[Part 1 of this series focused on why language matters in mental health advocacy and on suicide prevention in the workplace. This article explores wording related to suicide that we want to see change. Part 3 will look at wording related to mental health.] We are often asked: What is the best way to talk about suicide? “Died by suicide” Much of the language related to suicide death comes from a stigmatizing history. The term “committed suicide” originated when suicide was thought of as a sin or a crime, instead of as a fatal outcome of a set of thoughts, often a result of a mental health condition. The phrase is still the most common way for people to describe a death by suicide in the general public, the media and even in the mental health sector. We can ask ourselves: Does someone die by committing a car accident? By committing cancer? Certain terms are commonly used to describe whether a person has died or not: People talk of a “successful” suicide or an “unsuccessful” attempt. The use of the word "successful" is highly insensitive to the tragedy of a death by suicide. Similarly, we hear the term “completed suicide” to refer to a death by suicide. In North American culture, we place a positive value on success and on completion, so we suggest a certain amount of good when we refer to a suicide as successful or complete. When talking about suicide in general, test language by substituting the word “cancer” for the word “suicide.” If the result sounds odd, chances are the phrase has come from a stigmatizing origin. For example, we wouldn’t say “the cancer was successful”; we would say “a person died from cancer.” Thus, “died by suicide” is the best option we have to describe suicide death. See Also: The Daily Grind is Good for the Mind We should talk about suicide by viewing it through the same lens we use to look at cancer, car accidents and other causes of death. We can seek to apply a public health advocacy approach, rather than a blame-the-victim approach, which is a result of the use of archaic language. “A person who is thinking of dying by suicide” When we label people, and group them according to an identifier, we are seeking to simplify who they are. It is a short-cut language strategy that also short-cuts understanding and connection. In suicide, there is often a label: “a suicidal person”; “he is suicidal.” Using our rule about swapping “suicide” for “cancer”: Are you cancerous, or are you a person who has cancer? We prefer: “a person who experiences suicidal thoughts,” “a person who is thinking of dying by suicide.” For most who die by suicide, we believe their choice would have been to live if they could have found a way out of the mindset of dying. Unbearable psychological pain may be accompanied by very strong internal commands to die. This experience is not the usual type of rational choice in the way we commonly think about choice. People often say “a person chose to die by suicide.” Inside this thinking, there is a sense of absolving of responsibility anyone other than the person who died, which we understand. It is very difficult to grasp that a person has died by suicide, and we often seek solace in language that implies that the person acted completely freely. We wish to undo this type of phrasing that implies that true “choice” is part of the picture. We prefer that people do not use the word “choice” when talking about a death by suicide. Also in the language of suicide, we find phrases that imply that a person who has made a suicide attempt is manipulative and is just “seeking attention.” The phrase “suicide gesture” has an implication that intent is not genuine. We prefer: “an action with suicide intent.” “Precipitating events” When a person dies by suicide, and we wish to talk about what led up to their death, we often talk about “triggering events.” The word “trigger” is problematic because of its strong connection to firearm use. Also, by calling something a triggering event, the phrase denies an opportunity for people to have mastery over the impact of the event. It is preferable to use a more objective term to describe prior events and challenges. We prefer: “precipitating events.” Clarity around “survivor” The term “suicide survivor” is confusing. Depending on how it is used, this phrase may mean a loved one left behind when a person dies by suicide. At other times, the term means someone who has survived a suicide attempt. Thus, the preferred terminology for people who are left behind is: “a person who is bereaved by suicide,” or “a person who is surviving a suicide loss.” People who attempt suicide but do not die can be referred to as: “a person who attempted suicide and survived.” In addition, the field of suicide prevention also seeks the expertise of people who have lived through a suicide crisis and did not have an attempt. Sometimes these folks are included under the umbrella of “people with lived experience of suicide.” In conclusion, “messaging matters” in suicide prevention and suicide grief support. For more best practices, review “The Framework for Successful Messaging by the National Action Alliance for Suicide Prevention": http://suicidepreventionmessaging.actionallianceforsuicideprevention.org/.

If you are suffering from an injury or illness that is preventing you from working, it’s likely you have lost a livable income, and you may be facing the threat of economic hardship. Many people, who are unable to work due to a serious illness or injury, are able to receive Social Security benefits as compensation. But, according to John C. Shea, a disability lawyer in Richmond, VA, applying for Social Security benefits is often a long and arduous process, whether because you are gathering all of your medical documents, making sure you ask all the right questions or patiently waiting to hear if you qualify,. The Waiting Period and Financial Help Once you have applied and are waiting for a response as to whether you qualify for benefits, the Social Security Administration (SSA) reports that the decision process can take anywhere from three to five months (keep in mind that the process can take even longer if you’re initially denied and file an appeal). Waiting nearly half a year is not “financially doable” for most individuals. Here are some helpful tips for getting financial help while waiting for SSA’s answer:

• Are You Able to Work?: In some cases, individuals seeking SSDI benefits may be able to work, but there limitations on how much you can earn. Chances are, your illness or injury may limit your ability/length of time to work, anyway. If you’re interested in working, even very part-time while applying for SSDI benefits, it’s a good idea to talk to SSA; to avoid any extra issues or confusion, consult with a disability lawyer.

• Apply for Supplemental Programs: If your life is put on hold due to a life-changing illness or injury, unfortunately, your needs and expenses won’t take a break. Groceries and other utilities are life essentials but are often big financial expenses. If you’re running into financial problems, rather than skipping bills and risking having your heat or electricity shut off, consider applying for energy assistance and take a look at programs like SNAP for food assistance.

• Creating a Budget and Cutting Expenses: Downsizing on your monthly budget may be one of the easiest ways to save you some money while waiting for SSDI benefits. Although you may not want to give up certain “luxuries” like cable television or your costly cell phone plan, making some budget cuts here and there may save you hundreds of dollars a month. It’s also a good idea, while planning out your budget, to look ahead as much as a year. While SSA’s decision may take a few months, you may encounter some discrepancies that lengthen the process.

Accept Assistance Asking for and accepting help can be difficult, especially if you’re struggling to come to terms with a lengthy illness or injury. If a friend or family offers to help you, strongly consider accepting the offer. Whether you insist on treating the help as a loan or a gift, the offer can help keep you financially afloat while you wait for your benefits.

The healthcare industry is changing – same old headline. Since we’ve been in the industry, the “unsustainable” cost increases have been the talk every year, yet somehow we have not reached a tipping point. So what’s different now? How has ACA affected the healthcare industry, and more specifically the insurance companies? The drafters of ACA set up a perfect adverse-selection scenario: Come one, come all, with no questions asked. First objective met: 20 million individuals now have coverage. Next objective: Provide accurate pricing for these newly insured. Insurance companies have teams of individuals who assess risk, so they can establish an appropriate price for the insurance protection. We experience this underwriting process with every type of insurance – home, life, auto. In fact, we see this process with every financial institution, like banks, mortgage companies and credit card companies. If a financial institution is to serve (and an insurance company is a financial entity), it has to manage risks, e.g., lend money to people who can repay the loan. Without the ability to assess the risk of the 20 million individuals, should we be surprised that one national insurance carrier lost $475 million in 2015, while another lost $657 million on ACA-compliant plans? If you’re running a business and a specific line has losses, your choices are pretty clear – either clean it up or get out. See Also: Healthcare Quality and How to Define It Risk selection is complex. When you add this complexity to the dynamics of network contracting tied to membership scale, there is a reason why numerous companies have decided to get out of health insurance. In 1975, there were more than 2,000 companies selling true health insurance plans, and now there are far fewer selling true health insurance to the commercial population. Among the ones that got out were some big names – MetLife, Prudential, Travelers, NYLife, Equitable, Mutual of Omaha, etc. And now we’re about to be down to a few national carriers, which is consistent with other industries – airline, telecommunications, banking, etc. Let’s play this one out for the 20 million newly covered individuals. The insurance companies have significant losses on ACA-compliant plans. Their next step – assess the enrolled risk and determine if they can cover the expected costs. For those carriers that decide to continue offering ACA-compliant plans, they will adjust the premiums accordingly. While the first-year enrollees are lulled into the relief of coverage, they then get hit with either a large increase or a notice to find another carrier. In some markets, the newly insured may be down to only one carrier option. The reason most individuals do not opt for medical coverage is that they can’t afford it. If premiums increase 15% or more, how many of the 20 million have to drop coverage because premiums are too expensive? Do we start the uninsured cycle all over again? Net net, ACA has enabled more people to have health insurance, but at prices that are even less sustainable than before. ACA offers a web of subsidies to low-income people, which simply means each of us, including businesses, will be paying for part or all of their premium through taxes. As companies compete globally, this additional tax burden will affect the cost of services being sold. As our individual taxes increases, we reduce our spending. While ACA has the right intention of expanded coverage, the unintended consequences of the additional cost burden on businesses and individuals will have an impact on job growth. While it’s hard for anyone to dispute the benefits of insurance for everyone, we first need to address the drivers behind the high cost of healthcare, so we can get the health insurance prices more affordable. Unfortunately, ACA steered us further in the wrong direction. Self-insured employers are the key to lead the way in true reform of the cost and quality of healthcare.

It's the nature of our industry that commercial insurance carrier appetites are constantly evolving. As business landscapes shift to accommodate emerging risks, insurers must continuously refine their specialties, products and services. It's a necessary part of risk transfer; yet it can be confusing for a carrier's distribution partners. Because commercial insurance agents and brokers deal with dozens--and sometimes hundreds--of different carriers, they often find themselves struggling to stay abreast of shifting appetites. Brokerages of all sizes struggle to overcome the hurdle posed by "appetite clarity," and carriers and managing general agencies (MGAs) struggle to find a simple method to demystify the situation. See Also: Next Generation of Underwriting Is Here Carriers and MGAs need to evaluate opportunities to leverage online search tools that can integrate into an agent's daily workflow and enable insurers to communicate appetite. Such tools, like IVANS Market Appetite, operate similar to current search engines. At the start of the search process for a market for new and renewal business, the tools provide agents with an instant list of carriers, MGAs and wholesalers with appetite for the specific risk. These tools can help underwriters overcome the "three major hurdles of underwriting": Hurdle #1: Changing Appetites The carrier or MGA says: "We made substantial changes to our appetite more than a year ago to move away from an industry segment that wasn't in our specialty wheelhouse. Yet I'm still seeing a high volume of submissions in that category that I'm having to decline. It's hurting my conversion ratio and confusing my brokers." Problem solved: It takes significant time for changes in appetite to be effectively communicated through a carrier’s network. This requires changing every piece of collateral, market guides and online postings and redistributing the updated assets. Many times, appetites change again in the time it takes to update these assets, exacerbating the issue. Carriers and MGAs need to leverage online tools that instantly communicate their latest appetite, ensuring products are visible to agents when they begin to search for a market where they can submit their risk. Consistent appetite visibility through online tools also improves carrier and MGA staff’s productivity by increasing the number of in-appetite inquiries and reducing time spent reviewing submissions of no interest, while enabling carriers and MGAs to focus more time on returning quotes and building relationships. Hurdle #2: Limited Relationships "I am worried that my competition has a broader network of brokers than I do. I truly value the partners I do have, but I would like to grow my book, and I wish I were seeing more new risks." Problem solved: Even with formidable communications and relationship strategies, carriers can be complex to navigate from the outside, and brokers who have strong relationships with one division may overlook the opportunity to bring an alternative submission type to another business unit. Online market search tools enable underwriters to get in front of brokers and agents that they haven't interacted with before. Hurdle #3: Unwanted Submissions The carrier or MGA says: "I wish I had more time for new business. I spend hours reviewing submissions that ultimately need to be declined. On top of that, I have a thick stack of renewals to get through. There has to be a less time-consuming way to get more profitable new business into my book." Problem solved: Carriers' and MGAs' time, and brokers' time, is exceedingly valuable. IVANS found that 60% of submissions in commercial insurance go unquoted – resulting in significant time wasted on non-revenue-generating activities. Online market search tools increase in-appetite submissions to drive better submissions in the pipeline, allowing carriers and MGAs to focus on the most profitable lines of business and industries. As the market changes, these tools ensure consistent representation of carriers' and MGAs' latest appetite, so submission mix remains strong as agents are continuously kept informed.

A historical challenge in workers’ compensation has been creating the best possible approach to communication: consistently reinforcing transparency, putting the injured employees’ needs first and reassuring them that their claims team is working in their best interests. Employers today, more than ever before, are engaged in the workers’ compensation process and, in partnership with Sedgwick, have developed efficient healthcare and treatment solutions that provide the highest quality of care. They have also developed return-to-work programs that not only accommodate potential injury-related restrictions and ensure compliance with state and federal employment laws (e.g. Americans with Disabilities Act) but that also encourage employees to come back to work as quickly as possible. This approach ultimately results in an improved experience and outcome for all parties. The responsibilities of claims and managed care professionals encompass many activities that already assist with this process, but there is an emerging need to take employee care above and beyond the standard claims management efforts. This expanded approach involves being an advocate for the employee by listening, communicating, providing information and proper medical care, explaining how this complicated process works—and being there to assist them at every turn. From the time an injury occurs to the moment the claim is closed, the examiners, the nurses and the colleagues who assist the employee all serve important roles that can have an impact on the outcome of the claim. It’s through their experiences that our industry can see the value of employee advocacy and the advantages it can bring for all parties involved. Exploring the Shift in Philosophy  There seems to be a change in the philosophy of employers as it relates to workers’ compensation injuries. Today, businesses are more interested in making sure their injured employees get everything they need to recover, and they are willing to spend the money and do all the right things as a part of their responsibilities as an employer. Instead of questioning claims, they are more focused on restoring the health of their employees. To do this successfully, employers must work closely with claims administrators to develop and implement a process around employee advocacy. This may include assigning a trained, knowledgeable member of the claims team to guide employees through the process or connecting them with a nurse who can assist with their medical concerns. There are different options based on the individual employer’s needs, but each one is designed around the same objective: improving injured employees’ health and well-being. Surrounding the Employee With Support The employee advocate typically performs an outreach to the employee after receipt of the first report of injury. The advocate is someone who asks how the employee is doing and offers a sympathetic ear. The advocate is also someone who has information on their claim and is connected to all of the resources available to assist the employee. This initial call can offer several advantages, including:

• Reassuring the employee that the employer cares and that the employee is not going to lose his job for filing a workers’ compensation claim;
• Providing guidance to the injured employee that could prevent a minor claim from becoming something major;
• Answering initial questions to resolve possible issues that could lead to litigation—if the employee needs additional information, the advocate can get what she needs and call back; and
• Keeping everyone calm at the outset of the injury and having a positive impact on the employee’s attitude.

In this role, the advocate becomes the employee’s key contact and will make sure the employee does not feel alone in this process. The topics for the advocate’s outbound calls may include explaining workers’ compensation; setting expectations related to claim investigation, medical bills, prescriptions, benefit payments and return to work; or explaining the roles of the adjuster or nurse case manager assigned to the employee's claim. Providing Specialized Clinical Advocacy Clinical resources may be needed for an employee based on his injury. This type of advocacy includes a phone call from a registered nurse who will ask the employee how she is doing, answer her medical questions and direct her to the best provider for her injury. At this time, the nurse may also identify any psychosocial issues or other concerns that may affect the employee’s ability to recover or return to work, and the nurse may then direct the employee to behavioral health or return-to-work specialists. Benefits and Proven Results When employees are injured at work, this can be an unsettling time for them—filled with many questions. Providing upfront communication and a healthcare team focused on their well-being can make the process better for everyone. Employer benefits include reductions in litigation, medical costs and lost time. With the average cost of litigated workers’ compensation claims about 65% more expensive than non-litigated claims, reassuring employees and keeping them as happy as possible throughout the claims process can have immeasurable value. We have experience working with several employers that have implemented successful advocacy programs. One is a retail company that has an advocate who contacts every employee on the first day of an injury to see how they are doing. This company's goal was to reduce litigation, and it has accomplished that through this process. The company feels having someone reach out gives each employee a sense of security, as well as the reassurance that he won’t lose his job due to filing a claim and the feeling that he is part of a system that protects him. Focusing on the Employee Examiners, nurses, assigned advocates and other members of the claims and managed care teams all work together to ensure the injured employee has the best possible outcomes. Having a team to surround the employee with care and recovery solutions provides significant dividends related to the continuation of productivity and employee morale—and it can positively influence the overall view of their employer.

Healthcare Matters sits down with Dr. Richard Anderson, chairman and CEO of the Doctors Company. In part 2 of this series, we discuss how physicians should address patient requests for unneeded medical tests, which are unnecessary or excessive.

A few weeks ago, in our opening blog series on the Insurance Renaissance, we discussed how the climate of change we saw in the Renaissance of the 1400s holds lessons for the current state of insurance. In both periods, we see the epicenters of change and innovation. For insurers, the Renaissance is more than an analogy. It represents a real pattern of cultural shift with insurance business implications. Its hallmarks are now repeating themselves. For example, today we see digital use and globalization as potent business drivers. If global barriers to communication hadn’t fallen, and new technologies hadn’t become so prevalent, it is unlikely that we would be in the midst of such groundbreaking change. The lowering of barriers during the Renaissance brought about similar change. During its beginnings, Florence was in the midst of a trading boom that brought new money, goods and ideas into the region from Western Europe, Greece, Arabia, Egypt, Persia and China. Banks grew. Florence became the financial center of Italy and the broader region. Trade routes reduced provincial barriers. Shipping improved. A system of insurance was even in practice, protecting Italian cargoes on their voyages as early as 1300. These cultural crossings (networks!) resulted in leaps forward in art and science. Ideas were currency just as important as textiles and spices. Innovations in practical sciences, such as mathematics and architecture, benefited from broader thinking. It was funded and driven by the new wealthy — a trading class that hadn’t previously existed in quite the same way. Today, we are seeing a similar influx of money and a new class of insurance technology investment. The Sydney Morning Herald, covering a report on disruption by PwC, recently stated it this way: “The insurance industry has largely remained the same in the past 100 years, but the sector is in for its biggest shakeup as investors continue to pump billions of dollars into 'insurtech,' fueling sweeping changes through technology. "Insurance is the second-most disrupted industry today thanks to a growing number of start-ups and technology companies eyeing slices of the insurance pie.” So, where insurers previously may have had great ideas, they now have ideas + technology (InsurTech) + financial resources + people/talent to pursue their ideas. At the same time, with no barriers to access, no legacy systems to hold them back and access to robust insurance cloud platforms, start-ups and greenfields from within and outside the industry are becoming new, innovative players. For organizations that wish to remain competitive, the questions then become: How do we adapt with ease to the change and disruption? Can we reimagine the possibilities of doing things differently? What do we need to do technologically to seize the opportunities in a shifting market? The new pursuit of agility, innovation and speed Business innovation and digital readiness is a real, palpable, bankable asset. Organizations that plan to fuel their own growth, create partnerships and generate innovative products need to quickly consider and shift gears to transform to the digital age, highlighted in our Future Trends: A Seismic Shift Underway report. Simplifying environments to bring consumers closer to service and closer to the point of sale will help. Modernizing environments to generate and test products faster is vital. Transforming business operations, using data for continual improvement and opening every available channel are goals worth setting. To thrive, large or small, the new organization needs agility so that it can quickly capitalize on the innovative ideas found by mixing itself in the marketplace. Insurance, once somewhat isolated, is now becoming part of the digital mix. Like adding an Indian voice track to a French pop tune with a rap beat, the results can be pretty hip. Where can insurers find inspiration in the cross-industry digital mix? How do they spontaneously get inspired? The short answer is, “Look around.” But the real answer is, “Look nearly anywhere, and you will find innovation.” Genius moments happen most often in environments where groups of people are in touch with industries, geographies, technologies and groups outside of their own environments. Those groups include, of course, consumers. Looking at consumer purchase patterns across all industries will give insurers a new view of how to reach them. For example, recent Google research found that nearly 20% of smartphone users research or purchase products while they are in bed in the morning or evening. Mix this fact with the idea that consumers are also looking for multiple quotes and good information on insurers and you can understand how mobile-ready aggregators (such as PolicyGenius) are on the rise. Urbanites who seldom drive don’t want to pay high auto premiums. They might rather opt out of driving altogether. Mix that trend with telematics capabilities, and a pay-per-mile insurance product (such as MetroMile) makes tremendous sense. It doesn’t take real genius to see genius opportunities. It just takes time spent observing customer and market trends and marrying those trends to technological capabilities. Customers are also increasingly moving their retail purchases to online purchases. That’s great news for insurers who have never been terrifically suited for retail-type sales anyway. What insurers need is face time at the right time, when someone recognizes his or her need for it. Hence, we see insurers increasingly partnering with companies that can buy them face time with products that match up with timely needs. Digital capabilities, integrated data capabilities and agile administration will all assist insurers as they reach into the mix to find their unique niche of opportunities. The same InsurTech that is causing the formation of insurance start-ups and is funded by venture capital is available to traditional insurers. In many or most cases, established insurers are in a better position to capitalize on it by simply prioritizing their need for innovation — deciding that their organizations will be centers of innovation. See Also: The 5 Charts on Insurance Disruption Insurers can tap into further ideas by looking at product trends in foreign countries, tapping into the expertise of technology partners, working cooperatively with universities to hold innovation days, partnering with companies outside the industry like automotive, retail and more and spending concerted time looking at the road ahead. In all these cases, insurers will find innovative encouragement by inviting ideas from outside the organization to transform the culture and ultimately the business. After all, it is the Renaissance within each individual insurance company that will provide innovation, excitement and opportunity to compete. So pursue agility, innovation and speed … and join the Insurance Renaissance rapidly unfolding.

It seems everyone in workers’ compensation wants analytics. At the same time, a lot of confusion persists about what analytics is and what it can contribute. Expectations are sometimes unclear and often unrealistic. Part of the confusion is that analytics can exist in many forms. Analytics is a term that encompasses a broad range of data mining and analysis activities. The most common form of analytics is straightforward data analysis and reporting. Other predominant forms are predictive modeling and predictive analytics. Most people are already doing at least some form of analytics and portraying their results for their unique audiences. Analytics represented by graphic presentations are popular and often informative, but they do not change behavior and outcomes by themselves. See Also: Analytics and Survival in the Data Age Predictive modeling uses advanced mathematical tools such as various configurations of regression analysis or even more esoteric mathematical instruments. Predictive modeling looks for statistically valid probabilities about what the future holds within a given framework. In workers’ compensation, predictive modeling is used to forecast which claims will be the most problematic and costly from the outset of the claim. It is also the most sophisticated and usually the most costly predictive methodology. Predictive analytics lies somewhere between data analysis and predictive modeling. It can be distinguished from predictive modeling in that it uses historic data to learn from experience what to expect in the future. It is based on the assumption that future behavior of an individual or situation will be similar to what has occurred in the past. One of the best-known applications of predictive analytics is credit scoring, used throughout the financial services industry. Analysis of a customer’s credit history, payment history, loan application and other conditions is used to rank-order individuals by their likelihood of making future credit payments on time. Those with the highest scores are ranked highest and are the best risks. That is why a high credit risk score is important to purchasers and borrowers. Similarly, workers’ compensation claim data can be collected, integrated and analyzed from bill review, claims system, utilization review, pharmacy (PBM) and claim outcome information to score and rank-order treating physicians' performance. Those with the highest rank are the most likely to move the injured worker to recovery more quickly and at the lowest cost. Both predictive modeling and predictive analytics deal in probabilities regarding future behavior. Predictive modeling uses statistical methods, and predictive analytics looks at what was, is and, therefore, probably will be. For predictive analytics, it is important to identify relevant variables that can be found in the data and take action when those conditions or events occur in claims. One way to find critical variables is to review industry research. For instance, research has shown that, when there is a gap between the date of injury and reporting or the first medical treatment, something is not right. That gap is an outlier in the data that predicts claim complexity. Another way to identify key variables is to search the data to find the most costly cases and then look for consistent variables among them. Each book of business may have unique characteristics that can be identified in that manner. Importantly, predictive analytics can be used concurrently throughout the course of the claim. The data is monitored electronically to continually search for outlier variables. When predictive outliers occur in the data, alerts can be sent to the appropriate person so that interventions are timely and more effective. For example, to evaluate medical provider future performance, select data elements that describe past behavior. Look at past return-to-work patterns and indemnity costs associated with providers. If a provider has not typically returned injured workers to work in the past, chances are pretty good that behavior will continue. For organizations looking to implement analytics, those who have already made the plunge suggest starting by taking stock of your organization’s current state. “The first thing you need to know is what is happening in your population,” says Rishi Sikka, M.D., senior vice president of clinical transformation for Advocate Health Care in Illinois. “Everyone wants to do all the sexy models and advanced analytics, but just understanding that current state, what is happening, is the first and the most important challenge.” The accuracy and usability of results will depend greatly on the quality of the data analyzed. To get the best and most satisfying results from predictive analytics, cleanse the data by removing duplicate entries, data omissions and inaccuracies. For powerful medical management informed by analytics, identify the variables that are most problematic for the organization and continually scan the data to find claims that contain them. Then send an alert. Structuring the outliers, monitoring the data to uncover claims containing them, alerting the right person and taking the right action is a powerful medical management strategy.

A friend and colleague, Chunka Mui, once said, "Marketing is when a company lies to its customers. Market research is when a company lies to itself."

In the insurance industry, talk of the protection gap manages to combine both problems: It's something of a lie to customers and is an even bigger lie to ourselves.

People routinely talk about the protection gap -- the difference between losses incurred and the amount that are covered by insurance -- as though the number shows how much more insurance people and organizations should be buying. We comfort ourselves with the size of that number, because we think it represents opportunity for us. We also, frankly, get a little condescending about the people and organizations that aren't bright enough to buy our product to cover their losses.

But if you look at it from the customer standpoint, there isn't a gap. We're just kidding ourselves.

To make the math simple, let's pick a country at random and make up some numbers out of whole cloth. Let's imagine we're Gabon, and we, as a nation, incur $1.5 billion of losses a year, while only $500 million is covered by insurance. We're told we have a protection gap of $1 billion. We should buy $1 billion of additional coverage.

It'll only cost us $1.3 billion.

That's because -- again, in very rough numbers -- the insurer has to tack on 20% on top of the losses to cover expenses and needs its 10% profit margin to keep shareholders happy.

But why would Gabon decide to overpay by $300 million a year? The insurer's employees and shareholders are surely nice people who could use the money, but shouldn't Gabon take care of its citizens?

I understand about peace of mind and surely believe that insurance plays a crucial role in the world economy, but, from a certain perspective (one that many customers take), I'd be better off going to a casino and playing the slot machines rather than buy insurance. The casino might even throw in free drinks and a show.

Insurance needs some new math to replace the protection gap, and we need to stop acting as though it's a real thing that a customer might care about.

The first step is to cut expenses radically -- perhaps 50%. I use that number because a famous consultant/author with whom I have worked is going to argue in a book soon that every business needs to cut operating expenses by 50% within five years. I also see enough innovation happening around the edges in insurance that I think radical cost cuts are possible. For instance, at the Global Insurance Symposium in Des Moines last week, I met the founder of RiskGenius, whose artificial intelligence could automate the work of whole swaths of people at brokerages who review the constant stream of changes in policies.

But even that new math only shrinks the problem. Add half the previous expenses onto that $1 billion of insurance for Gabon, stir in the required profit, and you're still asking the country to pay $1.2 billion to cover $1 billion of losses.

The real change can only happen when insurance gets out of its product mindset and shifts to a service mentality. Then someone could go to Gabon and say, "Our insurance company knows an awful lot about how losses occur. How about if we advise your government, your companies and your citizens and help you prevent as many as we can?"

Then, perhaps, you shrink those losses by a third -- and keep some of that difference as profit. If you still take that whack at expenses, you could tell Gabon: "We'll take responsibility for your $1.5 billion of losses (both the insured and the uninsured), and it'll only cost you $1.25 billion. You'll come out $250 million ahead, while we cover all our expenses and earn $100 million profit."

That $250 million gain is the kind of gap a customer will believe in.

This is the final part of a four-part series. The first article is here. The second is here. The third is here. FinTech is more than technology. It is a cultural mindset. Companies hoping to flourish need to shift their thinking to better meet customer needs, constantly track technological developments, aggressively engage with external partners and integrate digitization into their corporate DNA. To fully leverage the potential of FinTech, financial institutions (FIs) should have a top-down approach and embrace new technologies in every aspect of their businesses. Putting FinTech at the heart of the strategy The majority of our respondents (60%) put FinTech at the heart of their strategy. In particular, a high number of CEOs agree with this approach (78%), supporting the integration of FinTech at the top levels of management. Advances in technology and communication, combined with the acceleration of data growth, empower customers at nearly every level of engagement, making FinTech essential at all levels. Our survey supports this notion. Among the respondents that regard themselves as fully customer-centric, 77% put FinTech at the heart of their strategy, while, among respondents that see themselves as only slightly customer-centric, only 27% put FinTech at the same level. A smaller but still significant share of respondents disagrees with putting FinTech at the heart of their strategy (13%). This might be a business risk in the long run, as firms that do not recognize the impact of FinTech will face fierce competition from new entrants. As rivals become more innovative, incumbents might run the risk of being surpassed in their core business strengths. The share of respondents from fund transfer and payments organizations that want to put FinTech at the heart of their strategy exceeds 80%, a high proportion compared with other sectors. At the other extreme are insurance and asset and wealth management companies, where, respectively, only 43% and 45% of respondents consider FinTech to be a core element of their strategy. Adopting a ‘mobile-first’ approach Adopting a "mobile-first" approach is the key to improving customer experience. As Section 2 shows, the biggest trends in FinTech will be related to the multiple ways financial services (FS) engages with customers. Traditional providers are increasingly taking a "mobile-first" approach to reach out to consumers (e.g. designing their products and services with the aim of enhancing customer engagement via mobile). More than half (52%) of the respondents in our survey offer a mobile application to their clients, and 18% are currently developing one. Banks, 81% of which offer mobile applications, are, increasingly, using these channels to deliver compelling value propositions, generate new revenue streams and collect data from customers. According to Bill Gates, in the year 2030, two billion new customers will use their mobile phones to save, lend and make payments. Significant growth in clients using mobile applications is expected by 2020. While, currently, the majority of respondents (66%) contend that not more than 40% of their clients use their mobile applications, 61% believe that, over the next five years, more than 60% of their clients will be using mobile applications at least once a month to access financial services. Toward a more collaborative approach Whether FS organizations adopt digital or mobile strategies, integrating FinTech is essential. According to our survey, the most widespread form of collaboration with FinTech companies is joint partnership (32%). Traditional FS organizations are not ready to go all-in and invest fully in FinTech. Joint partnership is an easy and flexible way to get involved with a technology firm and harness its capabilities within a safe test environment. By partnering with FinTech companies, incumbents can strengthen their competitive position and bring solutions or products into the market more quickly. Moreover, this is an effective way for both incumbents and FinTech companies to identify challenges and opportunities, as well as to gain a deeper understanding of how they complement one another. Given the speed of technology development, incumbents cannot afford to ignore FinTech. Nevertheless, a significant minority—rather than a non-negligible share (25%)—of survey respondents do not interact with FinTech companies at all, which could lead to an underestimation of the potential benefits and threats they can bring. According to The Economist, the majority of bankers (54%) are either ignoring the challenge or are talking about disruption without making any changes. FinTech executives confirm this view: 59% of FinTech companies believe banks are not reacting to the disruption by FinTech. Integrating FinTech comes with challenges A common challenge FinTech companies and incumbents face is regulatory uncertainty. FinTech represents a challenge to regulators, as there may be a risk of an uneven playing field between the FS and FinTech companies. In fact, 86% of FS CEOs are concerned about the impact of overregulation on their prospects for growth, making this the biggest threat to growth they face. However, the problems do not correspond to specific regulations but rather to ambiguity and confusion. Industry players are asking which regulatory agencies govern FinTech companies. Which rules do FinTech companies have to abide by? And, specifically, which FinTech companies have to adhere to which regulations? In particular, small players struggle to navigate a complex, ever-increasing regulatory compliance environment as they strive to define their compliance model. Recent years have brought an increase of regulations in the FS industry, where even long-standing players are struggling to keep up. While most FS providers and FinTech companies would agree that the regulatory environment poses serious challenges, there are differences of opinion on which are the most significant. For incumbents, IT security is crucial. This highlights the genuine constraints traditional FS organizations face regarding the introduction of new technologies into existing systems. On the other hand, fund transfer and payments businesses see their biggest challenges in the differences in operational processes and business models. The complexity of processes and emerging business models, as explained in Section 1, which aim to lead the payments industry into a new era, have the potential to both disrupt and complement traditional fund transfer and payments institutions. Their challenge lies in refining old methods while pioneering new processes to compete in the long run. Just more than half of FinTech companies (54%) believe management and culture act as roadblocks in their dealings with FIs. Because FinTech companies are mainly smaller, they are more agile and flexible. And, because most are in the early stages of development, their structures and processes are not set in stone, allowing them to adapt more easily and quickly to challenges. Conclusion Disruption of the FS industry is happening, and FinTech is the driver. It reshapes the way companies and consumers engage by altering how, when and where FS and products are provided. Success is driven by the ability to improve customer experience and meet changing customer needs. Information on FinTech is somewhat dispersed and obscure, which can make synthesizing the data challenging. It is therefore critical to filter the noise around FinTech and focus on the most relevant trends, technologies and start-ups. To help industry players navigate the glut of material, we based our findings on DeNovo insights and the views of survey participants, highlighting key trends that will enhance customer experience, self-directed services, sophisticated data analytics and cyber security. In response to this rapidly changing environment, incumbent financial institutions have approached FinTech in various ways, such as through joint partnerships or start-up programs. But whatever strategy an organization pursues, it cannot afford to ignore FinTech. The main impact of FinTech will be the surge of new FS business models, which will create challenges for both regulators and market players. FS firms should turn away from trying to control all parts of their value chain and customer experience through traditional business models and instead move toward the center of the FinTech ecosystem by leveraging their trusted relationships with customers and their extensive access to client data. For many traditional financial institutions, this approach will require a fundamental shift in identity and purpose. The new norm will involve turning away from a linear product-push approach to a customer-centric model in which FS providers are facilitators of a service that enables clients to acquire advice and interact with all relevant actors through multiple channels. By focusing on incorporating new technologies into their own architecture, traditional financial institutions can prepare themselves to play a central role in the new FS world in which they will operate at the center of customer activity and maintain strong positions, even as innovations alter the marketplace. FIs should make the most of their position of trust with customers, brand recognition, access to data and knowledge of the regulatory environment to compete. FS players might not recognize the financial industry of the future, but they will be in the center of it. This post was co-written by: John Shipman, Dean Nicolacakis, Manoj Kashyap and Steve Davies.