This article was excerpted exclusively for Insurance Thought Leadership from a 43-page research report by the author and published by Aite Group on December 12, 2012 as further described here. This new report from Aite Group reviews the many different vendors, products, and services that help Property & Casualty insurance carriers achieve claims excellence. Based on a May through August 2012 Aite Group survey of North American Property & Casualty insurance company claims executives, the report assesses the executives' views of and reliance on various vendors, products, and services.

Introduction
The insurance industry has recently been transformed from operating in a product-centric model to operating in a customer-centric model across the entire enterprise, from sales and marketing to underwriting and from claims to billing. Today's new consumers are better informed than ever, have a heightened sense of service entitlement, and are quick to exchange information, experiences, and opinions with one another using smartphones and social media, where their influence exceeds that of insurance company marketing. And over the past several years, in a fiercely competitive marketplace, North American insurance carriers have spent billions of advertising dollars on promoting their companies based almost entirely on the responsiveness and quality of their claims services.

It has long been understood that the claim is the "moment of truth" for property & casualty insurers with their policyholders, and it is truer today than it has ever been. When a claim is filed — by an average 10% of all personal lines insurance policyholders every year or, put differently, by the average policyholder once every 10 years — the claim is more often than not triggered by a traumatic or at least unpleasant event. Consider as well that the typical claimant has been dutifully paying his or her insurance premiums for years with nothing tangible to show for it and now, at this time of high anxiety, needs and expects prompt and attentive assistance.

Vendors play a crucial role in enabling carriers to achieve the elusive goal of claims excellence. Supporting the entire insurance claims process (though mostly transparent to claimants) is a large, well-coordinated, mostly virtual team of claims professionals with diverse skills and responsibilities. These professionals are supported by tens of thousands of claims software, services, and solutions vendors. Further, these third-party service providers frequently interact in-person with claimants earlier in the process and more frequently than do insurance claims representatives and as such become the face of the insurance company.

The extent to which all of these many different resources work together on behalf of the claimant and provide excellent customer service can dictate the claimants' level of satisfaction and, in many cases, their intent to renew their insurance with that carrier as well as the opinions they will share and post about their claims experience. Because the challenges facing today's property & casualty claims executives, including ongoing resource constraints and the many other factors described above, are unprecedented in terms of their number and complexity, claims vendors that best help them solve these challenges are the most highly valued and rewarded.

Claims Software
Carriers rely heavily upon a large and diverse variety of proprietary and third-party claims software systems and databases to manage every aspect of claims operations, from first notice of loss (FNOL) through claims payment. There are several hundred discrete operational processes across property & casualty claims, including auto, property, and workers' compensation lines of business. These processes include the claims management system (CMS) — the "core" or main operating system supporting the entire claims operation — and many other vendor software solutions — of which our report looked at vendor management software, automobile repair and property loss estimating software, and casualty management software.

Example: Claims Management System Software
Underpinning and supporting the entire claims operation is the carrier's claims management system, defined as the "core system" and the system of record for all activities and interactions for all claims. The extent to which internal and external applications, including vendor products and services, are integrated with the claims management system determines the overall efficiency and effectiveness of the claims process and, in turn, the policyholder satisfaction with the process.

Claims Services
Property & casualty insurance claims departments rely more heavily upon third-party claim service providers than one might imagine. Using the services, software, and solutions of about 250,000 claim service providers, U.S. property & casualty insurers spend approximately US$300 billion in the course of resolving 100 million claims. As discussed in this report's introduction, third-party service providers frequently interact in-person with claimants and are often the face of an insurance company. Moreover, the extent to which all of these many different resources successfully work together on behalf of claimants can dictate claimants' satisfaction with their insurance company.

For all of these reasons, successful carriers value these relationships and spend a great deal of time and effort selecting, managing, and working closely with vendors to ensure claims are handled quickly, courteously, and professionally, no matter how complex the process may be "behind the curtain." While there are many others, the services and solutions included in our report include First Notice of Loss, claims analytics, insurance replacement rental cars, total loss vehicle valuation, salvage management, collision repair networks, national independent appraisal and adjusting services and litigation management solutions.

Example: Insurance Replacement Rental Cars
Insurance replacement rental cars are used extensively by insurance companies to provide temporary transportation to claimants whose automobiles are being repaired after an accident (most auto insurance companies include or offer temporary rental car coverage for a small additional premium). Of all the claims vendor services used by carriers, this category may be the most critical in terms of ability to influence the customer claims experience, policyholder satisfaction, and retention. In addition, it represents a significant overall claims cost for insurance companies and a major challenge for claims adjusters in terms of logistics, the many associated claims process touchpoints, and overall time consumed in managing the process.

Enterprise has come to dominate the insurance replacement rental car segment for a few simple but not-so-obvious reasons. Primarily, it focused on and perfected solving the unique needs of this very different segment of the rental car market. Its competitors treated insurance replacement rentals as just another small portion of their second-largest segment (the local market), choosing instead to focus on their larger and still-growing airport markets.

Enterprise quickly identified the many major pain points of insurance claims adjusters who were tasked with managing temporary rentals as part of the auto accident and repair claim process, and it ultimately simply assumed all of those responsibilities in exchange for the carriers' rental car business at competitive prices. Enterprise also understood the critical value of developing working relationships with local insurance agents and body shops, and it tasked their branch managers with doing both aggressively. Finally, Enterprise's family-owned and -run business philosophies have informed its business operations, including its college graduate-focused recruiting practices, its internal career-promotion policy, and its fierce focus on customer service.

Enterprise's impressive success may well be the insurance industry's best example of the rewards available to vendors who learn how to execute and manage insurance claims process outsourcing to the highest possible level of customer satisfaction.

The graph below illustrates respondent perception of the listed insurance replacement rental car vendor solutions' performance, regardless of whether respondents currently use them. As might be expected given the explanation above, perception of Enterprise performance is almost completely positive.

About This Report
This article is excerpted from a 43-page research report by the author and published by Aite Group on December 13, 2012 as further described here.

Companies with products and services named in the complete report are ABRA, Accenture, Acuity Management Systems, Aderant, Allegiant Systems, Allstate Insurance, Aon eSolutions, AQS Inc., Arbitration Forums Inc., Athenium, Audatex (a Solera company), Auto Claims Direct, Auto Injury Solutions, AutoNation, Avis Budget Group, BlueWave/Cover-All, Bottomline Technologies, Brightclaims, Caliber Collision, CARSTAR, CCC Information Services, CGI, ClaimForce, ClaimHub, Claim Toolkit, CodeBlue, Collision Revision, Copart, Corvel, Cox Enterprises, Craig/is, Crawford & Co., CSC, Cunningham Lindsey, CynCast, Detica NetReveal, Eagle Adjusting, Enterprise Rent-A-Car, Exigen, EXL Services, FairHealth, FairPay, FINEOS, Fiserv, FixAuto, Gerber/Boyd, Group 1, Guidewire, The Hartford, Hertz, HSG, HyperQuest, IA Net, IBM, Ingenix, Innovation Group, Insurance Auto Auctions, ISCS, ISO, Legal Services Group (LSG), LexisNexis, Lynx Services, Maaco, Manheim, Mitchell, Mitratech, MSB, NuGen IT, PDA Appraisal, Pega Claims, Penske, Performance Gateway, PowerClaim, Premier Prizm, Procura, QCSA, Quest, Ravello, Safelite Solutions, SAP, SAS, SCA Appraisal, Service King, Simsol, Sonic, Sterling, StoneRiver, SunGard, Symbility, Systema, Total Resource Auctions, Trillium, Tropics, Trover Solutions, Trumbull Services, Tymetrix, Van Tuyl, Verisk Analytics, Vista Equity Partners, Wipro, Wolters Kleuwer, and Zywave.

January 1 is going to be a day like none other in recent memory for the California workers' compensation system. Most of the provisions of Senate Bill 863 (De León) will be operative. A flurry of regulatory initiatives near the end of this year will allow implementation of many of these provisions. There will be considerable confusion and costs associated with these new laws and procedures as they come on line. The goal and hope of virtually all in the system will be that in time the objectives of this major legislation will be met, and we will have a system that is more efficient and better aligned than what resulted from the last major reforms in 2003 and 2004.

Those in charge of implementing this legislation — largely in the Department of Industrial Relations and Division of Workers' Compensation — have done an admirable job dealing with the intent and inherent conflicts in this new law. Their outreach through various forums — though maddening from a timing standpoint — has greatly assisted the community in its understanding of all the various nuances of SB 863 and its interaction with a voluminous body of regulations and court decisions already existing and in many cases left unaffected by this legislation. There are limits to what the Division can do, and those limits are largely set forth in the Labor Code as it will exist on January 1. Those who think that the regulatory process is a second bite at the apple to deal with issues inartfully drafted or largely ignored in the legislative process are going to be disappointed.

There is a debate as to whether SB 863 will reduce costs in 2013 and by how much. The benefit increases are hard dollar increases, while the various reforms intended to produce savings and offsets require both effective implementation and accurate analysis. They also take time. This dynamic is at the core of Commissioner Jones' November 30th pure premium order. The Commissioner's decision clearly showed, as did the actuarial analyses presented to him, that the reforms are mitigating the increased costs in the system from day one. It is equally clear that until there is experience under the reforms and the reforms are fully implemented, the full measure of savings cannot be completely or accurately estimated.

Prior reforms, specifically Assembly Bill 227 (Vargas) and Senate Bill 228 (Alarcon), combined system changes, such as mandatory utilization review, with well-defined elimination or reduction of benefits. These 2003 measures eliminated vocational rehabilitation and capped chiropractic treatments — changes that were easily quantifiable the moment the ink dried on then Governor Gray Davis' signature. The next year, Senate Bill 899 (Poochigian) added reforms to medical control and permanent disability rating that quickly manifested additional considerable savings in medical and indemnity losses, but also resulted in higher loss adjustment and medical cost containment expenses. And, as we saw with the Almaraz, Guzman, and Ogilvie decisions, reforms of the permanent disability system eroded significantly once reshaped by the Courts.

Medicare and Social Security are in deep trouble — deep trouble. The nominal national debt is puny compared to the unfunded liabilities in Medicare and Social Security. How does $16T — yes "T" as in trillion — compare to $86T? There is a good article in the Wall Street Journal written by Chris Cox and Bill Archer. Click here to read the full article.

Historically, the government has had success in transferring these types of liabilities to the private sector. One way was to deliberately underpay doctors and hospitals under Medicare with the full expectation that those shortfalls would be absorbed by private payers. In my career I had discussions with the Centers for Medicare and Medicaid Services about that very thing. One Centers for Medicare and Medicaid Services official admitted that was part of their strategy. He also said that would continue as long as private payers were willing to absorb the Medicare underpayments to providers. That has worked so far.

Another example was when the government declared that private group plans would be primary over Medicare for workers over age 65. For those of you too young to remember, that was not always the case.

One possible big transfer of Medicare costs to the private sector would be to declare that companies have to offer COBRA for five years or so for every employee age 65 and up who terminates employment. I guarantee you that type of transfer to private companies will be "on the table."

For those of you benefit managers who are in the first half of your career, you will be facing measures not unlike ones I've described here. Brace yourselves.

I was recently going through my notes, preparing to give one of my workshops on the subject of Personal Effectiveness. In preparation for the workshop each participant is requested to read some background material so all who attend have a passing understanding of (1) what the Best Practice looks like in action, (2) what it contributes to the business, and (3) if it's truly beneficial, how a business team would put it to work.

The material I pondered that caused me to start writing about it in this article is a Harvard Business Review article: Beware the Busy Manager by Heike Bruch and Sumantra Ghoshal.

The authors ask an intriguing question — Are the least effective executives the ones who look like they are doing the most? Hmmmmm.

Of course, being seasoned scholars, the authors backed up their observations in their article with some impressive research. For about a ten year period they studied the behavior of busy managers in companies in the US, UK, Germany and Switzerland, interviewing hundreds of managers. Their findings were not particularly encouraging. They report fully 90% of managers squander their time in all sorts of ineffective activities. In other words, a mere 10% of managers spend their time in a committed, purposeful, and reflective manner. Okay, what does that look like?

It seems the highly effective 10% had these common traits: (1) concentrated attention — focus, (2) vigor fueled by intense personal commitment, and (3) selecting a manageable number of projects for early contribution. From both my CEO days as well as consulting experiences, these patterns are absolutely what I have observed in highly productive executives. Of the three, I want to elaborate a bit more on the last one, the number of projects currently under management.

In our consulting practice I have facilitated a significant number of strategic planning sessions. As part of preparing an annual Strategic Plan, one of the very significant by-products is the Action Plan, which schedules accomplishment for all the projects that enable the achievement of the Strategic Plan. Most companies struggle with the above three traits — focus, commitment and scope in the Strategic Plan implementation process (the Action Plan). In fact, I would say just about 10% really do it well. Of the traits, the scope (number of initiatives) seems most troubling.

We urge clients approaching the Action Plan for the first time to limit the number of goals / projects / activities to a critical few, get them accomplished as soon as possible, then select some others and do the same.

The tendency is to select way too many initiatives and then get bogged down, get discouraged and abandon a potentially powerful process.

In support of simplifying the focus and reinforcing vigor and commitment, I developed the Law of Three. Applying this principle, you are encouraged to pick three high-impact projects and work like heck to get them accomplished in the next three months.

Variations on this theme are encouraged as long as it supports the accomplishment of the critical few projects that will have the greatest impact. This is where strategy and personal effectiveness team up for high performance. It is effective!

There are three major concerns and opportunities that must be considered. First, is the impact of SB 863, the major reform legislation bill passed late in this year's session of the legislature. Second is the continued increase in loss cost on prior years' claims. Lastly, will the weak economy improve enough to start bringing new workers into the workplace and what impact will that have on Workers' Compensation costs?

SB 863 holds the promise of lower claims costs, improved efficiency in claims processing procedures, and ultimately rate relief for California employers. At issue is the time frame for writing new regulations that will implement the new law. They are scheduled to take effect on January 1, 2013 which may lead to rushed procedures and unintended consequences. Also major parts of the law will be challenged in court. The Independent Medical Review procedures raise the issue of right to appeal. The injured employee attorneys have already indicated they will challenge this portion on constitutional grounds. Time will tell what the ultimate impact of the new legislation will be on the system, but immediate reduced costs are not expected.

Unfortunately, increasing premiums and rates will almost certainly continue into 2013. The Workers' Compensation carriers are spending 138 cents for every dollar of premium. The overly competitive marketplace coupled with medical cost inflation has led to large developments in claims settlements beyond case reserves. The collapse of the economy has also led to decreased premiums, while claims have increased.

It will take at least 24 months for this cost bubble to work its way through the system. The most recent actuarial review of past years' claims cost indicates that rates are over 9% lower than they should be. While the Workers' Compensation Insurance Rating Bureau governing board, in a purely political move, decided to recommend no increase in rates to the Department Of Insurance, underlying costs continue to increase.

Finally, as the economy slowly recovers and payrolls increase, we will see hiring pick up. While it seems like this would lead to lower loss ratios as premiums go up, just the opposite is true. As you add employees in general, they will be less skilled, need more training and will be less able to work safely immediately. Increasing workforces will lead to increased accident rates and increased loss ratios.

The carriers will always compete for very clean, well-managed and low loss ratio accounts, so now is the time to redouble efforts with safety programs, training and claims management.

Are you aware of the Independent Employee Act Defense? If you are, then you do not need to read on. However, I am willing to bet that most of you are not so that is why I am offering this for your reading enjoyment.

The question is "What do you do if you are fined by OSHA for a serious penalty?" Among the various defenses available, there is the Independent Employee Act Defense (IEAD). It is all based on the 1980 Mercury Service, Inc., case which by the way is still cited in Cal/OSHA legal circles.

In this defense, the employer must plead that the act of the employee that caused the injury was an independent act of the employee, and the employer should not be held liable. The argument by the employer is that "I did everything the law required me to do, but the employee violated company policies and procedures and that is what caused the injury."

Now this seems simple but it is not. In order to prevail with the affirmative defense, it must first be pled on the appeal following the citation and for the employer to prevail, he/she must prove all five of the following elements:

1. The employee was experienced and trained on the job. Using the case noted as our base, the employee was a diagnostic specialist on automobiles. The employer presented over 70 training certificates from the manufacturer out of which over 30 were on engine diagnostic and performance checks. Also, training certification from a nationally recognized body was provided by the employer. OSHA accepted the employer's claim on this issue. However, OSHA reviewed all of the safety training that had been completed by the tech.
2. The employer has a well-defined safety program in place. This one is so obvious. You must prove that you have a well-defined and active safety program in place. Here, the employer provided its Injury & Illness Prevention Program Manual along with copies of the various training sessions that had been given. These were taken directly from the manufacturer's service manual that were relevant to the tasks being performed at the time of the injury. OSHA again accepted this part of the defense as well.
3. You must have a policy of sanctions against employees who violate your safety program. Employers must have a policy of sanctions which is enforced equally against any employee who violates your safety rules or is involved in unsafe acts. Here the employer reported that he did not have such a policy as injuries were virtually non-existent and therefore not needed. The employer lost on this one at OSHA as no policy was in place and as any earlier violations that may have occurred had not been documented.
4. You must also have an effective enforcement program in place. The written policy noted above must be enforced equally and be well documented. Here, OSHA held that the enforcement part of the employer's overall safety program had "no teeth" and that the program which was well written was never followed nor enforced. Here, as you can see, the employer lost.
5. The employee caused the safety infraction which he/she knew was contrary to the employer's safety requirements. Here, the employer must prove that the employee had the requisite knowledge of the safety requirement which he knowingly violated, whether on purpose or by his/her own negligence. The employer provided a copy of the safety rules in place at the time of the injury which had been signed and acknowledged by the injured employee. They also provided a copy of the shop manual (specific directions on the servicing of vehicles) which all technicians refer to repeatedly. This document also outlined the safety procedures for each task as well as the relevant safety issues.

So what does this say to you? It says that if you have an effective Injury & Illness Prevention Program and training program in place which is well documented and enforced you may be able to effectively defend against an OSHA serious violation. However, the important thing to remember is that proper documentation wins the day. Without it, don't even try to defend as you will most likely lose. The watch word by most agencies is that lack of documentation means that there was no documentation and you lose.

A storm has been brewing since requirements for set asides were established in order to protect Medicare from future medical expenses from work comp and general liability claims. With the mandatory requirement that all work comp and general liability claims be reported in electronic format, CMS has the mechanism to look back and identify if they have ever made any work comp-related medical payments. Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 adds new mandatory reporting requirements for group health plan (GHP) arrangements and for Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation. Failure to comply will subject any company to a fine of $1,000 per day and "double damages."

While this practice has been required for many years in workers' compensation, the new mandatory reporting application to civil matters has dramatic implications. It should be noted that Medicare's status as a secondary payer under 42 U.S.C. § 1395y (b) creates the right to reimbursement, which has the potential to simultaneously impede settlement and impose a possible risk of future liability against all parties.

In the 1980s, Congress amended the Social Security Act to include the Medicare Secondary Payer Act ("MSP"), which effectively enacted Medicare liens. In 2003, the Government clarified its position that self-insured entities were also included in the Medicare Secondary Payer Act in passing the Medicare Act of 2003. The 2003 revisions altered the Medicare Secondary Payer Act to expressly include self-insured entities as "responsible" parties obligated to reimburse Medicare.

Prior to the Act, Medicare did not have an efficient mechanism to identify or evaluate instances where Medicare's liability should have been secondary to the "responsible" party (or it's insurance carrier), and could only recoup payment from insurance plans to the extent that payment had been made or could "reasonably be expected to be made promptly."

The 2003 amendments to the MMA, found in Title III, were specifically enacted to overturn court decisions that limited the effectiveness of the Medicare Secondary Payer Act private cause of action. The amendments made it easier for injured Medicare recipients to bring these private actions on Medicare's behalf against an expanded class of entities and individuals with insurance, and they clarified when such entities and individuals must pay the Medicare beneficiary's medical expenses. The Amendments state:

All businesses, trades, and professions are deemed to have insurance, regardless of whether they carry their own risk. Any judgment or payment — including a settlement — conditioned on the recipient's compromise, waiver, or release of claims against the person or entity that commits the wrongful act (whether or not there is a determination or admission of liability) demonstrates a plan's responsibility to reimburse Medicare.

This legislation thereby expanded the possible defendants for the private cause of action to include any person or entity (including a business, trade, or profession without insurance), the entity's insurance company, and the plaintiff's self-insured employer or the third-party administrator. With these amendments it is now crystal clear that Medicare's right of reimbursement applies to almost all settlements in which Medicare payments have been made on a plaintiff's behalf. In addition, Congress applied the amendments retroactively to the original passage of the act in 1980. Court decisions since the 2003 amendments were enacted have consistently allowed the private cause of action to proceed against insurers and similar entities, including employers, who are deemed responsible for injuries. Therefore, responsible parties need to be made aware of the double exposure and how both the 2003 amendments to the Medicare Secondary Payer Act statute and the subsequent court cases expand the class of entities with direct exposure to damages.

The latest update took place very recently. On October 1, 2012, the Supreme Court declined review of a lower court's Medicare Secondary Payer decision. The important facts decided in this case (Hadden vs United States) is the fact the Supreme Court of the United States declined review of a 6th Circuit decision that upheld the government's authority under the Medicare Secondary Payer law to recover all expenses paid on behalf of a Medicare beneficiary when that beneficiary, in turn, recovers from a third party. The ruling helped define "Responsibility" under 42 U.S.C. 1395y (b)(2)(B)(ii), as that term was clarified under the 2003 amendment to the Medicare Secondary Payer Act. In this respect, the court essentially ruled that when there is a settlement, the primary plan demonstrates "responsibility" as defined under the Medicare Secondary Payer Act statute, thereby entitling Medicare to a full recovery of its claimed conditional payment amount — even if the settlement is for a compromised or reduced amount.

How will this affect employers?

One scenario is that when CMS/Medicare learns (and they will) it has been paying for work comp-related medical care, it will seek repayment from the claimant. The claimant, having spent the work comp settlement, will be unable to pay. Ultimately, it will be the employer and/or insurance carrier that will be held accountable. And should CMS have to pursue the employer in court, the amount is doubled. Unbelievably, the insured or employer could pay the future medical cost twice — once to the claimant at settlement and later when Medicare seeks reimbursement of the medical care they paid on behalf of the claimant. Legal attempts to put language in settlement agreements that the claimant agrees to be responsible for the cost of all future medical care has or will likely meet with failure because federal law will trump settlement agreements every time. Claimants, employers, and insurers are still bound by the requirements of the MSA statutes. Another scenario allows for a private cause of action to proceed against insurers and similar entities, in which there is still a potential for double costs.

Going forward, claims adjusters should have systems in place to verify compliance with the MSA requirements of CMS. However, problems may arise when you look backwards; there is no statute of limitations on compliance with the MSA requirements. CMS can review claims that were closed last year, five years ago or more for that matter to check for compliance. If CMS finds medical payments are owed, then you have 10 days to pay to avoid penalties and interest. One potential solution is baseline testing that can establish if there is an injury and if it is related to or aggravated by the date of loss.

Do you honestly believe that individuals deserve the right and responsibility to make their own choices about health care? Before you answer, remember, the party in charge of spending the money becomes the ultimate decision-maker. When it comes right down to it, most people say they support patient rights, but only in the context of someone else paying the bill.

Here's why those two issues cannot be separated:

When discussing health savings accounts with employers, I often hear concern that connecting financial factors to health decisions will lead to employees making bad choices (mostly by not getting the care they need). I hear a widespread belief that asking people to take financial accountability for healthcare produces negative outcomes, not positive ones.

Rarely do I hear policy-makers acknowledge that the opposite is also true. Actually, when we remove financial accountability we actually expose people to risk because we encourage people to stay uninformed.¹ Economists use the term "rational ignorance" to describe instances where the cost of becoming informed exceeds the perceived value and hence people remain rationally ignorant.

If you understand that all medical procedures — especially those done unnecessarily — contain inherent risk, then remaining uninformed increases the risk associated with healthcare decisions. (For a refresher on why more care is NOT better for patients, review the wonderful work of Fisher and colleagues.^{2 3})

Rational Ignorance
Because it takes time, effort, and sometimes money to be informed, we choose where to place our energy, attention, and resources. Like any other endeavor, why go to the trouble if the potential benefit isn't greater than the cost? Under normal circumstances, there is much to be gained by being informed:

• Money Saved (by comparing prices of different brands and stores);
• Value Gained (by comparing what we can GET for the price);
• Time Saved (by knowing an option is closer or easier to use);
• Best results (by knowing how to use the item you get — e.g., medicine — appropriately, you have a better chance of it working);
• Personal Control or Preferences (the satisfaction, peace of mind, or other personal preferences that are met when you decide what's best for you);
• BUT — it also takes work.

Two factors ultimately influence whether we decide to become informed about a topic: the value one perceives getting out of it (in the many forms described above), combined with one's ability to influence the eventual decision or situation. If we feel we have no influence, and it doesn't really bring us personal value anyway, why spend the time and energy to be informed? Rationally-we wouldn't. Rationally, we remain ignorant. For example, unless it is a rare topic that affects us in a significant way, few voters invest significant time and energy understanding the referenda on the ballot, because we don't feel like our vote will influence what happens anyway. Why bother?

Think about it: most of us know a lot more about the features on the cars we might purchase (which involve our choice and our financing) than we know about which doctors in our community deliver the best care for the best price.

Compare medical services to other activities and needs in our life:

When Choosing How To Spend Our Money:
When you bought your house, did you look at prices in that neighborhood to see if you were paying a fair price? Did you investigate whether the neighborhood was safe, and have an inspection to be sure the value was accurate?

When Choosing How To Spend Our Time:
Do you read reviews or ask friends about movies or books before you buy them?

On your last vacation, did you research different activities in the area, to best meet your expectations for the trip?

Remarkably, medical care is one of very few services we "select," while knowing almost nothing about the cost, the quality, and without guarantee from the person providing it.

We stay rationally ignorant about healthcare because we know someone else is in control.

While healthcare reform has evoked high emotion and political interest, most citizens are not particularly informed about the specifics. For the most part, under new rules someone else pays for the majority of the cost of care, and that someone else will decide what type of care will be allowed.

Regardless of whether the "someone else" is government or a private insurer, consumers will remain largely uninformed and disconnected from all related information — including price, safety, and quality. Not because agencies won't attempt to make information available, but because the cost of becoming informed exceeds its value. Unless we have great experience, influence or resources, we know we are not in control anyway.

The Ethics of Health Care Reform, published by the Non-partisan Institute for Policy, compared six different models for providing health care, and concluded that none was ideal.⁴ However, they came to the following conclusion:

"There is only one system that promotes patient choice, and yet still maintains the elements of a well-functioning health care system that ensures access to quality care while keeping costs under control: the consumer driven model" (p. 8). (It was a high-deductible plan with a funded HSA.)

While not using the term "rational ignorance," the report focused on the patient as the rightful decision-maker. "When a third party-government, insurer or employer controls most of the health care funds, that entity eventually becomes the decision maker, not the patient" (p. 4).

Payment Equals Control
The party with the purse strings decides who gets paid, for what, and how much. It's a simple equation. Thus, anyone who truly agrees that the consumer/patient should be the rightful decision-maker must also agree that they should have control over the money spent. Deciding and paying are one in the same.

When we insist that patients should decide about care — but only within the context of a third-party payment system — we create an illusion of patient influence. Patients understand that someone else — a doctor or an insurer — will be granting ultimate permission. This explains why most of us remain ignorant — rationally.

Some will insist that healthcare decisions are far too complex and/or dangerous for patients to make without a doctor acting on their behalf. But the opposite is true. While patients may need or want support in understanding options, that support should come from a person who first and foremost serves the patient. Doctors are humans, influenced by incentives and rules (inherent in the payment mechanism); their advice will reflect who is paying them, and for what. That alone should remind patients that control of payment is an important component of healthcare decisions.

This matters: Protecting people from financial responsibility for healthcare exposes them to risks by encouraging them to remain uninvolved in care decisions. Payment decisions cannot be separated from care decisions because true ownership requires control of both. It's critical that employers understand how plan design can encourage employees to be rationally informed.

References

¹ Downs A. An Economic Theory of Democracy. New York: Harper; 1957.

² Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273-87.

³ Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138:288-98.

⁴ Matthews M. The ethics of health care reform. Institute for Policy Innovation Issue Brief; 2009. Accessed October 22, 2009.

Most marketing and communication departments know all too well that social media and social networking sites are a treasure trove of opportunity for elevating your personal or corporate brand. Employees use social media for personal use, but also use it as a forum to talk about their boss, their company, their products, their problems and whatever else is on their mind. There are 200 plus social media sites in English alone, Facebook recently reached one billion users, and Twitter puts out more than 170 million tweets per day. That is a lot of free advertising!

However, what many businesses fail to remember is that, despite all of the positive aspects social media brings to a firm's marketing, communication, and sales efforts, it's also ripe with opportunity to damage their brand and cause a financial loss. While it's free marketing, it's also a lot of unedited content being published online that could be about your business, about your products, or attributed to you. Could a competitor feel that your employees are slandering their people or products? Could a competitor gain inside information about your organization? Could an employee divulge information that could get them fired? Could you or your employees inadvertently offend prospects and clients? In short, yes. As social media use continues to evolve and grow, it's important to consider this exposure to your organization.

Using Social Media To Generate Business Leads
All of this can be scary, but you can't ignore the great opportunities created by social media. Any organization not taking advantage of social media sites is signaling that it is not evolving with the times, and there is nothing close to matching the immediacy of broadcasting your news through social networking sites. A well-crafted social media strategy can generate a lot of interest in your product or services and drive traffic to your website where more specific information can be provided.

"In time, the proper execution of a focused social media strategy is an efficient means of staying in front of prospects. When the prospect has a business problem, your positioning as a credible, knowledgeable resource can help you get in the door and, hopefully, close the deal," says Randy Stoloff, Director of Marketing and Social Media at AmWINS Group Benefits in Warwick, Rhode Island.

It is critical to have all content reviewed by someone within your organization that can be responsible for stopping improper content from being released. It's also important to review applicable insurance policies such as a website media policy or cyberliability policy to be sure social media activities are covered.

Using Social Media For Crisis Response
Imagine a time down the road when your best customers follow your social media feed and you need to get news out in a hurry about something that could cause your most prized customers harm. Assuming you have or hire qualified public relations professionals that can help you craft the proper way to phrase the announcement, you can get important news out immediately to show your concern for your customers and for transparency. Social media provides the most immediate way to communicate to your target audience. There are many insurance products currently available that assist with handling the public relations aspect of a crisis response. Having your social media presence established prior to a crisis will help you deal with the crisis in a targeted fashion.

Can Social Media Sites Be A Network Security Risk?
Besides the potential for hackers to use employee information on social media sites to figure out passwords, the sites can also be used to transmit computer viruses and other dangerous malware. As a result, many corporations block employee access to social networking sites. If the corporation has a cyberliability insurance policy in place, be sure it addresses security issues emanating from social media. The coverage may be limited to networks owned or controlled by the corporation.

Should I Address Social Media In My Employee Handbook?
This is a topic that requires legal counsel with experience in employment law as well as social media. It makes sense as a business owner to establish a guideline on what social media activities are permissible for employees, but it must be carefully worded. The National Labor Relations Board has published guidelines that may help. Most companies work very hard to establish a professional image and reputation. Employees often mistakenly think that commenting in social networking sites is somehow exempt from personal responsibility. The press is full of examples of disgruntled employees commenting on working conditions, complaining about their managers or coworkers, or commenting on confidential internal activities. Employees have been terminated for their conduct and they've sued for wrongful termination. You are likely to find coverage for the wrongful termination claims on your employment practices liability (EPL) insurance policy. Working with a professional is critical for navigating this minefield. You may not be able to avoid the litigation, but you can lay the groundwork for an effective defense.

Do I Need A Social Media Component In My Employment Contracts For My Executives?
Your top executives can also make mistakes using social media. Sensitive information can be leaked out accidentally by people who see the most sensitive information. Similar to non-executive employees, managers who have been terminated due to their social media activities have sued their employers for wrongful termination. Again, look to an EPL policy for coverage for that type of claim.

Should I Review The Social Media Content Posted By Job Applicants?
Many states have enacted laws barring employers from requesting full access to an applicant's social media profile. We have all heard stories about a prospective employer seeing improper pictures or comments by the applicant which influence the decision to hire or not hire them. Some employers have taken it one step further and requested login credentials from job applicants in order to see all the content they have posted. It seems like an obvious invasion of privacy, so laws are being written to protect the rights of job seekers. The claims that can arise from this scenario could have coverage apply under the "wrongful failure to hire" coverage on an employment practices policy, as well as an "invasion of privacy" policy as part of a cyberliability policy.

Scared Yet?
There are reasons to be concerned, but the opportunities need to be investigated with a proper foundation of preparation. It is also important to remember that there are insurance products available to help protect you after missteps. If you have an employment practices liability policy, you likely have some protection from wrongful termination claims and invasion of privacy claims brought by your employees. If you have an internet media or cyberliability policy, you could have remedies for allegations of libel, slander, defamation and invasion of privacy claims brought by other parties. A strong cyberliability policy will have protection from breach of security claims if hackers use social media to access your computer network for malicious purposes. It's possible that other insurance products can offer assistance as well. AmWINS represents multiple insurers with all of these insurance products and can help you select the proper coverage for you and your clients.

Tell the truth. What are your real expectations for your safety management program? "Let's be honest," said one exasperated business owner. "I'd be happy if it only got my workers to do what they're supposed to do in the first place."

If compliance is your answer, go to the back of the line.

Why settle for so little when the potential exists for much more? Safety management programs can be designed to solve a myriad of problems facing businesses, not just compliance. High personnel turnover, generational and cultural conflicts, and non-productive employee behaviors can all be reduced through safety management, but only if more attention is paid to the "human elements" that cause a loss to happen.

Perhaps the darker truth is that we haven't capitalized on the full potential of safety management efforts because we haven't known how to properly "gear them up" — to organize and "sell" them to oft-resistant workers in a way that achieves maximum benefit.

Failure to Launch
Tim Reis, Global Director Data Governance at The Manitowoc Company, thinks he knows why many programs struggle. Midway through the implementation of Manitowoc's five-year safety management system plan, Reis found that engaging employees in the roll-out effort was more critical to its success than initially believed.

"We spent two years putting good processes in place and establishing accountability," said Reis, adding that the success of additional stages of his safety management plan "will be dependent on our ability to make good processes excellent and our ability to engage employees."

Unfortunately, many companies discover Reis' lesson too late, having launched safety management programs without taking the necessary first steps to engage employees.

Predictable Resistance
Resistance to ill-conceived safety implementation plans is predictable. But until recently, the source of worker resistance has been a subject of intelligent guesswork. Anthony Lauchner, a senior project manager with McCarthy Building Companies, blames the independent nature of workers.

"I figure that guys whose independent attitude isn't accepted in other industries naturally gravitate to my industry," said Lauchner. "Historically, we've accepted them, allowing them to get away with an attitude that works against safety improvement."

The search for solutions to change-resistant workers has been prolific, if not futile. One operations manager even consulted a program for troubled youth to find guidance in handling workers he considered to be little more than grown-up juvenile delinquents.

Fortunately, we now know how specific temperamental, generational and cultural factors contribute to resistance in workers. This knowledge provides us with three strategies for starting successful safety management programs. Use of these strategies results in a deeper acceptance of safety efforts and reaps benefits far beyond simple worker compliance.

1. Overcome a Temperament of Resistance
Safety management programs should be geared to overcome the historical root cause of worker resistance: emotional apathy that breeds disloyalty.

Due in part to my extensive research of the personality traits and behavioral tendencies of change-resistant workers, we now know that the independent nature of workers is symptomatic of emotional withdrawal, not outward belligerence (as it might appear).

Nervousness, pessimism, indifference, inhibition and an argumentative nature are all traits for which resistant workers consistently rate themselves as needing improvement. These traits are indicative of an emotional hole into which workers retreat, escaping from emotional investment in the job or with coworkers.

Anthony Lauchner labels it a temporary work mentality. Others call it a penchant for disloyal behavior, the type that ruins safety management programs and is reflected in high personnel turnover rates.

While serving as project manager and safety liaison for Jacobs Facilities, Gary Douthitt witnessed the detrimental effects that the emotional hole had on his safety management system for project managers. When tasked with collaborating with contractors to identify safety hazards, Douthitt's managers didnt seem to care.

"It was easier for them to note conditions on their report and walk on rather than stop and deal with unsafe behaviors on the spot," said Douthitt.

As old fashioned as it sounds, building safety systems on care and compassion rather than command is the solution for bridging the emotional gap between workers and safety.

One way that owners and managers can demonstrate the compassion of safety management is obvious. "Don't fire workers when they take the time to do the job safely," says Lauchner. By exercising safety patience, he says, the company will convince the employee that safety management is a noteworthy emotional investment, equal to production.

Owners may also want to provide training that develops interpersonal communication skills to those responsible for the program's implementation. Gruff, authoritative communication only pushes workers further into emotional regression, away from safety management objectives.

2. Appeal to Generation Me
Consider the radical difference in values separating young workers from older ones when initiating a safety management program.

The egocentric nature of Generations X and Y, known collectively as Gen Me (approximately ages eighteen to thirty-five), represent serious obstacles to a safety program. According to reliable measures, narcissism, the unhealthy over-focus on self, is seven times higher in Gen Me as in previous generations.

Jean M. Twenge, Ph.D. of San Diego State University states in her book Generation Me, "Young people have been consistently taught to put their own needs first and to focus on feeling good about themselves," adding, "I see no evidence that today's young people feel much attachment to duty or group cohesion."

In short, Gen Me does not naturally possess a mindset that lends itself to a collaborative safety management program.

To secure "buy in" from a generation not keen on placing the group's needs over the individuals, a safety program needs to harness the power of Gen Me's self-focus. Oddly, this can be achieved by appealing to the inflated sense of self-esteem they feel when networking socially.

Such networking abilities are crucial to the success of safety management. Toolbox talks, Job Safety Analyses (JSAs), and team incident investigations are a few of the safety management tools that are dependent upon good socialization skills. Due to the emotional withdrawal syndrome discussed earlier, older workers have been historically weak in this skill set.

Companies should target its present and future Gen Me leaders for special inclusion in the planning and implementation of safety management programs. This includes taking seriously their opinions on how to sell the program to other Gen Me workers as well as taking advantage of their technologically advanced interpersonal communication skills.

3. Capitalize on Present Cultural Change
In order for safety management to achieve maximum impact, safety managers should better accommodate the cultural sea change brought by an increasing number of Hispanic workers. The construction industry is one example of this influx.

According to a 2011 U.S. Bureau of Labor Statistics report, Hispanic workers account for 24.4 percent of all construction workers (roughly 2.2 million workers). Two of every three construction new hires are Hispanic, and the percentage is expected to increase.

While most construction supervisors identify the language barrier as their primary cultural safety concern, my research indicates that the difference between Hispanic and non-Hispanic on-the-job behavioral tendencies poses the greatest threat to the success of safety management programs.

Behavioral data I have collected from 750 non-Hispanic construction supervisors demonstrates that over 76 percent of those workers classify themselves as more task-oriented than people-oriented. On the other hand, Hispanic supervisors are equally more people-oriented than task-focused.

Project manager Lauchner agrees. "My non-Hispanic workers are more hard-driven, less forgiving than my Hispanic ones," he says. "By nature, Hispanics on my crews are equally hard workers but more willing to listen and be team players."

While the "steady Eddy" nature of Hispanic workers is well-suited to the goal of safety compliance, some feel their lack of aggressiveness is a liability. One owner of a drywall installation company told me that he wishes more Hispanics would naturally step into leadership roles because they are better at enforcing his company's safety message with other Hispanics.

Building proactive safety leadership qualities in Hispanics while educating non-Hispanics to the significant upside of their people skills, is a key to gearing up an all-inclusive safety management program. As with Gen Me, safety managers should target in advance key Hispanic line workers who can advise the company on how to best engage others in implementing the program. Training these workers with better leadership skills yields a safety return on investment that improves a significantly growing sector of America's industrial workforce.

A Perspective Long Overdue
Moving beyond the days of the wishful hopes of worker compliance demands a radical change to traditional safety management thinking. Generational, cultural and temperamental factors once given afterthought now stand as earmarks of whether a safety management system is fully engaging workers, thus reaching its peak potential.

Frank E. Bird, Jr., and George L. Germain, authors of Practical Loss Control Leadership, must have envisioned this day when they developed their famous loss causation model. They suggest that we examine two main categories to determine the basic causes of loss: job factors (systems and standards) and personal factors (humans).

After years of gearing up safety management programs that are focused primarily on systems and standards compliance, it is the personal factors of culture, age and personality that now show us a better way to achieve total safety.