Tag Archives: 2014

Survey: Predictive Modeling Lifts Profits

The breadth and depth of predictive modeling applications have grown, but, of equal importance, the percentage of participants reporting a positive impact on profitability has dramatically increased, Towers Watson’s most recent predictive modeling survey finds.

Our 2014 Predictive Modeling Benchmarking Survey indicates the use of predictive modeling in risk selection and rating has increased significantly for all lines of business over the last year, continuing a long-term trend. For instance, in the personal auto business, 97% of participants said that in 2014 they used predictive modeling in underwriting/risk selection or rating/pricing, compared with 80% in 2013, a 17-percentage-point increase. For standard commercial property/commercial multiperil (CMP)/business-owner peril (BOP), the number jumped 19 percentage points, to 51%, during the same time period (Figure 1). In fact, the percentage of participants that currently use predictive modeling increased for every line of business covered in the survey.

Figure 1. The use of predictive modeling in risk selection/rating has increased significantly for all lines of business over the last year

Does your company group currently use or plan to use predictive modeling in underwriting/risk selection or rating/pricing for the following lines of business?

Sophisticated risk selection and rating techniques are particularly important in personal lines, where models have now penetrated most of the market. An overwhelming 92% of survey participants cited these techniques as essential drivers of performance or success. To a significant degree, this was also true for small to mid-sized commercial carriers, with 44% citing sophisticated risk selection and rating techniques as essential and another 42% identifying them as very important.

Even as the use of predictive modeling extends to more lines of business, there is an increasing depth in its use. Predictive modeling applications are increasingly being deployed by insurance companies more broadly across their organizations as their confidence in modeling increases. For example, 57% of survey participants currently use predictive modeling techniques for underwriting and risk selection, and another 33% have plans to use them over the next two years. Although a more modest 28% currently use predictive modeling to evaluate fraud potential, a sizable additional 36% anticipate using it for this purpose over the next two years. Survey participants report plans to deploy predictive modeling applications in areas including claim triage, evaluation of litigation potential, target marketing and agency management. These applications will favorably affect loss costs, expenses and premium growth.

THE BOTTOM LINE

Eighty-seven percent of our survey participants report that predictive modeling improved profitability last year, an increase of eight percentage points over 2013 (Figure 2). The increase continues a pattern of growth over several years.

Figure 2. Companies implementing predictive models have increasingly seen favorable profitability impacts over time

What impact has predictive modeling had in the following areas?

Slide 9 of Executive Summary

A positive impact on rate accuracy helps explain the improvement. In fact, the percentage of carriers citing a positive impact on rate accuracy has increased every year since 2010, when 70% cited a positive impact. In three of the past four years, the percentage-point increase in carriers citing a positive impact has hovered around 10%. In this year’s survey, nearly all (98%) of the respondents reported that predictive modeling has improved their rate accuracy. Improved rate accuracy has both top- and bottom-line benefits: It boosts revenue because it enables insurers to price more effectively in very competitive markets, retaining existing customers and attracting potential customers with rates that accurately reflect their level of risk. At the same time, rate accuracy drives profit because it also helps carriers identify and write more profitable business,and not focus solely on market share and price.

More accurate rates also improve loss ratios, which have improved in parallel, according to our survey participants. In 2014, 91% of survey participants cited the favorable impact of predictive modeling on loss ratios, an increase of 14 percentage points over 2013. When premiums more accurately reflect risk, losses are more likely to be properly funded.

TOP-LINE GROWTH

The bottom-line fundamentals — profitability, rate accuracy and loss ratio improvement — identified in our survey are complemented by top-line benefits. Positive impacts were registered on renewal retention (55%), underwriting appetite (46%) and market share (41%).

THE NEXT STEP

Sophisticated risk selection and rating are cited as essential by many of our participants, but our survey indicates that, despite favorable trends, insurers are still far from leveraging sophisticated modeling techniques to their fullest, even in pricing. Two-thirds of participants aren’t currently using price integration (the overlay of customer behavior and loss cost models to create metrics that measure different rate scenarios) for any products. A few are past price integration and are currently implementing price optimization (harnessing a mathematical search algorithm to a price integration framework to maximize profit, volume and other business metrics) for some products.

The disparity between what is viewed as the optimal use of modeling techniques and the current level of implementation needs to be bridged if insurers want to leverage predictive modeling as a competitive advantage to identify and capture profitable business. Increasingly, insurers are making greater use of analytics including by peril rating (which replaces rating at the broad, line-of-business level with specific rating by coverage), proprietary symbol (customizing vehicle classifications for personal automobile policies) and territorial and credit analysis.

Those insurance companies that can’t employ sophisticated risk identification and management tools face the possibility of losing profitable business and adverse selection.

MORE PROGRESS IS STILL POSSIBLE

Profitability is hard-earned in the current competitive property/casualty market, and predictive modeling is recognized by a steadily growing number of companies as an invaluable tool to improve both top- and bottom-line performance that ultimately reflects in earnings growth. Our survey suggests that insurers are increasingly comfortable with predictive modeling and are using it in a growing number of capacities. However, participant responses also indicate that there are still many benefits offered by predictive modeling and other more sophisticated analytical tools that have not been achieved, such as treating data as an asset and more effectively using predictive modeling applications to improve claim and other functional results. Improving performance on these issues alone could make a significant difference in the profitability of insurance companies and offers all the more reason to explore new ways to benefit from data-driven analytics and predictive modeling.

ABOUT THE SURVEY

Towers Watson conducted a web-based survey of U.S. and Canadian property/casualty insurance executives from Sept. 3 through Oct. 22, 2014. The results discussed in this article represent the views of 52 U.S. insurance executives. Responding companies represent a significant share of the U.S. property/casualty insurance market for both personal lines carriers (17%) and commercial lines carriers (22%).

2014: The Future Is Coming at You Faster Than You Think

Without a doubt, 2014 will be a pivotal year for the insurance industry – a new future is dawning, reshaped more quickly than expected by powerful influences such as customer expectations, forces from outside the industry, and technology. We will see the acceleration of these influences. 

This pace of technology change, challenging decades of business traditions and assumptions, is unprecedented in the history of the insurance industry. The industry’s biggest technology disruptions and changes usually came along every decade or two, from the introduction of mainframe computers in the 1950s and ‘60s, to the personal computer in the ‘80s, to the Internet and e-business in the late ‘90s and early 2000s, and the first iPhone/smartphone in 2007. 

Now, changes are coming every month, with new technologies, the mash-up of technologies and new uses for these technologies. There are next-gen technologies such as mobile, cloud, data and analytics, telematics and collaboration tools. There are emerging technologies such as 3D printing, the Internet of Things (billions of devices that talk to each other without human intervention), drones, driverless cars, and wearable devices. The speed of experimentation, innovation and adoption will intensify. Insurance will begin to be redefined and reshaped, from the inside as well as from outside the industry.

As other industries have experienced, from retail to books, music and movies, the insurance industry is finding the very foundations of the business being challenged, requiring new thinking, experimentation, innovation and adoption of the new technologies. To respond to this continual disruption, insurance leaders will create a culture and model around continuing collaboration and ideation that extends outside their organizations. Legacy business assumptions, operations, systems and culture will begin to fall away. 

Increasingly, insurers will recognize that tracking and assessing the potential and use of next-gen and emerging technologies (both within and outside the industry) will be paramount to their competitive advantage and long-term survival. But insurers often lack the time, expertise and resources to track details of technology trends, follow outside industry perspectives, find and access research and case studies and stay current on trends outside the U.S. market. Insurers will increasingly look at creating and participating in an ecosystem of outside experts and resources to capture the potential, inspire their leadership and enable their journey of change, transformation and innovation. 

The journey toward reinventing insurance has started, whether you are on the road or not. No business, regardless of its size, can go it alone and expect to completely take hold of all the possibilities. It will be interesting to see the innovation ecosystems that emerge to help fully capture the potential, change legacy cultures and enable the ideas and technologies to be put into operation uniquely within each insurance organization.

Workers’ Compensation Issues to Watch in 2014

Rates Continue to Climb

In most of the U.S., rates for workers’ compensation insurance are continuing to climb, driven by rising medical costs, the low-interest-rate environment and the general unprofitability of the line of business.  This is in spite of the fact that many states have undertaken regulatory reform aimed at controlling medical costs and driving costs out of the system.  Despite significant investment in medical management efforts, workers’ compensation costs are consistently higher than group health costs for the same diagnosis. Why is this? Numerous studies have shown that a small percentage of medical providers are driving a large percentage of the workers’ compensation costs. Implementing treatment guidelines, drug formularies and utilization review protocols is a step in the right direction. However, until regulators find a way to remove abusive medical providers from the workers’ compensation system, high costs will always be a problem. Rather than treating the symptoms, we need to address the causes of rising costs.

The Potential Expiration of TRIPRA

Unless Congress takes action, the Terrorism Risk Insurance Program Reauthorization Act (TRIPRA) will expire on Dec. 31, 2014. Carriers are now writing coverage without the backstop of TRIPRA. What does this mean to the workers’ compensation industry? Companies with high employee concentrations in certain cities are already seeing fewer options, with some carriers scaling back their writings to reduce their exposure to a potential terrorism event.  Some carriers are setting policy expiration dates to coincide with the expiration of TRIPRA or are advocating for unilateral mid-term premium increases if TRIPRA is not renewed or is materially modified.  Many workers’ compensation underwriters are pushing for higher rates because of this issue.  If TRIPRA is allowed to expire, companies in certain industries and geographic areas may have no option but to obtain future coverage from their state funds as the commercial marketplace pulls back to avoid the increased risk.  The longer it takes Congress to act, the more pronounced this issue will become.

Impact of the Affordable Health Care Act (AHCA)

There has been much speculation about the potential impact that the ACHA will have on workers’ compensation.  Some feel it will increase leakage from group health to workers’ compensation, while others feel it will have the opposite effect. One thing for certain is that with increased coverage being provided on the group health side, the overall utilization of services will go up. With a finite number of medical providers available, this means it is imperative that workers’ compensation payers identify the providers who deliver the best clinical outcomes for injured workers. The focus on workers’ compensation medical networks in the future will need to shift from fee-for-service discounts to quality of care and best outcomes. This may cost more on a fee-for-service basis, but getting appropriate and timely care will generally lead to faster return-to-work, ensure the proper treatment and ultimately lower costs.

Integrated Disability Management

More employers are realizing that the impact of federal employment laws like the Americans with Disabilities Act (ADA) and the Family Medical Leave Act (FMLA) must be considered on workers’ compensation claims. Companies are also realizing the value of managing non-occupational disability so that valued employees can get back to the workplace and be productive. As a result, companies are requesting that their TPAs develop integrated disability management programs designed to handle both occupational and non-occupational disability in a consistent and effective manner. These integrated disability management programs are the next generation of claims handing and will expand in the future.

State Legislative Issues

Several states that passed significant reform legislation in the last two years are working to implement those reforms. Passing a law is only the first step, as the rules, regulations and implementation of those laws determines if they will achieve their intended purpose. The most significant issues to watch are in California, New York and Oklahoma.

When California passed SB 863 in 2012, the expectation from the state’s legislature was that it would increase benefits to injured workers while lowering costs for employers in the state. While the benefit levels for permanent disability have been increased, the savings components are still a work in progress. Litigation and unanticipated consequences of the bill have resulted in increased complexity and continually rising insurance rates.  For example, a significant component of the intended cost savings was to result from the new Independent Medical Review (IMR) process.  However, in recent months the volume of IMR requests has been many times what was anticipated, preventing the IMR provider from meeting the required turn-around guidelines and adding significant administrative costs to the system.  Based on their analysis of the higher costs, the California WCIRB recommended an 8.7% pure premium increase for 2014. There is currently talk of potential clean-up legislation to go along with the continued efforts at implementation. We will know by the end of the year whether SB 863 will be able to produce the promised cost savings.

New York streamlined its assessment process, resulting in a significant reduction of the assessment rate for most employers. These rates are adjusted annually and have varied significantly in the past few years.  It remains to be seen if these assessment savings will continue into the future.  In addition, New York has been struggling to implement the reforms that were passed in 2007 legislation, and it was 2013 before the last of the regulations were issued for this law. This 2007 bill was another piece of legislation that promised cost savings that have yet to fully materialize.

The big news in Oklahoma is the bill that allowed employers to opt-out of workers’ compensation starting in February 2014. The Oklahoma Supreme Court recently upheld the constitutionality of the legislation, clearing the way for its implementation. However, there have been delays in developing the rules and regulations supporting the opt-out plans, and this has in turned delayed carriers’ development of policies to cover new benefit plans. It appears unlikely that everything will be in place so that employers will be able to opt out beginning in February. In addition, the Oklahoma legislation included significant reforms to the underlying workers’ compensation system, so many employers considering opt-out will wait to see the impact these system changes will have on their workers’ compensation costs before proceeding.

Vendor Consolidation

In the last few years, there has been significant vendor consolidation in the worker’s compensation industry. First on the TPA side, and most recently on the medical management side. Much of this consolidation was driven by private equity investments where the tremendous medical spend in workers’ compensation is seen as an opportunity for a profitable return on investment.

All this consolidation is making buyers of these services uneasy. They question how this consolidation will affect the quality of the services they receive and wonder how their goals of reducing costs align with private equity’s goals of increasing revenues. These are legitimate concerns, and it is imperative that buyers remain vigilant concerning vendor partners.

Analytics

Despite the huge amount of premium, exposure and claims data produced by the workers’ compensation industry, many complain about the lack of actionable information. Dashboards and many other analytic tools do a nice job pulling data together in one place, but ultimately the data is only as good as what one does with it. As an industry, we will see a continued focus on the use of more meaningful analytics that can assist in identifying savings opportunities, formulating action plans and measuring the impact of change.

Assessing Return on Investment for Medical Cost Management Efforts

In the last few years, the money spent on medical management has been steadily increasing.  Programs including bill review, utilization review and nurse case management are all necessary components of any successful workers’ compensation program. However, it is important that these programs are constantly monitored to ensure they are being utilized appropriately. If left unchecked, these “cost-saving” issues can actually become cost drivers.

Impact of Presumption Laws on Municipal Budgets

In 2013, there were a handful of municipalities that filed for bankruptcy because of large underfunded workers’ compensation and pension obligations. This trend is not only likely to continue, but could get worse. The presumption laws in most states can turn common health conditions like heart disease and cancer into workers’ compensation claims. In California and Nevada, for example, a large number of retired police officers and firefighters are collecting both their pension and the benefits from a workers’ compensation presumption claim. The statute of limitations for linking these diseases to the workplace has been extended to more than 10 years in some jurisdictions. The resulting burden for paying the costs of these benefits in the case of public entities ends up falling on taxpayers.

Medicare Set-Asides

Many felt that the passage of the SMART Act in January 2013 was the end of the battle on Medicare Secondary Payer compliance issues. In fact, this was just the beginning of the fight. Implementation of the SMART Act has been slower than expected and the legislation did nothing to address the huge costs associated with Medical Set-Aside arrangements. The rules and case law associated with Medicare are constantly evolving, and now it appears that these reimbursement rights will be expanded to Medicaid coverage, which would create an entirely new monitoring and compliance area.  This is an issue payers need to remain diligent on.

Please join me on Jan. 15, 2014, for a Marsh-sponsored webinar to discuss these issues and other potential legislative developments to watch in 2014.  Click here to register.