaging games that result in rewards and continue to motivate consumers to live healthy lifestyles. On top of its consumer influence, gamification will be used to improve the workplace. Forty percent of the Global 1000 top companies will use gamification as an incentive and to transform business operations. Keeping employees engaged, especially during a transition, can be highly difficult. Gaming technology is pioneering this issue. In 2012, the gamification market was $242 million. According to a M2 Research study, the market will be $2.8 billion by the end of this year. In other words, we have a lot to look forward to when it comes to interactive engagement as consumers and employees in the insurance world. 4. Drones and Aerial Imagery While drones are often used as devices for personal enjoyment, they are also transforming the way insurance companies evaluate claims. In the past, insurers needed to visit a physical location to estimate damage and losses. However, drones can now capture aerial images that allow them to more quickly respond to catastrophic events and process claims. Cognizant, a consulting firm, estimates that drones will make insurance adjusters’ work flow 40% to 50% more efficient. The insurance industry’s growing use of drones will help improve safety practices in the aftermath of a disaster by having fewer people — insurance agents and consumers — on the ground taking photos. Drones also allow insurance carriers to better assess how an event occurred and the resulting damages with high-resolution images from all angles. 5. Home Automation As consumers continue to adopt smart home technology, from voice-controlled lights to sensors that detect pipe leaks, they will benefit from home insurance premiums that are more directly tied to their lifestyles. Some insurance companies offer discounts to homeowners who use smart home technology that can decrease their home’s risk of damage or burglary. Smart thermostats, smoke detectors, security systems and deadbolt locks can all improve a home’s safety and can decrease your homeowners or renter’s insurance bill. See also: How Technology Breaks Down Silos   Insurance companies will continue to adapt as this technology continues to popularize. More and more homeowners are investing in smart home technology — 45% of all Americans, in fact. New technology has paved the way for a more personalized experience for insurance customers. As a result, insurance companies are shifting away from transaction-based services and are moving toward building relationships with their always-connected consumers.

In a high-profile case that highlights the potential for insurance fraud, a Los Angeles woman who was featured in Season 4 of the “Bridezillas” television series pleaded no contest to 14 counts of submitting fraudulent documents and making false claims to receive workers’ compensation benefits. Anita Maxwell, 55, was sentenced to one day in county jail, three years of summary probation, 200 hours of community service and restitution in the amount of $11,873.79. Maxwell, a clinical partner, had alleged a neck, back and shoulder injury while assisting a patient. She lied to her medical providers in a recorded statement obtained by Probe Information Services, where she denied she had any prior injuries to her neck, back or shoulders. Maxwell’s prior medical records were located by Probe Information Services in a medical canvass, and those records were presented to her medical providers. Medical providers confirmed Maxwell had denied any prior injury or treatment, thereby concealing information in an attempt to obtain WC benefits that she was not entitled to receive. Her primary treating physician testified that, had he known about the concealed information, he would have provided a different opinion as to apportionment of permanent disability. Based on her attempted theft of permanent disability benefits, Maxwell was charged with insurance fraud for multiple counts of material misrepresentations. Maxwell was featured in the first episode of the fourth season of WE Television's “Bridezillas” in 2007, where she was humiliated after being left at the altar. She isn’t the first reality TV star to be charged with workers’ comp fraud. In 2011, “Real Housewives of Orange County” participant Devon Lynn Kile pleaded guilty to fraud charges in a $30 million premium fraud scheme. In 2012, James Frank Smith, who was a participant in the History Channels’ “Ax Men” series, was charged with fraudulently claiming he was unable to work. See also: How Should Workers’ Compensation Evolve?   Maxwell had been charged in 2014, but the case languished until she pleaded no contest this month.