When it comes to general liability insurance for long-term care facilities, ratings are often based on the CMS 5 STAR rating system. This is data that consumers view as the holy grail of quality metrics for skilled nursing facilities. It essentially says a facility rated 5 STAR is well above average, and a facility rated 1 STAR is much below average. This provides a good overview for nursing home quality, but there are flaws inherent to this system, whether it is inaccurately reported data, variation in quality standards between states and survey districts or facilities that specialize in higher acuity and have sicker patients in-house. Here are some of the variables that I have noticed not only as an insurance underwriter but also as a licensed nursing home administrator for more than 20 years. 1. Health Inspections STARS – This is a three-year average of annual surveys and complaints surveys and is calculated based on the number of citations and their severity compared with the state averages. The average is not as important as knowing the facility is improving with survey compliance or getting worse. 2. Staffing STARS – This is based not only on the number of hours of care provided to each patient per day by nurses and nursing assistants but is also heavily weighted to the number of RN hours. What you need to know is that the staffing data used is only for a two-week period that is self-reported by the facility during the annual survey. This is a limited snapshot and may not be indicative of normal staffing patterns or could be inaccurately reported. 3. Quality Measures STARS – This is based on 18 quality measures (QMs) for short-stay and long-stay residents. Some of the more scrutinized are for the prevalence of pressure ulcers, falls and antipsychotic medication. What you need to know is, if the facility has a focus in caring for these types of high-acuity patients, the star ratings may be lower in comparison with state averages, and this is not necessarily an indication that the facility is deficient. 4. Overall Rating STARS – A rating of 1 to 5 stars is based on health inspections, staffing and quality measures ratings combined into one. The more stars the better. What you need to know about this is that the facility is being compared in relationship to other facilities in a geographic area. Why this is relevant is, if all the facilities around you are excellent operators, a low star rating may not be a good indication of that facility's overall operation. 5. Trends – A facility that is improving or declining cannot be detected with just an overall 5 STAR score. The CMS 5 STAR system has many good points and provides a consistent rating for all 16,000 nursing home in the U.S. but should not be used without interpretation for insurance purposes. We need to first validate that the self-reported data used for each facility is accurate and also consider the types of residents the facility has chosen to admit and care for. Higher-acuity residents will have an effect on the three categories that drive the overall rating and could make the facility appear as an underperformer. Lastly, both the quality performance and performance improvement of a facility are becoming a heightened area of focus for centers. Effective quality improvement programs play a role in assessing risk that is easily overlooked. Here’s a link the CMS website: CMS 5 STAR Ratings

This is part of a series of interviews by Shefi Ben Hutta with insurance practitioners who bring an interesting perspective to their work and to the industry as a whole. Here, she speaks with Gokul Sudarsana and Rohit Rajan, the founders of NYC-based startup Isaac Re, to discuss the often forgotten space of reinsurance.  To see more of the “A Word With Shefi” series, visit her thought leader profile. To subscribe to her free newsletter, Insurance Entertainment, click here. Icebreaker: Two truths and a lie:

• One of us once ate a scorpion
• One of us went to kindergarten at a South Korean army base
• One of us played in a celebrity basketball tournament

(See answers at the bottom of the post) Describe Isaac Re in 50 words or less: Isaac Re is a software marketplace where you can invest in bonds that are backed by insurance risks. As an investor, these bonds will provide you with attractive returns and substantial diversification opportunities for your portfolio. Simultaneously, this allows our insurance partners to make better decisions with their capital and gives them the ability to write new business, closing the coverage gap across America. Why Isaac Re? A core inefficiency in the insurance industry is the high cost of capital, especially in a hard market when capital is scarce. This, in turn, increases prices. By spreading risk across the larger capital market, we smooth out the insurance risk capital cycle, helping insurance companies raise capital cheaply and, in turn, make insurance more affordable to close the coverage gap. How did the idea develop? While I (Gokul) was working in the industry, one of the most powerful insights I gained was that the insurance capital market is inefficient. Rohit and I grew up together; his background is in engineering, and I’m an actuary. As we started talking about this problem, it became clear to us that bringing together our complementary skills and building a software-oriented insurance capital marketplace would be a huge opportunity for us. What's in a name? Isaac Re is a tribute to Isaac Newton. Insurance is a prime example of a big data-driven industry. Valuing risk is built on a wide range of data sources that push and pull prices toward equilibrium, much like gravity. Biggest challenge: Insurance is a slow-moving industry. A solution like ours fundamentally re-optimizes the insurance capital landscape. This requires the buy-in, commitment and shared vision of industry executives and thought leaders. What does competition look like? Right now, these transactions are highly bespoke, over-the-counter arrangements that involve large deal teams to execute. We are the first company to use software to automate the refinancing value chain. Why Global Insurance Accelerator? The GIA is a unique opportunity to go through an insurance-focused accelerator, which helps us quickly connect to industry stakeholders. It is a launching pad to energize the industry and build long-lasting partnerships. What’s on your to-do list? We are announcing partnerships with the insurance and investment communities, and our pilot transaction will be completed shortly after. If not for Isaac Re, what would you be doing? Hard question. The more we develop the vision and realize the impact it can have, the more we can’t imagine spending our time on anything else. Where do you see Isaac Re in five years? We see a tremendous growth opportunity after we prove out the pilot. We have big plans for leveraging our infrastructure down the road. Today, we connect insurers with institutional investors. Tomorrow, we can connect a previously underinsured policyholder directly with an individual investor. Best life lesson: Lead by example.   Icebreaker answers: 

• One of us once ate a scorpion - Truth
• One of us went to kindergarten at a South Korean army base - Truth
• One of us played in a celebrity basketball tournament - Lie

Rohit ate a scorpion, and Gokul went to kindergarten in SK. (For what it's worth, Rohit once played pickup basketball with Don Cheadle.)

In a recent article by CIO, the volume of healthcare data at the end of 2013 was estimated at just over 150 exabytes, and it is expected to climb north of 2,300 exabytes by 2020—a growth rate of 1,500% in just seven years. In response, both healthcare payers and providers are increasing their investments in technology and infrastructure to establish competitive advantages by making sense of the growing pool of data. But key actionable insights—such as how to improve the quality of patient care, increase operational efficiency or refine revenue cycle management—are difficult to find. Core challenges surrounding data analytics (capturing, cleaning, analyzing and reporting) are complex and daunting tasks, both from a technical and subject matter perspective. It's no surprise, then, that many healthcare organizations struggle to make sense of this data. While the advent of big data technologies, such as Hadoop, provide the tools to collect and store this data, they aren't a magic bullet to translate these heaps of information into actionable business insights. To do so, organizations must carefully plan infrastructure, software and human capital to support analysis on this scale, which can quickly prove to be prohibitively expensive and time-consuming. But, by starting small in the new era of big data, healthcare organizations are able to create an agile and responsive environment to analyze data—without assuming any unnecessary risk. To do so, however, they must be able to answer three questions:

1. What narrowly tailored problem has a short-term business case we can solve?
2. How can we reduce the complexity of the analysis without sacrificing results?
3. Do we truly understand the data? And, if not, what can we learn from the results?

To illustrate the effectiveness of starting small, consider two examples: that of a healthcare services provider looking to prevent unnecessary hospital visits and that of a large healthcare provider looking to universally improve revenue cycle operations after a three-practice merger. The first example concerns an organization that specializes in care coordination. This particular organization consumes a sizeable volume of claims—often more than five million a month. And to supplement core operations (e.g. patient scheduling and post-visit follow-ups), it sought to answer a question that could carry significant value to both payers and providers: How can we reduce the number of unnecessary hospital visits? By digging even further, there was a more-refined question from payer and provider clients: Can we identify patients who are at a high risk for a return visit to the ER? Last, but not least, the organization eventually asked the key question many such big data projects fail to ask: Is there a short-term business case for solving this problem? To answer the question, the organization considered all available data. Although the entire patient population would provide a significant sample size, it could potentially be skewed by various factors relating to income, payer mix, etc. So the organization decided to narrow the search to a few geographically grouped facilities and use this sample as a proof of concept. This would not only limit the volume of data analyzed but would also reduce the complexity of the analysis because it does not require more advanced concepts of control groups and population segmentation. The approach may also allow, if necessary, subject matter experts to weigh in from the individual facilities to provide guidance on the analysis. The results returned from the analysis were simple and actionable. The service provider found that particular discharge diagnoses have comparatively high rates of return visits to the ER, often related to patients not closely following discharge instructions. And by providing the payers and providers this information, the service provider was able to improve the clarity of discharge instructions and drive post-discharge follow-ups to decrease the total number of unnecessary readmissions. The cost of unnecessary admissions was significant enough to grant further momentum to the small data project, allowing the project to expand to other regions. In the second example (a large, regional healthcare services provider looking to improve revenue cycle operations), a similarly tailored question was posed: How can we improve revenue cycle efficiency by reducing penalties related to patient overpayments? At first glance, this seems to be a relatively small insight for traditional revenue cycle analyses. Questions that could potentially have a larger impact (Who owes me money now? Which payer pays the best rates for procedure XYZ?), could provide a larger payoff, but they would inevitably complicate the task of standardizing and streamlining data and definitions for all three practice groups. However, the analysis would provide a jumping off point that would improve understanding of the data at a granular level. Not only was this regional provider able to create reports to identify delayed payments and prioritize accounts by the "age" of the delayed payment, it was able to better understand the underlying cause of the delayed payments. It was then able to adjust the billing process to ensure timely payments. Once again, timely payments significantly helped the working capital requirements of the organization by proving a rather short-term and significant business case. As a result, the small data project was expanded to include more complex revenue cycle management problems related to underpayment and claims related to specialty practices. In both examples, the organizations deliberately started small—both in terms of the amount of data and the complexity of their approach. And by showing restraint and limiting the scope of their analyses, they were able to define a clear business case, derive actionable insights and gain momentum to tackle larger challenges faced by the organization.

I’ve said before regarding Opt Out—the alternative plan in Oklahoma that allows employers to escape the workers’ compensation system but maintain the benefits of exclusive remedy—that repeatedly using the word “transparency” will not make it so. Yet, when it comes to “the Oklahoma Option,” the word "transparency" is tossed around like cheap hash on a roadhouse griddle. Proponents continually use the word to describe the scheme. It is used so much that, if it were true, the entire concept would be completely invisible because it would be so incredibly, endlessly transparent. And, of course, the Oklahoma Option is anything but. Really smart people will know the story of Schrodinger’s cat from advanced science classes they took at some hoity-toity university or elementary school. The rest of us Neanderthals have learned about it from the weekly science lessons we get watching the hit television show "The Big Bang Theory." For those of you who neither attended fancy schools nor are "Big Bang Theory" aficionados, Schrodinger’s cat is a thought experiment devised by Austrian physicist Erwin Schrodinger in 1935. It illustrates the problem of quantum mechanics applied to everyday objects. In the experiment, a cat, a flask of poison and a radioactive source are placed in a sealed box. If an internal monitor detects radioactivity, the flask is shattered, releasing the poison and killing the cat. The Copenhagen interpretation of quantum mechanics implies that, after a while, the cat is simultaneously thought of in two states. In other words, if the box remains unopened, the cat may be thought of as both alive and dead. I think that experiment lends itself well to Opt Out transparency. In the realm of Opt Out promotion, the word “transparency” is sprinkled around like holy water. It is used as if it intended to sanctify and purify the concept for the consuming public. It is employed to describe the communication that employers use to educate their workers about their rights and responsibilities. It is used in reference to the overall plans and approval process, and it is used to defend the existence of the plan. Problem is, Opt Out is not transparent in the way proponents would have you believe. See Also: Texas Is NOT an Opt-Out State For instance:

• The application process to have an employer plan approved is now confidential. All documents and information submitted to the state to obtain approval to Opt Out is closed to public eyes. This is because of reforms specifically pushed by Oklahoma Opt Out proponents last year.
• The plans themselves are not available through the state. They were initially, but they have been removed from public access since the previously referenced reforms took effect. At the recent WCRI conference in Boston, a workers’ compensation director for a very large and well-known company took up that issue, directly telling Option author Bill Minick that she was uncomfortable with Opt Out and that she wanted to know where she could actually see existing employer plans. (I wanted to rush up to this woman and hug her in front of all 400 attendees, but I did not know her personally and thought it probably would have appeared wildly inappropriate and would possibly lead to some sort of assault charges being filed). Minick assured her the plans were easily obtainable, mentioning that ProPublica published many. He also told her several courts have copies. He did not mention that courts only have those copies because they have been entered into evidence in multiple lawsuits, and I noted he did not tell her she could get them from the state. Someone on the panel suggested Minick could just send them all to her, and he agreed he could. I am not sure he agreed he would. In a recent article on InsuranceThoughtLeadership.com, Minick stated, “The idea of establishing a public database of SPDs (summary plan description) has also historically proven impractical.”

That statement, explaining why plans are not available to the public, was made in an article describing how transparent Opt Out is. I swear, I could not make this stuff up if I tried. Furthermore:

• There is absolutely no audit function allowing the state to see how employers are managing their plans. They are under no obligation to report their activity to anyone.
• Under many of these plans, an employee appealing a denial may not testify or submit evidence at that appeal. The people reviewing the appeal are selected by the employer.
• Even the denial letters issued on behalf of some employers contain strict confidentiality language, instructing the injured worker not to share the information contained within the letter with “any unauthorized individuals.”

I could go on (and on and on and on), but you get the idea. So, this is the paradox known as Schrodinger’s Opt Out. The Oklahoma Option has been placed, by legislative and regulatory fiat, in a sealed box and kept away from prying eyes. It is in that state that it may be simultaneously thought of as both transparent and not transparent. Only by opening the box and thrusting the concept under the unforgiving light of scrutiny do we learn the truth. That, of course, is what is happening. The Oklahoma Option, recently found to be unconstitutional, has been subjected to tremendous review in a variety of formats and mediums. The claims of transparency do not hold up when exposed to that scrutiny; instead, opaqueness rules the day. The concept of transparency when related to the Oklahoma Option can only survive in a closed and impenetrable box, where the claims can be protected from prying eyes. The cat is out of the bag, and the concept is out of Schrodinger’s box. The transparency variable cannot be easily applied in that situation. Just repeating the word many times will not change that reality. And that, for my" Big Bang Theory" friends, is the big Bazinga.

The insurance industry has remained much the same for more than 100 years, but over the past decade it has seen a number of exciting innovations and new business models. As part of PwC’s Future of Insurance initiative, we’ve interviewed numerous industry executives and have identified six key business opportunities (illustrated below) that incumbents need to take advantage of as they try to meet customer needs while improving core insurance functions. See Also: Key to understanding InsurTech Because FinTech offers substantial promise to take advantage of emerging opportunities, funding for start-ups is surging. Increased funding activity not only demonstrates venture capitalist investors’ interest but also indicates how incumbents may leverage FinTech to address their specific business challenges. The insurance-specific branch of FinTech, InsurTech, is emerging as a game-changing opportunity for insurers to innovate, improve the relevance of their offerings and grow. InsurTech, has seen funding in line with FinTech investment overall, and we expect investments to increase as new players and investors enter the space. As Figures 2 and 3 show, activity around early-stage InsurTech companies has generated considerable buzz. Moreover, experienced insurance executives have joined start-ups, including Insureon and Lemonade, to help them develop new types of products and services, like small business aggregators and peer-to-peer insurance models. All of this indicates that investors and the industry are eager to get on board with early stage start-ups to meet the six areas of opportunity we illustrate above and describe in detail as follows: 1) Meet changing customer needs with new offerings – Customer now expect personalized insurance solutions. One size simply does not fit all any more. Usage-based models are partially addressing these expectations, but the sharing economy also is challenging existing, more traditional insurance products. New players are able work from a clean slate and leverage a variety of available resources to fill market gaps. For example:

• Metromile, a start-up, has developed a customer- (rather than risk-) centric value proposition for occasional drivers. It offers a low base rate and then charges a few cents per mile driven. Metromile also offers an app that provides personalized driving, navigation and diagnostic tips, and can even remind drivers where they parked. Furthermore, the company has entered into a partnership with Uber that allows drivers to switch from personal to Uber insurance.

• USAA has invested $24 million in Automatic Labs, a telematics platform that claims it will “connect your car to your life” and provides a full suite of integrated apps (including wearables).

• In the life sector, Sureify has developed a platform that allows insurers to underwrite life insurance based on lifestyle data inputs they obtain from wearables.

• In the peer-to-peer space, Lemonade claims to be the world’s first peer-to-peer carrier, but other companies like Guevara and InsPeer have been exploring variations of the same model. Bought by Many, a start-up that uses social platforms in its go-to-market strategy, helps individuals join or even create affinity groups, as well as find insurance solutions for their specific needs across different product lines. Of note, leading Chinese insurer Ping An has partnered with Bought by Many to create personalized travel insurance by leveraging social media data.

Some large insurers have decided to develop start-ups in-house. For example:

• MassMutual is using internal resources to build Haven, a new, stand-alone, direct-to-consumer business.

2) Enhance interaction and build trusted relationships - Established carriers have to manage increasing customer expectations and provide seamless service despite their large and complex organizations. In contrast, new market entrants are not burdened with large, entrenched bureaucracies and typically can more easily provide a seamless customer experience – often using not just new technology but new service concepts. For example, self-directed robo-advisers are convenient, 24/7 advisers that provide ready access to information that can empower consumer decisions about financial planning and investment management. And investors have taken notice:

• Northwestern Mutual acquired Learnvest, a leading robo-adviser with an estimated value of more than $250 million.

• Other robo-advisers, such as FutureAdvisor, have been part of important deals, while others (including Betterment, Personal Capital and Wealthfront) have raised funds above $100 million.

Moreover, disintermediation and the emergence of new online channels is occurring in all lines of business:

• The Chicago-based start-up Insureon has created an aggregator that specializes in micro and small businesses. It taps into existing profit pools that personal and commercial carriers are trying to reach.

• To become a B2C player in the digital small business market, ACE Group has recently taken a 24% ($57.5 million) stake in Coverhound, which enables customers to directly compare coverage options and pricing from various carriers.

3) Augment existing capabilities and reach with strategic relationships - The insurance industry historically has included intermediaries, service providers and reinsurers. In most cases, the carrier has led the business relationship because of its retail market position and scale. However, companies increasingly are peers. Accordingly, joint ventures and partnerships are a good way to augment existing capabilities and establish symbiotic relationships. For example:

• BIMA Mobile has partnered with mobile telecom companies to provide life insurance solutions to uninsured segments in less developed countries. It offers simple life, personal accident and hospitalization insurance products on a pay-as-you-go (PAYG) basis for a set time period (usually just a few months). Policyholders can obtain a pre-paid card and activate and manage their policy from a mobile phone.

• AXA has acquired an 8% stake in Africa Internet Group for EUR75 million, opening opportunities for the company in unpenetrated markets.

New B2B2C entrants also are helping forge mutually beneficial relationships:

• Zenefits was one of the first to create channels to connect insurers, brokers, employers and employees.

• Flock, which features broker managed benefits where plans can be designed to cover a range of options from enrollment to life events, offers what it says are “absolutely free” HR and benefits solutions.

4) Leverage existing data and analytics to generate risk insights - Established insurers traditionally have had the advantage over prospective newcomers of being able to leverage many years of detailed risk data. However, data – and new types of it – now can be captured in real-time and is available from external sources. As a result, there are new market entrants that have the ability to generate meaningful risk insights in very specific areas.

• Several Internet of Things (IoT) companies, including Mnubo, provide analytics that generate insights from sensor-based data and additional external data sources like telematics and real-time weather observation. The promise of the better risk assessment and management resulting from this model is likely to appeal to personal and commercial carriers.

• Facilitating this real-time data collection are drone start-ups, including Airphrame and Airware. Drones provide the ability to analyze risk with embedded sensors and image analytics. They also can operate in remote areas where it has traditionally been difficult for humans to tread, thereby saving time and increasing efficiency. In fact, American Family’s venture capital arm is investing in drone technology to explore new approaches to access and capture risk data.

• In the life space, P4 Medicine (Predictive Preventive, Personalized and Participatory) offers insurers better insights that they can apply to life and disability underwriting. Lumiata is offering the potential for better predictive health capabilities, while Neurosky is developing next-generation wearable sensors that can detect ECGs, stress levels and even brain waves.

5) Use new approaches to underwriting risk and predicting loss - Protection-based models are shifting to more sophisticated preventive models that facilitate loss mitigation in all insurance segments. Sensors and related data analytics can identify unsafe driving, industrial equipment failure, impending health problems and more. More deterministic models, like the ones that now exist for crop insurance, are starting to emerge, and new entrants are offering both risk prevention (not just loss protection) and a more service-oriented delivery model. For example:

• The South Africa-based company Discovery has a partnership with Human Longevity. They are teaming to offer whole Exome, whole genome and cancer genome sequencing, to clients in South Africa and the UK. Gene sequencing can identify risks before they manifest themselves as problems, but also raises ethical questions. It has the potential to completely disrupt life underwriting and places certain responsibility on the company to help customers manage genetic risks (while being careful about actually mandating lifestyle choices). But, on the whole, managing genetic risks in advance can benefit both the end-consumer and the insurer because, if they work together, they can better manage or even avoid long-term health problems and associated expenses.

• On the automotive side, Nauto, a San Francisco- based company, offers a system that provides visual context and telematics with actionable information about driving behavior, including distracted driving. The company claims that its system can help insurers design new pricing strategies and pinpoint areas of premium leakage that they otherwise may not notice.

See Also: InsurTech Trends to Watch For in 2016 6) Enable the business with sophisticated operational capabilities - Effective core systems enable insurers to operate at a large scale. Because of cost, establishing these systems has traditionally been a barrier to market entry. However, access to cloud-based core solutions has facilitated scalability and flexibility. Developments like this, combined with new developments like robotics and automation, have provided new market entrants compelling differentiators. As just one example, underwriting automation is now available in life and commercial lines (notably for small and medium businesses). Some carriers have adopted simplified processes and “Jet” underwriting, in which they leverage external data sources to expedite approval. This has resulted from the availability of risk insights that support new underwriting approaches. Several companies are offering to optimize and augment processes via improved collaboration, artificial intelligence and more. For instance:

• OutsideIQ offers artificial intelligence solutions via an as-a-service underwriting and claims workbench that uses big data to address complex risk-based problems.

• In addition, automating claims can improve efficiency and also effectively assess losses. Tyche offers a solution that uses analytics to help clients estimate the value of legal claims.

Implications: Think like a disruptor, act like a startup In a time when societal changes, technological developments and empowered customers are changing the nature of the insurance business, established insurers need to determine how InsurTech fits in their strategies. The table shows the various approaches insurers are taking. More specifically, insurers are:

• Exploring and discovering – Savvy incumbents are actively monitoring new trends and innovations. Some of them are even establishing a presence in innovation hotspots (e.g., Silicon Valley) where they can learn about the latest developments directly and in real time.

Action Item: Plan an InsurTech immersion session for senior management. This should be an effective eye opener and facilitate sharing of relevant insights on desired InsurTech solutions. Subsequently, FinTech analyst platforms can keep management up to date on the latest developments and market entrants.

• Partnering to develop solutions – Exploration should lead to the development of potential use cases that address specific business challenges. Incumbents can partner with start-ups to build pilots to test in the market.

Action Item: Select a few key business challenges, identify possible solutions and find potential partners. A design environment (“sandbox”) will help boost creativity and also provide tools and resources for designing and fast prototyping potential solutions. This approach also can help establish the baseline and approach to building future InsurTech solutions.

• Contributing to InsurTech’s growth and development – Venture capital and incubator programs play an important role strategically directing key innovation efforts. Established insurers can play an active role by clearly identifying areas of need and opportunity and encouraging/working with start-ups to develop appropriate solutions.

Action Item: Define a strategy to direct startups’ focus on specific problems, especially those that otherwise might not be addressed in the short term. Incumbents should consider start-up programs such as incubators, mechanisms to fund companies and strategic acquisitions. (N.B.: It is vitally important to protect intellectual capital when imparting industry knowledge to start-ups.)

• Developing new products and services – Being active in InsurTech can help incumbents discover emerging coverage needs and risks that require new insurance products and services. Accordingly, they can refine – and even redefine – product portfolio strategy. This will result in the design of new risk models tailored to underserved and emerging markets.

Action Item: Take a close look at emerging technologies and social trends that could be business opportunities to define product strategy, determine required capabilities and develop a plan to build a portfolio and seize market opportunities. FinTech has become a buzzword, but whichever way the FinTech/InsurTech market itself goes, the reality underpinning it is not a passing fad. Insurers that are actively involved with InsurTech in any of the ways we describe above stand to gain, whichever way the market moves. They can use their capital and understanding of customers and the market to both inspire and exploit innovative technologies and correspondingly grow their business.

When is the last time you haggled with your doctor over pricing? It’s certainly not a negotiation most Americans are prepared for or even one they know how to approach. However, when it comes to workers' compensation settlements, the system anticipates that, after settlement, injured workers can persuade their doctors to bill them fairly, according to the state’s fee schedule. In reality, the system is naïve, and injured workers are instead being unfairly stripped of their settlement funds because they are routinely overpaying for treatment. Injured workers deserve better, and engaging a professional administration service like CareGuard provides them just that. CareGuard offers injured workers a sophisticated advocate and group-buying power to make sure they can navigate the healthcare system and get the lifetime of treatment they were promised in their settlement, with money to spare. Each year, tens of thousands of injured workers decide to settle their cases. The vast majority (more than 95%) of these workers have no help when it comes to properly spending their funds on healthcare. After settlement, most injured workers pay out-of-pocket for treatments related to their injury, relying on their often limited knowledge of healthcare to figure out what treatments they should pay for with their funds. When they do decide to use their funds to pay, they must navigate a complex maze of fee schedule guidelines that have been provided by the state to find the correct prices. In reality, it’s nearly impossible to comply with the guidelines without a computer application deciphering the numerous pages of schedules, CPT codes, rates, modifiers and rules. The result is that, in most instances, when injured workers are left on their own after settlement, they fail to manage their care appropriately. They overpay for treatments and drugs, depleting their funds more rapidly than expected. They lose track of bills and fail to comply with regulations, putting their Medicare and other benefits at risk. And even when they are aware they can negotiate, injured workers are left to haggle out pricing on their own, pitted against a complex and apathetic medical system. Keep in mind that most of these individuals have far more healthcare needs than the average person. Professional administration services provide access to discounted drug, provider and medical equipment pricing, as well as access to technology that provides a hassle-free experience with medical care. Those services also provide support from a dedicated team of representatives and advocates to answer questions and help the injured worker navigate their medical care. With professional administration, there is no utilization review or any requirement to use a medical provider network (MPN). Instead, injured workers can see any provider they would like, giving them the freedom to get the care they need with the added support to help minimize administrative red tape. The culmination of all these benefits is that professional administration helps alleviate injured workers' concerns about settling their cases. It is a tool that can help everyone at the settlement table prepare the claimant for post-settlement success and minimize any backlash or misunderstandings after settlement. Professional administration is often overlooked because of a common misconception that it is very expensive, costing tens of thousands of dollars. At CareGuard, our pricing is typically below $5,000, and it can be even less for smaller cases. As a result of the low pricing and high discounts we offer our members, we also find that, on average, we save the injured worker over five times the cost of our services each year. The workers’ compensation system was built to protect injured workers. Significant work and resources are dedicated to ensuring the system runs well. However, the system was poorly designed to care for injured workers who have settled their case and have exited the system. Professional administrators pick up where the system left off and ensure the injured worker has a smooth transition to life post-settlement.

Amazon is revered for being a very forward-looking business. So, with the inclusion of a “zombie apocalypse” clause in its latest terms of service, should we all be worried? It’s right there in paragraph 57.10 of the company’s Lumberyard games development engine, a 3D game design program for use with Amazon Web Services (AWS): In this paragraph, Amazon notes the program is not intended for use with “life-critical or safety-critical systems,” except if the Centers for Disease Control and Prevention (CDC) declares the presence of a “widespread viral infection transmitted by bites or contact with bodily fluids that cause human corpses to reanimate and seek to consume living human flesh, blood, brain or nerve tissue and is likely to result in the fall of organized civilization.” Translation: If the zombie apocalypse comes to pass, you can use Lumberyard for whatever the heck you want. All right, so Amazon is injecting some humor in what are typically long, boring and dense terms of service that, let’s face it, no one ever reads—for any company. But the fact that the flesh-eating undead can be referenced in a document like this with almost nobody noticing speaks to a larger and more serious issue: Disclosure documents like Amazon's are an awful way to communicate important information to your customer. Companies bury important details in opaque disclosures they count on no one reading. Examples abound—coverage exclusions for your insurance, service fees for your bank account, cancellation fees for your gym membership, price increases for your cable TV package or conflicts of interest for your financial adviser. Organizations hide behind these disclosure documents and point to them as evidence that anything important is, indeed, revealed to the customer. But here’s the key these companies are missing: Disclosure is not a proxy for transparency. Indeed, as practiced these days (with pages of unintelligible fine print), disclosure is the antithesis of transparency. So let’s start referring to disclosure documents for what they really are: a tool businesses use to convey information they don’t want anyone to see. Until more companies reject such disingenuous practices (like Southwest Airlines has done with its Transfarency strategy), consumer trust in businesses will continue to erode. Do you want to strengthen your customer relationships? Go beyond the legally required disclosures and start communicating with people in a clear and forthright way. That sends a signal to your customers that you’re advocating for them and helping them avoid unpleasant surprises, whether that's in the form of excessive fees, conflicts of interest or, even, the zombie-induced fall of organized civilization. That’s the kind of advocacy from which loyal brand advocates are born. This article first appeared at Watermark Consulting.

Yelp Eat24 customer-support representative Talia Jane recently wrote a heart-wrenching blog about the difficulties she faced in living on her meager salary. “So here I am, 25 years old, balancing all sorts of debt and trying to pave a life for myself that doesn’t involve crying in the bathtub every week,” she wrote. Her situation was so dire that, on one occasion, she could not even come up with the train fare to work.  She lived on the junk food that they provide at work. Her message was addressed to Yelp CEO Jeremy Stoppelman. What did the company do? It fired her on the spot. Yes, Jane made a mistake in posting this message on Medium rather than sending an email to Stoppleman. But her situation isn’t unique. She outlined the contours of a life that are familiar to many of the people working on the lowermost rungs of technology’s corporate ladder. After a social media backlash, Stoppleman acknowledged that the cost of living in San Francisco is too high and tweeted that there needs to be lower-cost housing. But the problem is more complex than San Francisco’s housing costs. The problem is the growing inequality and unfair treatment of workers. And technology is about to make this much worse and create a cauldron of unrest. Silicon Valley is a microcosm of the problems that lie ahead. Sadly, some of its residents would rather brush away the poverty than face up to its ugly consequences. This was exemplified in a letter that Justin Keller, founder of Commando.io, wrote to San Francisco Mayor Ed Lee and Police Chief Greg Suhr.  He complained that the “homeless and riff-raff” who live in the city are wrecking his ability to have a good time. The Valley’s moguls do not overtly treat as inconveniences to themselves the bitter life trajectories that lead to experiences such as Keller complained of; but they have largely been in denial about the effects of technology. Other than a recent essay by Paul Graham on income inequality, there is little discussion about its negative impacts. The fact is that automation is already decimating the global manufacturing sector, transforming a reliable mass employer providing middle-class income into a much smaller employer of people possessing higher-level educations and skills. The growth of the “Gig Economy”—ad hoc work—is shifting businesses toward the goal of part-time, on-demand employment, with aggressive avoidance of obligations for health insurance and longer-term benefits. And the tech industry has a winner-takes-all nature, which is why only a few giant digital companies compete with each other to dominate the global economy. A substantial part of the value they capture is concentrated at the center and mostly benefits a few shareholders, executives and employees. With technology advances and convergence, we are in the middle of a gold rush that is widening inequality. Already, in Silicon Valley, the Google bus has become a symbol of this inequity. These ultra-luxurious, Wi-Fi–connected buses take workers from the Mission district to the GooglePlex, in Mountain View. The Google Bus is not atypical; most major tech companies offer such transport now. But so divisive are they that in usually liberal San Francisco, activists scream angrily about the buses using city streets and bus stops, completely ignoring the fact that they also take dozens of cars off the roads. Teslas, too, have become symbols of the obnoxious techno-elite—rather than being celebrated for being environmentally game-changing electric vehicles. In short, there’s very little logic to the emotionally charged discussions—which is the same as what we are seeing at the national level with the presidential primaries. Intellectuals are trying to build frameworks to understand why the divide, which first opened up in the 1990s, continues to worsen. Thomas Piketty explained in his book Capital in the Twenty-First Century that the economic inequality gap widens if the rate of return on invested capital is superior to the rate at which the whole economy grows. His proposed response is to redistribute income via progressive taxation. A competing theory, by an MIT graduate student, holds that much of the wealth inequality can be attributed to real estate and scarcity. Silicon Valley has both: an explosion in wealth for investors and company founders, and a real-estate market constrained by limits on development. We need to immediately address San Francisco’s housing crisis and raise wages for lower-skilled workers. Both are possible; the region has enough land, and the industry has enough wealth. In the longer term, we will also need to develop safety nets, retrain workers and look into the concept of a universal basic income for everyone. It is time to start a nationwide dialogue on how we can distribute the new prosperity that we are creating with advancing technologies.