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$1.2 Trillion Disruption in Personal Insurance

The active, accurate valuation -- in real time, without human involvement -- of all the things people own will turn the industry on its head.

Most of us don't think much about insurance. That's by design, of course. Insurance is supposed to be a safety net that affords us the leisure of not thinking about it. Unless of course, we have to. That generally happens about once a year when we're reacquainted with our premium. Ouch. According to statisticians, most of us will also have to think about our insurance about once every seven to eight years when we'll encounter a loss of some sort. Another ouch.

My insurance is pretty confusing. I pay for coverage of my house – a fairly precise calculation based on its quality, size, age, materials, etc. I get a guarantee that, if I keep paying my premium, my home will be covered for its replacement costs. That's pretty reassuring. But then it gets a little weird. I get a "blanket" (insurance-speak is very comforting), which is really a formula that assumes that all the stuff I own is worth, um, somewhere around 50% to 70% of the value of my home. Huh? Maybe there's a bit of science to this, but surely there's a lot of guess…and, according to research, about 39% of the time the formula is just wrong. (As one insurance CEO recently confessed to me, most folks are probably 50% underinsured). The complications go on: If I own something really valuable, some bauble or collectible, well, that has to go on a list of things that are really valuable, and those things get their own coverage. Then, so my stuff continues to be well-protected, I have to re-estimate the value of those things from time to time, or employ an appraiser. What's more, if I buy something or donate something I own, or if any of my things goes down or up in value for whatever reason, my insurance doesn't change -- because my provider doesn't know about these changes. And, if you've ever had a claim to file, the process starts with the assumption of fraud, with the burden of proof borne by the policyholder, because most people don't have an accurate accounting of their possessions and their value. Still another ouch.

So while I'm not supposed to be thinking about insurance, maybe I should be paying closer attention.  

Change is coming like a freight train, and its impact has the potential to shake one of the world's largest industries to its core. For a little perspective: The property and casualty insurance industry collected some $1.2 trillion (!) in premiums in 2012, (or about twice the annual GDP of Switzerland). 

At the core of the P/C insurance enterprise is (and I know I am simplifying here) the insurance-to-value ratio, which estimates whether there's enough capital reserved to insure the value of items insured --  if values go up, there'd better be enough money around in case of a loss. All good, right? Except that for as long as actuaries have been actuarying, the value side of that ratio has been a guess -- especially for personal property (the stuff I own other than my home). So, if I forget to tell my insurer about something I bought, or if I no longer own that painting, watch, collectible, antique; or if the precious metal in my jewelry has increased...then what? Am I paying too much, or am I underinsured for the current value of the things I own? Of course, these massive companies make calculated allowances for the opacity...but these allowances also cost us policyholders indirectly in increased premiums, and the inefficiency costs the insurer in potential returns on capital. 

The coming changes can be summarized in terms of three trends. First is the expectation of the connected generations, now entering their most acquisitive years and set to inherit $30 trillion of personal wealth. Second is the connected availability of current data about the value of things. Third is the emergence of the personal digital locker for things.

Data, data! I want my data! -- the expectation of the connected generations.

If they're anything, the connected generations are data-savvy and mobile. If you’ve shopped for just about anything with a Millennial recently, you’re familiar with their reliance on real-time data about products, local deals, on-line values and even local inventories. (I was with one of Google's brains, and he showed me how retailers are now sending Google local inventory data so now it can post availability and price of a searched-for item at a local store). Smartphone usage is nearly 90% for Gen Xers and Millennials, and data is mother's milk to the children of the connected generations who are being weaned on a diet rich with direct (disintermediated) access to comparisons, descriptions, opinions, crowd-sourced knowledge and even current values. The emerging generations rarely rely on the intermediation of experts (unless validated on a popular blog with a mass following) and are not likely to be satisfied with an indirect relationship with those affecting their financial health. Smartphones in hand, depending on data in the cloud, they will demand and receive visibility into the data shaping all their risk decisions.    

And here's where the insurance revolution will begin: A connected generation that is apt to disintermediate and has access to real-time info on just about any thing will demand that they insure only what they own (bye bye, blanket); that their insurance should track to real values, not formulaic guesses; and that they have the ability to reprice more frequently than once a year. 

The time is coming for variable-rate insurance that reflects changes in the values of items insured and is offered on a real-time basis for any item that the owner deems valuable. 

The price is wrong -- the real-time valuation of everything.

Over the past few years, several data services have sprung up whose charters are similar: something like developing the world's largest collection of data about products -- their descriptions, suggested retail price, current resale value, user manuals, photos and the like. No one has yet dominated, but it's early yet, and someone (or probably a few) will conquer the objective. Similarly, there are a few excellent companies that are collecting and indexing for speedy retrieval the information about every collectible that has been sold at auction for the past 15 years. I know something of these endeavors because our core product relies on the availability and accuracy of these data providers to collect the values (and other attributes) of the items people are putting into their Trovs (our moniker for the personal cloud for things). It is only a matter of time before we will be able to accurately assign a fair market value to most every thing -- in real-time and without human intervention. This real-time value transparency will transform the way that insurance is priced, and how financial institutions view total wealth.

My stuff in the clouds -- the automated collection and secure storage for the information about my things.

Within 12 to 24 months, connected consumers will embrace applications that will automatically (as much as possible) collect the information about all they own and store it in a secure, personal cloud-hosted locker. These "personal data lockers" will proliferate because of their convenience, because of real financial incentives from insurers and other service providers and because data-equipped consumers will have powerful new tools with which to drive bargains based on the data about everything they own. These new tools will pour fuel on the re-invention of insurance because all the information needed to provide new types of insurance products will be in the personal cloud-hosted data locker.

Progressively (pun noted, not intended) engineered insurance products that account for the connected generations' expectation of access to data, the abundance of data about products and collectibles and the active collection and accurate valuation of the things people own may turn the 300-year-old insurance industry on its head. Doubtless, the disruption will leave some carriers grappling for handholds and wondering how they could have insured against a different outcome.

This article first appeared in JetSet magazine.

Are You About to Hire Your Next Workers’ Comp Claim?

Once you hire someone, you are presenting him a debit card with an unlimited credit line.

In many workers’ compensation claims’ situations, we learn that the employer has made a bad hiring decision and not matched the right employee to the right job. Of course, once the injury occurs, it is too late to change the decision. Strictly from a monetary prospective, once you take on an employee you are presenting him a debit card that has an unlimited credit line.

Many prospective employees have mastered the interview process and can paint themselves as being ready, willing and able to do whatever the employer wants. How can employers get past the facade and make sure they have the right person for the right job?

The place to begin is with one of the many tools that provide what is known as an employee assessment process. The tool should, first, help determine the unique needs of the business and what the job position entails. This includes necessary skills, the attitudes the employee needs to possess and the personality characteristics that are most suited for the job. 

For example, an operating engineer needs not only the experience and skills to properly operate the equipment, but also:   

-- The ability to make good judgments for the safety of the equipment, as well as, himself and those around him.
-- A personality that allows little tolerance for risk. 

With the full list of requirements developed, employers can use the process to probe the personality of the prospective hire and see whether it is a match both for the job and for the personalities of those who will supervise him -- let’s face it, having personalities that can get along and communicate well are key to success, but that need is often overlooked by those doing the hiring.

Depending on what industry you're in and what type of job you wish to fill, we recommend that you obtain an opinion from a human resources professional. You should also use the other, more common verification approaches, such as reference checks, background and drug checks and post-offer medical examinations.

When you don't go through an employee assessment process, you can wind up with the sort of problem I saw an employer have recently when it hired a well-paid technician who had a good work history and positive references from prior employers. He interviewed well; seemed to have excellent knowledge of the employer’s industry; seemed smart; and seemed to understand how the relationships within the industry made a business successful. But, early in his tenure, problems surfaced because of: 

-- Poor communication with fellow technicians and a lack of a sense of the need to be a team player; projects took longer than necessary.
-- Constant complaints about the tasks he was assigned and about the employer’s process.
-- Difficulty consistently following his supervisor’s instructions.
-- A tendency to cut corners that endangered others and led him to injure himself.

The last injury he had at work started at his wrist and "grew" to other body parts. He decided he could no longer work. A sub rosa investigation found that “the growth" of the injury was exaggerated. The investigation found that he could carry and play with his children and perform other physical tasks at his home. By the time all the issues were sorted out, the direct and indirect costs for the employer exceeded $100,000.

Had an assessment process been in place, it is my view that this engineer could have been identified as a bad fit before he was hired, and the problems avoided. 

Why are many employers not taking advantage of an assessment process to help them improve their hiring batting average? After probing, we find that most employers do not have a realistic idea of the real costs of hiring and replacing employees. If they really knew how costly the hiring process could be, they would stop using their gut feelings.

HR consultants who work in a variety of industries tell us that hiring the wrong person can cost employers tens of thousands of dollars. Depending on the skill level and how high up the position is in an organization, the costs of turnover can be more than twice an employee’s annual salary, according to the Center for American Progress. And this does not include the costs of any work-related injuries.

An employee can be a valuable asset or can be a big liability. So let’s use the best approaches available to make sure your employee selection process is as good as it can be.

What are you waiting for?  Let’s get started!

Five Steps to Improve Your Sales Process

Something in Tom's tone that spring day in 1984 really got my attention. It's a day I will never forget.

Early in my sales career, I had the privilege of being under the leadership of Tom Vanyo, a master salesman, motivator, mentor and friend, who said to me one day in the spring of 1984, "If you don't make a major change today, you will be doing the same thing next week, next month and next year."

Tom had underscored on several occasions the importance of keeping track of my numbers. I typically responded, "What does it matter? I'm already one of your top producers." I made all the excuses: "I'm too busy. It's more paperwork. I don't have time."

Here was the bottom line: Did I really want to know? It was too easy to go home at the end of the day, pat myself on the back and say I had a busy day. But busy doing what?

There was something in Tom's tone that day in 1984 that really got my attention. It was a day I will never forget.

I went back into my office and started making some major changes to my sales process. I kept track of every dial, contact, appointment, sale and how many times each day I would ask for a referral. The numbers revealed how little I was actually doing each day. I thought I was really productive, but I wasn't. I got faked out by being busy. My paycheck revealed I was one of Tom's top producers, but my daily numbers told the whole truth.

Over the next year, I made several significant changes, and those changes showed in my results. I doubled my income that year and -- what I found interesting -- didn't work more hours. I was simply more productive.

You will never know what's working and what's not unless you keep track.

Are the fundamentals of sales the same today as they were in 1984 or even 100 years ago? My answer is yes! I love what Jim Rohn, the great business philosopher, said many years ago, "There are no new basics and fundamentals." It's so true. The basics of sales have not changed in thousands of years of recorded history.

What has changed is how we connect, educate and engage with our prospects and customers. Years ago, we connected by foot or horseback. Then along came the railroad, then the telegraph and telephone, then the Internet, websites, Twitter, Facebook, LinkedIn and so on.

Selling is a contact sport. In other words, you have to be in the presence of the prospect or customer, but certain principles always apply, whether the connection is by phone, voicemail, email, face-to-face or even through social media.

Do you have a sales process? If you do, and it is documented and honed, it will serve you as you grow.

Here are the five most important steps in a sales process:

Step 1: What is the purpose of this phone call, email, voicemail or meeting? This step establishes the "why." Sticking to the purpose of a call, meeting or voicemail will keep you on track throughout your presentation.

Step 2: Who is the right person I need to talk with to get the right results? This step identifies the "who" -- it will point you to the decision maker. It is important that you are speaking with the right people.

  • How much time do you waste talking with the wrong people?
  • Who is your target audience?
  • Where are they located?

Step 3: What is the game plan for this call or meeting? This step establishes the "how" -- preparing for each call or meeting is how you project knowledge, confidence and a professional tone.

  • How often have you found yourself in the middle of a meeting or phone call not prepared?
  • What happens to your confidence?
  • What communication tools are you going to use to connect with your prospect or customer?
  • What days and times during the week are the best times to contact your prospect or customer?
  • What skills have you developed to work though their objections?

Remember this, if you are confident, others will be confident in you.

Step 4: What is the solution for this prospect or customer? This step defines the "what" -- key questions will help you identify their problems, which will allow you to recommend the right products and services. So often a customer is not even aware of his problems or is not sure what he wants. It's important to help prospective customers become aware of the problems they may experience without your product or service. 

Step 5: Have I clearly communicated the next step? This step directs the "where" -- communicating the next step helps guide the prospect or client to make decisions that serve her well.

  • Is the prospect or customer clear about the next steps that will help her solve her problems?
  • How are you going to ask for her business?

Following these five steps will help you develop a simple, repeatable sales methodology that will take the guesswork out of each call you make or meeting you conduct. You'll be prepared for anything you face, even the tough ones.

What does your list look like?

3 Essential Elements of Any RTW Program

<p>The best return-to-work (RTW) programs resolve three problems before they can even become problems.</p>

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At many different employers and insurance carriers, I’ve noticed every company has a slightly different light-duty program (or return-to-work (RTW) program). The more successful always have these three elements: 1. Ensure the injured worker's job duties do not exceed medical restrictions I have faced this situation many times: Employer tells claimant to return to work in a light-duty position. The job duties, however, exceed the claimant’s work restrictions, and the claimant leaves work. Employer doesn’t want to pay temporary total disability (TTD) because a light-duty job was given to the claimant and he refused to do it. The judge or arbitrator, however, orders employer to pay TTD because the light-duty job exceeded the claimant’s work restrictions. No one is happy about this type of situation. To ensure that the claimant is not placed in a light-duty job that exceeds his work restrictions, every employer should have documentation that lists the specific duties and task analysis for every job. In other words, the documentation should spell out the amount of lifting required by the position, the frequency of repetitive activities, the amount of stooping and bending required, etc. This way, if the claimant attempts to assert that the job exceeds his work restrictions, the employer will have documentation to demonstrate that it does not. Without this type of documentation, the judge or arbitrator would have nothing more to go on than the claimant’s testimony at trial. Remember, a judge or arbitrator will order reinstatement of TTD benefits if the light-duty job exceeds the claimant’s work restrictions. This kind of pitfall can be avoided before it happens. 2. All return-to-work offers must be in writing Another common situation: Employer tells claimant over the phone that he is to return to work on Monday. Claimant doesn’t show up for work; TTD benefits are terminated; and often the claimant’s position is eliminated because of his no-call, no-show. Twelve months later, when the case goes to trial, claimant testifies that employer never asked him to return to work. I produce the supervisor as a witness, who testifies that he told claimant over the phone to return work. Claimant testifies that was never said. Judge rules in favor of the claimant and orders employer to pay 12 months of TTD benefits even though we offered to bring claimant back to work. This trap is easy to avoid. Make sure that the return-to-work offer is always in writing -- email works just as well as a mailed letter. With this, claimant cannot later say he was never told to return to work. The problem is solved before it ever has the chance to become a problem. 3. Make sure that the light-duty job passes the “straight face” test If you follow this link, you will see a story from Louisiana where Walmart assigned a claimant on light duty to sit in a chair in the restroom. This is an example of a light-duty job that does not pass the “straight face” test. If this claimant were to simply walk off the job, he would then argue that this was not a legitimate job, and, in all likelihood, a judge or arbitrator would agree with him. Claimant would then be awarded TTD benefits even though the employer tried to return the claimant to work. Make sure the RTW job fulfills some legitimate need or purpose within the company. If you use this Walmart example, it would have been perfectly acceptable to have the claimant clean the restrooms as part of his light-duty job. Walmart could have told the claimant to sit outside the restroom and monitor the cleanliness of the restroom every 30 minutes or so. However, ordering him to actually sit in a lawn chair in the restroom transforms what would have been a legitimate job into one that appears vindictive and illegitimate.

J. Bradley Young

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J. Bradley Young

J. Bradley Young is a partner with the St. Louis law firm of Harris, Dowell, Fisher & Harris, where he is the manager of the workers' compensation defense group and represents self-insured companies and insurance carriers in the defense of workers’ compensation claims in both Missouri and Illinois.

Obesity as Disability? Workers' Comp Effects

Employers are being asked to shoulder not only the responsibilities of a work injury but also of issues with little tie to the work environment.

A federal district court ruled in April 2014 that obesity itself may be a disability, amounting to the first shot in a war of lawsuits on grounds of obesity discrimination and opening up additional liability for workers' compensation claims across the country.

The case is Joseph Whittaker v. America’s Car-Mart, in the federal district court for the Eastern District of Missouri. Although the case is pending in Missouri, the implications apply nationwide because the court is applying provisions of the ubiquitous Americans with Disabilities Act (ADA).

The plaintiff claims the company, a car dealership chain, fired him from his job as a general manager after seven years of employment even though he was able to perform all essential functions of his job, with or without accommodations. He alleges that “severe obesity … is a physical impairment within the meaning of the ADA,” and that the company regarded him as being substantially limited in the major life activity of walking.

Attorneys for the company had moved to dismiss the case, arguing that obesity was not a disability under the Americans with Disabilities Act, and citing language from the Equal Employment Opportunity Commission that, “except in rare circumstances, obesity is not considered a disabling impairment.”

The judge rejected the company’s position, noting: “Plaintiff has sufficiently pled a claim that he is disabled within the meaning of the ADA.”

The plaintiff’s argument could be seen as a legal extension of the medical policy change made by the American Medical Association in June 2013, when the AMA adopted a policy that recognizes obesity as a disease.

Application to workers' compensation

One of the main issues in many workers' compensation claims is whether the employee is able to return to work in the open labor market. If the employee can’t, there is a focus on whether the inability to return to work was caused by the work accident alone, or is caused by pre-existing conditions, or a combination of the pre-existing disabilities and the work-related injuries. Claims are then adjudicated based on the primary cause of the inability to return to work.

Although most states have statutes that limit an award for permanent total disability benefits to those situations where the work injury alone is the cause, the practice is must different. For example, if a claimant has pre-existing disabilities and is then injured at work and cannot return to the workforce, judges are often reluctant to award minimal benefits, knowing that the claimant cannot ever return to work. It is much easier for the judge to find that the work injury alone is the primary cause and to award permanent total disability benefits even if the work injuries are only part of the equation.

Once obesity is accepted as a valid disability, injured workers could more easily argue that their obesity is a permanent condition that impedes their ability to return to work, as opposed to a temporary life-choice that can be reversed.

Injured workers could more easily qualify for Social Security disability benefits and for permanent total disability benefits, as the work injury is usually the last event in a chain of events (including, now, a history of obesity).

Once again, employers are being asked to shoulder not only the responsibilities of a work injury but also the responsibility of dealing with issues that have little, if any, relationship to the work environment.

After the ADA became law in 1993, I remember hearing the Americans with Disabilities Act referred to as “The Lawyers Full Employment Act.” Unfortunately, that moniker is now coming closer to reality.

‘Interactive Finance’: Meshing with Google

Insurers are at a tipping point. The way forward -- to a future like Google's or Facebook's -- involves giving rewards for information that details risk.

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The insurance industry is poised to enhance its power, burnish its prestige and increase its income in the 21st century by developing interactive finance to mesh with Internet enterprises. By interactive finance, I mean rewarding institutions and individuals with financial or strategic advantage for revealing information that details risk. Insurance industry success requires recognizing information as this century’s distinct commodity, analogous to steam in the 19th and oil in the 20th. Information also needs to be seen as an indispensable element in fresh, emerging digital currencies. Information technologies are adequately mature, and mobile and broadband communications networks sufficiently widespread, that digital currencies like Bitcoin are beginning to emerge. Cognitive computing, big data, parallelization, search, capture, curation, storage, sharing, transfer, analysis and visualization are commonplace; three-quarters of American households enjoy broadband access; and nine in 10 Americans carry mobile telephones. User-generated information now is everywhere. Insurance industry leaders would be wise to cultivate interactive finance. It could be used to manage institutional investments with less risk and more liquidity. Interactive finance could also be used with retail consumers to create experiences, incentives and products to help manage what promises to be massive, new wealth. A key part of interactive finance -- navigating crowds and matching parties -- is up and running. For instance, with Airbnb and accommodation or Uber and ride sharing, individuals reveal information voluntarily to enable counter party matching. Both are emerging as phenomenally successful simply by using information in new ways to create efficient markets. The glimmerings of these potential gold mines are now eliciting insightful commentaries about how insurers might aggregate and parse information gathered through “crowd-sourcing.” Sharing portions of the reward with institutions and individuals through protected communications channels -- also known as interactive finance -- will provide the broad avenues and fastest expressways to 21st century wealth among insurers. In two, insightful articles published here on ITL, Denise Garth discerns the key value of information. “Consider the explosion of new data that will be available and valuable in understanding the customers better so as to personalize their experience, provide insights, uncover new needs and identify new products and services that they may be unaware of,” she observes of the strategic alliance betweenFacebook and AXA. “For insurers, the coming years promise unparalleled opportunity to increase their value to their customers. Those that are best able to capitalize on the key technology influencers will reap the most in rewards,” Garth notes in an earlier article on Google. Indeed, Facebook is poised to offer a money-transfer service in Europe. Pending regulatory approval in Ireland, Facebook would be permitted to employ user deposits in fiat currencies to become a payment services powerhouse with what seems tantalizingly close to a virtual currency. “Authorization from the central bank to become an ‘e-money’ institution would allow Facebook to issue units of stored monetary value that represent a claim against the company,” the Irish Times reported. The company will use its acquisition of WhatsApp for access and traffic and will build on its 30% participation in revenue with Candy Crush Saga and Farmville games. Facebook will also take advantage of “‘passporting,’ which allows digital payments to be used across EU member states without having to gain regulatory approval from each one,” according to a news report. Should Facebook succeed, AXA’s partnership with Facebook would put it well ahead of its competition in employing mobile markets to acquire and retain clients. In an article on ITL on how Amazon could get into insurance, Sathyanarayanan Sethuraman enumerates “the convenience of on-demand buying. . . personalization of product and service delivery.” Crucially, he notes the importance of “building trust through transparency in pricing,” which provides impelling “reasons for insurers and Amazon to create a distribution model to match ever-evolving customer demands.” Brian Cohen indicates in a thoughtful commentary on ITL that companies can collect customer feedback that is volunteered on social media and can also use new channels to provide new types of information. For instance, he says that, when inclement weather approaches, agents can caution readers to secure objects that may cause damage to their property, as a means toward generating webpage traffic and strengthening client relationships. Joseph Sebbag cautions that technological mismatches can threaten insurance industry value. “Insurers’ numerous intricate reinsurance contracts and special pool arrangements, countless policies and arrays of transactions create a massive risk of having unintended exposure,” he notes in an intriguing essay evaluating information technology and reinsurance. Focusing on a company with which I am very familiar, former Comptroller General David Walker says Marketcore has transformative IP in interactive finance that could provide pathways to phenomenal growth for the insurance industry and, in general, finance. The mechanism is incentives for “truth, transparency and transformation” that will make risk vehicles and markets perform more efficiently and reliably. (Walker is honorary chairman of Marketcore; I am an adviser.) Marketcore generates liquidity by rewarding individuals and institutions for sharing information, such as the history of individual loans being bundled into residential mortgage-backed securities. The reward could be a financial advantage, say a discount on the next interval of a policy for individuals purchasing retail products. The reward could also be a strategic advantage, say foreknowledge of risk exposure for institutions dealing in structured risks like residential mortgage-backed securities or bonds, contracts, insurance policies, lines of credit, loans or securities. Through interactive finance, Marketcore creates efficient markets for insurers and reinsurers. All do well as each does good. Risk determination permits insureds, brokers and carriers to update risks through “a transparency index. . . based. . . on the quality and quantity of the risk data records.” Component analysis of pooled securities facilitates drilling down in structured risk vehicles so insurers and reinsurers can address complex reinsurance contracts and special pool arrangements with foreknowledge of risk. Real time revaluation of contracts clarifies “the risk factors and valuation of [an] instrument” and, in so doing, “increases liquidity and tracks risks’ associated values even as derivative instruments are created.” These interactive finance capabilities are at tipping points for insurers and reinsurers, as outlined so thoughtfully by Garth, Sethuraman and Cohen. As those thought leaders say, large Internet enterprises like Google, Amazon and Facebook are striving for market reach and domination. Because of distributed wire line and wireless networks and the Internet, experts project that global trade will grow to $45 trillion from $6.5 trillion in less than 10 years. Global mobile transactions are projected to show more than 33% average annual growth, with 450 million users in a $720 billion market by 2017. Only if Amazon, Facebook and Google offer new services can they exert market power in global electronic commerce analogous to late 19th century railroads, energy and steel industries. Each of them needs services like insurance no less than railroads required passengers and freight; than coal and oil required factories, homes, offices and motor vehicles; than steel required cities, railroads, trollies and cars. These Internet enterprises must have insurance, among other services associated with their brands, to remain dominant. All seek to create voluntary, de facto, walled gardens for their brands, and what better way to do so than to get users to rely on their brands to manage risks and pay bills? None of these Internet search-and-connect giants can recoup its investments in mobile applications, drones and data centers unless it has voluminous, recurrent transactions and traffic engaging its mobile capabilities. For instance, Derek Thompson reports that the iPhone drives 60% of Apple revenue and that mobile advertising accounts for 60% of Facebook advertising revenue. John Greathousespells out the implications for advertising in a thoughtful essay on conversion rates and mobile formats. A service like insurance brings in users and encourages stickiness. In this way, insurance is the correlative to apps, drones and data centers. All these Internet giants are less without it. Similarly, consumers and institutions are keen to participate in the value that they create with their participation in information technology and communications networks. Citizens and consumers, while resenting unremitting spying, shrug off the constant sale of metrics about their data to advertisers as inescapable and would love to turn tables on all these massive, intrusive public- and private-sector forces. People would willingly patronize a firm rewarding them for revealing risk information that they are comfortable sharing. By rewarding institutions and individuals with financial or strategic advantage for voluntarily revealing risk-detailing information, interactive finance expressly rewards users for what they forego voluntarily with daily Internet use. At this stage, the Internet firms have first-mover advantage when it comes to gathering and using people’s information. When I recently watched streaming video of Masterpiece Theatre’s “Mr. Selfridge,” there was the anomalous propinquity of an advertisement for an Internet tire seller in the bottom right portion of my display – within a day or so of my searching Google for motor vehicle tires. Clearly, Google, Internet ad placers and, in my case, the tire vendor are selling and purchasing access to user experiences. The sole party excluded from the value chain is the person who creates value in the information. Earlier loyalty programs prefigure some of the notions of interactive finance. In mid-20th century America, supermarkets, gasoline stations and retailers often rewarded customer loyalty with S&H Green Stamps. Airlines, grocery chains and hotels employ loyalty programs and provide reward cards to provide incentives for recurrent patronage. In keeping with the times, Bellycard supports customer retention with a scannable card and mobile application. Each time I buy Italian bread and scan the card at the local bakery, I earn points toward a pastry. What of insurance brokers, who reward consumers with incentives on forthcoming purchases for revealing risk information that they are comfortable sharing? Or insurer carriers, which protect asset values and boost shareholder confidence through enhanced capacities for risk detection and real-time valuation of risk exposures? From here on out, the emphasis needs to be on rewarding customers and institutions by enabling them to create wealth with the information they are willing to reveal and by commanding information as a commodity and as the cornerstone component of emerging digital currencies. Insurers that can tap Internet industry demands for users, provide rewards for information and equip themselves to manage their risks more effectively can position themselves to dominate their sector well into the second quarter of the 21st century. “Insurance is above all a relationship,” remarks Elise Manzi, account manager with Biddle & Company Insurance Brokers, based in Newtown Square, Pennsylvania. “We’re devoted to continuing to provide our clients with the exceptional services they have come to expect of us through these new communications capabilities. Interactive finance sounds like a great relationship builder.” Ernest Tedesco, head of Philadelphia-based Webesco, says, “For brokers, web services support client retention and communication. For large retail carriers like Progressive and Geico, web services enable them to reach consumers directly with service and product offerings. Anything kludgy on one of these sites will send customers scurrying to competitors.” He adds that if Google and other Internet giants get into the retail insurance space, current industry leaders need to be ready to respond aggressively with technology or will be disintermediated. “Back-office executives managing trillions in risk will find themselves at competitive disadvantage without real-time and near-real-time risk detection, which web services visualize.” By meshing with Internet industry firms on interactive finance terms, the insurance industry will have all the strength of the Internet yet sustain more discretion to manage institutional and customer experiences on terms much more favorable than those that musicians and publishers experience with Apple. As Erik Brynjolffson and Andrew McAfee point out in The Second Machine Age, digitization both spawns vast new bounty and stimulates an increasingly drastic spread between the small fraction of winners and everyone else. How better to build crowds and grow volumes than to provide incentives to customers by rewarding them for sharing information they are willing to reveal and to serve institutional clients with foreknowledge of oncoming risks to sustain competitive advantage and protect liquidity. It is as straightforward as that. For my part, I am optimistic about Marketcore because its IP enables insurance industry adopters to organize, channel and reward rich, diverse crowds of capital accumulation through interactive finance. Large, incumbent Internet firms like Amazon, Facebook and Google may still prosper from first-mover advantages based, in part, on recognition that information is the distinct commodity of the 21stcentury. But each and all now must offer more to maximize return on investments in capital-intensive operations. And that’s where any insurers, deploying Marketcore IP as sword and shield, stand most to gain for themselves and the people and institutions whose trust they hold.  

Security Lessons From Concentra and QCA

"Covered entities"&nbsp;should consider using the Concentra, QCA&nbsp;and other resolution agreements as a road map for tightening HIPAA compliance.

"Encrypt your laptops and other mobile devices."

That is one of the key lessons that leaders of health plans, health care providers, health care clearinghouses ("covered entities") and their business associates should take away from the Department of Health and Human Services Office for Civil Rights (OCR)'s April 22 announcement that Concentra Health Services and QCA Health Plan of Arkansas collectively are paying $2 million under separate resolution agreements stemming from thefts of unencrypted laptops.

The agreements contain equally significant, more broadly applicable lessons about some of the specific processes, actions and documentation that OCR wants covered entities and associates to implement. They must be prepared to defend the adequacy of their Health Insurance Portability and Accountability Act (HIPAA) "culture of compliance" if they file a breach report or otherwise face a HIPAA audit or investigation from OCR.

Consequently, covered entities and their leaders should also consider using these and other resolution agreements as a road map for reviewing and tightening their management oversight and other HIPAA compliance documentation and practices generally.

Concentra Resolution Agreement

Under the Concentra Resolution Agreement, Concentra agrees to pay OCR $1.7 miliion and adopt a corrective plan to settle potential violations of the HIPAA Privacy and Security Rules and evidence their remediation of OCR’s findings.

OCR opened a compliance review of Concentra after receiving a breach report that an unencrypted laptop was stolen from its Springfield Missouri Physical Therapy Center on Nov. 30, 2011. OCR’s investigation concluded that Concentra previously had recognized in multiple risk analyses that a lack of encryption on its laptops, desktop computers, medical equipment, tablets and other devices containing electronic protected health information (ePHI) was a critical risk. While steps were taken to begin encryption, Concentra’s efforts were incomplete and inconsistent, leaving patient PHI vulnerable throughout the organization. OCR’s investigation further found Concentra had insufficient security management processes in place to safeguard patient information.

QCA Resolution Agreement

QCA’s much smaller $250,000 monetary penalty under the QCA Resolution Agreement also resulted from a breach notification of the theft of an unencrypted laptop and also requires corrective actions. OCR opened its investigation after QCA reported in February 2012 that an unencrypted laptop computer containing the ePHI of 148 individuals was stolen from a workforce member’s car. OCR’s investigation revealed that while QCA encrypted its devices following discovery of the breach, QCA failed to comply with multiple requirements of the HIPAA Privacy and Security Rules, beginning from the compliance date of the Security Rule in April 2005 and ending in June 2012.

To resolve OCR’s charges that it violated HIPAA, QCA agreed to the $250,000 monetary settlement and is required to provide HHS with an updated risk analysis and corresponding risk management plan that includes specific security measures substantially similar to those imposed on the Concentra Resolution Agreement to reduce the risks to and vulnerabilities of  ePHI. QCA is also required to retrain its workforce and document its continuing compliance efforts.

Lessons 

Unquestionably, encryption of laptops and other mobile device is a key takeaway of the resolution agreements against Concentra and QCA. OCR Deputy Director of Health Information Privacy Susan McAndrew made this point clear in the announcement of the agreements, stating: “Covered entities and business associates must understand that mobile device security is their obligation,” and, “Our message to these organizations is simple: Encryption is your best defense against these incidents.”

However, leaders of covered entities and business associates must not overlook the more subtle but equally important messages in these resolution agreements about the management oversight and other specific actions, documentation and other evidence that OCR may expect organizations to produce. The Concentra and QCA resolution agreements, as well as their predecessors, contain detailed information about various other processes and procedures that OCR views as necessary or helpful to compliance efforts. 

Both the Concentra and QCA agreements, as well as the Skagit County Resolution Agreement announced in March 2014, require specific attestations from an officer of the entity that she reviewed reports, made reasonable inquiry regarding their content and believes them to be accurate. These attestation requirements send a clear message that OCR views leaders as responsible for taking ownership of HIPAA compliance in the same manner as typically applies to other federal sentencing guideline compliance efforts. See HIPAA Covered Entities Should Review & Correct HIPAA Policies In Response To New County Hospital Resolution Agreement, Other Developments. In light of this, leadership of all covered entities and their business associates should evaluate the adequacy of their current management oversight and documentation in proving the “culture of compliance” expected by HIPAA.

Both resolution agreements require that Concentra and QCA conduct and document and report to OCR on a series of specific steps toward compliance. OCR requires Concentra and QCA, among other things, to conduct a "thorough risk assessment" of the potential vulnerabilities to the confidentiality, integrity and availability of all ePHI, then develop and implement a "detailed risk management plan" that addresses the identified compliance concerns, the plan and timeline for their redress and steps for monitoring and verifying that those actions are taken.

From the resolution agreements' discussion, leaders should expect that the documentation and evidence that OCR may require their organizations to produce will include:

  • A detailed risk management plan that explains the strategy for implementing appropriate security measures;
  • Evidence of all implemented and all planned remediation actions, along with timelines for their expected completion; compensating controls must be identified that will be in place in the interim to safeguard Concentra ePHI;
  • For any changes to information technology (IT) infrastructure, software or other components, an updated risk analysis must be prepared for ePHI;
  • Documentation of the encryption status of mobile and other devices and PHI; an organization must track compliance with requirements to encrypt devices containing ePHI and must require specific review and documentation that ePHI will not be used on computer or other devices that are unencrypted.
  • Documentation that required workforce training is completed, along with the training materials used, the topics covered, the length of the session(s), when training session(s) were held and attestations or other documentation from individual workforce members that verifies participation, understanding and affirmation of the need to comply with HIPAA.

The resolution also suggests what OCR expects from privacy officers in terms of periodic reports about compliance with HIPAA, and some of the types of information that should be included:

  • A summary of the organization’s security management process and the security measures taken during the reporting period, including, if applicable, any documentation of training related to those measures;
  • A summary of the organization’s encryption efforts taken during the reporting period; and
  • A summary of the organization’s security awareness training efforts taken during the reporting period.

So, leaders of covered entities or business associates should consider requiring periodic reporting to management on their organization’s ePHI and other privacy and security compliance that will produce documentation.

Because the Concentra and QCA& resolutions are only two of several existing ones, and likely will be supplemented by others, management also should ensure that resolution agreements and other guidance and developments under HIPAA are systematically reviewed and responded to in a well-documented manner.

CMS' New MSA Toolkit for Self-Administration

Finally, CMS has recognized the Achilles heel of Medicare Set-Asides -- self-administration -- and done something about it.

The Achilles heel in Medicare Set-Aside compliance in workers' compensation settlements has always been self-administration. For cases within the CMS' “review threshold,” carriers and self-insureds have procured Medicare Set-Aside allocation reports at no small expense. They file for CMS approval, insisting that settlement documents provide for separate set-aside funding. Then, in 99% of the cases, the money is turned over to the claimant with little or no direction other than to go forth and administer your own set-aside account.

Most of us would be unable to keep track of the moving target of which medical goods and services Medicare will pay for. We’re not so good at submitting annual reports, either. According to the Pew Research Center, only about a third of Americans even prepare their own tax returns. Yet, insurers and self-insureds leave themselves open to Medicare Set-Aside reimbursement liability by trusting that the injured workers will be up to the self-administration task.

Finally, CMS has seen the problem and done something about it. On March 21, 2014, CMS published a Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements. This booklet guides the self-administering former claimant through the steps, which are numerous and not all easy.

For many on both sides of the negotiating table, review of this booklet may be the deciding factor in choosing professional administration. The problem is that many settlements are too small to make custodial administration cost-effective. Some carriers and third party administrators have access to the Medicare Secondary Payer Charitable Foundation, which provides no-cost professional administration. Its account starting minimum is $25,000. Parties should check on the availability of this option before finalizing the settlement.

The purpose of Medicare Set-Asides is to prevent a double-dip: The U.S. taxpayer should not be paying medical bills for which the claimant already received advance payment through insurance. Publication of the toolkit is an important further step toward that goal.

Reimagining Insurance: More on AXA-Facebook

The bold partnership by AXA and Facebook, and others like it, are ushering in the dawn of a new future that is full of possibilities. 

The reactions to the Strategy Meets Action blog “The Shot Heard Around the Industry: AXA and Facebook” have been enlightening. The blog has drawn polarized reactions ... from some who envision the potential, and from others who only see today’s view of Facebook and insurance. The responses of this latter group explain a lot. They see the industry as risk-averse, steeped in tradition, lacking in creativity and slow to change, labels that inhibit an insurer’s ability to be imaginative. This time-worn outlook will need to change if insurers are to survive and thrive in this fast-changing environment.

Like it or not, the increasingly rapid pace of change is because of modern and major influencers: the customers' being in control; the new business models used by other industries and companies like Facebook, Google and Amazon; and next-gen and emerging technologies that are converging and challenging decades of business traditions and assumptions.

A new perspective is required that can inspire new directions for insurance.

Industries -- including retail, books, travel, entertainment and pharmaceuticals -- have found the very foundations of their long-held business and operational models challenged, necessitating innovation. Those that have not innovated … well, they are no longer the market leaders in their space, or maybe even no longer in existence. Just consider the iconic brands of Kodak, Blockbuster, Circuit City, Time magazine, Borders, the Boston Globe, CNN or JC Penney. Their inability or unwillingness to see and act has cost them greatly. Even companies that were recently considered innovative are challenged. Look at Yahoo, Blackberry and Nook.

Yet other companies are embracing innovation, new technologies and outside-in approaches. As noted by one response to our blog, automotive companies like Ford, BMW and GM focused on the “connected car.” Companies offering “shared car services” like Uber, Zipcar and Lyft are recognizing the importance of being customer-driven. And Facebook and Google keep expanding the realm of possibilities to grow and strengthen the customer relationships and experiences through acquisitions such as Facebook’s Instagram, Face and Oculus, or Google’s Nest, Titan Aerospace and Zagat, to name a few.

What separates those who innovate from those who don't? It’s the vision of leadership. Leaders who can innovate can define a future vision, create a culture of innovation, identify and understand the influencers of change and embrace an outside-in approach.

The insurance industry must learn and respond fast, because it is facing the same types of challenges that have reshaped other industries. The strategic partnership of AXA with Facebook is a game-changer, distinguishing their leadership and their willingness to take an outside-in approach. We are not likely to see the inner workings for competitive reasons, but AXA has taken a bold step toward becoming a next-gen insurer. By leveraging a company like Facebook with massive expertise in understanding the digital experience and the changing expectations of customers, AXA is being transformed to a digital insurer in terms of brand presence, customer experience and customer loyalty.

Being a digital insurer is so much more than just having a website, more than using channels like social media to sell or advertise and more than having a mobile app to report claims. A digital insurer is a powerful integration -- of the website, mobile platforms, social media, mobile messaging, location services, crowdsourcing, business and customer applications, online video, content management, customer communications, sales enablement, branding and marketing – that creates a seamless, engaging customer experience. And the digital insurer is underpinned with sophisticated data and analytics that know, influence, anticipate and engage the customer in a way that creates a next-gen customer experience.

After all, in today’s world it really is all about customer experience and customer loyalty. AXA’s bold move in taking an outside-in approach -- by partnering with a company that has been a leader in redefining the customer experience, redefining the digital experience, embracing new technologies, and using data and analytics -- has created an opportunity for AXA to do different things that will position it as a leader in this new digital world.

The coming years hold the promise of unparalleled opportunity for insurers to increase their value to their customers. Those that remain tied to tradition and the past, choose to ignore the key influencers or wait too long to react will risk losing relevance. Those that are willing to take the bold steps forward will stand to gain the greatest rewards.

Yes, there are lots of details to be defined, piloted and implemented over the next few years in the AXA-Facebook partnership. And there will always be naysayers. But this bold move and others like it are ushering in the dawn of a new future that is full of possibilities. This is transformation and innovation. This is what will define winners and losers. And that is what is so exciting!

A Better Way to Measure Claim Risk

Very powerful information residing in claims data is, for now, virtually ignored:&nbsp;diagnostic codes in the form of ICD-9s.|Very powerful information residing in claims data is, for now, virtually ignored: diagnostic codes in the form of ICD-9s.

The medical portion of workers’ compensation claims is now almost 60% of claim costs. That fact alone should easily convince payers to focus on the rich medical information in their data. Yet, very powerful information residing in claims data is virtually ignored -- diagnostic codes in the form of ICD-9s. The problem is few in the industry really understand ICD-9s or how they could supercharge medical management. ICD-9s, which are not unique to workers' compensation, are the World Health Organization's International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). They are a standardized method of describing injuries, illnesses and related issues worldwide. ICDs are the codes that classify mortality data worldwide. The ICD-CM is used to code and classify morbidity data from inpatient and outpatient records and doctor’s offices. The purpose of the ICD is to promote international comparability in the collection, classification, processing and presentation of mortality statistics. Revisions of the ICD are implemented periodically so that the classification also reflects advances in medical science. Those who bill for medical services in the U.S. are required to use one of two standard forms from CMS (Centers for Medicare and Medicaid Services), the HCFA-1500 (Health Insurance Claim Form) for outpatient services and UB-04 (Unified Billing) for hospitals and other facilities. Both standardized forms require the medical provider to list ICD-9s appropriate to the medical procedures for which they are billing. The data derived from these forms should be analyzed and incorporated into medical management processes. Bill review organizations and payers capture data from the standardized billing forms in their systems. Nevertheless, while the ICD information is documented in systems, its use ends there. ICD-9s are difficult to interpret in the form seen on bills.ICD-9s are displayed in the form of codes, not descriptions of injuries and illnesses, and they number in the thousands. Individuals cannot remember the codes, nor do they have the time to look up codes for interpretation. Instead, they simply ignore them. Yet knowledge resides in ICD-9 codes that can be translated to powerful medical management tools. When the ICD-9s in a claim are monitored electronically and concurrently, they reveal and inform. ICD-9s reveal migrating claims, which are those where the injured worker is moving away from recovery, rather than toward it. Such claims always accrue ICD-9s. However, few notice what is happening. Standard processes and systems in workers’ compensation only record the ICD-9s. They do not monitor, interpret or even count them. Migrating claims are those becoming more complex and costly, often an insidious process that is missed by claims adjusters and medical case managers until considerable damage is done. What happens in migrating claims is the injured worker is not recovering and is referred to multiple specialists. Each specialist adds new ICD-9s to the claim, thereby increasing claim risk. Using a computerized system designed to monitor ICD-9s is a powerful knowledge solution. Alerts can be sent to appropriate persons when the number and severity of ICD-9s in a claim increases beyond a certain point. Migrating claims cannot be missed, and intervention is implemented early, thereby significantly improving effectiveness. A way to optimize the power of ICD-9s is to score them individually for medical severity. Each claim then contains a total ICD-9 score in the system, which translates to the claim risk score. A system designed to monitor ICD-9 scores in claims keeps a running total, the claim risk score. As ICD-9s are added, the claim risk score increases. As a claim migrates and accumulates ICD-9s, an alert is transmitted to an appropriate person. Migrating claims cannot go unnoticed. Claim ICD-9 scores are predictors of risk and cost. Claim ICD-9 scores can be monitored from the outset and throughout the course of the claim. The claim ICD-9 score reveals the seriousness and complexity of a claim. Medical doctors managing difficult claims can be differentiated from those handling less arduous claims, thereby creating fairness in measuring provider performance. The ICD-9 contains thousands of codes, and the ICD-10 revision will triple the number of codes, making its information value exponentially greater. ICD-10 is to be activated in October 2014. However, it now may be postponed to 2015. Regardless of the government’s decision about when the ICD-10 is required, wise medical managers are using the ICD factor as an important and revealing evidence of claim progress -- or regression.