Shifting ‘Healthcare’ to ‘Well Care’
Today's healthcare is a losing battle. Incentives are completely misaligned. The solution is a switch to "well care."
Today's healthcare is a losing battle. Incentives are completely misaligned. The solution is a switch to "well care."
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Craig Hasday is President of <a href="http://frenkelbenefits.com/">Frenkel Benefits</a> and Senior Executive Vice President of Frenkel and Company. Frenkel Benefits is one of the largest privately held independent employee benefits brokers in the United States. He is a nationally recognized healthcare leader, who has sat on the national advisory boards of Aetna, UnitedHealthcare and WellPoint, as well as the regional advisory boards of most major carriers.
The disruption in the industry’s traditional distribution system requires a "2D" strategy, optimizing both the front and back ends.
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Denise Garth is senior vice president, strategic marketing, responsible for leading marketing, industry relations and innovation in support of Majesco's client-centric strategy.
Many say autonomous cars are years away, but costs are tumbling, and, as Sun Tsu said, all battles are won or lost before they are ever fought.
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Michael Murray is a University of Chicago-trained economist passionate about providing decision-quality information and insight that helps others profit from deep understanding of both the big picture and subtle nuances.
As the industry changes, jobs will morph. Imagine a future full of drone pilots, Internet of Things architects and telemedicine nurses.
As the insurance industry continues its slow but steady journey into a digital future, the skills required by the insurance workforce of tomorrow will also change. Here is my take on some of the insurance jobs we can expect to see in (I hope) the near future.

It's happening more and more - fraudsters submit an insurance claim only to have it thrown out because someone's discovered footage showing the whole thing was staged. My two favorite examples of recent times are the pregnant woman case and the Bugatti Veyron case. With more of our lives shared online, it's easy for insurers to check our digital alibis, and digital forensic investigators (basically people who get paid for trawling social media) are the mechanism to do this.
Cyber insurance is becoming a must have for corporations, but it won't be long until it becomes a must have for individuals, as well. To effectively price this insurance, a new breed of digital natives with actuarial skills will be required to work out the risk and loss associated with a personal hack of your Facebook, Twitter, Instagram, LinkedIn and email accounts.
If you're currently working as an insurance assessor, I recommend you start learning how to fly a drone. On any given day in the future, you could have five drones at your command, each one automatically programmed with a flight path of claim sites to visit. As each drone arrives on site, you take manual control to get a good look with the on-board camera. Same job, but no more climbing roofs or visiting wreckers.
Panel doctors beware! Five years from now, most medical examinations will be done at your local "telemedicine booth," where you'll self-assess using the same tools a doctor would use. A live telemedicine nurse, located anywhere in the world, will be on a video conference screen located in the booth to guide you through any tricky parts and to verify that it's actually you taking the tests.
It's already possible to control many Internet-connected things in your home - televisions, fridges, air-conditioners, door locks, lamps and pet food dispensers - using smart phone apps. So, in theory, it should also be possible for these devices to notify you when they've been stolen (televisions), had food spoil because of a power failure (fridges) or been broken into (door locks), or when a pet stops eating and falls ill (pet food dispensers) - all of which are also insurable events. The challenge for IOT solution architects is to take the data and use it to trigger automated claim applications and approvals. It's an exciting (though less private) future.
These are just a few of the jobs that insurers can expect to start recruiting for shortly, if they haven't already. Do you agree? Have we missed anything? Please comment below!
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Michael Tempany is director of SMS Management & Technology Asia, an Asia-Pacific management consulting firm. He is passionate about digital transformation and has helped insurers across Asia transform their businesses. Clients include AXA, Prudential, Manulife, Allianz, Zurich, QBE, IAG and AIG.
Insurers can increase the opt-in for optional products like disability by streamlining the enrollment process with modern technology.
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CIOs need a new set of skills and new types of relationships. But too many CEOs are still at a loss on how to think about the future.
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.
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Matthew Josefowicz is the president and CEO of Novarica. He is a widely published and often-cited expert on insurance and financial services technology, operations and e-business issues who has presented his research and thought leadership at numerous industry conferences.
The top trends include: 3) "Huge $dollars$ are being poured into start-ups" and 4) "New ecosystems are emerging."
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:
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.
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Deb Smallwood, the founder of Strategy Meets Action, is highly respected throughout the insurance industry for strategic thinking, thought-provoking research and advisory skills. Insurers and solution providers turn to Smallwood for insight and guidance on business and IT linkage, IT strategy, IT architecture and e-business.
To gain consumers' trust -- a huge challenge for insurers -- you must abandon the "black box" approach and become transparent.
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.
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Dax Craig is the co-founder, president and CEO of Valen Analytics. Based in Denver, Valen is a provider of proprietary data, analytics and predictive modeling to help all insurance carriers manage and drive underwriting profitability.
The millennia-old search for an elixir of life continues, with no prospect for success -- and at enormous cost to the healthcare system.
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.
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Tom Emerick is president of Emerick Consulting and cofounder of EdisonHealth and Thera Advisors. Emerick’s years with Wal-Mart Stores, Burger King, British Petroleum and American Fidelity Assurance have provided him with an excellent blend of experience and contacts.
It used to be necessary to buy a best-of-breed technology solution to get capability specific to a certain LOB or process. Not any more.
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.
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Andy Scurto is Guidewire’s head of products, InsuranceNow, and manages strategic direction. He founded ISCS (acquired by Guidewire), where his deep understanding of both insurance and IT led to the development of products with uniquely rich flexibility and capabilities.