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A Word With Shefi: Ashili at Smart Drivinc

Smart Drivinc aims to provide peace of mind to parents and others by developing affordable, crash-prevention technologies.

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This is part of a series of interviews by Shefi Ben Hutta with insurance practitioners who bring an interesting perspective to their work and to the industry as a whole. Here, she speaks with Shashaanka Ashili, founder of Smart Drivinc. To see more of the "A Word With Shefi" series, visit her thought leader profile. To subscribe to her free newsletter, Insurance Entertainment, click here. Describe Smart Drivinc in 50 words or less: We are focused on developing crash-prevention technologies in affordable ways. Our solution for distracted driving is affordable, configurable, tamper-resistant and backed by intelligent evolutionary algorithms. How did the idea develop? In 2014, my wife’s car was rear-ended by a distracted driver. A non-fatal, four-car pileup resulted in a total loss of the car. Finding another car, with infants in the family, was a painful process. The unfortunate part is that the accident could have been prevented, had the driver been a bit more careful. That is the focus of Smart Drivinc - crash prevention. What's in a name? Our solution is supported by smart technologies that make driving safer...hence Smart Drivinc. Describe your typical client: Our B2B clients are companies with employees on the road: sales workers, insurance adjusters, etc., for whom we reduce risk by preventing accidents. Our B2C clients are parents of novice drivers, for whom we provide peace of mind. What does competition look like? The space is crowded with all kinds of solutions, however, we are the only company that solved this problem in an affordable fashion and created a win-win ecosystem for end users and insurance carriers. What’s on your to-do list? The top of my to-do list includes forming collaborations with insurance companies. Our solution not only reduces accidents but also brings new customers to the table. What are you most excited about with respect to Smart Drivinc? At the end of the day, what matters and excites us most is providing peace of mind to parents and making our roads safer. Why are you part of the Global Insurance Accelerator? GIA occupies a niche, a space that has not been visible before. Combining insurance and technology in the Heartland is a brilliant strategy. For the past three weeks, we've met with the best in the industry and were offered unconditional support for our venture. I learned a lot from each individual meeting. GIA has created a mentor pool that is like a library where you can find answers to everything. The best part is they're one call or one email away from us. One takeaway: Make no assumptions, stop "talking" and start "asking." Who else has been supportive of your cause? CEO of MinMor Industries, Joe Morris, is one of our strong supporters. Thank you, Joe! Biggest challenge: By profession, I am a bio-optical systems guy, no relation to the insurance or the transportation industries. Developing contacts and traversing these sectors was my biggest challenge. Being selected to GIA solved this problem for us. Where do you see Smart Drivinc in five years? Our motto is "Crash Prevention," and we have several products lined up to address this, with the goal of launching a product once a year. For instance, we are developing a suite of products to personalize one's interaction with his/her car, starting with the actual purchase of the car, down to maintenance, insurance and even the sale of the car. Best life lesson: Believe in yourself; you will have some discouraging encounters.

Shefi Ben Hutta

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Shefi Ben Hutta

Shefi Ben Hutta is the founder of InsuranceEntertainment.com, a refreshing blog offering insurance news and media that Millennials can relate to. Originally from Israel, she entered the U.S. insurance space in 2007 and since then has gained experience in online rating models.

23 Questions on the Use of Narcotics

At some point, the evidence of death and destruction from our prescription drug abuse epidemic will overwhelm the lobbyists.

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During my Feb. 23  webinar titled "History of Heroin Use: Impact on Prescription Drug Abuse," there were a series of questions that I could not address during the Q&A time. In fact, 23 questions. I finally finished my written responses, and One Call Care University is distributing them to the 938 confirmed attendees of the webinar. However, I thought it might be an interesting exercise to make them more broadly available here. BTW, because of the very positive feedback from attendees, One Call Care University has scheduled another webinar on the same subject on Aug. 25 (obviously with some updated content). I appreciate their support. So, if you missed the Feb. 23 webinar, pencil in Aug. 25 on your calendar. See Also: Progress on Opioids--but Now Heroin? Also, in case you didn't notice, I have written two heroin-related blogposts since February 23 that provide even more context - “Breaking Point: Heroin in America” and “The Heroin Triangle … in My Hometown.” And now, the 23 questions ... and answers. I would appreciate any additional insights you may have, so I can continue to expand my perspective and understanding, so feel free to submit comments.
  1. Will the recent conviction of Dr. Tseng in the overdose death of three patients have an impact on physicians dispensing narcotics? I certainly hope so. It is a very high-profile prosecution and conviction of a physician who was prescribing for the benefit of her pocketbook and not for the patients. As with other high-profile events, this could be used as a launching point for even further prosecution (beyond the continuing investigations that typically result in surrendering MD or DEA licenses). Whether this affects the opinions (and actions) of actual prescribers, only time will tell.
  2. As a workers' comp adjuster, I received a request for approval of Narcan for an injured worker who is taking morphine medications. It was denied, but what would be the ramifications of approving Narcan to a workers' comp injured worker? Would there be a chance of getting a death claim if the injured worker died after the Narcan dose? I’d be interested in knowing the rationale for denial – was it deemed unrelated/non-compensable, or were there concerns about its medical efficacy, or was it a concern along the lines of your second question as to the implications or liability? The latter is an interesting question, because by approving Narcan it could be extrapolated that you know the dangers of the drugs for which you’re approving an antidote. On the other hand, if you don’t approve the Narcan, did you not perform the necessary due diligence to ensure the patient didn't die from an overdose. These are legal questions – I’m not an attorney, so you should probably consult yours – but I could see both respective questions and answers creating issues. Ultimately, the best thing that can be done for the patient/injured worker is to help him taper from the dangerous drugs he's using to a treatment that does not introduce the possible side-effect of death (i.e., remove the need for Narcan by removing the drugs). As I mentioned on the webinar, we’ve made a mess, and now we have to clean it up. I believe the cleaning up process is going to be a major focus for many years to come.
  3. What can be done about the physicians who are ordering unnecessary narcotics such as hydrocodone and oxycodone and seem to be the majority? It’s upsetting when a patient goes to an urgent care and is given narcotics for simple injuries such as a small laceration to a finger, or a bumped toe - how and why is this happening? Part of the solution is better education for prescribers – they should be informed of all treatment options and focus on those with the least amount of negative side effects that helps the patient (which may mean not giving patients the drugs they think they need). Part of it is better education for the patient – own your healthcare, ask questions and if the side effects are worse than the original malady then do your own research (plenty of free resources on the Internet). Part of it is the pharmacy/pharmacist/PBM – leverage common sense (and automated triggers) to connect the potency of the drugs to the illness/injury being treated. Part of it has to be legislated – mandatory access of PDMPs where real-time access is available, CME for doctors to ensure they know everything they need to about the treatment of pain, investigations by the DEA and state and local enforcement, restrictions on physician dispensing. Ultimately, prescribing behavior needs to change. But putting the responsibility solely on the prescriber is not sufficient.
  4. How do you view chronic use of Tramadol? Tramadol was added as a Schedule IV drug as of Aug. 18, 2014. Prior to then, it had not been scheduled (i.e. was not a controlled substance). The DEA changed the classification because the long-time arguments were all disproved: that people can’t get addicted, there is no withdrawal process, and there is no possibility of overdose. If it quacks like a duck and walks like a duck and smells like a duck – it’s a duck. More research showed that Tramadol quacked and walked and smelled like a narcotic. That said, it’s less potent and has less serious side effects than Schedule II (e.g. oxycodone, methadone) or Schedule III (e.g. Vicodin, Tylenol with Codeine). Per all EBM guidelines, long-term use of narcotics can be supported if the patient has exhausted all conservative non-pharma and pharma treatment, has adequate pain control and levels of function/quality of life and is on the lowest possible dosage. That obviously leaves open the possibility of long-term use, but the bar is fairly high. Anybody in this position should talk with a doctor.
  5. How do you view long-term use of Flexeril (Benzodiazepine)? Flexeril (cyclobenzaprine) is a muscle relaxant. While it is less dangerous than Soma (carisoprodol), the side effects from any muscle relaxant can be dangerous (check out my favorite website’s assessment). In general, muscle relaxants are not recommended for long-term use, but, as with the above question on Tramadol, use should be based on the effects (positive and negative) to the patient and whether there are treatment options (non-pharma and pharma) that might equally resolve the condition without the dangers. Anybody in this position should talk with a doctor.
  6. What do we tell patients who have chronic back pain, who have failed all conservative treatment and who are unable to obtain strong-enough medication for short-term exacerbations, and their physician will not prescribe any narcotic? What choice do they have but to seek street drugs? This is the tricky part – not restricting access to drugs to the point that people who really need them can’t get them. That is often the concern raised by advocates for opioids. If the patient has not shown signs of abuse (e.g. running out of their 30-day supply in 22 days, doctor/pharmacy shopping, using illicit drugs or non-medical prescription drugs) then the doctor should consider prescribing the lowest possible dosage to resolve the issue, whether it’s chronic pain or momentary exacerbations. That prescription should be accompanied by accountability tools like pill counts and random drug tests and opioid treatment agreements. And it should also be accompanied by counseling to address the psychosocial needs of the patients (e.g. giving them methods to cope with the pain, helping them deal with problematic family situations, providing vocational rehab to provide some work outlet). In my mind, this decision starts and ends with an honest and transparent dialogue between the doctor and patient. If the patient doesn’t feel listened to, or the doctor feels like the patient isn’t being honest, bad decisions can be made. If, after all these controls have been introduced, the doctor still doesn’t feel like narcotics are the answer, then the patient should likely solicit a second opinion. Of course, in workers' comp, that would process through the payer (carrier, TPA, self-insured) … So the circle of honest and transparent dialogue also needs to include them.
  7. Have you seen correlation for suicide for people taking Xanax and drinking alcohol? The biggest concern in combining Xanax and alcohol is accidental death from side effects such as slowed respiration and heart rates and seizures. Severe depression is another potential side effect, which could certainly lead to a suicide attempt. Suicidal thoughts as a specific side effect are not nearly as common as just going to sleep and never waking up again. My suggestion? Never mix alcohol with any opioid, benzodiazepine or muscle relaxant. Period.
  8. Do you think that decreasing the use of prescription opioids will just push more people to street heroin? It already has. And that is why we have concurrent epidemics of prescription painkiller abuse and heroin. For those who have become dependent or addicted to opioids, they need to be helped by a methodical tapering process to other methods for resolving their pain and non-pharma ways to deal with that pain (e.g. yoga, stretching exercises, an active lifestyle) and psychological treatment (e.g. CBT, establishing coping mechanisms). It is inhumane to remove drugs, especially those with high possibility of abuse and addiction, and not replace them with other mechanisms to treat their physical and psychological pain. Just detoxing or removing access will likely just force patients into finding other methods to self-medicate (heroin or other illicit drugs, alcohol, etc.) So, the answer to this Rubik’s Cube is difficult because only removing supply of opioids could create unintended consequences that could be as bad or even worse than the original problem.
  9. Why aren't MDs (particularly pain management specialists) held more accountable for addiction? Isn't it malpractice? That argument could certainly be made. Doctors, in general, are given great latitude to practice the art of medicine. That latitude has often resulted in great treatment that would have otherwise not been tried – the discovery of penicillin, the transition of minoxidil (Rogaine) from high blood pressure to hair growth, any number of treatments for cancer. But with latitude comes responsibility for bad choices, and once discovered taking an alternate path. At this point, it could not be argued that opioids are very dangerous and overused and that extreme care is needed to ensure that the benefits outweigh the risks. So why do physicians/prescribers, including pain management specialists, often still prescribe when the evidence is clear? And why aren’t they held accountable? We’re seeing increasing accountability by the DEA, state and local law enforcement who are actively pursuing “pill mills” and inappropriate prescribing patterns. We’re seeing increasing accountability from the use of PDMPs and prescribing profiles from PBMs to target high-quantity prescribers. We’re certainly seeing increasing accountability from investigative media who are searching for stories. When will that translate into medical malpractice (defined as “any act or omission by a physician during treatment of a patient that deviates from accepted norms of practice in the medical community and causes an injury to the patient”) is anyone’s guess, but I can see that as a natural consequence over time by patients and their attorneys.
  10. What can be done to report opioid abuse? Each state’s PDMP (prescription drug monitoring program) is a macro way of recognizing abuse and misuse by patients and prescribers -- some states have combined data. However, for now, access is limited to prescribers, pharmacists and in some cases law enforcement. So the primary means of identifying abuse and misuse will be the prescriber and family/friends. So how do they report it, and to whom? The first step should be intervening directly with the abuser/misuser to help her recognize, admit and enact changes to stop her substance abuse. That intervention may require involving a professional in substance abuse or mental health. If the abuser will not admit there is a problem, the next step will be determined by the level of abuse, illegality and connectedness. If you know someone who is abusing opioids or other dangerous drugs, and he won’t respond to your private conversations about the issue, then engage with a professional.
  11. If Rx opioids are intended for post-surgical pain and end of life, why do doctors prescribe them for WC back injuries with no end game plan in sight, and why won't the WC judges  get involved? Why are doctors not held accountable for this problem? As mentioned in an earlier answer, the motivations for prescribing and using outside the on-label uses for these drugs can be varying. As can the accountability. But I think that is changing as doctors become more aware of the epidemic and their role in it. I have seen a generational shift by new doctors who attended medical school, while media including USA Today and CNN have ensured the general population knows we have a problem. The doctors who were in practice or in medical school during the mid-1990s when advocates complained of opioid phobia and under-treatment of pain are coming to a similar conclusion. By no means has there been enough education yet, or conversion of prescribing behaviors, but pressure from the White House to the governor’s house to a mom’s house is certainly creating momentum toward appropriate use. Those of us who serve as educators will continue to be unrelenting in the battle for hearts and minds, but ultimately it comes down to individual decisions by both prescribers and patients to do the right thing.
  12. Do you know if authorities who arrested Tseng confiscated the $5 million she made? I’ve not seen any evidence they did.
  13. Why do people snort pills vs. taking them normally? Drugs like OxyContin and Opana are ER (extended release) and formulated to take effect over a period of 10 to 12 hours. That does not provide the intense and immediate high desired by people addicted to or dependent upon heroin-type euphoria. When pills are crushed and snorted or injected, users bypass the wait associated with the extended release. Abuse deterrent formulations are an important component to help make the high more difficult to obtain. I spoke at a summit on Abuse Deterrence in Alexandria, VA, on March 19, so be watching for a post on what I learned from the speakers prior to my presentation.
  14. Is Demerol similar to or it is also an opioid? Similar to morphine? Demerol (meperidine) is indeed an opioid. Morphine is 10 times more potent than Demerol, however it is NOT recommended for palliative care (i.e. for chronic pain). According to drugs.com, it has 73 major, 701 moderate and seven minor drug interactions along with 16 disease interactions. So it’s a very complicated drug.
  15. What do you recommend someone take with a chronic illness that is not life-threatening? There are many people who take, appropriately, prescription drugs to manage chronic conditions like diabetes, hypertension, rheumatoid arthritis and a variety of other ailments – and without those drugs, their health (and often their life expectancy) would be compromised. Chronic pain, physical or psychological, is real. And unique to each individual, both in the pain itself and the ability to manage it. Which means the treatment is often unique for that specific individual, and therefore the road map can be filled with trial and error. In some cases, chronic pain can be appropriately managed by prescription drugs. But likely that isn’t the only method for management, and in some cases prescription drugs create more issues (i.e. side effects) than they solve. Finding a pain management clinician who believes in the BioPsychoSocial model and thinks drugs are used only after all conservative options are exhausted is key. Following is a list of alternative treatments that is at least a starting point: Physical – An active lifestyle; seven to eight hours of sleep each night; Proper nutrition and weight management; Alternative treatments like acupuncture, massage therapy, yoga; Reducing or removinge alcohol consumption; Smoking cessation. Psychological – Cognitive Behavioral Therapy to adjust attitudes about pain; Develop coping mechanisms through methods like deep breathing, meditation, biofeedback; Dealing with the anxiety or depression that often comes with chronic pain; Developing a support system of family and friends; Decreasing avoidance by enhancing the “fight” attitude; Reducing stress. For further reading, two good articles can be found at http://www.webmd.com/pain-management/guide/11-tips-for-living-with-chronic-pain and http://www.medscape.com/viewarticle/576064
  16. How long does a person need to be on methadone for weaning? That varies on the person, the complexity and scope of the drug regimen being weaned and any co-morbidities that might complicate the process. One clinical resource I’ve read says a patient with significant risks can be tapered in a closely monitored environment over seven to 14 days, but typically it’s a slow process of 5% to 10% declination every one to two weeks (so how long it takes depends upon the starting dosage).
  17. Many providers order opioids in workers' comp and are not willing to budge in discontinuing/weaning these medications. What recommendations do you have to assist in this process? In some cases, opioids are appropriate, so don’t automatically assume all opioids (and the corresponding drugs/classifications to address side effects) are inappropriate. If the opioids are creating more harm than good (based on levels of activity, quality of life, number/severity of side effects, subjective assessment of pain), and if evidence-based medicine indicates there are other treatment options that should be tried, that information should be relayed to the prescriber. If the prescriber will not talk to anyone, or does not accept the evidence of a better way, then the goal would be to either compel the prescriber to change the drug regimen or to change to a different provider. The path for that is different for each jurisdiction and often includes utilization review, independent medical exam (IME), forcing a provider change, a legal challenge, reporting the provider to the state’s medical association or discussion directly with the injured worker. First, every effort should be made to present objective, clinical evidence in a collegial manner to the prescriber to help him see things differently. If, given the evidence and the chance to review, the prescriber still refuses to listen or change then there is ample evidence of your due diligence that will demonstrate your desire to do the right thing for the injured worker.
  18. I have been informed that once a person is on meth he always goes back. People are never able to get off it. Is that true? If not, do you know the statistics for successful results? There are circumstances where somebody could successfully detox and stay off meth, but it is so addictive that the odds are high they will relapse or die. I found a statistic that 93% of those in rehab for meth addiction relapse, and the national rate of recovery is 16% to 0%. This article provides a good overview: http://luxury.rehabs.com/crystal-meth-addiction/recovery-statistics/.
  19. Is Hep C a germ that develops or is it an actual virus passed by dirty needles? Hepatitis C is a “virus (a type of germ) that causes liver disease.” From my study of opioids and heroin, it’s clear that Hep C can be a direct result of heroin use because of shared needles. “Dirty needles” typically means ones that have been contaminated by bacteria or blood residue from previous user(s) of that needle, and that can certainly be a method for addicts who are scrounging for resources (like needles) to continue their habit. Dirty needles are one reason why communities may have a “clean needle” program. Which is an interesting conversation – does providing clean needles encourage heroin use, or is it a helpful precaution? For more information, this can be a helpful resource: http://health.williams.edu/keephealthy/general-health-concerns/hepatitis-c/.
  20. What is your take on nurse-monitored injection sites, and have they been found to decrease community outbreaks of disease? What have been some of the community concerns related to these sites? This is a trend I’ve read about, not only in the U.S. (Indiana’s response to the Hepatitis C outbreak because of heroin abuse is a needle exchange program via Senate Enrolled Act 461) but abroad (Canada, Portugal, Netherlands). The programs are often called “injection rooms” or “safe havens” or “needle exchanges,” sometimes even coming with outright legalization or decriminalization of drugs like heroin. Concerns are whether providing these options legitimizes use and therefore enables the addicts. Obviously, the preference would be to help people rid themselves of addiction and corresponding behavior. As far as results, studies in Portugal indicate decriminalization has not affected drug usage but has dramatically decreased drug-related pathologies like STD and Hep C and HIV. For more information about that, please read https://en.wikipedia.org/wiki/Drug_policy_of_Portugal.
  21. So what is the generally correct progression or step down in using an opioid after surgery? What would be a "pre-red flag"? Step therapy is going to be directly related to the level of pain associated with the effects of the surgery or injury. In some cases, that could be one to two days with a rapid de-escalation (e.g. Percocet to Tramadol to Ibuprofen). In other cases, where the trauma is significant or followed by painful physical therapy, step therapy could be two to three weeks or even months. Not only is the titration related to the severity of the pain, but so is the tolerance to pain or the side effects by the patient (e.g. the constipation is enough for the patient to want something different). Following are some “pre-red flags” that you might consider: Did the provider prescribe an unusually high days’ supply or quantity (e.g. a 30-day supply or 60 pills)? Did the patient run out of supply before the next office visit? Is there no evidence in the provider’s notes that a discussion occurred with the patient on the tapering process (i.e. articulating the exit strategy)? Was there a tapering attempted, but the patient did not respond well? Instead of tapering down (e.g. 20mg to 10mg, Percocet to Tramadol) is the potency increasing (Percocet to OxyContin)? Is it clear that the patient is not moving toward therapy and activity per expectations? In other words, “pre-red flags” are going to be gleaned from the provider’s notes during and post-surgery and prescribing patterns.
  22. Have you seen Suboxone prescribed as a painkiller vs. a manner by which to wean off heroin? What are your thoughts on Suboxone? The FDA is very clear in its labeling – “SUBOXONE sublingual film is a partial-opioid agonist indicated for treatment of opioid dependence.” Therefore, use of Suboxone for pain is considered off-label. Typically, the FDA approves uses (on-label) where the manufacturer can clearly document the benefits of use for a specific condition, so being considered off-label means the evidence was either not clear or not presented. There are many drugs prescribed off-label (the FDA allows off-label use, only restricting manufacturers from advertising or advocating off-label use), and Suboxone certainly qualifies. For all of the labeling details, go to http://www.accessdata.fda.gov/scripts/cder/drugsatfda. Interestingly, Butrans is another buprenorphine formulation that has been approved “for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.” There are some benefits to both in their built-in abuse deterrence mechanisms. While they’re not 100% airtight, they do put enough obstacles in place to make abuse more difficult (although Suboxone is highly abused in prisons). The concern I’ve heard from payers is that these drugs do not facilitate the tapering of opioids, so they are just added to the overall drug regimen, and they are much more expensive than many of the generic opioids, so reconciliation of therapeutic value vs. financial value is troublesome. Unfortunately, abuse deterrent mechanisms are not as widely available for generics as for name brands My personal opinion is there are less expensive treatment options than Suboxone, so it should be reserved for exceptions.
  23. Do you believe that legislation will be written in the near future that will penalize health providers if they exceed recommended narcotic treatment guidelines? Public policy is not only something based on evidence but also on politics. There certainly are enough treatment guidelines available from a variety of sources that indicate thresholds and areas of concern that would highlight abuse while protecting access to patients who receive benefits. Unfortunately, many of those guidelines don’t come with the necessary mandates or penalties for non-adherence. There are powerful lobbyists employed to maintain the status quo. At some point, I think the evidence of death and destruction from our prescription drug abuse epidemic will overwhelm the lobbyists and public policy will not only create mandates but also stronger enforcement mechanisms. The momentum is clearly on the side of more oversight. And it would not surprise me if personal injury lawyers start issuing more lawsuits and medical malpractice to rid the medical practice of the bad actors. Until then, it’s up to the DEA and state/local law enforcement to find and prosecute inappropriate prescribers, to provide help to substance abusers and to educate everybody of the dangers.

Mark Pew

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Mark Pew

Mark Pew is a senior vice president at Prium. He is an expert in workers' compensation medical management, with a focus on prescription drug management. Areas of expertise include: abuse and misuse of opioids and other prescription drugs; managing prescription drug utilization and cost; and best practices for weaning people off dangerous drug regimens.

How to Resist Sexy Analytics Software

You may think it's IT's job to avoid falling for attractiveness, but soon the majority of IT spending will be the responsibility of others.

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Who’s made the mistake of buying apps or sexy analytics software just based on appearance? Go on, own up. I’m sure at one time or other, we have all succumbed to those impulse purchases. It’s the same with book sales. Although it should make no difference to the reading experience, an attractive cover does increase sales. But if you approach your IT spending based on attractiveness, you’re heading for trouble. Now you may be thinking. Hold on, that’s what my IT department is there to protect against. That may be the case in your business, but as Gartner has predicted, by 2017 the majority of IT spending in companies is expected to be made by the CMO, not the CIO. There are advantages to that change. Software will need to be more accessible for business users and able to be configured without IT help, and the purchasers are likely to be closer to understanding the real business requirements. But, as insight teams increase their budgets, there are also risks. This post explores some of the pitfalls I’ve seen business decision makers make. Given our focus as a blog, I’ll be concentrating on the purchase of analytics software on the basis of appearance. 1. The lure of automation and de-skilling: Ever since the rise of BI tools in the '90s, vendors have looked for ways to differentiate their MI or analytics software from so many others on the market. Some concentrated on “drag and drop” front ends, some on the number of algorithms supported, some on their ease of connectivity to databases, and a number began to develop more and more automation. This led to a few products (I’ll avoid naming names) creating what were basically “black box” solutions that you were meant to trust to do all the statistics for you. They became a genre of “trust us, look the models work” solutions. Such solutions can be very tempting for marketing or analytics leaders struggling to recruit or retain the analysts/data scientists they need. Automated model production seems like a real cost saving. But if you look more deeply, there are a number of problems. Firstly, auto-fitted models rarely last as long as ‘hand crafted’ versions, and tend to degrade faster as it is much harder not to have overfitted the data provided. Related to this, such an approach does not benefit from real understanding of the domain being modeled (which is also a pitfall of outsourced analysts). Robust models benefit from variable and algorithm selection that are both appropriate to the business problem and know the meaning of the data items, as well as any likely future changes. Lastly, automating almost always excludes meaningful "exploratory data analysis," which is a huge missed opportunity as that stage more often than not adds to knowledge of data and provides insights itself. There is not yet a real alternative to the benefits of a trained statistical eye during the analytics and model building process. 2. The quick fix of local installation: Unlike all the work involved in designing a data architecture and appropriate data warehouse/staging/connectivity solution, analytics software is too often portrayed as a simple matter of install and run. This can also be delusory. It is not just the front end that matters with analytics software. Yes, you need that to be easy to navigate and intuitive to work with (but that is becoming a hygiene factor these days). But there is more to consider round the back end. Even if the supplier emphasizes its ease of connectivity with a wide range of powerful database platforms. Even if you know the investment has gone into making sure your data warehouse is powerful enough to handle all those queries. None of that will protect you from lack of analytics grunts. See Also: Analytics and Survival in the Data Age The problem, all to often, is that business users are originally offered a surprisingly cheap solution that will just run locally on their PCs or Macs. Now, that is very convenient and mobile, if you simply want to crush low volumes of data from spreadsheets or data on your laptop. But the problem comes when you want to use larger data sources and have a whole analytics team trying to do so with just local installations of the same analytics software (probably paid for per install/user). Too many current generation cheaper analytics solutions will in that case be limited to the processing power of the PC or Mac. Business users are not warned of the need to consider client-server solutions, both for collaboration and also to have a performant analytics infrastructure (especially if you also want to score data for live systems). That can lead to wasted initial spending as a costly server and reconfiguration or even new software is needed in the end. 3. The drug of cloud-based solutions: With any product, it’s a sound consumer maxim to beware of anything that looks too easy or too cheap. Surely, such alarm bells should have rung earlier in the ears of many a marketing director who has ended up being stung by a large final "cost of ownership" for a cloud-based CRM solution. Akin to the lure of fast-fix local installation, cloud-based analytics solutions can promise even better, no installation at all. Pending needing firewall changes to have access to the solution, it offers the business leader the ultimate way to avoid those pesky IT folk. No wonder licenses have sold. But anyone familiar with the history of the market leaders in cloud-based solutions (and even the big boys who have jumped on the bandwagon in recent years), will know it’s not that easy. Like providing free or cheap drugs at first, to create an addict, cloud-based analytics solutions have a sting in the tail. Check out the licensing agreement and what you will need to scale. As use of your solution becomes more embedded in an organization, especially if it becomes the de facto way to access a cloud-based data solution, your users  thus license costs will gather momentum. Now, I’m not saying the cloud isn't a viable solution for some businesses. It is. But beware of the stealth sales model that is implicit. 4. Oh, abstraction, where are you now I need you more than ever? Back in the '90s, the original business objects product created the idea of a “layer of abstraction” or what was called a “universe.” This was configurable by the business (but probably by an experienced power user or insight analyst who knew the data), but more often than not benefited from involvement of a DBA from IT. The product looked like a visual representation of a database scheme diagram and basically defined not just all the data items the analytics software could use, but also the allowed joins between tables, etc. Beginning to sound rather too techie? Yes, obviously software vendors thought so, too. Such a definition has gone the way of metadata, perceived as a "nice to have" that is in reality avoided by flashy-looking workarounds. The most worrying recent cases I have seen of lacking this layer of abstraction are today’s most popular data visualization tools. These support a wide range of visualizations and appear to make it as easy as "drag and drop" to create any you want from the databases to which you point the software (using more mouse action). So far, so good. Regular readers will know I’m a data visualization evangelist. The problem is that without any defined (or controlled, to use that unpopular term) definition of data access and optimal joins, the analytics queries can run amok. I’ve seen too many business users end up in confusion and have very slow response times, basically because the software is abdicating this responsibility. Come on, vendors, in a day when Hadoop et al. are making the complexity of data access more complex, there is need for more protection, not less! Well, I hope those observations have been useful. If they protect you from an impulse purchase without having a pre-planned analytics architecture, then my time was worthwhile. If not, well, I’m old enough to enjoy a good grumble, anyway. Keep safe! :-)

Paul Laughlin

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Paul Laughlin

Paul Laughlin is the founder of Laughlin Consultancy, which helps companies generate sustainable value from their customer insight. This includes growing their bottom line, improving customer retention and demonstrating to regulators that they treat customers fairly.

Texas Is NOT an Opt-Out State

Texas has always been an Opt In state -- no one need buy workers' comp insurance -- but some mischaracterize Texas in pursuit of an agenda.

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There were two sessions on “Opt Out” at the 32nd WCRI Annual Issues & Research Conference, but a single, critical point was generally omitted by all six speakers across both sessions; an omission that could cause confusion for those not well-versed in the vernacular of alternative workers’ compensation systems. Texas is not an Opt Out state. It never has been. No one may “opt out” in Texas. Period. Instead, Texas is, and always has been, an “Opt In” state. Workers’ compensation coverage is not required of employers there. They can choose to buy insurance, or not. They can choose to set up alternative plans, or not. Either way, they can “opt” for some sort of coverage or go completely bare; they don’t have to have a policy, a plan or a prayer. Those that do not acquire coverage or self-insure under state auspices are called “non-subscribers,” on the surface, the distinction about Opt Out vs. Opt In may seem like a shallow and insignificant point. But the differences in the Texas and Oklahoma systems run deep, and the speakers should have pointed that out. Instead, I believe some intentionally conflate the two for the benefit of their arguments. Most notably, for employers in Texas who choose not to opt in for workers’ compensation coverage, open liability prominently remains. They can be sued for negligence. They can be found responsible for pain and suffering. They are wide open to all of the foibles and pitfalls generally absent for those who choose to participate in the grand bargain and the exclusive remedy it provides. By comparison, employers in Oklahoma have managed to develop a system that gives them unparalleled secrecy and control while maintaining the benefits of exclusive remedy. They have liability protections that Texas employers can only dream about. Common sense would tell us that any alternative plans in Texas are probably better than those found to their north in Oklahoma. The looming reality of open liability means that employers actually have to be responsible if they wish to avoid litigious challenges and expensive jury verdicts. Yet people continually speak of “Opt Out” as if it was one common theme in both states. Our session speakers are not the only ones to do that. Recent articles in ProPublica and NPR also failed to adequately define the difference between the two. See Also: The Bizarre Decision on Oklahoma Option Bill Minick, a Dallas attorney whose firm has written most of the Oklahoma Option plans, mentioned the more than “20 years of history” when talking about the “proven” success of Opt Out. He did not really mention that the 20 years he repeatedly referred to was all based in Texas. Oklahoma has only offered the Option for two years, and only 60 of the state's 70,000 employers have gone that route. Similarly, presenter Elizabeth Bailey of Waffle House, spoke only of their experience in Texas as a non-subscriber. To her credit, she was the only speaker to deliver hard statistics about the experience in that area, but she made no mention of the Oklahoma Option except to note that they had elected not to Opt Out in Oklahoma. She did not say why. And I really would’ve liked to know. Really, none of the speakers made an effort to define the difference between these two systems. To the uninitiated, it would seem they are the same thing. They are not. Oklahoma-style Opt Out is what is being proposed in at least two other states, not Texas-style non-subscription. Future sessions on the subject should clarify that point, focus on actual Opt Out and call out presenters if they dilute or confuse the facts. Additionally, only one speaker, Trey Gillespie of Property Casualty Insurers Association of America, really mentioned that the Oklahoma Option has been ruled unconstitutional in that state. From an overall panel perspective, that fact was almost a non-event, like it never even happened. But more on that later… See Also: Five Workers' Compensation Myths The point is, the Texas non-subscriber system has been around for a long time. The Oklahoma Option, by Minick’s own admission, is an “experiment” (one commenter at the conference pointed out that Frankenstein's monster was also an experiment). We should not confuse the two. Oklahoma Opt Out, along with proposed similar plans in Tennessee and South Carolina, are unique creatures that deserve to be fully judged on their own scant merits and significant flaws. We should stop providing them cover by supporting them with the alleged achievements of a dissimilar system. After all, Texas has never been an Opt Out state, and we should stop talking about it like it is.

Bob Wilson

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Bob Wilson

Bob Wilson is a founding partner, president and CEO of WorkersCompensation.com, based in Sarasota, Fla. He has presented at seminars and conferences on a variety of topics, related to both technology within the workers' compensation industry and bettering the workers' comp system through improved employee/employer relations and claims management techniques.

What New Delhi’s Free Clinics Can Teach U.S.

The Swasthya Slate, costing just $600 and no bigger than a cake tin, performs 33 common medical tests and can be operated with minimal training.

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Rupandeep Kaur, 20 weeks pregnant, arrived at a medical clinic looking fatigued and ready to collapse. After being asked her name and address, she was taken to see a physician who reviewed her medical history, asked several questions and ordered a series of tests, including blood and urine. These tests revealed that her fetus was healthy but that Kaur had dangerously low hemoglobin and blood pressure levels. The physician, Alka Choudhry, ordered an ambulance to take her to a nearby hospital. All of this, including the medical tests, happened in 15 minutes at the Peeragarhi Relief Camp in New Delhi, India. The entire process was automated — from check-in, to retrieval of medical records, to testing and analysis and ambulance dispatch. The hospital also received Kaur’s medical records electronically. There was no paperwork filled out, no bills sent to the patient or insurance company, no delay of any kind. Yes, it was all free. The hospital treated Kaur for mineral and protein deficiencies and released her the same day. Had she not received timely treatment, she may have had a miscarriage or lost her life. This process was more efficient and advanced than any clinic I have seen in the West. And Kaur wasn’t the only patient; there were at least a dozen other people who received free medical care and prescriptions in the one hour that I spent at Peeragrahi in early March. The facility, called the “mohalla” (or people’s) clinic, was opened in July 2015 by Delhi’s chief minister, Arvind Kejriwal.  This is the first of 1,000 clinics that he announced would be opened in India’s capital for the millions of people in need. Delhi’s health minister, Satyendar Jain, who came up with the idea for the clinics, told me he believes that not only will they reduce suffering but also overall costs — because people will get timely care and not be a burden on hospital emergency rooms. The technology that made the instant diagnosis possible at Peeragarhi was a medical device called the Swasthya Slate. This $600 device, the size of a cake tin, performs 33 common medical tests including blood pressure, blood sugar, heart rate, blood haemoglobin, urine protein and glucose. And it tests for diseases such as malaria, dengue, hepatitis, HIV and typhoid. Each test only takes a minute or two, and the device uploads its data to a cloud-based medical-record management system that can be accessed by the patient. The Swasthya Slate was developed by Kanav Kahol, who was a biomedical engineer and researcher at Arizona State University’s department of biomedical informatics until he became frustrated at the lack of interest by the medical establishment in reducing the cost of diagnostic testing. He worried that billions of people were getting no medical care or substandard care because of the medical industry’s motivation in keeping prices high. In 2011, he returned home to New Delhi to develop a solution.
Swasthya Slate is a mobile kit that empowers front-line health workers with usable technology for prevention diagnosis care and referral of diseases. The Swasthya Slate kit was launched in the state of Jammu and Kashmir by the Ministry of Health in 2014. (Swasthya Slate)
  Kahol had noted that, despite the similarities between medical devices in their computer displays and circuits, their packaging made them unduly complex and difficult for anyone but highly skilled practitioners to use. They were also incredibly expensive — usually costing tens of thousands of dollars each. He believed he could take the same sensors and microfluidics technologies that the expensive medical devices used and integrate them into an open medical platform. And with off-the-shelf computer tablets, cloud computing and artificial intelligence software, he could simplify the data analysis in a way that minimally trained front-line workers could understand. By January 2013, Kahol had built the Swasthya Slate and persuaded the state of Jammu and Kashmir, in Northern India, to allow its use in six underserved districts with a population of 2.1 million people. The device is now in use at 498 clinics there. Focusing on reproductive maternal and child health, the system has been used to provide prenatal care to more than 22,000 mothers. Of these, 277 mothers were diagnosed as high-risk and provided timely care. Mothers are getting care in their villages now instead of having to travel to clinics in cities. A newer version of the Slate, called HealthCube, was tested last month by nine teams of physicians and technology, operations and marketing experts at Peru’s leading hospital, Clinica Internacional. They tested its accuracy against the Western equipment that they use, its durability in emergency room and clinical settings, the ability of minimally trained clinicians to use it in rural settings and its acceptability to patients. Clinica’s general manager, Alvaro Chavez Tori, told me in an email that the tests were highly successful, and “acceptance of the technology was amazingly high.” He sees this technology as a way of helping the millions of people in Peru and the rest of Latin America who lack access to quality diagnostics. The opportunity is bigger than Latin America, however. When it comes to healthcare, the U.S. has many of the same problems as the developing world. Despite the Affordable Care Act, 33 million Americans ,or 10% of the U.S. population, still lacks health insurance. These people are disproportionately poor, black or Hispanic, and 4.5 million are children. They receive less preventive care and suffer from more serious illness — which are extremely costly to treat. Emergency rooms of hospitals are overwhelmed by uninsured patients seeking basic medical care. And even when they have insurance, families are often bankrupted by medical costs. It may well be time for America to build mohalla clinics in its cities.

Vivek Wadhwa

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Vivek Wadhwa

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.

Insurance in the Age of the 12th Man

Our long-term goal at Hamilton USA is to get the questions that an agent or broker asks an insured down to two: name and address.

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Brian Duperreault, chairman and CEO of Hamilton Insurance Group, told attendees at A.M. Best’s 23rd annual conference in Scottsdale, AZ, that the insurance industry has been an analog laggard rather than a digital leader, and that the clock is ticking on responding to the needs of a digital world. The address follows: Thank you, Matt, and thanks for that wise review of the forces that have shaped the industry over the years. Hearing that history line makes me feel pretty old. I lived through a lot of those highlights. You’ve heard where we’ve been as an industry, and I’ve been asked to give you some thoughts on where we’re going. The title I’m using is Insurance in the Age of the 12th Man. I’m sure most of you know what I’m referring to by the 12th man – any Seahawks fans with us today? – but in case you don’t: The reference to a 12th man was first used more than 100 years ago to describe a really dedicated football fan. It gained some significant traction at Texas A&M, and the Aggies still claim it’s theirs – in spite of what the Seahawks say. The point is this: Fans can be so fanatically loyal to their team, it’s like having a 12th man on the field. Fans can shape the game and often affect a win or loss. I’ve heard they can even make the earth move. Last month, fans at a soccer game in the U.K. celebrated a last-minute goal so “enthusiastically” that it was recorded as a minor earthquake. Why am I referring to the 12th man in a talk about the future of insurance? Because we’re doing business in an age that’s profoundly different from anything we’ve ever experienced, and I believe it’s driven by what I’m going to call the 12th man phenomenon. Virtually every industry has been redefined by an increasingly demanding customer, and it’s doing the same to ours. It’s the fan base – the collective 12th man – that’s driving how we develop, market and distribute our product. And for many companies, there’s not much time left to figure out how to stay in the game. PwC just released its annual CEO report and noted that access to digital technologies means that we’re more connected, better-informed and, in PwC’s words, “increasingly empowered and emboldened.” This isn’t just a shift in market forces. The market has always been changing, and we’re used to that. This is something entirely different. Given the digital world we’re living in and the impact of real-time communication through social media, the market’s voice is much more crystallized. There’s an immediacy, an intimacy that we’ve never had to deal with before. This is a voice that’s loud, clear and specific. One of the best examples of the effect of the 12th man is Uber. You probably know Uber’s story. Its founders were so fed up with how hard it was to get a cab when they wanted one that they developed an app that puts a taxi at your fingertips. They didn’t just enhance the taxi industry; they blew the existing model apart. They didn’t care what the regulations were. They just made it work – and it continues to work, because Uber gave customers what they wanted. AirBnB did the same thing to the hotel industry.
  • If you’re used to downloading apps to watch a movie, do your banking or order your groceries;
  • If you customize how, when and where you listen to the radio or watch TV;
  • And if this uncluttered, efficient, highly personalized way of living is what you’ve been used to since you could walk, then
There’s no reason that you’re going to expect anything less when you’re buying insurance. Maybe this sounds like background noise to those of us who’ve been in the business for a while. After all, our industry has been resilient over the centuries. It’s been a safe bet for decent returns on investment. But people my age see the world through an analog prism. This is our Achilles heel - because there’s a generation of 80 million Americans who see the world through a digital lens. This is the workforce that Matt referred to earlier. They’re going to be the buyers and sellers of our products. They’re going to run our companies. As the largest voting bloc in the U.S., they’re going to elect our governments. They’re going to be a noisy and demanding 12th man. They already are. This expectation for a streamlined and efficient buying experience is one of the main drivers behind my company, Hamilton Insurance Group. We believe that insurance has been an analog laggard, not a digital leader. We think we can do something about that. As I give you thoughts on what will shape our industry over the next decade, I’m going to keep coming back to the 12th man. I’ve seen lots of lists of future industry trends – some of them are mine – but I think it comes down to:
  • How to build a sustainable company
  • How to be smart about data and
  • How to strip waste out of our industry.
Let’s look at sustainability. Traditionally, creating shareholder value in an insurance company has had two main components: investments and underwriting. Right now, we’re between a rock and a hard place on both counts. We’re in a prolonged zero-lower-bound period where interest rates dip in and out of negative territory. In a traditional insurance company, there is no money to be made on the fixed instruments that most companies are required to invest in. Having low-yield assets on a balance sheet for regulatory purposes virtually ensures little investment income. What’s a CEO or CFO to do? Well, you can shift your investment philosophy and invest in equities or alternative instruments with a higher yield. But you have to prove you can handle the additional risks that come with a different mix of asset allocations. You also need an expert asset manager who’s well-versed in current regulations, as well as the commitment of your executives and board, to move to a riskier investment strategy. You can bank on profitable underwriting – but in a market like this, that’s a grueling experience. Terms and conditions are tough, and margins on most lines of business are razor thin. You have to stay disciplined and resist the siren call to write discounted business. And it seems the days of large reserve takedowns are over. You can look for M&A opportunities, which in many cases may delay the inevitable and add the stress and cost of effectively integrating what are likely to be legacy systems and cultures. And while you’re grappling with investments, underwriting and M&A, you have to keep an eye on the rapidly changing digital world, which could render your company obsolete. So what’s a sustainable business model look like in the age of the 12th man? I think part of the answer lies in a flexible regulatory environment. If you’re a company in Bermuda, where your regulator is the Bermuda Monetary Authority, you can establish an alternative investment strategy, as my company has done, in return for putting up additional capital, and work with a data-driven investment manager like Two Sigma, which manages Hamilton’s investments. Almost a decade ago, the BMA embraced the Solvency II framework and then fought to get Solvency II Equivalency for Bermuda. Their persistence will be rewarded when official recognition of Bermuda’s equivalency takes legal effect on March 24. I don’t think it’s a coincidence that virtually the day after Bermuda’s Solvency II Equivalency was announced, XL Catlin announced it was moving its company registration to Bermuda. I think others will follow. Bermuda has reacted well -- better than most -- in recognizing that flexibility is key to staying solvent. In the States, things are more complicated. Deloitte released a report last month that said one of the biggest challenges for today’s insurance companies is trying to comply with new capital regulations that were originally designed for banks and don’t provide much flexibility in modifying an investment strategy. It’s an accepted tenet that regulation works best when it addresses market failures and protects insurance buyers. But regulation can over-correct: In some cases, states have been too slow to rewrite laws, some of which have been in place for almost 100 years. Today’s regulator has to confront the effect that the digital dynamic is having on both the insurer and the insured. This creates the need for a delicate balancing act: defining the right regulatory regime in a market that’s morphing in front of our eyes. A word about rating agencies – sometimes referred to as de facto regulators: Some agencies, like A.M. Best, have been forward-thinking in broadening the factors they consider when assigning ratings. I applaud Best’s for undertaking the survey on predictive analytics that Matt discussed. This is a meaningful contribution to the dialogue. We need more of that from our regulators and rating agencies. Best’s has also done the work to understand alternative assets. For example, at Hamilton, Best's spent time onsite with our investment manager, recognizing that these complex strategies require some effort to understand. Having said that, I’d like to urge rating agencies to put more weight on the 12th man’s voice. How you’re accepted by the market matters. The quality of the relationships you establish, the panels you’re on, the submissions you receive – that all matters. I said investments and underwriting were traditional aspects of building sustainability. M&A can play a role, and technology definitely does. However, in this second decade of the 21st century, there’s so much more to running an insurance company. In addition to a vocal, demanding 12th man, we’re living in a world of extreme political polarization, exchange-rate volatility and social instability. And against that fragmented, disrupted backdrop, there’s the expectation that a company’s commitment to purpose should be as important as its commitment to profit. Almost half of the 1,400 CEOs surveyed by PwC feel that, in five years, customers will put a premium on the way companies conduct themselves in global society. Building a sustainable company is one of most complex issues we’re going to face over the next decade. Now let’s look at data. A few years ago, we were all talking about Big Data. It was THE buzz word. Looking back, I think it’s safe to say that most of us didn’t know what we were talking about. But living with the effect of disruptive technology, we’ve been on a steep learning curve. We’ve begun to wrap our heads around what we can do with the massive streams of data available to us. EY just released a study on sensor data. It’s worth a read if you haven’t seen it. As lead director at Tyco, I have to declare my interest in the subject. We’re spending a lot of time looking at how streaming data can help us develop better products. We’re taking a holistic, data-driven look at behavior across multiple channels to give our clients the insight that helps them optimize their performance. EY says top-performing insurance companies are already innovating with telematics, wearable technology and sensor data. EY lists the competitive advantages of being smart about data this way:
  • You can assess risk more precisely
  • You can design products faster
  • You can connect with customers more directly
  • You can revolutionize claims handling
  • And – you can maximize profitability because of better targeting
The implications for what sensor data can do for our industry are remarkable. We’re talking about sensors on people, on cars, on ships and planes, in offices and homes, on GIS systems that provide data about climate – pretty much anything on the earth, or in the sea and sky. Understanding this voluminous amount of data, finding correlations and eliminating bias can help us develop policies that are better-written, more comprehensive and more relevant. Being smart about data also helps us come to grips with emerging risks, particularly a risk like cyber. At Hamilton, we’re taking a cautious position on cyber. We’re not writing it as a class until we’ve identified an approach that gives us comfort. We haven’t found one yet, mainly because there’s been a tendency to underestimate the interconnectedness of cyber risk. Too often, discussion about cyber revolves around hacking. But if you put any credence in what I just said about the impact of sensor data, you have to believe that there’s data-based risk in everything we do nowadays. If that’s true, what are the implications for cyber? Getting back to sensor data – Access to this type of intelligence has some significant implications for our distribution partners. The role of the broker and agent has been evolving for years, but data analytics is one of the greatest threats – or opportunities – for the partners who help us develop and distribute our products. Who owns the data? Who interprets it? Does the insurer or the insured need anyone to do that any more? Then there’s the duality of the role that brokers and agents play. They represent the insurer’s interest as well as the insured or reinsurer. Serving two masters is never easy. How well can you do that in an age of colliding data sets? I think the answer to whether there’s still value in an intermediary is a qualified yes - IF the broker or agent brings a level of expertise and counsel that far surpasses what the carrier offers or the client can determine by himself. This means setting the gold standard for manipulating and interpreting data. A last comment on data – One of my own learnings over the last year or so is that if a company is going to embrace data and technology, it has to be a company-wide initiative. It can’t be done in silos. I don’t think it works to have an incubation or innovation lab where a dedicated team is exploring a new risk management frontier and the rest of the organization is conducting business as usual. You’ll have constant dissonance between the analog and the digital. At Hamilton, one of the advantages of being a start-up is that we’ve been able to make technology a focus of our strategic plan from the beginning. Last year, we bought a Lloyd’s syndicate that we’ve completely rebuilt. The benefit of not having any legacy has allowed us to create an end-to-end, integrated system with all reports coming from one centralized data warehouse. We’ve already demonstrated the value of this model. When Lloyd’s moved to require its syndicates to report pricing data for gross rather than net performance, a lot of managing agencies struggled. We didn’t. Finally, I’ll look at the last issue I listed in my opening comments – getting rid of the waste in our industry. By waste, I mean the massive cost of doing business. I’ve been beating this drum since Hamilton was established a couple of years ago, and I’ll keep at it because, if anything puts our industry at risk, it’s the inefficient way we acquire business. Thirty to 40% of every premium dollar goes to acquisition and managing the business. At Lloyd’s, it’s even higher, largely because analog data-gathering weighs on the market like an albatross. The quest to make buying insurance easier and more efficient through data analytics is the DNA of our U.S. operations, where our focus is small commercial business. We want to remove the pain of the rate/quote/bind experience and sharpen the underwriting. We’re blessed with employees who believe in our mission and who have moved mountains to make it real. They’ve spent the last year stripping unnecessary questions from the forms used in the acquisition process. We know a lot of that data suffers from human bias or error, and much of it is available from public sources that are more reliable.  We use data that comes from dozens of different sources as part of our risk scoring and underwriting process. Our long-term goal at Hamilton USA is to get the questions that an agent or broker asks an insured down to two: name and address. Smart data analytics, as well as more informed underwriting, will do the rest. We’ve also created streamlined portals for quotes and are just weeks away from launching mobile-based technology that rates, quotes and binds business owners policies. The small commercial segment that we’re working in has an average policy size of under $25,000. This is business with small margins and high transactions. Efficiency is critical if you want to make any money. And there’s ample room for doing just that. In the U.S., this is a $60 billion market. It’s almost $90 billion when specialty risks are included. You can see why speed to market can make a huge difference in profitability. Speed to market doesn’t mean we’re cutting out the middleman. There’s plenty of room at the table for brokers, agents and MGAs – as long as they want to align their systems and practices with our cutting-edge analytics. We’re working with partners who are as excited as we are about the potential that data analytics represents. We’re being approached by many others who are interested in taking this journey together with Hamilton. And there’s a generational component to all of this. Some older clients want to do business with a broker or an agent. It’s a relationship they recognize and feel comfortable with. But remember that 12th man. There are 80 million of them for whom a middleman just gets in the way. In closing – I know that Matt was a keynote speaker at a conference earlier this month organized by Valen Analytics. I understand there was lots of good discussion and some fascinating stats underscoring the imperative to embrace data analytics. Apparently, 82% of companies surveyed last year by Valen say that underwriters are resisting analytics. 30% worry about a loss of jobs. 30% don’t trust the data. 77% of underwriters and actuaries argue about pricing. The No. 1 reason? Underwriters dismiss data in favor of their own judgment. While we continue to resist change, venture capital companies are looking at our industry and seeing dollar signs. In 2015, VCs invested $2.65 billion in start-up insurance companies like Oscar, Gusto and PolicyGenius. Ten years ago, that figure was $85 million. So the clock is ticking. There’s not a lot of time left to figure out how to build sustainable companies, be smart about data and be more efficient. Above all else, we need to get over our inherent resistance to change. If insurance as we’ve known it was an ecosystem, large sections of it would be on the endangered species list. But I’m an eternal optimist. I know we have bold people working in insurance and reinsurance. I know a lot of us get what needs to be done. So let’s just do it – before that 12th man comes down from the bleachers and does it for us.

Brian Duperreault

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Brian Duperreault

Brian Duperreault is chief executive officer of Hamilton Insurance Group, the Bermuda-based holding company of property and casualty insurance and reinsurance operations in Bermuda, the U.S. and the UK. Duperreault was president and chief executive officer of Marsh & McLennan from 2008 to 2012 and, before that, chairman, CEO and president of ACE.

What the U.K. Can Teach on Aggregators

Aggregators collect lots of highly useful data -- but can, for instance, be used by consumers to try what-if scenarios and game their risk ratings.

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In the last 10 years or so, the single biggest development we have seen in U.K. personal auto insurance distribution is the phenomenal rise of aggregators – known otherwise as “price comparison websites.” Top aggregators in the U.K. marketplace such as Confused.com, Moneysupermarket.com and Comparethemarket.com have grown, leveraging the high usage of Internet among U.K. households. According to the latest industry reports, aggregators accounted for around 56% of the new motor insurance policies sales in the U.K. in 2013. The overall potential of aggregator share in the U.K. personal auto new business is capped at around 60%, which means aggregator growth is fast approaching stagnation. Though this is evidenced by the flattening growth we are seeing in recent years when compared with earlier periods (when market share rocketed from 25% in 2007 to 45% in 2009), aggregators are here to stay – purely because U.K. customers still see cheaper cost as the major preference in choosing auto insurance. For insurers and brokers who operate in markets with a heavy aggregator presence, the options are pretty clear and simple -- either to partner with aggregators or to compete with them. There are pros and cons in both these approaches. The advantages brought about by aggregators to customers are too obvious – exposure to a larger variety of auto insurance products, competitively priced quotes and, most importantly, an efficient purchasing process. For insurers and brokers specifically, aggregators provide medium- and small-sized players (who don’t have the scale to compete with the biggies) the opportunity to generate business by advertising their products at a low marketing cost.  Also, through their online platforms, aggregators collect large quantities of customer data around customer website visits and browsing patterns. These can be gainfully used by the insurers/brokers to build a better picture of their customers’ profile and risks as well as put in necessary checks for improving fraud control. See Also: Driver Safety Ratings Add Sophistication Key risks are:
  • Too much emphasis on providing the most competitively priced quote based on a minimal set of questions results in quotes incorrectly priced and a below-par underwriting performance for the insurer
  • Consumers get the ability to make purchase decisions based on what-if scenarios (like inputting lower mileage or switching then main driver to see the resultant reduction in premiums), possibly inducing them to provide incorrect information and purchasing unsuitable cover
  • Reduced due diligence at the underwriting stage associated with online policy acceptance can result in increased risk of fraudulent claims – including instances of intentional fraud such as use of stolen credit card information, dead letter box addresses and identity fraud.
Some large insurers in the U.K. have withdrawn from partnerships with aggregators to compete directly in this space. Aviva, for example, offers a quotes comparison facility on its website, while DLG encourages its customers to go online to its site to avoid paying aggregators' commissions. A few major factors that influence large insurers and brokers to move away from aggregators are:
  • Having a product listed consistently lower in an aggregator's rankings is perceived by insurers as hurting their brand
  • Insurers/brokers rely on opportunities to reward customer loyalty and retention at every possible point (through cross-selling/upselling discounts, etc.) to maximize their revenues, while aggregators thrive on customer churn, leading to a possible conflict in business models and weaker customer relationships
Still, none can deny that aggregators are a fixture in the personal auto insurance business for the foreseeable future. Some larger insurers that offer auto insurance online directly to customers also agree that it’s possible to build effective partnerships with aggregators. Some ways of ensuring success through aggregator channels for insurers and brokers are:
  • Collaborate more closely with aggregators to sell on brand rather than just on price – insurers/brokers will primarily own customer relationships and have profit-sharing agreements in place that provide incentives for aggregators to cross sell more of an insurer's products apart from auto
  • Build systems to ensure that the wealth of data from aggregators is well-utilized for smarter and more frequent pricing of auto quotes (for example, daily rather than monthly or quarterly)
  • Design and segment customized auto policies specifically for aggregators, with underwriting models reflecting the questions set
  • Ensure that the aggregator online platform is updated on a periodical basis and that all components reflect the preferences of the insurers, brokers, customers etc.

Venkat Ramachandran

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Venkat Ramachandran

Venkat Ramachandran is industry principal (insurance) with HCL America and has 20-plus years of experience across core operations, business consulting and insurance solutions management.

Insurance 2.0: How Distribution Evolves

In designing business models and products for Insurance 2.0, customers should be thought of as <em>intent-driven</em> or <em>opportunity-driven.</em>

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At American Family Ventures, we believe changes to insurance will happen in three ways: incrementally, discontinuously over the near term and discontinuously over the long term. We refer to each of these changes in the context of a "version’ of insurance," respectively, “Insurance 1.1,” “Insurance 2.0” and “Insurance 3.0.” The incremental changes of “Insurance 1.1” will improve the effectiveness or efficiency of existing workflows or will create workflows that are substantially similar to existing ones. In contrast, the long-term discontinuous changes of “Insurance 3.0” will happen in response to changes one sees coming when peering far into the future, i.e. risk management in the age of commercial space travel, human genetic modification and general artificial intelligence (AI). Between those two is “Insurance 2.0,” which represents near-term, step-function advances and significant departures from existing insurance processes and workflows. These changes are a re-imagination or reinvention of some aspect of insurance as we know it. We believe there are three broad categories of innovation driving the movement toward “Insurance 2.0”: distribution, structure and product. While each category leverages unique tactics to deliver value to the insurance customer, they are best understood in a Venn diagram, because many tactics within the categories overlap or are used in coordination. venn   In this post, we’ll look into at the first of these categories—distribution—in more detail. Distribution A.M. Best, the insurance rating agency, organizes insurance into two main distribution channels: agency writers and direct writers. Put simply, agency writers distribute products through third parties, and direct writers distribute through their own sales capabilities. For agency writers, these third-party channels include independent agencies/brokerages (terms we will use interchangeably for the purposes of this article) and a variety of hybrid structures. In contrast, direct writer sales capabilities include company websites, in-house sales teams and exclusive agents. This distinction is based on corporate strategy rather than customer preference. We believe a segment of customers will continue to prefer traditional channels, such as local agents valued for their accessibility, personal attention and expertise. However, we also believe there is an opportunity to redefine distribution strategies to better align with the needs of two developing states of the insurance customer:those who are intent-driven and those who are opportunity-driven. Intent-driven customers seek insurance because they know or have become aware they need it or want it. In contrast, opportunity-driven customers consider purchasing insurance because, in the course of other activities, they have completed some action or provided some information that allows a timely and unique offer of insurance to be presented to them. There are two specific distribution trends we predict will have a large impact over the coming years, one for each state of the customer described above. These are: 1) the continuing development of online agencies, including “mobile-first” channels and 2) incidental sales platforms. Online Agencies and Mobile-First Products Intent-driven customers will continue to be served by a number of response-focused channels, including online/digital agencies. Online insurance agencies operate much like traditional agencies, except they primarily leverage the Internet (instead of brick-and-mortar locations) for operations and customer engagement. Some, like our portfolio company CoverHound, integrate directly with carrier partners to acquire customers and bind policies entirely online. In addition to moving more of the purchasing process online, we’ve observed a push toward “mobile-first” agencies. By using a mobile device/OS as the primary mode of engagement, the distributor and carrier are able to meet potential customers where they are increasingly likely to be found. Further, mobile-first agencies leverage the smartphone as a platform to enable novel and valuable user experiences. These experiences could be in the application process, notice of loss, servicing of claims, payment and renewal or a variety of other interactions. There are a number of start-up companies, some of which we are partnered with, working on this mobile-first approach to agency. To illustrate the power of a mobile-first platform, imagine a personal auto insurance mobile app that uses the smartphone camera for policy issuance; authorizes payments via a payment API; processes driving behavior via the phone’s GPS, accelerometer and a connection to the insured vehicle to influence or create an incentive for safe driving behavior; notifies the carrier of a driving signature indicative of an accident; and integrates third-party software into their own app that allows for emergency response and rapid payment of claims. Incidental Channels In the latter of the two customer states, we believe “incidental channels” will increasingly serve opportunity-driven customers. In this approach, the customer acquisition engine (often a brokerage or agency) creates a product or service that delivers value independently of insurance/risk management but that uses the resulting relationship with the customer and data about the customer’s needs to make a timely and relevant offer of insurance. We spend quite a bit of our time thinking about incidental sales channels and find three things about them particularly interesting:
  1. Reduced transactional friction—In many cases, customers using these third-party products/services are providing (or granting API access to) much of the information required to digitally quote or bind insurance. Even if these services were to monetize via lead generation referral fees rather than directly brokering policies, they could still remove purchase friction by plugging directly into other aggregators or online agencies.
  2. Dramatically lower customer acquisition costs—Insurance customers are expensive to acquire. Average per-customer acquisition costs for the industry are estimated to be between $500 and $800, and insurance keywords are among the top keywords by paid search ad spend, often priced between $30 and $50 per click. Customer acquisition costs for carriers or brokers using an incidental model can be much lower, given naturally lower costs to acquire a customer with free/low cost SaaS and consumer apps. Network effects and virality, both difficult to create in the direct insurance business but often present in “consumerized” apps, enhance this delta in acquisition costs. Moreover, a commercial SaaS-focused incidental channel can acquire many insurance customers through one sale to an organization.
  3. Improved customer engagement—Insurance can be a low-touch and poorly rated business. However, because most customers choose to use third-party products and services of their own volition (given the independent value they provide), incidental channels create opportunities to support risk management without making the customer actively think about insurance—for example, an eye care checkup that happens while shopping for a new pair of glasses. In addition, the use of third-party apps creates more frequent opportunities to engage with customers, which improves customer retention.
Additional Considerations and Questions The digital-customer-acquisition diagram below shows how customers move through intent-driven and opportunity-driven states. Notice that the boundary between customer states is permeable. Opportunity-driven customers often turn into intent-driven customers once they are exposed to an offer to purchase. However, as these channels continue developing, strategists must recognize where the customer begins the purchase process—with intent or opportunistically. Recognizing this starting point creates clarity around the whole product and for the user experience required for success on each path. intent Despite our confidence in the growth of mobile-first and incidental strategies, we are curious to see how numerous uncertainties around these approaches evolve. For example, how does a mobile-first brokerage create defensibility? How will carriers and their systems/APIs need to grow to work with mobile-first customers? With regard to incidental channels, which factors most influence success—the frequency of user engagement with the third-party app, the ability of data collected through the service to influence pricing, the extensibility of the incidental platform/service to multiple insurance products, some combination of these or something else entirely? Innovation in how insurance is distributed is an area of significant opportunity. We’re optimistic that both insurers and start-ups will employ the strategies above with great success and will also find other, equally interesting, approaches to deliver insurance products to customers.

Kyle Nakatsuji

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Kyle Nakatsuji

Kyle Nakatsuji is a principal at American Family Ventures, the venture capital arm of American Family Insurance, where he is focused on identifying and supporting early-stage companies affecting the future of the insurance industry. American Family Ventures invests across a variety of sectors, including IoT, Fintech, SaaS and data/analytics.

6 Limitations of Big Data in Healthcare

No. 5: Miscoding can render analysis meaningless -- one company didn't know it was paying for 25 organ transplants a year.

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Claims data captures the services provided to a patient. This information can be grouped into different cohorts—those getting preventive exams, those seeing specific physicians or hospitals for conditions, etc. The data can be grouped by diagnosis. However, all claims data is just a collection of medical bills. Medical bills do not contain a complete look at the patient, such as important information about a patient’s prognosis. That’s a gap. Thus, it is important to set appropriate expectations on the use of the data. Here are six limitations that should be placed on the expectations: Number 1 (one of the most important): Avoid the averages Most claims data sets are not normally distributed, so the averages do not provide relevant information. In most discussions today, employers evaluate the average cost of employees with specific conditions, e.g., diabetes or high blood pressure. This is a flawed approach because spending by employees with various chronic conditions is skewed, thus not really “averageable.” For example, assume 90% of an employee population with diabetes is spending $10,000/year and 10% is spending $250,000/year; the average will be a meaningless $34,000/year. All too often, a wild goose chase ensues, when in fact the focus should be on the $250,000 cohort to understand why they were so much more expensive. See Also: Why Healthcare Costs Bleed Firms Dry Number 2: Follow the money A superior use of claims data is to look at distributions of spending. In most plans today, roughly 8% of enrollees are consuming 80% of plan dollars, and these 8% typically change every 12 to 18 months. (We still run into benefit managers who were unaware of that turnover.) The future belongs to micro-managing these “outliers,” rather than the 92% who spend only 20% of the dollars. If you study those outliers carefully, you will find that only about 7% of their spending possibly would have been preventable, and then only if they faithfully did what their doctors told them to do decades earlier. A cardiologist recently told me that, of the patients he has seen with a significant acute blockage, about 25% had no known health risks of any kind…no high blood pressure, cholesterol, diabetes, obesity, smoking, genetic predisposition, etc. As such, there is a component of randomness in terms of who gets blocked arteries. The same holds true for cancer. For the other 75%, their physicians have usually counseled them on the importance of exercise and nutrition and the dangers of tobacco use, but to no avail. Number 3: Realize the limitations for quality designations Yet another big error is trying to use claims data to determine the best-quality doctors. You had better be really, really talented to try that one. Why? We are in an era in which many doctors are making their “quality” and “outcomes” look better by referring their most complex and riskiest patients to someone else. (Much has been written about this.) On the other hand, there are highly effective doctors who take responsibility for their riskiest patients, but as a consequence score poorly on so-called “quality measures.” The real travesty is that the low-scoring doctors may be the most cost-effective and provide the best care. Number 4: Misdiagnoses are a real cost driver Another huge shortcoming of claims data is one that readers of Cracking Health Costs know about. Namely, a large number of patients with complex health problems are simply misdiagnosed – today, that’s about 20% of the outliers in benefit plans, accounting for 18% of claim dollars. Thus, you cannot rely on diagnoses in claims data, and you cannot tell who is getting diagnoses right or wrong – this takes detective work beyond claims data. Click here for a good article by the Mayo Clinic on rates of misdiagnoses. We have sent hundreds of people to the Mayo Clinic for second opinions and can verify by personal experience the truth in that article…same for other clinics we have used for employers. Our first rule in selecting a Center of Excellence is its success in correctly diagnosing patients with complex health problems. Huge amounts of claim dollars are spent on treatments or surgeries that are either completely erroneous or clearly suboptimal. An executive at a Fortune 100 company once said to me that the biggest quality failure in healthcare is to misdiagnose a patient…everything that follows harms the patient. See Also: To Go Big (Data), Try Starting Small Number 5: Coding can affect the data analysis During a data analysis for a very larger employer, with more than 250,000 covered lives, executives told me they had not paid for a solid organ transplant in a number of years. Based on their size, they should have been paying for about 25 a year. After further detective work, we discovered their consultant was using a DRG grouper that coded all transplants as ventilator cases…who knows why…but a huge error. The benefit team had no idea they were really paying for about 25 a year at an average cost over five years of about $1.5 million each. Number 6: Reversion to the mean One thing we’ve learned from years of claims analysis of big companies’ benefit programs is that if you have enough life years of data, it all looks about the same, i.e., it reverts to the mean. If the workforce is comparatively older, they will have somewhat more high-cost claims.

Tom Emerick

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Tom Emerick

Tom Emerick is president of Emerick Consulting and cofounder of EdisonHealth and Thera Advisors.  Emerick’s years with Wal-Mart Stores, Burger King, British Petroleum and American Fidelity Assurance have provided him with an excellent blend of experience and contacts.

BPO for Life & Annuity Market

Growth is hard enough in today’s market; it’s harder when your back-office holds you back. Business process outsourcing (BPO) can help.

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Life and annuity insurers are focusing on three areas to drive growth: distribution, product and brand. Growth is hard enough in today’s market, but it’s even harder when your back office holds you back, both in terms of fixed costs and limited capabilities. Accordingly, achieving operational efficiency is table stakes for life and annuity insurers competing in an extended soft market. Fortunately, given recent advances in technology and expansion of provider capabilities, business process outsourcing (BPO) has become a feasible way to reduce costs and increase efficiencies. 

Based on what we’ve seen in the market, we think BPO providers are ready to move from their traditional role as vendors to true business partners. With scale, advanced technology and money to invest, the best of them offer great opportunity for insurers to significantly lower costs and benefit from complementary services over the long term. 

Why BPO and why now? 

For years, insurers have tried numerous methods to achieve greater operational efficiency, including process reengineering, Six Sigma, and LEAN. Many companies also have pursued sourcing (primarily in IT) to stem the tide of rising fixed costs. While these initiatives have reduced costs and complexity to a certain extent, they have not lowered costs and operational complexity enough to enable the business to focus first and foremost on growth. 

Fortunately, times have changed. Some BPO providers have recently offered savings on a per-policy basis (inclusive of both operational and IT costs) of anywhere from 20% to 40%. (Benefits depend on how much savings a company has already realized and how much additional opportunity for savings remains.) BPO now offers the potential for greater long-term cost reductions and efficiencies than the methods insurers have used in the past. 

In Europe, BPO and ITO (information technology outsourcing) has already played a major role in closed block businesses. Life, annuity and pensions BPO has a global market of more than $2.6 billion, nearly half of it in the U.K. In this case, the main point of BPO has been legacy policy cost reduction, but it also offers carriers an alternative operational platform for achieving faster speed to market for new products and for tapping into advanced customer service capabilities. 

Legacy modernization is another important reason for considering BPO. As key staff retire, there is a real threat of knowledge loss, not least because legacy systems are concurrently moving toward the end of their effective working lives. Many BPO providers feature up-to-date and evolving technology platforms that are an attractive alternative to incurring continuing fixed costs in-house. 

The key for carriers is to select a BPO provider that will keep its platform current rather than simply provide a “your mess for less” service (i.e., administration of your aging platforms). Without the right scope, BPO can backfire and actually result in a more complex operating model, with resulting stranded costs and a suboptimal customer experience. 

What is large-scale BPO? 

To understand what BPO entails, it is helpful to compare the different kinds of shared services that are available:

  • Captive shared services are when a carrier creates a wholly owned subsidiary to deliver services at a reduced cost. They can be established domestically, near-shore or off-shore.
  • Out-tasked shared services occur when a carrier hands over administration of its systems to a third party that offers wage arbitrage, but the carrier maintains ownership of the process and underlying systems.
  • In contrast, in a BPO transaction, the insurer hands over administration to a partner, who runs the former’s technology platform. In other words, the partner owns the process. Implementation may occur through a lift and shift approach (i.e., the partner takes over the carrier’s legacy platforms), through conversion (data is converted from the carrier’s legacy to the partner’s modern platform) or through a phased combination of both. To smooth the transition, ameliorate community and reputational concerns and improve change management, there is typically a significant amount of rebadging of employees from the carrier to the BPO partner.
  • Ideally, after BPO, the insurer is a service level agreement (SLA) manager, and the BPO partner controls the process. (N.B.: Contracts should be in place that stipulate performance requirements.) The insurer’s focus on the sourced business should be on performance and analytics, made possible through regular data feeds from the BPO partner.
  • In brokered BPO, the insurer contracts with a third party that isn’t itself offering BPO services but instead will manage the transition to a BPO provider. Ideally, the third party manager will have successful past experience with the BPO provider and managing the complex details of conversion from legacy platforms to new ones.

BPO is not one-size-fits-all. There are different varieties that insurers can match to their individual goals and circumstances. 

Managing retained alongside sourced business 

While moving the entirety of operations and IT to a BPO provider may seem appealing, insurers realistically will continue to be involved in many operational and IT activities. They often will retain key components of their operations and IT that they deem to be market differentiators. These most often relate to the customer experience (both with the agent and insured) and include call centers, portals and analytics. 

To remain effective, the operational platform that support retained components will continue to require maintenance, upgrades and BPO integration. Extensive up-front effort will be necessary to promote seamless integration of retained and outsourced components. In addition, despite inclusion of a broad scope of operations and IT components, certain operational functions will remain with the insurer, namely HR, legal and compliance. 

Given significant sourcing, the question is if the insurer’s reliance on these functions will decrease and, if so, how to shrink them without increasing operational risks like:

  • Interruption of customer channels and operations: Businesses have been caught by surprise when service grinds to a halt at a provider.
  • Brand-damaging criticism: Businesses that fail to meet customer expectations – even if the cause is outside their walls – may see an increase in complaints, some going viral on social media.
  • Regulatory violation: A data error or breach at your service provider can put you in violation of regulations and jeopardize your customers’ trust.
  • System vulnerabilities: In a complex infrastructure that has dependencies you don’t even realize, a service interruption might trigger a series of problems that can affect your business.
  • Inaccurate reporting: Service provider processing errors can cause a misstatement of compliance, performance, operational or financial information.
  • Risk management lapse: Not knowing the controls around service contract terms can lead to unreported breakdowns in areas hitherto considered secure.

A good way to reduce the chance of BPO-related risks is to insist on a provider that comports with advanced service organization control (SOC) reporting. SOC 2 provides assurance that the provider has controls around the sourced technology and systems supporting the sourced business processes, but only to a pre-defined audience. SOC 3 provides the same assurance but more broadly to anyone interested in the provider’s control and allows the posting of a public seal on the provider’s website. 

Embarking on BPO: An end-to-end approach 

Given the significant potential for disruption to distribution partners, policy/annuity holders, employees and the community at large, BPO requires a more iterative approach to execution than many other forms of operating model transformation. When evaluating BPO partners that best match criteria for in-scope functions and blocks of business, some carriers find that a single BPO partner may not meet all needs. Accordingly, it is imperative to determine the best BPO fit for each block of business.

Implications: Insights from BPO initiatives

  1. Plan big. Scope thoroughly enough to actually simplify management instead of just adding another layer of complexity to what you already have.
  2. Choose a partner, not a vendor. Approach the BPO as a relationship that will grow over time. Vet your prospective partner’s record of investment in other relationships and appropriately provide incentives to each other with thoughtful contracts that promote accountability.
  3. When vetting BPO providers, consider the amount of investment they’ll make to upgrade their platforms over time to continue delivering effective service.
  4. Don’t underestimate the amount of time that staff need to prepare for BPO. Identify all necessary business rules and ensure that key individuals and cryptic systems are aware of and understand them. You do not want any service interruptions.
  5. Map all dependencies on the policy administration platforms you’re seeking to move, inclusive of all ancillary applications.
  6. Realize that each part of the operating model you retain will add another layer of integration complexity to BPO.
  7. The prevalence of shared services and the opacity of many service-based cost-pools mean that many companies struggle to understand their IT spending. Therefore, it is vital to have an agreed-upon allocation method that won’t leave significant stranded IT costs post-BPO.
  8. Considering there will be more lines of accountability for running the business during and after the BPO, unless you use a brokered approach, you’ll have to create or augment an existing service provider management team.
  9. You may need multiple BPO partnerships. For example, the BPO partner that best meets your life book needs may not be the best choice to meet your annuity book needs.
  10. Ensure contracts account for all reasonable contingencies (e.g., growth, M&A, divestitures and spin-offs).

Paul Livak

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Paul Livak

Paul Livak is a director in PwC Advisory’s financial services practice. He is an experienced management strategy consultant with 15 years of experience focused on insurance and financial services. Particular areas of expertise include incentive compensation management (strategy through execution), optimizing transparency for sales producers, business intelligence and operations and IT transformational strategy.


Bruce Brodie

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Bruce Brodie

Bruce Brodie is a managing director for PwC's insurance advisory practice focusing on insurance operations and IT strategy, new IT operating models and IT functional transformation. Brodie has 30 years of experience in the industry and has held a number of leadership positions in the insurance and consulting world.