Businesses, brace yourself for health plan enforcement! With the Supreme Court's much anticipated June 25, 2015, King v. Burwell decision dashing the hope that the Supreme Court would provide relief for businesses and their group health plans from the Patient Protection and Affordable Care Act (ACA) mandates by striking down ACA, U.S. businesses that offered health coverage in 2014 and those continuing to sponsor health coverage must swiftly act to review and verify the adequacy of their 2014 and current group health plan's compliance with ACA and other federal group health plan mandates. Business must also begin finalizing their group health plan design decisions for the coming year.

Prompt action to assess and verify compliance is particularly critical in light of the much-overlooked "Sox for Health Plans" style rules of Internal Revenue Code (Code) Section 6039D. The rules generally require group health plans that violated various federal group health plan mandates to self-identify and self-report these violations, as well as self-assess and pay the excise taxes of as much as $100 a day per violation triggered by uncorrected violations. While the mandates were applicable prior to 2014 for uncorrected violations of a relatively short list of pre-ACA federal group health mandates, ACA broadened the applicability of Code Section 6039D to include ACA's group health plan mandates beginning in 2014. This means that, in addition to any other liability that the company, its group health plan and its fiduciaries might bear for violating these rules under the Employee Retirement Income Security Act, the code, the Social Security Act or otherwise, the sponsoring business also will incur liability for the Code Section 6039D excise tax for uncorrected violations, as well as late or non-filing penalties and interest that can result from late or non-filing.

Many employers have significant exposure to these Code Section 6039D excise tax liabilities because many plan sponsors or their vendors have delayed reviewing or updating their group health plans for compliance with some or all of ACA's mandates. In many cases, businesses delayed in hopes that the Supreme Court would strike down the law, Congress would amend or repeal it, or both. In other cases, limited or continuing changes to the regulatory guidance about some of ACA's mandates prompted businesses to hold off investing in compliance to minimize compliance costs. Regardless of the past reasons for such delays, however, businesses sponsoring group health plans after 2013 need to recognize and act to address their uncorrected post-2013 ACA violations exposures.

Although many businesses, as well as individual Americans, have held off taking long overdue steps to comply with ACA's mandates pending the Supreme Court's King v. Burwell decision, the three agencies charged with enforcement - the IRS, Department of Labor and Department of Health and Human Service -- have been gearing up to enforce those provisions of ACA already in effect and to finalize implementation of others in the expectation of the ruling in favor of the Obama administration. As a practical matter, ACA opponents need to recognize that the Supreme Court's King decision realistically gives these agencies the go-ahead to move forward with these plans for aggressive implementation and enforcement.

Although technically only addressing a challenge to the Obama administration's interpretation of the individual tax credit ("Individual Subsidy") that ACA created under Code Section 36B, the Supreme Court's decision eliminates any realistic hope that the Supreme Court will provide relief to businesses or their group health plans with any meaningful past or current ACA violations by striking down the law itself. Of all of the currently pending challenges to ACA working their way to through the courts, the King case presented the best chance of a Supreme Court ruling that would wholesale invalidate ACA's insurance reforms, if not the law itself, because of the importance of the Individual Subsidy to the intended workings of those reforms. By upholding the Obama Administration's interpretation of Code Section 36B as allowing otherwise qualifying individuals living in states without a state-run ACA health insurance exchange to claim the Individual Subsidy for buying health care coverage through the federal Healthcare.gov health insurance exchange, the Supreme Court effectively killed the best possibility that the Supreme Court would invalidate the insurance reforms or ACA itself. While various challenges still exist to the law or certain of the Obama administration's interpretations of its provisions, none of these existing challenges present any significant possibility that the Supreme Court will strike down ACA.

While the Republicans in Congress have promised to take congressional action to repeal or reform ACA since retaking control of the Senate in last fall's elections, meaningful legislative reform also looks unlikely because the Republicans do not have the votes to override a presidential veto.

In light of these developments, businesses must prepare both to meet their current and future ACA and other federal health plan compliance obligations and defend potential deficiencies in their previous compliance over the past several years. The importance of these actions takes on particular urgency given the impending deadlines under the largely overlooked "Sox for Health Plans" rules of Code Section 6039D for businesses that sponsored group health plans after 2013.

Under Code Section 6039D, businesses sponsoring group health plans in 2014 must self-assess the adequacy of their group health plan's compliance with a long list of ACA and other federal mandates in 2014. To the extent that there exist uncorrected violations, businesses must self-report these violations and self-assess on IRS Form 8928 and pay the required excise tax penalty of $100 for each day in the noncompliance period with respect to each individual to whom such failure relates. For ACA violations, the reporting and payment deadline generally is the original due date for the business' tax return. Absent further regulatory or legislative relief, businesses providing group health plan coverage in 2014 or thereafter also should expect to face similar obligations and exposures. As a result, businesses that sponsored group health plans in 2014 or thereafter should act quickly to verify the adequacy of their group health plan’s compliance with all ACA and other group health plan mandates covered by the Code Section 6039D reporting requirements. Prompt action to identify and self-correct covered violations may mitigate the penalties a company faces under Code Section 6039D as well as other potential liabilities associated with those violations under the Employee Retirement Income Security Act (ERISA), the Social Security Act or other federal laws. On the other hand, failing to act promptly to identify and deal with these requirements and the potential reporting and excise tax penalty self-assessment and payment requirements imposed by Code Section 6039D can significantly increase the liability the business faces for these violations substantially both by triggering additional interest and late payment and filing penalties, as well as forfeiting the potential opportunities that Code Section 6039D otherwise might offer to qualify to reduce or avoid penalties through good-faith efforts to comply or self-correct.

While current guidance allows businesses the opportunity to extend the deadline for filing of their Form 8928, the payment deadline for the excise taxes cannot be extended. Code Section 6039D provides opportunities for businesses to reduce their excise tax exposure by self-correction or showing good faith efforts to comply with the ACA and other group health plan mandates covered by Code Section 6039D. Businesses need to recognize, however, that delay in identification and correction of any compliance concerns makes them less likely to qualify for this relief. Accordingly, prompt action to audit compliance and address any compliance concerns is advisable to mitigate these risks as well as other exposures.

Businesses preparing to conduct audits also are urged to consider seeking the advice from qualified legal counsel experienced in these and other group health plan matters before initiating their audit, as well as regarding the evaluation of any concerns that might be uncovered. While businesses inevitably will need to involve or coordinate with their accounting, broker and other vendors involved with the plans, businesses generally will want to preserve the ability to claim attorney-client privilege to protect all or parts of their audit investigation and analysis and certain other matters against discovery. Business will also want assistance with proper evaluation of options in light of findings and assistance from counsel to document the investigation and carefully craft any corrective actions for defensibility.

The Audit Committee Collaboration (six associations or firms, including the National Association of Corporate Directors and NYSE Governance Services) recently published External Auditor Assessment Tool: A Reference for Audit Committees Worldwide.

It's a good product, useful for audit committees and those who advise them -- especially chief audit executives (CAEs), CFOs and general counsel.

The tool includes an overview of the topic, a discussion of important areas to assess (with sample questions for each) and a sample questionnaire to ask management to complete.

However, the document does not talk about the critical need for the audit committee to exercise professional skepticism and ask penetrating questions to test the external audit team's quality.

Given the publicized failures of audit firms to detect serious issues (fortunately few, but still too many - the latest being the FIFA scandal) and the deficiencies continually found by the PCAOB Examiners, audit committees must take this matter seriously.

Let me Illustrate with a story. Some years ago, I joined a global manufacturing company as the head of the internal audit function, with responsibility for the SOX program. I was the first to hold that position; previously, the internal audit function had been outsourced. Within a couple of months, I attended my first audit committee meeting. I said there was an internal control issue that, if not addressed by year-end, might be considered a material weakness in the system of internal control over financial reporting. None of the corporate financial reporting team was a CPA! That included the CFO, the corporate controller and the entire financial reporting team. I said that, apart from the Asia-Pacific team in Singapore, the only CPAs on staff were me, the treasurer and a business unit controller. The deficiency was that, as a result, the financial reporting team relied heavily on the external auditors for technical accounting advice - and this was no longer permitted.

The chairman of the audit committee turned to the CFO, asked him if that was correct and received an (unapologetic) affirmative. The chairman then turned to the audit partner, seated directly to his right, and asked if he knew about this situation. The partner also gave an unapologetic "yes" in reply.

The chairman then asked the CEO (incidentally, the former CFO, whose policy it had been not to hire CPAs) to have the issue addressed promptly, which it was.

However, the audit committee totally let the audit partner off the hook. The audit firm had never reported this as an issue to the audit committee, even though it had been in place for several years. The chairman did not ask the audit partner why; whether he agreed with my assessment of the issue; why the firm had not identified this as a material weakness or significant deficiency in prior years; or any other related question.

If you talk to those in management who work with the external audit team, the most frequent complaint is that the auditors don't use judgment and common sense. They worry about the trivial rather than what is important and potentially material to the financial statements. In addition, they often are unreasonable and unwilling to work with management - going overboard to preserve the appearance of independence.

I addressed this in a prior post, when I said the audit committee should consider:

• Whether the external auditor has adopted an appropriate attitude for working with the company, including management and the internal auditor
• Whether the auditor has taken a top-down and risk-based approach that focuses on what matters and not on trivia, minimizing both cost and disruption, and
• Whether issues are addressed with common sense rather than a desire to prove themselves

Does your audit committee perform an appropriate review and assessment of the external audit firm and their performance?

I welcome your comments.

One of the fascinating aspects of technology consulting is having the opportunity to see how different organizations address the same issues. These days, analytics is a superb example. Even though every organization needs analytics, they are not all coming to the same conclusions about where "Analytics Central" lies within the company's structure. In some carriers, marketing picked up the baton first. In others, actuaries have naturally been involved and still are. In a few cases, data science started in IT, with data managers and analytical types offering their services to the company as an internal partner, modeled after most other IT services.

In several situations that we've seen, there is no Analytics Central at all. A decentralized view of analytics has grown up in the void - so that every area needing analytics fends for itself. There are a host of reasons this becomes impractical, so often we find these organizations seeking assistance in developing an enterprise plan for data and analytics. This plan accounts for more than just technology modernization and nearly always requires some fresh sketches on the org chart.

Whichever situation may represent the analytics picture in your company, it's important to note that no matter where analytics begins or where it currently resides, that location isn't always where it is going to end up.

Ten years ago, if you had asked any senior executive where data analytics would reside within the organization, he or she would likely have said, "actuarial." Actuaries are, after all, the original insurance analytics experts and providers. Operational reporting, statistical modeling, mortality on the life side and pricing and loss development on the P&C side - all of these functions are the lifeblood that keep insurers profitable with the proper level of risk and the correct assumptions for new business. Why wouldn’t actuaries also be the ones to carry the new data analytics forward with the right assumptions and the proper use of data?

Yet, when I was invited to speak at a big data and analytics conference with more than 100 insurance executives and interested parties recently, there was not one actuary in attendance. I don't know why -- maybe because it was quarter-end -- but I can only assume that, even though actuaries may want to be involved, their day jobs get in the way. Quarterly reserve reviews, important loss development analysis and price adequacy studies can already consume more time than actuaries have. In many organizations, the actuarial teams are stretched so thin they simply don't have the bandwidth to participate in modeling efforts with unclear benefits.

Then there is marketing. One could argue that marketing has the most to gain from housing the new corps of data scientists. If one looks at analytics from an organizational/financial perspective, marketing ROI could be the fuel for funding the new tools and resources that will grow top-line premium. Marketing also makes sense from a cultural perspective. It is the one area of the insurance organization that is already used to blending the creative with the analytical, understanding the value of testing methods and messages and even the ancillary need to provide feedback visually.

The list of possibilities can go on and on. One could make a case for placing analytics in the business, keeping it under IT, employing an out-of-house partner solution, etc. There are many good reasons for all of these, but I suspect that most analytics functions will end up in a structure all their own. That's where we’ll begin "Where is the Real Home for Analytics, Part II" in two weeks.

The National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) just released their Hospital Respiratory Protection Toolkit. This toolkit provides a much-needed comprehensive resource for healthcare employers to use to protect their staff from respiratory hazards like airborne infectious diseases, chemicals and certain drugs that, when inhaled, cause illness, infection or other physical harm to healthcare workers.

We know that national public health preparedness has increased because of the Ebola virus cases in Dallas last year, but the nation may not know that federal agencies like NIOSH and OSHA are always working to prepare healthcare and other workplaces from exposures to dangerous organisms and chemicals that cause infection, illness and other harm. This new toolkit is evidence of that effort. According to the International Safety Center and its EPINet data, current compliance with the use of personal protective equipment (PPE) like respirators, and even lesser protection like surgical masks, is so low (less than 20%!) that this effort can only help to improve compliance.

The OSHA Respiratory Protection Standard has long required that healthcare employers have a respiratory protection program to protect workers exposed to respiratory hazards, but the standard is as complex as are the hazards and the circumstances surrounding patient care in hospitals. This toolkit helps healthcare and program administrators sort through the standard, overcome what they may see as daunting tasks and tackle their respiratory protection programs one step at a time.

The toolkit is long -- 96 pages long -- but fear not. It provides great pull-out, grab-and-go tools like the "Respiratory Protection Program evaluation checklist" and a "Respiratory Protection Program template" that can be used in healthcare facilities to create, adapt or modernize programs. Not all respiratory protection program administrators are seasoned at putting programs in place that are effective, and this resource will surely assist even the novice pull together a safe program.

Hats off to NIOSH and OSHA! You remind us that keeping our patients as safe as possible is only possible when we keep our workers as safe as possible.

Your comments about the utility of this resource would be appreciated by NIOSH, as it will help inform the development of future companion resources. You can kindly email your feedback directly to Debra Novak's email: ian5@cdc.gov.

In the past two years have revealed anything, it's that every conceivable mode of communication comes with its share of serious privacy and security issues. Email can be hijacked, mail servers can be breached and malware can turn your smartphone into a peepshow. Wikileaks revealed that even our phone conversations are at risk.

That said, don't panic! It's highly unlikely anyone is listening to your phone calls. (OK, it's possible, but you'd have to be incredibly sloppy or unlucky enough to download call-intercepting malware, or targeted by folks who can handle a price tag that hovers north of the $1 million mark.) The more relevant point here is that the big data mills at the NSA that may or may not be crunching your calls don't care if you're negotiating the sale of Ford to General Motors, much less if you've been naughty or nice - unless you're a world leader or someone perceived as a threat to America.

So what about the other, more likely ways you may be exposed? There are man-in-the-middle attacks that are fairly affordable for a hacker. There's malware from friend (hard to spot) and foe (you can't be alert to every danger every second of the day). It almost seems like the only way to be completely safe from intrusion is to have nothing you wouldn't want broadcast or skywritten on your smartphone, nothing you wouldn't want the world to know about in your browser history, not a single text message you want to keep private and no phone calls made or received that you don't want to share with Dr. Phil and his audience.

Recent news has been nothing less than terrifying. JPMorgan Chase and Home Depot joined the ever-growing list of mega-breach victims. Sony Pictures was gutted, with career-killing emails sent hither and yon, servers erased and trade secrets and intellectual property joyously tossed like flower petals from a float in the Rose Bowl parade. The hack initially stopped the release of "The Interview," costing the studio millions, and that's not taking into account future losses associated with class-action lawsuits brought by current and former employees whose personally identifiable information was stolen and published for the world to see, or enforcement actions by various and sundry state and federal regulators. It's major stuff. And then there were all those other cybercrimes. It all makes for a really uneasy feeling at the workplace.

The trend here is simply too clear: Nothing is sacrosanct, and nothing is beyond reach. And while there may be no way to keep prying eyes out of our email, there is a way to keep the most sensitive information pertaining to your business out of reach. With that thought foremost in my mind, it is, indeed, time to make some serious changes.

Call me old-fashioned, but I think I'd rather take my chances with the government listening to my phone calls. How about you? When I say, "phone call," I mean literally, like, on the phone-and I say this because, of all the ways we communicate, a landline affords the better shot at privacy and a more secure mode of communication.

The act of getting out of a chair and walking down the corridor to talk to a colleague helps to burn off holiday excesses, builds inter-office rapport and can't be hacked. Email and text have supplanted the collegial walk-by. There are those who will say that it's not efficient to pick up the phone. I'm not sure I buy that. Email and text streamline workflow only in theory. Each is just a swipe or click away from the major time-sucks provided by social media. And the interaction that happens without the interference of keystrokes or thumbing a screen provides sparks that just don't happen in the dynamic-free zone of tit-for-tat correspondence. And again, a face-to-face or headset-to-headset conversation is probably the most secure mode of communication in the post-Sony hack world.

I'm sure it will take some getting used to, but if anyone at my office needs a fast answer from me, I'm going to ask that whenever possible they tap my doorframe or give me a call. Beyond the security considerations, the truth is that I actually like talking to people, and I ultimately learn more about whatever it is we're talking about. For all their convenience, emails and texts are far from perfect modes of communication. Much meaning is lost when communicating by keystroke. Anyone who's emailed a sarcastic quip that was taken literally will confirm this.

There are other options. Sony Pictures had to revert to communication via fax during the days following the hack, but faxes leave too much to chance because you never know who's waiting on the other end of your transmission, and there's the added possibility that you might dial a wrong number.

If smoke signals weren't so easy to spot, I'd suggest that route. And while it's true that you never know when a fake cell tower's going to roll into your neighborhood, using the phone and having more face-to-face discussions at the office are perhaps the better ways to engage in team building through a group commitment to data security.

Have medical provider networks (MPNs) lived up to expectations of improving access to quality of care while reducing medical costs? Recent accusations raised against Janak K. Mehtani, M.D. ("Mehtani") before the Medical Board of California, Department of Consumer Affairs, would suggest not. (Specific details relating to case # 02 2012224474, effective Jan. 13, 2015, are available on the Medical Board of California website, under the option "Verify a License." At time of writing, a hearing had not been held, and the case status description states, "The physician has not had a hearing or been found guilty of any charges."

Following the investigation of a lodged complaint relating to this case, the executive director of the Medical Board of California raised the following accusations (1) gross negligence, (2) repeated negligent acts, (3) prescribing dangerous drugs without appropriate examination or medical indication, (4) failure to maintain adequate and accurate medical records and (5) general unprofessional conduct.

These accusations relate to three workers' compensation claims for services provided between 2008 and 2013. Two claims were identified as belonging to State Compensation Insurance Fund ("SCIF") (patients JC and RW) while the insurer for the third claim, involving a non-English-speaking 47-year-old female with a history of hypertension and chronic pain (patient GC), was not identified.

This article reviews the claims administrators' implementation of MPNs with reference to patient GC in the Mehtani case.

Insurers promote their MPNs as being quality medical providers who have undergone extensive credentialing before selection, with continuing quality assurance control of their services. Yet a random sample of insurers' MPN lookup facilities showed Mehtani -- a psychiatrist with a practice Sacramento -- being currently available to provide treatment, even though there are very serious accusations currently lodged against him. There is no warning, link or reference to the medical board website to alert an injured employee or the employer.

Information shown on claims administrators' MPN websites to assist an employee in selecting a provider or medical specialty, such as a psychiatrist, is limited to basic contact details, such as address, phone number, distance from a specified location (such as city or Zip code), gender and language. In the case of Mehtani, there is inconsistency in the list of languages spoken; some MPNs list Hindi and Punjabi, while others include Spanish. Does providing only minimal information limit the opportunity for correctly "matching" the patient (i.e., injured employee) to the medical provider, potentially compromising the physician-patient relationship?

Additional information in psychiatry would provide better opportunities for matching patient with psychiatrist. Sub-specialties such as psychosomatic medicine, addiction medicine or administrative psychiatry play key roles in the selection process. So do special interests such as psychopharmacology and pain management and additional training in psychoanalysis at institutes such as the American Psychoanalytic Association (APsaA). Rapport between the psychiatrist and patient is of paramount importance and is assisted further when matching is based on race, ethnicity and cultural groups.

While a review identified 120 psychiatrists located within two miles of the central business district of Sacramento (CBD), a random selection of insurers' MPNs identified only one psychiatrist, in this case Mehtani, as being within 200 miles of the CBD. Can this list be considered adequate for the employee to choose a psychiatrist, let alone attempt to "best match" a patient to a psychiatrist?

Some researchers suggest that, in patients with chronic pain, a psychiatrist may be the person best qualified to distinguish between medical comorbidity and concomitant somatic complaints and that the patients require careful multidisciplinary treatment, in which psychiatry can play an important role. Patient GC experienced a number of work-related injuries commencing in 2003 and was first seen by Mehtani in 2008, after experiencing depression and anxiety for two to three years. In line with a multidisciplinary treatment plan, Mehtani referred patient GC out for pain management and to a therapist for cognitive behavior management. Mehtani was to manage medications and provide supportive psychotherapy once a month for 12 months.

But who was responsible for approving and selecting the providers' Pain management providers are generally listed on MPN lists, but a random selection of MPNs found that cognitive behavior therapists and others providing cognitive behavior therapy, such as psychologists, mental health nurses and psychiatrists, were either not listed or not identified as providing cognitive behavior therapy. This lack further demonstrates the limitations of MPNs in selecting medical providers.

In the multidisciplinary or multidimensional approach to addressing chronic pain, an interdisciplinary approach is also required to maximize a psychiatrist's role in the treatment plan, where all parties involved work in a coordinated fashion. The overall responsibility of ensuring the multidisciplinary team adheres to a common objective rests with the claims administrator. In the case of patient GC, the claims administrator should have been responsible for all the activities performed by the psychiatrist (Mehtani), the pain management provider, the therapist providing cognitive behavior therapy, the primary treating physician and the pharmacist in cases where medications were being dispensed by an insurer's pharmacy network or a pharmacy was linked to an insurer's pharmacy benefit manager (PBM). Pharmacists and pharmacies can be held accountable for failing to identify and verify red flags that may appear when a prescription is presented. In the Mehtani case, the issue of prescribed medications is being raised in the accusations.

Documentation required by psychiatrists has been an issue of contention for some time, with many psychiatrists believing that they do not need to perform the same level of documentation generally required for "physiology-based medicine." Lack of documentation has also been raised in the Mehtani case.

Quality assurance controls for providers can be accomplished in many ways, including automation. Technology is available to monitor diagnoses (DSM-5, ICD-9 and ICD-10), treatments rendered (CPT codes) and pharmaceuticals dispensed through the National Drug Code (NDC) to track treatment and recovery progress, as well as monitor each provider's contribution to the objectives set by the claims administrator.

Patient GC had 40 visits for "medical psychoanalysis" with Mehtani between 2010 and 2013. All visits would have been invoiced by Mehtani and would have required documentation before payment was made. As lack of documentation was mentioned in the accusation document for all three patients, how was the claims administrator monitoring treatment progress and determining payment for services rendered over the period that Mehtani treated patient GC and the others?

The current health status of all three patients and whether they have returned to normality has not been stated in the accusation document. Patient GC was first injured in 2003, patient JC was injured in 1989, and no injury date was recorded for patient RW. Regardless of the outcome of the Mehtani hearing, could the injured employees file a tort claim against the insurer as to lack of quality care provided by their MPNs? Could a tort claim be filed by the employer against the insurer with regard to lack of controls to vet and verify costs associated with providing medical treatments by their MPNs? Although tort claims by the employee against the employer are not permitted under the workers' compensation agreement, the insurer and claims administrator are not direct parties to this agreement.

The question remains unanswered, of whether current workers' compensation medical treatment practices based on group health managed care programs, such as MPNs, are diametrically opposed to the workers' compensation ethos of "return to work" where "utmost good faith" between interested parties is the aspiration. This article however, suggests that they most probably are diametrically opposed.

For a more detailed outline of the processes and procedures claims administrators can utilize to manage and monitor their medical providers, refer to the article titled, "Treating Pain Pharmacologically," available from the website managingdisability.com under the Dialogue tab.

This is a question that seems to pop up a lot: Is there a place for social media in a "boring" business like insurance, plumbing or trucking?

While I do believe nearly any business can benefit from some social media presence, we do need to take a rational look as to whether it should really be a priority in the marketing mix for a "boring" business.

Are you a conversational business?

Let's re-frame this word "boring" and put it this way: "Do people normally talk about you over the dinner table or at a party?" If the answer is "yes," then social media should probably be a top priority for you. If it's no ... well, look at your budget options carefully to see where social media might fit in.

There have been a number of studies out there about the "conversationability" of a business and the connection to social media success. Not surprisingly, there is a hierarchy of conversationability - more remarkable products like sports teams and Hollywood movies are talked about twice as much as less remarkable brands like banks and over-the-counter medicine.

In a study of organic Facebook reach conducted by AgoraPulse, the company found that, across 8,000 companies, there was definitely a pecking order of conversationability. Organic reach is the content that is naturally connecting to customers without any promotion. Here is a list of the industry categories with the highest organic reach:

Amateur sports teams

Farming/agriculture

Fashion designer

Professional athletes

Music industry

Building products

Professional sports teams

Photographers

Zoos and animal-related businesses

Television programs

And here are the industries with the lowest Facebook organic reach:

Appliances

Books

Telecommunications

Household supplies

Tools and equipment

Phone/tablet

Chef

Musical instruments

Industrials

Transportation and freight

There is an implicit hierarchy of conversation popularity across industries. If you are in sports, entertainment or any of the other industries in the first list, there is an implied, fervent fascination with your content. There is something that people find naturally remarkable about you that gets rewarded with content transmission. If you're in the second list or somewhere in between, you have less of an organic opportunity for social sharing ... not necessarily because of the job you're doing with your content, but because your products just aren't naturally conversational.

Are you conversational ... or could you be?

There is another option. If you're in an industry with relatively low organic reach, can you become remarkable? It doesn't come easily or cheaply, but it is possible, as evidenced by the series of "Will It Blend?" videos produced by BlendTec blenders. A blender isn't the most remarkable product, but the brand made it so through its wacky challenge ... ripping apart the most unusual things (golf balls, an Apple watch) in its powerful blender.

One of my favorite examples of a company overcoming a low place on the remarkability continuum is the Chipotle restaurant chain, which sells burritos and tacos—nearly commodity products in the food business.

Chipotle began producing two-minute animated mini-movies telling a story of the restaurant as an oasis of natural goodness in an otherwise bleak and dystopian world of processed food. The first episode, a clay animation video with a soundtrack of Willie Nelson singing a Coldplay song, was extraordinarily popular with Chipotle's youthful audience and garnered nearly 9 million views in a year. The next year, the company went a step further by creating a free smartphone game to go with a new video. It had 4 million views in the first week.

Reality check: All this was created to sell burritos. It wasn't easy to become a conversational brand. It wasn't cheap, either. But it worked, and Chipotle's stock and market share soared. That's the nice thing about remarkability: You can apply it to almost anything.

The key to finding your remarkability is to think about what makes you surprising, interesting, or novel. In my book Social Media Explained, I suggest that marketing strategy needs to begin by finishing this sentence: "Only we ..." That's a tough task, but it's the essential path to discovering your remarkability.

In the case of Chipotle, the "only we" was creating a story of health and sustainability, a story far bigger than mere burritos and tacos. They broke a pattern of what people expected from fast food.

But wait...there's more

At this point, you might be thinking, "My business is boring and unremarkable and I’m not about to be a Blend-Tec or Chipotle. Why would I participate in social media?"

There are a lot of reasons, and here are a few:

Public relations - It's likely that some aspect of social media has to be incorporated into any plan for media relations, crisis planning, event planning and community relations.

Word-of-mouth advocacy - Social media opens up an entirely new way of identifying and nurturing powerful online advocates for your brand.

Cost savings - Social media represents an extremely cost-effective communication channel. Most research shows that, in terms of many traditional measures, the results are as good, or better, than paid advertising. There are many opportunities to leverage existing content and marketing materials across vast new audiences.

Customer service - You may not have a choice about this really. Social media has become a very popular way to complain about poor products and services. It's the new 800 number. Are you going to answer the call?

HR and recruiting - Social media, and particularly LinkedIn, has transformed the human resources function. One professional told me that a candidate's "social media footprint" was more important today than a resume! Whether you are trying to find talent or be found, social media is a critical piece of the puzzle.

Internal process improvement - Tapping into the free tools and information on the web can help unleash employee productivity, collaboration and problem-solving.

Lead generation - Even setting up a simple Twitter search can help you find customers looking for your products and services...even if you're boring.

Reputation management - The largest brands have social media "war rooms" set up so they can monitor conversations and sentiment about their products and brands in real time, at any spot in the world. Today, you need to be tuned in to the conversations and respond quickly or risk problems going viral.

Research and development - An active customer community can be a gold mine of new ideas and suggestions for products and innovations.

Search - Google is now showing tweets more prominently in search results. And you are just as likely to be discovered via your LinkedIn profile, blog post or video as on a website. An entire generation is finding businesses and services through Facebook search.

Social proof - In a world of overwhelming information density, we may look to clues from others to make a decision. How many positive reviews do you have? How many "likes" or followers do you have? It might sound weird, but people make decisions to connect to a company based on these badges of social proof (there is an entire chapter on the connection between social proof and content success in my book The Content Code).

The Trade Show Dilemma - Have you ever had to sit at a booth during a large industry trade show? Why did you do it? Because if we weren't there, people would think something was wrong. We would be ostentatiously absent. In this day and age, not being on Facebook or Twitter sends the same message. It shows you "don't get it."

The Net Generation - Your next pool of employees, customers and competitors prefer to use the social web over any other form of communication. You might enjoy reading a paper copy of the Wall Street Journal each morning, or even looking at an online version of your favorite news site. But nearly half of Americans under the age of 21 cite Facebook as their primary source of news. The social web is where a generation is going to connect, learn and discover. Ignore this at your peril!

So the short answer is "yes." There is a place for social media, even in a boring business, but your "conversationability" may influence how much effort you put into it. Comments?

This article was first posted on business2community.com

The more things change, the more they stay the same. What remains constant are the fundamentals of what makes insurance a well-capitalized, reliable cornerstone of the U.S. economy. The basic model of assessing risk, collecting insurance premiums, investing and paying claims still works. What's been completely upended is how carriers evaluate and acquire the best risks - and how much more important effective risk evaluation is today.

Advanced data and predictive analytics have changed the customer acquisition and retention game. When an insurer can pinpoint which policies are going to be the most profitable 10% and also know that same small segment is delivering 50% of total profit, you know the rules have changed.

The chart below represents a study of the portfolios from a diverse set of commercial insurers and lines of business. The study shows that that this surprising statistic holds true across companies. It helps demonstrate the real advantage -- and potential threat -- of data analytics. The insurer that can accurately identify the best 10% of the market is going to be able to compete on, and win, this business.

What does being data-driven mean in practice?

Information is a business enabler; you don't need to embark on "big data" or predictive analytics initiatives just for the sake of them. You shouldn't feel pressured to lead the rallying cry to become a data-driven organization because everyone is talking about it. You consume data to gain insights that will solve problems that matter and achieve specific objectives.

Data-driven decision making is a commitment and a passion to go beyond the limits of heuristics, because you know it's necessary to reach a new level of understanding of where your business is today and where it's headed in the near term. Data-driven cultures have a disciplined curiosity and rigor to find credible patterns in the data before finalizing their conclusions - which is why everyone emphasizes how important it is to create a test-and-learn culture. Armed with a solid business case, transparency and good processes, data-driven organizations use analytics in combination with human expertise to make better decisions.

Why is this so urgent?

A recent Bloomberg article reported that the workers' compensation industry posted its first underwriting profit since 2006, which is welcome news. At the same time, the article noted that this is directly related to how insurers have reacted to the current investment environment. In the absence of meaningful investment returns, insurers are keenly focused on bridging the gap by improving underwriting profits and enhancing operational efficiencies: "The reality is, in today's interest-rate environment, we need to be driving combined ratios under 100," said Steve Klingel, CEO of the National Council on Compensation Insurance (NCCI).

This isn't limited to one line of business. As Robert Hartwig, president of the Insurance Information Institute, noted in a recent interview, "You're not going to see vast swings you did 10 or 15 years ago, where one year it's up 30% and two years later it's down 20%". The reason he gave: "Pricing is basically stable... The industry has gotten just more educated about the risk that they're pricing."

Now what?

No one said implementing data analytics in an underwriting environment is a small task or a quick fix. Many companies focus primarily on selecting the right predictive model. In reality, the model itself is just one part of a larger process that touches many parts of the organization.

Data analytics can only be successful if developed and deployed in the right environment. You may find that you have to retool your people so that underwriters don't feel that data analytics are a threat to their expertise, or actuaries to their tried-and-true pricing models. Never underestimate the importance of the human element in moving to a data-driven culture.

Given the choice between leading a large-scale change management initiative and getting a root canal, you may be picking up the phone to call the dentist right now. It doesn't have to be that way: Following a thoughtful, straightforward process that involves all the stakeholders early and often goes a long way.

A recent study of the use of medical provider networks ( MPNs) in California by the California Workers' Compensation Institute (CWCI) found that, "While the use of the networks to medically manage treatment of work-related injuries has fulfilled the legislative intent to encourage network use, over time the MPNs have not lowered the cost of medical care."

David DePaolo, CEO of WorkCompCentral, says medical cost savings is only part of the picture. MPNs need to be managed because the medical impact on other aspects of claims such as disability, indemnity, return to work and other factors is significant.

So how should networks be managed?

Networks can be managed only by evaluating and monitoring individual performance.

A network is the sum of its parts, the parts being the physicians and other medical providers. A network cannot be managed as a whole. Each individual medical provider acts independently and with differing results. Moreover, each provider, even within groups or facilities, acts independently. Consequently, each must be evaluated and managed individually.

Since networks began in workers' comp back in the 1980s, their rationale has been that they offer discounts off stated rates for services, which they portray to payers as savings. The assumption is that all medical providers are equal. But no one checked.

No one checked because it was easier to claim savings through discounts than to evaluate the performance of individual medical providers in the network. Evaluating medical performance is especially tricky in workers' compensation because, in addition to cost and medical treatment factors, there are elements unique to the industry that must be considered. Indicators of quality performance are many and varied.

But indicators can be found in the data. They include medical treatment indicators such as direct medical costs, prescriptions, surgery, hospitalization and medical procedures analyzed by injury type. Non-medical performance indicators that are influenced by medical providers include return to work, indemnity costs and legal involvement, along with ultimate outcome indicators such as claim closure and disability ratings at the close of the claim.

The way to manage networks is to use the data to identify the best providers and monitor their performance.

The data necessary to evaluate medical provider performance, particularly physician performance, can be found in bill review data, claims system data, pharmacy data and the utilization review system. Unfortunately, the data resides in different silos, but, by combining the data from these sources at the claim level, individual provider performance can be measured.

Because the data reflects actual treatment and events, it is objective and quantifiable. Select quality indicators in the data, adjust for case mix and keep them constant over time.

Medical costs have increased to 60% of claim costs, calling into question the benefit of network discounts. The truth is that medical providers long ago learned how to overcome the cost of discounts by increasing treatment frequency and claim duration, as well as prescribing expensive procedures, among other tactics.

Going forward, the major hurdle in managing networks effectively is to de-emphasize discounts, while underscoring and rewarding quality performance. To make that financially feasible for the networks, a different approach to discounting should be entertained. For instance, those providers who rate highest in quality performance would be excused from discounts. Likewise, those performing the worst would be discounted the most.

To manage a network, the performance of individuals within it must be evaluated and monitored continually. No longer does it suffice to sign up providers for the network and walk away. When individual provider ratings slip, action should be taken.

Let providers know they are being monitored. It has been proven that observed performance leads to behavior change.