Tag Archives: amy radin

Getting Back in Step With People’s Needs

The origins of life insurance show up at least as long ago as the Middle Ages, when the notion of providing mutual aid emerged in organized structures. People came together via benefit societies for those in need and for the good of all.

Similarly, modern-day carriers originated with mutual ownership – a construct that prioritized maintaining an asset pool to cover claims at any time, including ones that might occur decades in the future.

A lot has changed. The top 25 life insurance carriers, which control 72% of the market, are largely public companies, so they must serve the demands of shareholders, not just policyholders. State, federal and global regulatory authorities watch over insurers’ moves with many goals – a big one being financial stability of carriers. But these efforts do not solve a problem highlighted in this year’s Insurance Barometer StudyOne-third of American households would have an immediate problem paying basic living expenses if the primary breadwinner died. And an additional one-third has no idea what they would do should they find themselves in this situation.

See also: What’s Next for Life Insurance Industry?  

Ask people inside the sector the question, “Why doesn’t everyone buy the coverage they need, and may even know they need?” Responses are variations on three themes: (1) potential buyers perceive the products as too expensive; (2) they don’t understand how insurance works and what its value is; and (3) they put it low on the priority list relative to other financial commitments.

None of these explanations is flat out wrong. But settling for them risks derailing innovators from solving a problem that will continue to affect people in need and the rest of us, too. It is a problem worth solving.

Insurtech has become a hot sector, but life insurance gets relatively limited focus from either startups or investors. Why? Experts offer a few theories: It is complex — loss curves run for decades. Unlike auto and home insurance, there’s no requirement to own life insurance — so there is no definite group of buyers. Asset growth in this economic and regulatory environment has become trickier. Capital requirements are tougher. And maybe founders and funders themselves don’t want to look death or the greatest personal catastrophe in the eye.

While these reasons sound plausible, there is a way to think about how to uncover sources of value and solve a marketplace and social problem hiding in plain site. Here is a proposed three-part plan:

1. Reframe the problem.

Life insurance has historically addressed the problem, “What if I die too soon?” The questions asked now about financial health sound more like, “How can I be sure I’ll cover my monthly expenses given my earnings?” “How will I ever retire?” And, “What if I live too long?” Fears about dying too soon have been pushed down the priority list. In an era of longer life expectancy and lower inflation-adjusted income for many Americans, the new priorities are smart. Consider, therefore, how to solve these problems. Listen to people’s desire for products that pay the living, provide coverage for long-term care and medical expenses and are designed with far greater transparency than today’s living benefit products. (Try to read an annuity contract, and you will get the point.)

2. Understand what motivates people.

Loss aversion theory, first proven by Nobel Laureate Daniel Kahneman and colleague Amos Tversky, demonstrates that people prefer to avoid loss rather than pursue the opportunity to realize an equivalent gain. No surprise, then, that confronting one’s mortality is a topic to be avoided — it is the ultimate loss. This is especially the case given that many see no upside to buying a life policy: “When I win, I lose.” There will be traction for those innovators who can get to a nuanced definition of “trigger events,” beyond the tired and obvious ones. Trigger moments are when people will be more likely to evaluate the loss/gain relationship in a new light.

See also: 8 Start-ups Aiming to Revive Life Insurance  

3. Don’t just play around the margins of what already exists.

Be open to the possibilities that: (1) Potential buyers who say your product is too expensive are trying to tell you that the price/value relationship is weak. (2) People don’t understand the value of many life insurance products because these products are too complex. (3) In a world, where people fear the consequences of living too long, a product that focuses on one’s death seems out of step. Test the receptivity for product concepts that include living benefits and allow people to make tradeoffs among features.

On the critical path: (1) cracking the code to combine delivering value to the buyer and financial feasibility all the way through claims payment, (2) executing with minimal fine print and (3) creating products that can be distributed through a cost-effective, multi-channel platform that leans digital/call center, innovates on commission structures and defines a new agent archetype.

It’s Time for Some Lemonade

Irrespective of your sector of interest or whether you are in the market for insurance, take a few minutes to watch this video, Science Behind Lemonade, and the App demo. There has been so much hype about the Lemonade launch over the past months, but this is the real deal in insurance disruption. It offers lessons for any innovator, as well as any incumbent thinking it can somehow sidestep the possibilities of technology.

See also: InsurTech Boom Is Reshaping Market  

A few specific stand-out attributes and accomplishments:

According to PropertyCasualty360.com, 66% of 18- to 29-year-olds rent their homes (vs. 37% overall), and 70% do not have renters insurance. What a smart move to make renters core to the V1.0 offering. Lemonade is introducing itself to a receptive market with a large unmet need in an easy-to-understand experience. This will, no doubt, be Step One in a longer relationship as the younger generation’s insurance needs become more complex.

Lemonade has broken the win/lose basis of traditional insurance. When I conduct research interviews with people who own or seek to buy insurance, it’s not uncommon to hear things like (literally), “when I win, they lose,” or vice versa. Aligning interests between the person buying insurance and the insurance carrier reframes the relationship, and can reinstate trust in one of the least trusted of all sectors.

Lemonade takes the sector back to the original concept behind insurance as it first appeared, all the way back in the 19th century — pooling funds so members of a community can cover for each other in times of crisis.

The intelligent use of UX + data + virtual agent to have a truly personalized, relevant conversation results in giving people something they need. This is as far from product-pushing as one could imagine is possible. (Note: Renowned behavioral economist Dan Ariely is part of the Lemonade team.)

Lemonade is surely an exemplar that will be studied — with attempts to imitate — within the insurance sector and beyond. But be warned that simply putting lipstick on a pig won’t work. The fact that Lemonade has been built from the ground up, driven by authentic purpose, will make imitation hard.

See also: Be Afraid of These 4 Startups  

A stat shared at a conference yesterday, which you may have already heard: 70% of millennials would rather do business with Google, Facebook or Amazon than with a traditional financial institution. Insert “Lemonade” into that sentence.

Kudos for a true disruptor for having the tenacity and focus to make a statement about what insurance can be. I’ll be shopping as soon as the company offers coverage in my state!

Health Startups Go After 3 Pain Points

In my last post, I outlined the four dimensions that are defining the opportunities for health insurtech innovation: the health of the American people, marketplace trends, the role of regulation and the players.

Incumbent health insurers are pursuing legacy tactics to compete in the ACA world. There are big M&A approved (Centene/Healthnet) and facing regulatory challenges (both Aetna/Humana and Anthem/Cigna). Many are increasing premiums. Others are leaving the public exchanges (notably, United Healthcare withdrew earlier this year, and Aetna just announced its withdrawal from 11 of the 15 exchanges).

Innovators addressing the root of user pain points can influence how plans are selected and healthcare is consumed. The levers are not easy to move. Success requires compliant ways of combining big data analytics and personalization with user-centric digital experiences.

The headline of a recently published New York Times article, Cost, Not Choice, Is Top Concern of Health Insurance Customers, would seem to state the obvious. Yet insurers have expressed surprise at the policy mix and which plans are proving to be most popular. Carriers participating in the public exchanges report poorer actual performance than anticipated in premiums (lower) and claims (higher). Users are gravitating toward lower-cost plan options and show a trend to self-select into higher-cost plans when they know a big health care expense looms.

This is not just an issue for incumbents. Oscar, among the most visible innovators in the US health insurance marketplace, reported a $105 million loss in 2015. Lack of scale is a challenge, but the company has also been affected by the user decision-making dynamics affecting established carriers.

See also: Matching Game for InsurTech, Insurers  

The results suggest (at least) three pain points:

1. People don’t see value because they don’t understand what they are buying.

  • When people think something is too expensive, it is because either they cannot afford it (i.e., it really is too expensive) or the perception of value does not justify the price.
  • Reportedly one in seven employees do not understand the benefits being offered by employers, of which health insurance is by far the biggest piece.

2. People are being held accountable for health decisions that they are not equipped to handle.

  • Faced with a complex set of choices and opaque information, it is no surprise that many go for the easy option: saving money now.

3. People don’t always make rational decisions.

  • A basic primer in behavioral economics will tell you that emotion, bias and other limitations — not rational analysis — drive decisions and that people discount perceived upside relative to downside. There is not enough upside to pay more in the short term.

Players who manage to affect these behavioral drivers stand to gain. Here are examples of companies working the issues.

Connecting disparate sources of data

PokitDok creates “APIs that power every health care transaction.” They aim to enable data connectivity across the silos that in today’s world require manual navigation. They define an ecosystem including Private Label Marketplaces, Insurance Connectivity, Payment Optimization and Identity Management. The company closed a $35 million B round last year. PokitDok is a pure technology play. Achieving their vision could be the “holy grail”: better economics and better patient experiences and outcomes without owning underwriting risk.

Helping employers

It hasn’t been lost on the startup world that 150 million employees purchase health care via employers, which is why many companies are focused on improving the benefits buying experience and promising to help employers lower costs. The ACA requires that all companies with more than 50 employees offer health insurance. This aspect of the regulation, coupled with the fact that health benefits expense has risen steadily, provides a specific and large innovation space.

Competitors include:

Lumity, who reported raising $14 million last fall, acting as an insurance broker. The company claims to be “the world’s first data-driven benefits platform for growing businesses” promising to simplify benefits selection for employers and employees. Employees are asked to provide health data, which are compared with aggregate profiles using proprietary algorithms. The big question: Will employees see enough benefit to share potentially sensitive information?

Zenefits, recovering from widely publicized regulatory issues, has new leadership. The company acts a broker, and focuses on small businesses.

Collective Health is targeting a wide range of businesses via “ready-to-go,” “configurable,” and “advanced” solutions. The employee experience components of the offering are aimed at helping users make better-informed decisions with less hassle.

SimplyInsured aggregates health insurance plan options for small businesses to make comparisons easier, and aims to automate processes presumably essential to creating a viable cost structure for serving this segment.

See also: InsurTech Need Not Be a Zero-Sum Game  

A number of benefits consultants including Aon and Towers Watson (the latter via their acquisition of Liazon in 2013) offer larger employers private exchange capabilities – these include portals for employee benefits enrollment enabled by data analytics and a friendly user interface. They act as or engage brokers to create benefits plans tailored to employers’ goals. Such portals can be helpful to employees, and check a box for employers seeking to improve the benefits experience, not just reduce expenses.

Health Advocate, founded in 2002, is the largest example of a relatively new industry positioned to help patients navigate an increasingly complex system towards the right care and reimbursement. The question being raised around these solutions – although as the de facto advocate within my own family I’d love to have a professional advocate to whom I could outsource – is whether they are a workaround adding yet another layer of expense to an industry that earns among the worst customer satisfaction scores of any. As an employer, however, it’s a benefits option that could be valuable given the stress of managing the health care process many employees undergo.

Motivating people to adopt healthier habits

Vitality, reported on in an earlier post, is a cobranded platform offering deals and rewards designed to motivate people who take steps towards better health. Hancock offers the HumanaVitality program, integrating Vitality’s rewards program into the insurance relationship. If people see near-term benefit to behavior change this could be a good use case upon which to build.

Facilitating patient payments to providers

Patientco is a “payments hub” supporting “every payment type,” “every payment method,” “every payment location.” Focus is on efficiently increasing revenue for providers, secondarily to improve the payments experience for patients. The company provides the ability to integrate its solution with other health technology solutions.

Providing better experience capabilities to carriers

Zipari is a customer experience and CRM platform providing a product suite including enrollment, billing, and a 360-view of members across engagement channels. The company targets is product line at insurers, both direct-to-consumer and group or employer channels.

See also: Be Afraid of These 4 Startups

The multiple miracles that would have to occur for a quick fix make it unlikely that we will see a simple, logical health insurance experience any time soon. We are relatively early in what is likely to be a long game. But, insurtech innovators and even more mature companies operating within and around the sector are demonstrating the capacity to go after the possibilities that data, technology and the ability to see creative solutions offer to mitigate the pain.

Can InsurTech Make Miracles in Health?

As an American and the de facto administrator of my family’s health insurance, I am reminded routinely of some of the complexities of the methods we employ to maximize health and pay for care in this country. Forces are driving individuals, providers, insurers and employers to change their approaches or suffer the consequences.

InsurTech companies that take aim at the U.S. healthcare industry by using software and data to improve efficiency and outcomes can benefit from this opportunity. Depending on whether you are an optimist or pessimist, the healthcare sector is the land of endless opportunity or unsolvable problems. Because the scale is huge, even small steps forward, aimed at opportunity pockets, can translate into significant wins.

Let’s view the situation through four lenses: the health of the American people, marketplace trends, the role of regulation and the players. You can unpack any one of these and understand why Venture Scanner has identified more than $26 billion in funding that is being poured into 1,300 health-technology companies across 21 categories and 48 countries. The issues and implications arising from any of these categories are intertwined, so even startups focusing on health insurers cannot disconnect from what is happening in the rest of the ecosystem. This post focuses on health insurance in the U.S., not the broader healthcare space or other geographies, because the U.S. is a) a massive market and b) a different structure from markets in Europe and Asia).

Americans, overall, do not live a healthy lifestyle

The U.S. came in last place in a 2013 ranking of affluent countries’ health in a Mayo Clinic Proceedings study that included four factors in its definition of “healthy lifestyle”: diet, exercise, weight and smoking.

Americans are getting fatter. More than one-third of the adult population is obese. Every single state has an obesity rate of more than 20%, adding an estimated $200 billion to the national healthcare tab.

A piece of good news from the Centers for Disease Control is that the percent of adult smokers has dropped steadily from 42% in 1965 to 17% in 2014. The trend among students has been less stable, but generally downward, peaking at 36% in 1997 and dropping to 16% in 2013.

This is a huge and shifting marketplace

Consider just a few dimensions:

  • Healthcare spending represents 18% of the U.S. gross domestic product, $3.2 trillion, or about $10,000 per person. As the population ages, government spending in the sector is expected to increase. Also consider that 30% of Medicare dollars go toward the 5% of beneficiaries who become very ill and then die each year.
  • Employers are taking action to shift costs to employees, and slow spending. Employers provide coverage to 150 million Americans. And, according to the 2015 Kaiser Family Foundation total average annual premium per employee has increased from $5,791 to $17,545 since 1999. Employees are being asked to pay more, or to avoid doing so by trading down to high-deductible plans. This creates near-term savings back to healthy families who don’t run into any medical surprises. What is rarely highlighted, however, is how many families are effectively assuming the financial risk of facing a large deductible in the event of, say, an unanticipated hospitalization. Because 62% of Americans have less than $1,000 in savings and 21% have no savings, the potential is real for individual families to face serious financial consequences as a result of this choice.
  • Only one in seven Americans understand the insurance plans selected yet are held increasingly responsible to manage decisions that could have implications not only for cost, but also for quality of life.
  • Insurance carriers have benefited from ACA (Affordable Care Act aka Obamacare, formally named the Patient Protection and Affordable Care Act) because of how the statute has expanded the market and provided premium subsidies for lower-income households. At the same time, insurance companies remain the least trusted of the healthcare subsectors.

Regulations focus on changing behavior, protecting patient data and stimulating innovation

ACA, signed into law in 2010 and upheld by the Supreme Court in 2012, is watershed legislation that set the sector up for reinvention. ACA takes both a carrot and stick approach to increase coverage and care effectiveness while lowering costs, e.g.,

  • If as a user you don’t purchase coverage, you face penalties.
  • If as an employer of 50-plus people you don’t offer coverage, you face penalties.
  • Health care providers are being given incentives to make “meaningful use” of electronic health records to create efficiencies and improve care decisions, and face penalties if they fail to use such tools
  • Primary care providers and general surgeons are being given incentives to move to low-coverage geographies.

These are just a few examples of how ACA is attempting to get people to change how they select, use and administer healthcare payments and services.

Two other regulations affect health insurers:

  • The Health Information Privacy and Protection Act, better known as HIPAA, the privacy, portability and security rule designed to protect patient health information, while improving data portability. HIPAA affects how data is stored, protected, used and transferred.
  • The HITECH Act (Health Information Technology for Economic and Clinical Health) was enacted to support the development of a nationwide health IT infrastructure, as well as define and maintain standards for health information technology products and how they interact with each other.

Any health care player — incumbent, startup or investor — must understand how the regulations work

For those who question whether ACA might be repealed, consider that, while this year’s election suggests anything can happen in politics, there have been more than 50 failed attempts by Republicans in Congress to undo the legislation. So, better to understand how the incentives and disincentives relate to any potential new business model, and appreciate how big a departure ACA’s core principles are from the traditional way in which the U.S. healthcare system has operated. The latter is vital to understand the dynamics of the new playing field and how individuals, providers, insurers and employers are responding.

The winning business models will be those that exhibit four characteristics:

  • Link to the regulatory levers – carrots and sticks for individuals and providers – and move them. This is where the commercial value lies.
  • Prove they can deliver better outcomes at lower cost.
  • Demonstrate potential to scale, by itself, via B2B partnerships, or via exit to a scale incumbent.
  • Have a viable basis for underwriting and risk management.

Success will be a function of software + data + tactical knowledge of the levers – both the regulations and how to motivate behavioral change where people are being asked to make radical changes.

The Start-Ups That Are Innovating in Life

In my last post, I provided categories within which to organize the innovation players within life insurance. Both start-ups and legacy businesses are pursuing solutions to industry pain points. Attention is being paid to distribution, product, client experience, speed, productivity, big data, compliance and other areas within the life category where inefficiency exists or where client needs are not met today.

The very complexity of life insurance will be a deterrent, at least in the near term, to the volume of innovations versus what we have seen in other areas of InsurTech. Much of the innovation, including the examples presented here in my April post, aim at specific issues with the current model for life insurance, versus taking a clean-sheet approach.

Entrants into the space aim to solve adviser problems, become the new intermediaries between the carriers and the client or assist the carriers themselves. For their part, carriers are funding and leading transformation efforts. They know they must adapt, but because it’s almost impossible to drive massive change from within an established business model and culture, it is likely that start-ups creating differentiated value that avoid becoming mired in complexity can do well.

Here are examples of opportunities:

Adviser conversations will move from the kitchen table to digital channels.

The Global Insurance Accelerator aims to drive innovation in the insurance industry. Of note in GIA’s 2016 cohort is InsuranceSocial.Media, a tiered offering that automates adviser participation in social media. Based on a user-defined profile, advisers are provided with algorithm-driven content that they can distribute via their social media identities.

Hearsay Social is a more evolved startup also enabling adviser social media. The company boasts relationships with seven out of 10 of the largest global financial services companies, among these New York Life, Pacific Life, Farmers and AXA. Hearsay addresses the compliance requirements that carriers have so their advisers can participate in social media: (1) archiving every instance of social media communication and (2) monitoring all adviser social conversations, intercepting compliance breaches. While not sexy, this capability is critical and commands C-suite attention.

An early-days market entrant also targeting adviser digital presence, LifeDrip claims to offer an automated marketing platform, including a personalized agent site, targeted content, signals on client readiness to buy and product recommendations.

Advisers as intermediaries are unlikely to disappear any time soon, but their role, engagement approach and capabilities must be more tech-savvy to appeal to virtually any consumer segment in this market with buying power. Expect additional new entrants that continue not to write off live intermediaries, and bring to market solutions to reshape the adviser relationship.

See also: How to Turn ‘Inno-va-SHUN’ Into Innovation

The new intermediaries are digital.

Smart Asset promises to simplify big financial decisions, including the purchase of life insurance, with an orientation toward how people make these decisions vs. pushing product. Shoppers can input data to a calculator and determine a coverage target; they are then encouraged to request a quote from New York Life. Smart Asset’s experience will be more credible when it includes multiple providers. It will require marketing investment to scale participation. Its basic approach could appeal to a large segment that will demand simple, low-cost product.

PolicyGenius has developed a consumer-friendly interface including instant quotes for life, as well as pet, renters and long-term disability insurance, following completion of an “insurance checkup.” As with other start-ups, this is a data-gathering exercise undoubtedly important to the company’s business model. AXA is an investor in PolicyGenius; the site promotes several major carriers as product providers.

Slice Labs is worth calling out because it is a direct-to-consumer play defining itself against a specific, important market segment – the 1099 workforce whose growth is being stimulated by the “on-demand economy.” Think not only about the Uber and Airbnb phenomena, but also the reality of more Americans moving away from traditional employer relationships where automatic access to benefits was a given.

Carriers will be viewed as start-up clients.

All of the companies mentioned already focus in and around the acquisition of new clients. InforcePro offers an automated solution for agents and carriers providing insights into sales opportunities and potential risks that exist within their current books.

Why does this matter? Insurance contracts are inordinately complex – even for the experts. Carriers and agents, particularly in recent years, have been forced to focus more heavily on maximizing the performance of the policies they have issued, versus just trying to sell more. The focus on the relationship with the policyholder has been skimpy. Life insurance policyholders can cancel a policy but cannot be “fired,” and represent continuing exposure, as their future claims can be on the carrier’s balance sheet for decades. With the risks and potential value now more obvious, in-force management has become a priority for focus and investment.

See also: Start-Ups Set Sights on Small Businesses

Carriers will drive efforts to innovate beyond incremental moves.

Haven Life owned by Mass Mutual but operated separately is a digital business whose product line is term life up to a $1 million benefit. The company operates in more than 40 states and represents a bold move for a 165-year old carrier. Nerdwallet rates Haven’s pricing as “competitive” – not the cheapest but well within range.

What is interesting about Haven is that it is not just implementing a shift of the same old approach to digital channels: Quotes are available in minutes, and coverage can become effective immediately, with the proviso that medical testing be completed within 90 days of policy issuance. In this space, this approach represents meaningful experience innovation.

Last year, John Hancock initiated an exclusive relationship in the U.S. with Vitality, marketing a program that gives rewards to clients who demonstrate healthy habits such as having health screenings, demonstrating nutritious eating habits, getting flu shots and engaging in regular exercise. Rewards range from cash back on groceries to premium reductions. This program is strategically significant because it aims at prevention, not just protection, linking preventative behaviors that clients control to cost savings.

Numerous carriers are participating in innovation accelerators, establishing their own incubators or forming dedicated venturing and innovation units. It remains to be seen which of these are what a colleague refers to as “innovation theater” and which are for real — drivers of new business opportunity. As with any early-stage plays, their stories will emerge over years, not quarters.