Tag Archives: benefits

Premium Leakage Due to Legacy Systems

When there’s a leak under your sink, do you let it keep dripping or call a plumber? Sounds like a simple question with an obvious answer. But what if you don’t know you have a leak? You’ve gotten used to a high water bill and less water pressure without even realizing how much you could be saving if you found the leak and fixed it. 

This scenario isn’t unlike an issue many of today’s insurance carriers are experiencing called “premium leakage.” Inefficiencies, inaccuracies and risky processes due to the use of legacy systems cause carriers to unknowingly “leak” premium they should be collecting. Fortunately, eliminating premium leakage is simply a matter of looking under the kitchen sink to find the source and taking the necessary steps to stop it. 

Where Legacy Systems Fall Short

The systems we now consider to be “legacy” (i.e. Excel, COBOL or VB6) have been relied on by insurance carriers for decades. For many carriers, these systems are seen as tried and true. Having accepted legacy systems as a way of life, carriers can have trouble noticing their shortcomings. 

But as we look beneath the surface, we can see that legacy systems are causing some of the major pain points insurance carriers face:

  • Multi-entry 
  • Siloed workflows 
  • Inaccurate data 
  • Manual errors 
  • Slow turnaround times 
  • Redundant processes 

These pain points are due to legacy systems’ inability to share data seamlessly across the organization, integrate both internally and with ecosystem solutions and automate rules and regulations. 

The Real Cost of Legacy Systems 

Legacy systems aren’t just painful, they’re costly. A recent FINEOS study shows that an estimated 5% to 10% of insurance premiums vanish every year due to the inefficiencies caused by legacy systems. Premium leakage comes from multiple areas within an insurance carrier’s operations. However, a few spots are notorious for leaking valuable premium: 

Case Setup Inaccuracies

A top culprit for premium leakage occurs when setting up and installing a new employer group on multiple systems that are not integrated. This process requires massive amounts of work-arounds and inevitably results in data inaccuracies across systems. Roughly 5% of annual premium can be lost just in this one area.

See also: Pressure to Innovate Shifts Priorities

Enrollment and Eligibility Management

This notorious source of premium leakage can make or break a carrier’s year. Whether the carrier or the employer is responsible for managing eligibility and enrollment, relying on legacy systems or repurposed solutions (i.e. using a P&C system for anything in the life, accident and health market and vice versa) means the carrier is ill-equipped to properly manage enrollment and claims eligibility. This results in millions of dollars lost that otherwise could fund additional staff, capital investments or strategic initiatives.  

What Carriers Can Do to Fight Premium Leakage 

The solution to eliminating premium leakage is the same as the solution to better mobility and flexibility: strengthening your core. Because legacy systems and custom solutions are inherently prone to premium leakage, carriers must rethink their core system solutions to combat it. 

So, what do these stronger core systems look like? They’re modern and integrated and allow data to flow freely between the carrier and the employer. They’re also purpose-built for the market they serve, enabling the insurance carrier to be a reliable source of truth for current plan and policy information, as well as member data for the employer. 

With stronger core systems in place, the premium calculations for both the employer and the carrier are based on the same source of truth. Further, when an employee is enrolling for coverage the benefits and provisions are accurate and truly reflect what is eligible. This turns into accurate premium being billed to the insured and, most importantly, the right benefits being paid when they are needed. The result is zero premium leakage, and money back toward the insurance carrier’s bottom line.

The Customer Experience Goes Beyond the Monetary Benefits

While monetary recoupment is an exciting reason to tackle premium leakage, there are also customer satisfaction benefits of upgrading from legacy systems. Modern core systems make processes more efficient and yield faster turnaround times on claims for the employee. As most claims are filed in times of serious illness/injury or bereavement, a quickly processed claim can significantly improve a customer’s experience during a difficult time. 

Additionally, the insurance carrier must meet the insured or enrollee where they are. To accomplish that objective, the digital experience offered must come with the same accessibility and ease experienced in most apps available to the insured. Carriers can’t offer a superior customer experience digitally when their technology backbone is made up of older legacy systems that are unable to support APIs or integration. They need modern systems that come equipped with APIs and the data structure to support the insured at all points of the policy lifecycle. 

See also: Insurance Outlook for 2021

Transformation Pays Off

Premium leakage can be eliminated when carriers decide it’s time to look under the kitchen sink, see the source of the leak for themselves and call in the plumber. In this case, the plumber comes in the form of a modern, SaaS-based core system. By addressing the costly inefficiencies caused by legacy systems, insurance carriers can keep the full measure of their projected premiums in their pocket while also providing a superior customer experience.

Trusted Adviser? No, Be a Go-To Adviser

One of the most clichéd claims made in our industry is that of being a “trusted adviser.” Sure, trust is essential. Clients need to trust in your ability to do your job, and they need to trust in your intentions when giving advice.

But is earning trust brag-worthy? Isn’t trust a minimum expectation of the advisor-client relationship?

The real goal should be achieving “go-to” status.

What questions do you want your clients to bring you?

More importantly, what questions are they bringing you now? Not to be an alarmist, but if those questions are limited to insurance issues, your client relationship is in danger.

When asked how they wanted to be viewed, one of our clients responded with the following, “I want to be THE partner my clients go to to ask their toughest questions. I want to help my clients accomplish their intentions.”

I LOVE that! Notice, it doesn’t say their toughest “benefits questions” or even “accomplish their HR intentions.” The commitment is to be the partner their clients go to for help with anything challenging their business.

How cool is that?! Or maybe the idea makes you feel a little uncomfortable?

It is increasingly necessary

If you’ve been in sales for any amount of time, you know it’s more challenging than ever to deliver value to a buyer. Heck, if you were selling a year ago, you see how much more difficult it became because of the pandemic.

The increased challenge to deliver value started way before 2020, though. There are many reasons, but one stands out.

Buyers no longer depend on a salesperson to learn about a product or service.

Not only that, buyers don’t want to talk to anyone until they decide they’re ready. They will self-educate on their own terms and at their own pace.

It’s not that they don’t eventually want to talk to a salesperson, but buyers are now way further into the buying process before they go to a salesperson with questions. This means the value bar has been raised significantly for salespeople. The further you’ve advanced on the value spectrum, the more important your eventual conversations will be.

How are you perceived?

If you want to know how prospects/clients perceive and categorize you, look no further than the questions you are asked.

Vendor — “Can you get me a better quote?”

If you are mostly getting price questions, you are viewed as a commodity.

Insightful Seller — “Can you help me effectively communicate my benefits program and deal with compliance issues?”

At this level, salespeople understand the commoditized product offering so well they can help buyers get more value from it than if they bought it from someone else.

Educational path to this level — Instead of studying your products and services’ features and benefits, study the problems they solve.

Trusted Adviser — “Can you help me better understand what solutions I should be considering and show me how to use them effectively?”

Salespeople at this level are selling the problems they solve rather than the products. The best at this level aren’t even really selling; the buyers trust they can help them make better buying decisions.

Path to this level – Study and implement a consultative selling process that makes the buying process more manageable.

Strategic Adviser — At this level, questions start to become, as you might guess, strategic. “You seem to understand our industry and the current business environment; what can we be doing to compete more effectively?”

These advisers bring a new perspective to the buyer and help them see things they hadn’t seen before, like environmental challenges and opportunities.

Path to this level — Study a specific industry or the business environment, in general.

Go-to Adviser — At this level, clients pull back their curtain and share their most vulnerable self. You know you’ve arrived in the relationship when asked, “We have some internal growth pains. Can we talk about suggestions you would have to get past them?”

Go-to advisers have proven their ability to address the challenges and opportunities a buyer faces internally, challenges that buyers don’t see on their own even though they are surrounded by them daily. Even if buyers do see the challenges, they don’t know how to address them.

Path to this level — Study business operations: marketing, finance, strategy, processes, everything it takes to run a successful business.

Challenge yourself to pursue the various educational paths along this value progression. By doing so, you will put yourself in a position to be that go-to relationship for your clients. Talk about a game changer!

See also: 3 Tips for Increasing Customer Engagement

You don’t have to have all the answers

If the idea of being “the partner your clients go to with their toughest questions” makes you uncomfortable, it shouldn’t. Just because they come to you with their toughest questions, it doesn’t mean they expect you to have all the answers.

To become a Go-to adviser, you only need to be willing to participate in conversations that lead to the answers.

I suspect you already take this approach in a much narrower way. If you are a benefits producer, you may find yourself in compliance conversations that reach your knowledge limit. At that point, you bring in a compliance specialist. Or perhaps you find yourself deeper in HR topics than you can handle, but you are comfortable because you know where to pass the baton.

A problem-solving framework

If you follow the educational paths mentioned earlier, you’ll create a foundation that can support a Go-to relationship. With that knowledge foundation in place, the following framework will be an effective way to help your prospects/clients think through any challenge they bring you.

1. Define the goal by asking, “If we were sitting here celebrating a successful resolution, what are some of the specifics we would be celebrating?”

This question will provide clarity as to what they want/need to accomplish.

2. “What are the PEOPLE issues you need to deal with to achieve a resolution?”

Maybe they have toxic people on the team; perhaps they need new people, or maybe they need to train those they have.

3. “What PRODUCT/SERVICE issues need to be addressed?”

Maybe there is a deliverable to be created, upgraded or even abandoned.

4. “Are there PROCESS issues standing in your way?”

It could be they have the answers they need but aren’t operating in a consistent, process-driven manner.

Will the complete answer be apparent with these questions? Probably not. However, by defining the goal and evaluating the people, product and process issues that determine success, you will help the prospect/client find clarity about what needs to happen next.

Your role as a Go-to advisor isn’t so much to give specific answers; it’s more about asking additional questions to reveal the path leading to the answer.

Is all this necessary?

You could make an argument that this type of progression isn’t necessary. I wouldn’t agree with you, but you could make the argument. After all, you will win the occasional deal based on price alone. Don’t fall into that “easy” trap.

It does take hard work to progress. However, every level you advance toward Go-to status provides exceptional ROI:

  1. It reduces the amount of competition.
  2. The buyer becomes less sensitive to price.
  3. You shorten the sales cycle.
  4. Your retention rate increases.
  5. You will find it easier to access decision-makers.
  6. The level of credibility you bring to the conversation will grow exponentially.

So, I’ll ask you a “not tough” question. Is it worth it to become a Go-to adviser?

Seems like a no-brainer to me.

This article was originally published here.

5 Trends for Employers to Watch in 2018

Advanced planning and preparation, strategic global thinking, shifts in legislative landscapes and sound technology investments are on the minds of most industry leaders as we move into 2018. As an extension of its own thought leadership program, Sedgwick has identified key trends that are likely to affect risk management and benefit decisions in the coming year.

To stay on top of issues that may affect our clients and industry partners throughout the year, we took a close look at internal research and colleague observations, external exploration and employer discussions and in-depth market monitoring of current and emerging risks. We will continue to watch and offer our projections on these potentially defining movements, classified into five categories:

  • Compounding global risks
  • Shifting tide of policy
  • Bridging the gaps
  • Leveraging interdisciplinary care
  • Improving experience through technology

Compounding global risks. An unusually high number of natural disasters in 2017 underscored the need for organizations to have a strong disaster recovery plan in place. Establishing strategic partnerships that can support an effective business continuity plan is critical. Preparation and action must occur before, during and after a catastrophe if an organization is going to recover and resume operations in a timely manner.

Additionally, the continuing threat and prevalence of emerging risks are expected to push the boundaries of organizational resources and resiliency. Cyber threats like data intrusion and ransomware are evolving and multiplying as the global economy becomes increasingly connected. As we continue to see terrorism, both international and domestic, in the headlines, it underscores the need to prepare and protect our people and property.

During these turbulent times, society’s reliance on first responders as a line of defense against risks of all types becomes even more critical. Caring for first responders’ overall physical and mental health is one way communities and businesses can increase preparedness for debilitating crises. Several states have taken up legislation aimed at increasing coverage for first responders. Organizations can anticipate that, as coverage grows, so will the need for specialized claims, managed care and disability services.

See also: Industry Trends for 2017  

Shifting tide of policy. Businesses can look for leave programs to expand in response to demand from their own employee populations, faced with the need to care for their own health and the welfare of their families. Parental leave, caregiver leave and other paid leave programs are on the rise; several states have already introduced new family-friendly paid leave bills, and others are clarifying and expanding regulations for leave benefits. This trend is expected to continue as the population shifts.

More than ever, vigilance is needed for employers to maintain compliance with continuing changes in the Americans with Disabilities Act, Family and Medical Leave Act and other connected federal, state and municipal laws. Throughout 2018, organizations can expect regulatory complexity to increase and fines and litigation to be a looming threat for non-compliance. Many organizations are facing policy changes and compliance demands with a renewed willingness to collaborate across disability, leave of absence and workers’ compensation teams.

It is impossible for organizations not to feel the impact of the prescription drug crisis on their workforces. The costs – personally and financially – of the misuse and abuse of opioids place undue burdens on society. Governmental agencies, pharmacy retailers and employers continue to look for ways to take back control through such means as legislation, drug formularies and first-fill limitations.

Bridging the gaps. Throughout 2018, organizations will seek new ways to bridge gaps in knowledge and services based on evolving needs and preferences of consumers. Organizations are joining in the race toward on-demand, self-service innovation to provide immediate resources to those in need. The infusion of machine learning and artificial intelligence is advancing many capabilities by automatically sifting through mountains of data, allowing service providers to detect patterns faster and formulate valuable insights to improve the quality of the customer experience.

Organizations are also seeking new ways to bridge diversity gaps. Different generations and populations have different needs when considering health concerns, technology, communication preferences and resources. We must address changing demographics within the workforce and determine how to better adapt practices to accommodate and support differences.

Focusing on the claims industry specifically, insurance carriers, third party administrators and self-administered employers must broaden the knowledge and capabilities of today’s claims professional. As seasoned professionals begin to retire, bridging the talent gap becomes increasingly important. Training of claims professionals must expand beyond the traditional claims process. Claims organizations must look holistically at how examiners are addressing the needs of their clients and consumers and how their part in the process affects the bigger picture.

Leveraging interdisciplinary care. The movement toward a whole health approach increases trust and engagement and places less influence on individual providers in favor of a more holistic, consensus view of treatments and interventions. As more employers embrace principles of advocacy, empathy and responsiveness, they are using centralized support to link teams and resources with a common focus on quality care. With this shift, organizations look forward to continued improvement in the consumer experience and stronger physical, emotional and financial health for employees.

We are seeing more businesses embrace integrated programs as a means to address the shared challenges of healthcare, return to work and compliance. In addition, the importance of data connectivity within organizations and across providers will grow as organizations work to avoid information gaps, optimize care and avoid potential dangers.

Interdisciplinary cooperation is also important as a means for exploring alternatives for pain management. Organizations can anticipate more collaboration between employers, physicians, claims specialists and patients as they move away from long-term drug prescriptions, looking instead toward alternative therapies and weaning techniques to help injured workers regain their health and productivity without the risk of addiction.

See also: 3 Technology Trends Worth Watching  

Improving experience through technology. Technology helps employers engage workers throughout their recovery, maintaining a stronger connection while they are away from work and making the process easier for them to understand. Better communication and improved access to on-demand care can help improve the claims experience, and increased consumer satisfaction is leading to accelerated outcomes and better overall health.

Telemedicine and other remote access offerings are still on the rise and evolving as other “tele” services are added to the mix. Eliminating some of the barriers of distance and time, these resources are connecting patients with the right providers for initial and follow-up treatments for minor injuries and illnesses, as well as support resources throughout the claims process. Chatbots and avatars are becoming more prevalent as support and service options for all lines of business. The industry is even seeing potential for these tools as virtual health coaches for workers’ compensation, disability and wellness programs.

Employers can also expect to see the claims industry reach the next level of decision optimization and use technology to deploy intervention strategies in real time. Analytics will influence next-generation methods for addressing all types of claims and be used to predict those that will become complex or incur large liability losses, anticipating care and pharmacy needs, prescribing appropriate steps toward resolution and facilitating return to work.

While the year ahead may bring challenges, it also brings a renewed sense of hope and excitement. As these and other trends materialize and develop, those who have anticipated and planned ahead will be in a position to capitalize on opportunities as they arise. Sedgwick will continue to guide our clients and the broader industry by tracking topics and trends like these that may affect employees, customers and businesses.

To read more, visit Sedgwick’s Navigating 2018 webpage.

5 Mistakes CFOs Make on Healthcare

Which sounds worse: getting shortchanged by a cashier at the grocery store or losing your life savings to a Bernie Madoff-type investment?The answer is obvious. Still, it’s a good metaphor for how to manage your healthcare investment and, more importantly, the glaring flaws in how healthcare is administered and delivered.

First, some background. The Employee Retirement Income Security Act of 1974 (ERISA) was designed to protect employee benefits, including health plans. The person exercising authority over a health plan is a “fiduciary” and legally bound to act in the best interests of the participants.

But, according to a recent article, chief financial officers (CFOs) are facing millions of dollars in personal liability suits due to a lack of “fiduciary oversight.” Whether the cause is negligence, omission or imprudent management, the result isn’t good: a potential lawsuit for the company and executive, mishandled or wasted money and shortchanged employees. Throw the Department of Labor into the mix (it’s been keeping a close eye on 401k plan fiduciaries in recent years), and the choice is cut-and-dried: Most companies need to up their game.

See also: A Way to Reduce Healthcare Costs  

Here are the five biggest mistakes CFOs make when designing, purchasing and managing their health plans.

1. Taking a gamble.

CFOs of middle-market companies are gambling with the organization’s healthcare by taking 19 to 125 times more risk than they should. Why would any organization risk $500,000 or $1 million when it can reduce exposure to less than $8,000?

It’s even more shocking at large companies when the bottom line is exposed to unnecessary healthcare overspending. Healthcare managers wager millions of dollars by ignoring reducible risk, and the mistakes hurt the bottom line. C-suite executives are surprised when I explain why “best practices” don’t work—until I show how many millions of dollars are trapped inside their healthcare budget.

2. Surrendering responsibility to unqualified departments and managers who don’t have P&Ls.

I always ask CFOs one simple question: “By a show of hands, who would hire a HR-level executive to lead a $100 million division of your company?” No CFO has ever raised a hand.

Yet the company’s healthcare investment is often treated as an operating expense that’s delegated to operations managers who don’t have the time or expertise to make the best-informed decisions. Too often, these decisions end up in the hands of consultants who, most often, will take a boilerplate path of least resistance by recommending “best practices” that only major in minor outcomes.

3. Not all healthcare costs are created equal.

For many, health-plan management falls outside standard business supply chain cost-control strategies. So, shift perspectives: Negotiate the highest utility for every dollar invested in the healthcare supply chain. Hospitals, outpatient surgery centers, physicians and pharmacy account for more than 90% of claims, and all can be negotiated. Successful cost reductions must focus on four areas: wasteful spending, excessive fees, poor quality and non-transparent pricing.

Who in his right mind would shop at a grocery store and fill up two carts, then leave knowing he’ll receive a bill 30 days later and only then be told how much everything costs? Well, that’s how most healthcare works.

4. Not involving senior executives.

I always ask CFOs: “Which two ‘best practices’ are most effective in reducing the frequency and severity of your claims this year?” The CFO soon realizes that, despite a legacy of best practices, there has been negligible improvement, with millions left on the table.

The CFO must be directly involved and recognize that healthcare investment is a capital allocation strategy—it requires the supervision of an executive with P&L responsibility.

5. Not knowing what you’re paying for.

Most CFOs don’t know whether their company’s medical plan pays retail, wholesale or institutional charges. Like with a 401k, it’s a CFO’s fiduciary responsibility to know the healthcare broker’s and consultant’s total compensation.

It’s imperative to ask the right questions to uncover where your dollars are going. Familiarize yourself with fees, commissions, bonuses, overrides, incentives, profit sharing, contingent fees, expense reimbursement allowances or performance-based compensation—because they all add up.

See also: Healthcare Debate Misses Key Point  

Being uninformed can cost your company a lot of money, or worse. When explaining in court that you consistently supervised and overpaid by as much as 10x for a poor-performing, low-quality medical plan, ignorance is no defense.

So there you have it: five common mistakes to avoid when buying healthcare. Take ownership, talk to an expert and educate yourself on sourcing the best solution for your company. You really can’t afford not to.

‘Alexa, What Is My Deductible?’

When it comes to adoption of technology, simple is most often better than complex. Steve Jobs and Apple went to great lengths to make their products simple. Without user adoption, products fail. Current technology trends continue the move toward simplicity with the advent of artificial intelligence and personal assistant tools like Amazon’s Echo and the Google Home. Before you know it, these tools will enter the benefits world. The question is, who is going to be first and best? And if I am a benefits broker, how does this affect my business?

While many brokers are aware of the vendors that call on them or have booths at industry conferences, I believe the benefits technology race is going to heat up, with new competition entering the market. These new competitors see the market opportunity to automate large segments of our economy, including health insurance and healthcare. You may have heard of some of these companies, like Microsoft, Google, Salesforce.com and Apple. This would be in addition to current leaders such as ADP and Paychex. The stakes of the game will change, and the price of entry, from an investment standpoint, is in the hundreds of millions of dollars. Those with the capital will quickly outpace those with less capital.

Don’t be surprised when you start to see major mergers and acquisitions in the HR and benefits space. Could Microsoft buy Ultimate Software? Why not? Microsoft already purchased LinkedIn and recently hinted at getting deeper into the HR space.

See also: Could Alexa Testify Against You?  

When I look at products like the Amazon Echo and Google Home, I see products that have very quickly grabbed market share, with high rates of adoption. My wife, who is not an early adopter of technology, quickly became a user of Google Home. Why? Because it is easy. Would she have a better understanding of her health insurance if she could simply ask Google? Absolutely!

Benefits technology, on the other hand, has not had broad adoption by employees. Yes, employers have bought systems or brokers have given them away, but when you look at utilization on the employee side it is abysmal. I believe the reason for this is because there is not enough value as a stand-alone solution to generate broad adoption. Keep in mind that the majority of people hardly use their healthcare in a given year, so there is little need to access such a system. I don’t know about you, but I can hardly remember the login to my computer, never mind something I may not use for six months.

The next generation of technology in the HR and benefits area is going to have broader and “everyday” value, while being much easier to use. Market-leading vendors, especially those with a great deal of capital, will invest in the latest technologies to try to win the technology race and gain more customers. And before you know it, you will be saying the following:

“Alexa, is Dr. John Smith from Boston in the Blue Cross network?”

“Ok, Google, request Friday off from work.”

“Hey, Siri, how much does the average office visit cost?”

“Alexa, what is the balance of my 401k?”

“Ok, Google, transfer $500 from my savings to checking.”

The advancement of technology and artificial intelligence has enabled many to have more personalized user experiences. Your Amazon Echo will “get to know you.” Maybe in the near future your doctor will get to know you a little better, too.

Many benefits brokers have chosen some technology vendor with a mission of putting as many clients on the system as possible. This is a risky position competitively as more advanced solutions from highly capitalized companies come along. I don’t know many sales people or business owners in any industry who like running around with the eighth best product. Even more so when it is not necessary. The market and your customers do not care if you have invested thousands of dollars on some technology that may quickly fall out of favor.

One should take the advice of Jack Welch, ex- CEO of General Electric, who once said,

“If the rate of change on the outside exceeds the rate of change on the inside, the end is near.”

For those who have purchased the Amazon Echo or Google Home, you don’t have to look far to see that the outside world is changing faster than the inside. The health insurance and healthcare industries often feel like they are moving at a snail’s pace. Private exchanges were lauded as change, when they really are a reincarnation of cafeteria plans from the ’80s.

See also: Why 2017 Is the Year of the Bot  

With the Trump administration, changes in health insurance legislation may create a shift that empowers the consumer. The industry may need an army of people on the front lines to help the industry move to a whole new paradigm. The vendors will need help and the employers, and employees will need it, too. The technology is there. Alexa is ready. Are you?