Financial education is crucial when it comes to helping employees understand the roles that optional products such as disability, critical illness and accident insurance play in protecting their financial futures, but education isn't enough. Making it easy for employees to sign up is equally crucial, to increase enrollment. Insurers can increase the opt-in for optional products by streamlining the enrollment process with modern technology. Let's take a look at four ways use of technology can increase enrollment through greater efficiency and awareness.

1. Provide quotes through the enrollment system. The fewer barriers to entry that employees have, the more likely they are to sign up for optional products. By having quote data sent through the enrollment system, you remove the necessity of employees having to enter data multiple times. They can get quotes and sign up for benefits through the same system. Providing instant quotes and more options for plan comparisons reassures employees they're getting a good deal.

2. Have a portal site for opt-in. With a specially designed user-friendly worksite portal, you can automate quoting, proposal generation and enrollment. When employers make enrollment mandatory and employees are required to log in to the portal site, employees are more likely to review the options available to them and sign up even if they initially intended to simply opt out. You can up-sell and cross-sell worksite marketing and optional individual products on the employee enrollment portal site. Employees can select what products they require and the payment method.

3. Allow for digital signatures. Providing authenticated signatures on multiple paper documents can be frustrating for employees and employers. Digital signatures are the perfect tool for collecting authenticated signatures on multiple documents while saving time and reducing waste. The technology is pretty standard and straightforward once you've made the commitment to digital signatures.

4. Ensure electronic data delivery for medical underwriting. In some cases, medical information is required for underwriting worksite products. This can be difficult and time-consuming to collect and dispense unless you allow electronic data delivery. Electronic data delivery also shortens the interval between underwriting and quote delivery, ensuring a better customer experience. Achieving electronic delivery requires integrating various systems and making sure they have seamless connections. It takes work, but isn't a massive project.

Insurers that have invested heavily in legacy systems often resist change, but these systems cause problems that are costly and time-consuming to fix-and can cost insurers clients. (According to Claims Journal, 59% of senior executives surveyed in 2015 admitted that they had to spend "considerable amounts of time" dealing with IT issues in legacy systems.) If your legacy system won't let you streamline enrollment, it's time for a change. No matter how you choose to increase awareness and participation in worksite optional products, make sure that you have the technological infrastructure in place to make enrollment fast, efficient and accurate. It makes a big difference.

The good news from the PCI Tech Conference in 2015 is that futurists like Vivek Wadhwa give the insurance industry at least three to five years before it is disrupted beyond recognition by data, analytics, the Internet of Things, self-driving cars, 3D printing, hyper-aggressive technology companies and essentially free energy.

The bad news is, many large insurers are still planning five-year technology transformation initiatives to shed their legacy burdens and take advantage of today's technology.

Insurer CIOs understand the challenge. They need to mitigate the effects of yesterday's inheritances. They need to address today's business needs, and they need to prepare the organization for tomorrow. They need a deep understanding of all three timelines, and the ability to help others understand.

CIOs need a new set of skills and new kinds of relationships. As one speaker put it, CIOs need to be communicators and story tellers as well as effective managers. They need visionary business executive partners who are willing to embrace the opportunities that technology creates, in the ability to deliver innovative products to changing markets. CIOs also need technology partners who will not just deliver today's solutions but co-evolve with the CIOs to meet tomorrow's challenges.

"I will invest in any technology initiative that increases our agility," said one insurer CEO who understands. But far too many CEOs are still at a loss as to how to quantify the value of technology and continue to manage their technology investments as if spending more than 5% of premium on IT were a greater sin than letting the future pass them by.

Meanwhile, while the conference was in session, Google Ventures announced an investment in innovative health insurer Oscar. The clock is ticking in insurance, and it's not counting down anymore. It's counting forward.

Many will pinpoint 2015 as a pivotal year - the turning point in the transformation of the business of insurance. External influencers and rapid technology advancements are resulting in major shifts in strategy, areas of focus and investment. Many insurers are thinking big - beyond the typical incremental change and toward bold moves that will establish them as leaders in the digital age.

Here are the top 10 trends that laid the foundation for this pivotal year and positioned the insurance industry for an amazing 2016 and the years beyond. The trends are dominated and enabled by technology developments, which continue to be interwoven into the fabric of insurance. The trends are:

1. Digital transformation is taking hold, even in insurance.
2. Innovation and innovative thinking have no boundaries.
3. Huge $dollars$ being are being poured into start-ups.
4. New ecosystems are emerging.
5. Distribution channels are under strain, leading to shifts in investments.
6. Core modernization is required and continues to consume insurers.
7. Positive shifts are occurring in customer focus and priority.
8. New tools, data and models are being embraced but are still a struggle to adopt.
9. Many technologies are maturing and being adopted - cloud, analytics...
10. Tech advancement is still outpacing the ability to consume.

Insurance executives can no longer ignore or play down these trends. Although the terms "disruption" and "transformation" are popping up everywhere, they are no longer buzz words but reality.

It would be a mistake to dismiss the magnitude of the shifts. As one senior industry executive put it, "Our industry will be substantially different five years from now. Companies that do not aggressively transform will be at risk of failing."

This view is shared by many industry leaders, who sense that the tide is shifting in the new digital era. Unfortunately, many others are hoping to ride out the rest of their career without driving change, an approach that is risky.

The full research brief describing the trends is located here.

It's no secret that there is a newfound aggressive and competitive environment in insurance. A combination of outside competition focused on disrupting the distribution channel and an increase in tech-driven carriers is fostering this environment, and adapting to this change goes beyond just adopting technology. Everything hinges on a carrier's ability to shed its conservative approach to business - both internally and when communicating to customers.

Although fairly new in the U.S., insurance price comparison sites are rising in both popularity and sophistication, enabling consumers to compare policies from insurers down to the last dollar in a matter of seconds. Carriers shouldn't fear these sites but should be prepared with a strategy that allows them to stay successful amid this disruption.

Regardless of the changes happening, insurance still remains a complex purchase, and brand trust is a valuable way to differentiate your company. Nicholas Weng Kan, CEO of Google Compare, shares that there is a level of comfort that customers need before they make the commitment to buy a policy; that is why more than half of sales still happen after a conversation with an insurance expert.

So how do you gain trust for your brand? The catalyst for success in modern business is through transparency, which breeds trust - something insurance desperately needs. According to a recent Ernst & Young study, insurance suffers from lower levels of trust than any other industry, with 57% of consumers expressing dissatisfaction at the lack of interaction from their insurer.

Below are steps carriers can take to elevate trust in their brand:

First Step: Get to Know Your Customer

An important aspect of successful businesses today is the ability to create a relationship with the customer. Carriers don't have the bandwidth to treat each customer with interpersonal attention but can still understand who they are and what they want. Through the use of analytics, carriers have quick access to valuable information about a customer. Brands that don't begin adopting these technologies to match customer needs can't keep up with those that do.

Netflix obliterated Blockbuster by using advanced analytics to know customers better. The same dynamic differentiates between the data-driven and traditional carrier: Once the customer acquisition approach is more segmented and targeted, carriers can also deliver the right price based on a more accurate risk profile.

While pricing may not be everything, competitive pricing is necessary. The E&Y survey found that 50% of consumers change their insurer because of price. Insurance is already a complex business that lacks linearity, and price is an important consideration for all customers. The most competitive carriers leverage predictive analytics as a useful tool to help distinguish the poor risks from the good risks so they can focus on the customer relationships that will benefit their business in the long term.

Second Step: Learn to Cater to the Millennial Generation

Millennials have overtaken the baby boomers as the largest consumer base in the country, at 75.3 million strong, and it is clear that they aren't satisfied with the insurance buying process. According to the 2015 Capgemini World Insurance Report, less than 30% of insurance customers around the world enjoy a positive customer experience, with North America seeing the deepest decline in satisfaction.

Millennials crave transparency and a buying process that is painless and streamlined. Trust is bred when they know their insurers have their best interests at heart and care about their well-being, as well as the causes that are important to them. Above all, Millennials demand efficiency and personalization. Using innovative technologies to interest and retain Millennials is key to gaining their trust. Not only will this breed a positive experience, but it limits the amount of confusion from the consumer, thus creating fewer touch points for the insurer or agent.

Last Step: Be Transparent

The industry holds tightly to how products and services are priced. That's just not going to work any more. Customers are sophisticated and expect insurance agents to connect them to information. Agents and insurers won't garner consumer trust with a "black box" buying process.

Consumers have moved on from the notion that they are better off when an expert makes choices for them, but they do want to be guided by experts and understand what is happening in each step of the process. According to another E&Y study, nearly 70% of global customers feel they initiate the purchase of new policies because of the availability of digital channels. Based on results, it was inferred that difficulty in accessing information contributes to customers leaving their current carrier.

If insurers continues to be secretive about how they conduct business and price their policies, then many of the new insurance innovations run the risk of being perceived negatively by consumers. For example, Internet of Things has broken into homeowners, with partnerships between Nest and well-known insurers such as Liberty Mutual, but if the pricing structure and benefits aren't clearly defined, there is a chance of a consumer backlash.

A Consumer Reports article earlier this year found that insurance is receiving criticism for using credit information to price personal auto policies. Of course, credit information is a strong indicator of loss and a smart predictive factor for any auto insurer, and it's used by many different industries. However, there is perceptual damage, leaving the industry blindsided by critics who assume that secrecy must automatically mean untrustworthy.

Insurance needs to find the right balance between doing a good job managing risk and developing a more innovative and transparent culture. Creating a positive consumer experience involves being more transparent about price and clearly defining the benefits and service offered by the carrier. Almost 40% of consumers are either not confident or only somewhat confident that they have the appropriate coverage. This should be a wake-up call to the industry that all aspects of customer engagement need attention.

For 3,500 or more years, mankind has been searching for the mythological elixir of life, the Fountain of Youth, the philosopher's stone, pool of nectar, etc. that will defeat aging and extend life, if not achieve immortality.

According to Wiki, "The elixir of life, also known as the elixir of immortality and sometimes equated with the philosopher's stone, is a mythical potion that, when drunk from a certain cup at a certain time, supposedly grants the drinker eternal life and/or eternal youth."

All around the globe from 400 BC on, alchemists from India to China to Europe were seeking the elixir of life. Many thought gold was an essential ingredient.

The Fountain of Youth, also known as the water of life, was part of the search for the elixir of life. That search was in full throttle during the crusades and was carried to the New World by Spanish explorers, the most famous of whom was Ponce de Leon in the 1500s. Even the Mayans had legends about waters of eternal youth.

The search for the elixir of life didn't end there.

In the 19th century in the U.S., many believed that bathing in special springs had healing powers. During that era, people flocked to eureka springs, hot springs, healing springs and many, many more. So-called healing spas are still very popular today.

"Snake oil" salesmen were peddling various cure-alls into the 20th century. A search on the Internet will reveal a large number of "promising" balms and salves, some of which actually worked for minor scrapes and burns.

If you're over 60 or so, you may recall Carter's Little Liver Pills. They were advertised to treat biliousness and other ailments. The FTC made the company drop the word "liver" from the name. Carter's Little Pills are still sold, but as a laxative.

If you watched the Lawrence Welk show, you saw ads for Serutan, which is "natures" spelled backward. It’s a "vegetable hydrogel."

Today, the search for an elixir of life, by various names, is still in high gear, and salesmen abound.

People still pursue the same goal of longer and healthier lives through a mix of vitamins, supplements, wellness, incentives, education, exams, tests, etc. that will push the time of their death out a few years.

But, alas, the human body and its organs simply wear out over time. No insurance plan, wellness plan, patient education program or prevention combination can defeat the inevitable. As we age, our bodies just wear out. For example, the reason brain aneurysms and strokes occur in the elderly is that blood vessels get thinner and more fragile with age. The same applies to other vascular diseases. Joint diseases are common as we age. Why? Joints just wear out over time. Dementia is usually related to aging. The list goes on and on.

According to NIH data, all cancer rates begin to skyrocket at about age 65. That is partially the effect of age-related diminishing immune systems. Our immune systems wear out as we age.

Companies are paying huge dollars to elixir of life promoters today, when all the facts show the elixirs just doesn’t work as advertised. Such companies’ intentions are good, even noble, but doomed to fail. Lesson: Whatever you seek, someone will find a way to sell it to you.

We are all going to have a mortal illness someday unless we die sooner from something like an auto accident. My grandfather died at age 99. Every organ in his body was failing. His kidneys were failing, as were his vascular system, his brain and his liver. Why? He simply outlived his body. I've known a number of good people who died a miserable death after years in nursing homes. I wouldn't wish that on my worst enemy.

Another factor driving up costs in the U.S. has been the creation of the emergency phone number system -- dialing 911 and having a life-saving trained team show up at your door in a few minutes. The 911 system saves live, no doubt, but there have been unintended health cost consequences.

If one survives a heart attack, the average cost is about $250,000. Because of the 911 phone system, some 80-year-olds are surviving three heart attacks in nine months just to die from the fourth one, adding $750,000 of cost to their last 12 months. Now, healthcare providers are even putting ventricular assist devices in people like that to keep them alive for one more day. The cost for that procedure alone is $900,000.

I'm not making a comment on the morality of deferring an elderly person's death for nine months at a cost of $750,000 to $2 million. But we need to have an adult conversation in America about how we are going to pay for all this. By any measurement, Medicare and Social Security are both totally unsustainable unless huge changes are made that will affect everyone. Beware of proposed changes that promote intergenerational rivalries.

This chart shows death rates by age). When people hit about age 50, the death and sickness rates begin to skyrocket.

This chart shows leading causes of death. See the strong correlation to aging and heart disease. People are simply outliving their hearts and blood vessels. In 1900, people rarely died of heart disease because they didn't live long enough to develop chronic conditions. Most of the chronic diseases we worry about are simply a consequence of aging. They are irreversible. As with the Hydra of Greek mythology, if you defeat one chronic condition, three others will pop up.

The third chart shows health spending by age; again, disease correlates to aging. That will always be the case until someone comes up with a way to prevent aging or finds an "elixir of life." That chart also illustrates the massive, wasteful spending on end-of-life care in the U.S. compared with peer countries.

People born in the U.S. today can expect to die along a bell curve centering on age 80. If we all do everything we can possibly do to be healthier for all of our lives, there will be slightly fewer deaths around ages 78 or 79. (A great source of information on this topic is Nortin Hadler’s The Last Well Person: How to Stay Well Despite the Health-Care System.)

In any case, if you are able to add a year to your life it will, obviously, be added to the end. For most people, that will mean another year in a nursing home, in assisted living or as an invalid at home. (For a Washington Post article on just how nasty nursing homes can be, click here. Again, I would not wish that on my worst enemy.) People sometimes tell me about someone who was more or less healthy and independent at age 90. For every person like that there are a hundred in nursing homes or dementia units.

Most people retiring today don't have enough in savings to support themselves for more than a few years, let alone enough to pay for assisted living or nursing homes when they are elderly and frail. Medicaid nursing home budgets are likewise unsustainable. Don't count on that. For many people, living a year or two longer will simply mean being a burden to your children for another year or two, both financially and emotionally.

What about your children's lives? Do you really want them to have to look after you well into their 60s? At that age, they should be concentrating on their own welfare.

As people age into their 80s and 90s, many become demanding in an irrational way. Some people aged 55 and up are relieved when their elderly parents pass away, but often with feelings of guilt. Most people have witnessed this in their own families.

Someday, researchers may discover a way to delay the effects of aging. Personally, I believe such is the province of science fiction. If aging is ever reversed, God help us. That would be very destructive to mankind.

Imagine our world populated by a billion or more centenarians. Imagine a nation with an average age of 65. Imagine yourself at age 90 with a 120-year-old parent or two. Who will look after whom? Will 70-year-old children or their 45-year-old children be able to look after and support such parents, grandparents and great-grandparents? The news from Asia is that many young people are no longer willing to support their centenarian parents or grandparents today, let alone great-grandparents.

What should we all do then? Simple. Spend less time wringing your hands over which illness will get you in the end; rather, make the most of the time you have. Worry will never add a day to your life.

The Romans had a blessing: May you live well and die suddenly.

Every five years or so, the insurance industry changes course. Hard market, then soft market. Keep the lights on, then innovate. Build, then buy. Outsource, then in-house. Best-of-breed, then suite.

Unlike with most politicians, some measure of this waffling is certainly beyond the control of insurers truly in the thick of it. However, other preferences reflect the uncertainty of markets and economies, the fluctuation of consumer expectations and demands and what some may call downright desperation to stay ahead of the curve.

Technology has long been recognized as an enabler, and it definitely fills that role when planned for strategically and implemented well. As the industry has taken up the challenge of providing faster, better, more personalized service to consumers, the demand for technology to facilitate the necessary processes has increased, as well. Core system modernization has become a top priority for insurers across all lines of business (LOBs). This means analyst firms and consultants are being engaged at a staggering (and expensive) rate to help spec out requirements, develop the request for proposal (RFP) and narrow things down to a very short list.

Interestingly, the biggest question for most insurers is not whether all of the core administration systems need to be replaced, but rather how and when is the best time to do it. Enterprise rip-and-replace projects traditionally come with a big stigma, a heavy dose of fear and bit of skepticism. Can it be pulled off successfully? With advances in technology such as the move toward cloud for deployment, the incorporation of configuration tools that promote insurer self-sufficiency and better implementation methodologies, the dark skies are definitely clearing.

Today's most modern enterprise suites provide better integration, better capability and better results than niche-focused solutions of the past. While suite components can, by and large, all be implemented individually, pre-integration, reliance on a single data repository, use of a common architecture, an ensured upgrade path and common user interfaces mean these solutions still have a serious competitive edge over standalone systems. But does this really mean there is no more need for best of breed?

Better Integration

Once famous for creating silos and building "kingdoms" within the enterprise, insurance technology has come a long way. Recognition that insurance processes could be completed faster, and with greater assurance of accuracy, if every relevant employee was looking at the same information, insurers are turning to enterprise suites as the solution of choice. The core administration (policy, billing and claims) components of most modern enterprise suites offer increased integration and conveniently draw information for customer service representatives (CSRs), agents and underwriters from a single data or document repository. Further, by building on similar workflows, user interfaces (UIs) and processes, enterprise suites minimize change management issues and decrease downtime needed for training.

Better Capability

It's pretty common to hear technology vendors talk about how their solutions let insurers concentrate on core competencies, but rarely is this turn of phrase actually applied to technology vendors. Insurance suites of the past typically built out full, robust capability for core administration processes, but only invested in the bare minimum when it came to supporting processes, functions and components. The best enterprise suites available today not only handle, but excel at, providing capability for peripheral processes that support core administration, including reinsurance, underwriting, document/content management, accounting/general ledger, agent/producer and consumer portals. This depth of capability was once only available to insurers through best-of-breed solutions, but now only highly customized situations and processes require such niche-focused systems.

Better Results

Even though everyone suspects it's a much higher number, best guesses throughout the industry say that insurers replace core administration systems only once every eight to 10 years. That low frequency hardly allows internal IT staff to gain any kind of proficiency in implementation methodologies or change management. The tightly integrated nature of suite components eases implementation challenges measurably, and at the end of the day, once you get into a groove, why get out? By taking advantage of teams already established for one replacement project for another, insurers can lessen business interruption significantly. Plus, using an agile implementation methodology that incorporates iterative releases will eliminate the scope creep and missed expectations inherent to waterfall projects.

Conclusion

Five or 10 years ago, it may have been necessary to buy a best-of-breed technology solution to get capability specific to a certain LOB or process. However, modern enterprise suites, whether implemented together or individually, today offer the same robust capability once offered only by best-of-breed solutions, but with better integration, faster access to critical data, significantly easier upgrades and ultimately, better results.

A large U.S. cable television company recently sought to better understand how its employees were using cloud apps to stay productive. Management had an inkling that workers routinely used about a dozen or more cloud file sharing and collaboration apps.

An assessment by CipherCloud showed the employees actually were using 204 cloud services that posed a security risk: 78 cloud storage apps and 126 collaboration apps, many of which included file-sharing functions.

Emerging risk: A major concern for the cable company was that sensitive information about customers and employees could leak unnoticed beyond its network perimeter.

Free cloud file storage makes it convenient to share data quickly and widely. The company learned that sensitive files had been moved into folders accessible to people who should not have had access to the information.

Wider implications: Like many organizations, the cable company routinely stores customer transactions data as well as employee healthcare data covered by HIPAA privacy rules. The rising use of free Web apps by employees has created many more opportunities for data leakage and could lead to sanctions and fines - or, worse, an embarrassing, expensive data breach.

The cable company set up sanctioned accounts with a popular cloud storage service-Box-for employees to use. It also has begun examining other steps it can take to impose tighter controls around sensitive company records.

Excerpts are from ThirdCertainty's interview with Willy Leichter of CipherCloud. (Answers edited for length and clarity.)

3C: Can you outline how the rising use of cloud apps in the workplace is creating security issues?

Leichter: A typical process is one person sends you something from a Dropbox account, and suddenly you become a Dropbox user. Or, often, departments will say, "OK, we're going to use Dropbox or Hightail for this particular project," and it kind of grows department by department. It grows virally.

The challenge is the very nature of the whole file-sharing world. It's like Swiss cheese. It's designed to be very easy to share and to open up public links and to let another person in.

That's where this cable company approached us. They had about a dozen different things they knew about and wanted to standardize.

3C: You found a lot more than a dozen cloud apps in use.

Leichter: We found well over 1,000 cloud apps, what we call shadow IT apps, that they were using. We have about 20 different categories of such apps; it could be software development tools, or it could be social tools. In one category, file-sharing tools, we found more than 120 apps. This one category is probably the most actionable category because file sharing involves sending people documents.

3C: How did this discovery help the cable company?

Leichter: They were trying to do two things. They were trying to standardize on two or three different file-sharing services and use monitoring tools on them. And they also wanted to shut down the worst offenders, which you can do easily enough.

3C: In general, what kinds of malicious or worrisome activity are you seeing in shadow IT?

Leichter: It's kind of a spectrum. Officially sanctioned apps are being scanned in real time, using tools we and others make. That's kind of a new world. We can give you all kinds of detail about who's using all these apps. Then there's the other 90% of the apps in shadow IT.

Anomalies can be where someone is sending huge amounts of files to some strange apps. Or someone is downloading stuff they shouldn't be at two in the morning. Or it could be multiple people using the same account from different IP addresses. Someone is logging in from San Jose and then an hour later they're logging in from Beijing. You can spot a lot of these and take steps to shut them down.

3C: What else surprised the cable company?

Leichter: One of the things they learned is why people were doing this. For the most part, it was because the company wouldn't pay for them to use an account. So they were account hopping from one freebie to the next. It was because people just did not want to pay for stuff.

So now the company is trying to steer people to use better practices through outreach and education. And it also is buying them accounts.

Automakers will have to focus on women if they hope to make driverless cars mainstream, according to a NerdWallet survey that shows men are far more likely to express interest in the new technology. The survey of more than 1,000 Americans nationwide also exposes a sharp divide in views on self-driving vehicles between Millennials and older Americans.

Only 37% of women surveyed by NerdWallet expressed any interest in owning a self-driving car, whereas half of men expressed interest.

The survey also found that 53% of respondents ages 18 to 29 were "very interested" or "somewhat interested" in owning a self-driving car, compared with just 41% of those 30 and older.

Among key findings of the survey:

• Most women expressed concern about the safety of self-driving cars, with 55% citing safety as among the biggest drawbacks of the new technology. Only 37% of men were worried about safety.
• 44% of men were concerned that driverless cars will take the fun out of driving; only 23% of women felt that way.
• Consumers have a limited amount of trust in autonomous car technology. When asked whether they would put a child alone in a driverless car to go to school or a friend's house, only 6% of those surveyed would close the door and wave goodbye.
• While consumers are not yet ready to embrace a driverless world, they are interested in safety technologies that are paving the way for fully autonomous vehicles. Blind-spot detection was by far the most popular new technology, with 42% citing it as the most appealing feature of semi-autonomous cars, followed by emergency braking to prevent crashes, favored by 30%.

Self-driving cars are here

Self-driving cars, also known as autonomous vehicles, once seemed the stuff of science fiction, but they are already testing on the highway and seem certain to end up in dealer showrooms before long. Yet our survey of more than 1,000 Americans found a distinct lack of enthusiasm toward the prospect of driverless cars, with only a small minority "very interested" in buying one and nearly twice as many saying they were "not at all interested."

Nevertheless, a transition to autonomous cars seems inevitable.

Google recently announced that it will begin putting its self-driving cars on public roads in Mountain View, CA, this summer. Over six years of testing, Google says its cars have been involved in only 11 accidents - none of which was the fault of the Google car. In most cases, the cars were rear-ended.

A self-driving Audi recently completed a trip from San Francisco to New York in nine days, driving in automated mode 99% of the time, according to Delphi Automotive, which made the technology.

Tesla CEO Elon Musk recently announced a software upgrade for some of the maker's electric cars that will make it possible for the cars to drive from San Francisco to Seattle without human input - "from parking lot to parking lot," as he put it at a news conference. However, the full autopilot feature will not be enabled, at least initially, he said.

While our survey found Americans as a whole relatively unenthusiastic about driverless cars, men were far more likely than women to express interest.

Self-driving cars use GPS and a variety of sensors (cameras, radar and lasers) to scan and identify the environment around the car. A computer in the car processes data from the sensors to decide on driving actions such as steering, braking and turning. Cars would be networked, using vehicle-to-vehicle (V2V) communication to talk to one another. Ultimately, a human driver becomes just another passenger and would be able to sit back and do other things while en route.

The potential for reducing car accidents could be significant. After all, the computer never takes its "eyes" off the road, never gets distracted, never gets tired.

On May 13, Transportation Secretary Anthony Fox announced that the U.S. Department of Transportation will fast-track rules to require V2V communication in future cars.

Still, many people are firm in their resistance to driverless vehicles: 28% vow they will never purchase a driverless car. Only a very small contingent (3%) is ready to buy a self-driving car right now. The majority of those surveyed (51%) would wait three years or longer after such cars became available before considering buying one.

NerdWallet also wanted to find out what would be appealing about driverless cars that could potentially win over customers. While more than one-third of consumers (36%) did not find anything appealing about driverless cars, about the same percentage liked the ideas of saving on car insurance and letting the car handle routine driving tasks.

Notably, fewer than one-third of people found the potential for improved safety to be a compelling reason to own a driverless car.

The older the age group, the more likely respondents were to say they couldn't find anything appealing about driverless cars, from a low of 26% among those ages 18 to 29, to 44% among those age 60 and older.

Safety and cost are top worries

Safety concerns are a major drawback of self-driving cars, according to 46% of respondents, but cost was the biggest worry.

Concern about safety also bubbled up when we asked about car insurance rates. Typically, cars that crash less are rewarded with lower auto insurance rates. But only 41% of people think owners of self-driving cars should pay less for insurance.

As another measure of trust in autonomous car technology, we asked whether people would put a child in a self-driving car alone to go to school or a friend's house. Only 6% gave a thumbs-up to that idea. Most people (76%) said no, and the rest were unsure.

However, people did show interest in safety technologies such as collision avoidance, suggesting the possibility that they will eventually come around to self-driving cars if they can be sold on the cars' safety promises (and if men can still have a little fun). Only 9% of people said they had no interest in any of the technologies we asked about.

A few are ready to spend today

There's a very small, enthusiastic contingent of people who are ready to embrace driverless cars today: 3% of respondents say they would purchase a driverless car today if they could, and 6% say they'd be willing to pay more than $10,000 extra for a fully autonomous car over a regular car.

Another 15% say they would pay $5,001 to $10,000 more. (Experts generally predict that self-driving cars will cost about $7,000 to $10,000 more than regular cars when they are introduced, with the price differential decreasing in subsequent years.) But pessimism about the value of autonomous cars still prevails: 50% of people say they wouldn't pay a dime more.

Methodology

NerdWallet conducted a national, online survey of 1,028 randomly selected Americans ages 18 and older on May 12-13, 2015, via SurveyMonkey. Respondents were 52% female and 48% male. By age, 22% were under 30, and 26% were over 60. Margin of error: four percentage points.

For the full study, click here.

As you know, I'm not a fan of physician dispensing. In limited cases, there can be benefits from patient compliance and convenience and from immediate treatment. However, my opinion is that in most cases physician dispensing creates a motivation to continue prescribing (because revenue to the physician is at stake) and causes patient safety issues (by bypassing the people who really understand drugs -- pharmacists and pharmacies -- and possibly not taking into account drug interactions).

On top of that, physician dispensing can increase lost time by an injured worker, as documented in a study of Illinois. When evaluating the differences between physician-dispensed and non-physician-dispensed medications, the study found:

• For physician-dispensed, non-narcotic drugs -- medical costs ▲ 39%, indemnity costs ▲ 27%, lost-time days ▲ 34%, average total claim ▲ 31%, # of prescriptions = 2.99
• For physician-dispensed narcotic drugs -- medical costs ▲ 78%, indemnity costs ▲ 57%, lost-time days ▲ 85%, average total claim ▲ 64%, # of prescriptions = 3.20

Several states have tried to combat inappropriate physician-dispensing over the past few years, using fee schedule and rules and even felonies as countermeasures. Some efforts have been successful, while others have just created a continuing cat-and-mouse game for repackagers and physicians vs. payers.

Well, effective Jan. 1, 2016, Nevada instituted its own type of reform, specific to workers' comp. The bill does not appear to be ambiguous or up for interpretation. The bill (SB 231) was signed by the governor on May 27, 2015, but the intended (and unintended) ripple effects started last Friday. Read the entire act here. To highlight:

• Section 1.1.a - A "provider of healthcare" can only provide an initial 15-day supply of Schedule II or III controlled substances to an injured worker. Note that this excludes pharmacists and hospitals, both reasonable carve-outs. Any subsequent such controlled substances must be dispensed by a pharmacy. Excellent.
• Section 1.1.b - The "provider of healthcare" dispenser must include the original manufacturer's national drug code (NDC) on bills and reports. Good. This doesn't necessarily fix the issue of repackagers becoming "manufacturers" of unique (previously unnecessary) dosages and inflating prices, but ...
• Section 1.1.c - A repackaged drug must not be used. Booyah.
• Section 1.1.d - For outpatient care, a non-prescription drug will not be reimbursable. Excellent.

While not all dangerous or clinically inappropriate drugs are Schedule II or III, these new rules should certainly make a dent in direct dispensing of those that are. This bill does not outlaw physician dispensing, but it does remove revenue motivation so a "provider of healthcare" will focus on the most clinically appropriate care (which may not be a drug). Working as a team, the "provider of healthcare" and the pharmacist should determine what, if any, drugs are clinically appropriate for the injured worker/patient.

It will be interesting to see how the repackaging industry responds. For an example of the state of the industry in Nevada, check out this website. (Nine uses of the word "revenue" on the repackager's home page. Hmmmm.)

If you operate in Nevada, keep your eyes and ears open. And if you see reactions, please let us all know!

This list of worst doctors came to me via email, and I thought it was too good not to post. The origin of this is a Medscape article written by Lisa Pevtzow, Deborah Flapan, Fredy Perojo and Darbe Rotach. Please read the Medscape article in full. It's a gem. The Medscape article shows pictures of these offenders.

Here is a summary of the worst doctors:

1) In July, Farid Fata, MD, was sentenced to 45 years in prison in Detroit for administering excessive or unnecessary chemotherapy to 543 patients. Some of them he deliberately misdiagnosed with cancer. In addition to enduring needless chemotherapy, the patients suffered anguish at the possibility of death. The massive criminal scheme netted at least $17 million from Medicare and private insurers.

2) Ophthalmologist David Ming Pon, MD, was found guilty in October of cheating Medicare by pretending to perform procedures on patients who did not need them. A federal jury convicted Dr. Pon on 20 counts of healthcare fraud. The scam netted Dr. Pon more than $7 million, according to the Department of Justice.

3) Joseph Mogan III, MD, was sentenced to about eight years in prison in March for operating two "pill mills" in suburban New Orleans. He gave out illegal prescriptions for narcotics and other controlled substances on a cash-and-carry basis. Dr. Mogan might have received a longer sentence had he not previously testified against a former New Orleans police officer who gave advice on how to operate under the radar of law enforcement. Prosecutors said the officer helped Dr. Mogan and his co-operator, Tiffany Miller, because Miller provided sexual favors and thousands of dollars in cash.

4) Dr. Aria Sabit pleaded guilty in a federal district court in Detroit in May to conspiring to receive kickbacks from a medical technology company. In 2010, Apex Medical Technologies, which distributes spinal surgery instruments, told the surgeon that, if he invested $5,000 in the company and used its hardware, he would share in the revenue. Ultimately, he received $439,000 from his investment. Dr. Sabit also pleaded guilty to stealing $11 million in insurance proceeds after billing Medicare, Medicaid and private insurers.

5) A Virginia jury awarded a patient $500,000 in June after an anesthesiologist made mocking and derogatory comments, which the patient accidentally recorded on a cellphone while he was sedated. The case inflamed the public after the Washington Post reported the story. The recording captured anesthesiologist Tiffany Ingham, MD, commenting on the patient’s penis and making fun of him. The surgical team also entered a fake diagnosis of hemorrhoids into his medical record.

6) A former researcher at Iowa State University was sentenced to 57 months in prison in July for systematically falsifying data to make an experimental HIV vaccine look effective. The researcher, Dong Pyou Han, PhD, was supposed to inject rabbits with a vaccine and test their sera for HIV antibodies. Dr. Han not only gave the head of the lab false test results about the vaccine, but he also injected the rabbits with human antibodies.

7) The Washington Medical Quality Assurance Commissions suspended the license of Arthur Zilberstein, MD, in June for sexting from the operating room. The commission said Dr. Zilberstein "compromised patient safety due to his preoccupation with sexual matters" during surgery. He was charged with exchanging sexually explicit texts during surgeries when he was the responsible anesthesiologist, improperly accessing medical-record imaging for sexual gratification and having sexual encounters in his office.

8) An Ohio cardiologist was convicted in September of billing Medicare and other insurers for $7.2 million in unnecessary tests and procedures. Dr. Harold Persaud put lives at risk by performing stent insertions, catheterizations, imaging tests and referrals for coronary artery bypass graft surgery that were not medically warranted, according to prosecutors.

Alas, such patient mistreatment and fraud is not that rare, as my readers.