Tag Archives: credit

New Way to Lower Healthcare Costs

Managers are more likely to limit rental cars to $30 a day than limit an open heart surgery to $100,000 — for ethical and regulatory reasons, many executives steer clear of involving themselves in healthcare decisions, other than selecting the broadest possible network access. But few expenses that executives know so little about matter more than those involved in healthcare do.

This article speaks to a cultural shift that could provide tremendous impact for employers. They can now lower costs while also improving outcomes.

Until now, employers have used two main strategies:

–They offloaded costs to employees, hoping that giving them more skin in the game would reduce their spending on healthcare. But the continuing lack of transparency about healthcare costs, combined with costs that rose faster than employers shifted them, resulted in insurance picking up more cost and consumerism being driven down.

–Employers also invested in wellness programs. But wellness programs are most attractive to the already healthy. And they attempt to reduce how often enrollees encounter the system. But we know that everyone will encounter care at some point. It is each encounter’s volume and cost that is at the heart of this out-of-control system.

The new, better approach was demonstrated in a whirlwind, 48-hour trip I took with some incredible healthcare leaders.

First, we met with the executives of Rosen Hotels in Orlando, who have saved hundreds of millions of dollars compared with average employer healthcare costs. Rosen’s single-digit employee turnover would delight most employers, but it is spectacular in the hospitality industry. Rosen achieves this turnover with a benefit-rich plan most employees would drool over: e.g., no-cost prescriptions, $750 max hospital out-of-pocket.

How does Rosen accomplish this? First, its healthcare thinking is based on what it wants to achieve rather than what it has to provide. Beginning with the CEO, Rosen’s top executives really care about every one of their employees, as evidenced by the more than a few employees who have been there for 40-plus years. (Remember, this is a hotel chain, not a hedge fund with six-digit salaries). The strategies deployed vary, but they mainly support making the highest value care as accessible as possible.

Value—a fair return or equivalent in goods, services or money in exchange for something—is seriously lacking in American healthcare. Rosen took it upon itself to provide healthcare whenever and wherever possible, using its clout to lower costs. The company arranged special prescription drug discounts with Walmart. Rosen has on-site medical directors who personally engage with each employee’s health. The directors visit employees in the hospital and help arrange home delivery of costly specialty medications from lower-cost pharmacies. The company monitors and supports sick employees’ recovery and progress. It also built a health-and-wellness center for all employees and dependents with primary care, prescriptions, fitness instruction and more. I know all this sounds expensive, but the impact far outweighs the cost.

The second part of our adventure involved a flight to the Caribbean island of Grand Cayman, just south of Cuba, a beautiful tropical setting an hour-long flight from Miami (and with direct flights from a dozen other U.S. cities). The morning after our late arrival, we enjoyed the beautiful sunrise for exactly 20 seconds before we were bused to a facility called Health City Cayman Islands (HCCI). The single building on 200 acres (with significant future expansion plans) is clean, new and functional, though it is not nearly as grand as many U.S. mega-hospitals. Now two years old, HCCI is a joint venture between Ascension Health (a non-profit U.S. health system) and Narayana Health, a top Indian health system based in Bangalore. HCCI’s Indian roots are very important, because that country has no national healthcare or insurance system. The Indians have a novel approach to healthcare: You pay for it.

Narayana Health, which has achieved Joint Commission International (JCI) accreditation, performs a volume of procedures unprecedented in most hospitals. This volume is produced by a highly experienced team with quality outcomes that equal or exceed the best U.S. hospitals, but the team does it at far lower cost. Dr. Devi Shetty, Narayana’s founder and a cardiologist who has performed more than 25,000 heart surgeries, is focused on reducing the price of an open heart surgery to $800. (It currently sits around $1,400). Compare that with a 2008 Millman report that pegs U.S. open heart surgery costs around $324,000.

Some employers—Carnival Cruise Lines, for example—are so convinced of HCCI’s value (better health outcomes at far lower cost) that they will pay for all travel, including a family member’s accommodations for the length of a stay, and often waive an employee’s out-of-pocket costs associated with the procedure.

While HCCI’s pricing is higher than its Indian sister facility, many people could afford to pay for HCCI’s care with their credit card, if that were necessary.

HCCI charges a single, bundled fee that covers all associated costs, plus the cost of most complications — the director says, “Why should the patient pay for something if it was our mistake?” Compare that attitude with that at U.S. facilities, which have financial incentives to deliver as much care for as long as possible, and which get paid more if they make mistakes. HCCI’s upfront pricing model creates a serious incentive for efficiency and quality, because the facility is financially responsible for complications, infections and extra tests.

Patients and purchasers (i.e. employers and unions) should realize that nearly all U.S. healthcare—hospitals, doctors, drug companies and even insurance carriers—are structured to benefit from more care, rather than good, efficient or innovative care.

This means that purchasers and patients must use any available levers to get the best healthcare value they can. As Rosen and HCCI have proven, those levers are increasingly available.

Why Credit Monitoring Doesn’t Work

Chances are you have received a letter stating that your personal data may have been compromised. Perhaps you were one of the 80 million people with an Anthem health insurance plan. Maybe you were one of the 21 million current or former employees of the federal government, or you could have been one of the 40 million who shopped at Target. There are countless examples where organizations failed to protect sensitive data and then were required to notify the affected individuals.

These notifications typically reveal how the breach happened, what steps are being taken to prevent another incident and what a company is doing to protect you from identity theft. Most organizations offer some form of credit monitoring and ID theft remediation services. Some states are beginning to mandate at least one year of credit monitoring under certain circumstances.

The Limits of Credit Monitoring

Offering credit monitoring seems to be a necessary post-breach strategy, and the very least a company would do. However, a deeper dive into what it does – and what it does not do – is long overdue.

Credit monitoring immediately notifies an individual that an attempt was made to obtain some form of credit in her name. Credit restoration services are usually offered when identity theft occurs. This is a valuable service that restores a victim’s good credit, saves time and alleviates stress.

Credit monitoring does not prevent identity theft. The only way to prevent an identity thief from accessing a victim’s credit is to either place a 90-day fraud alert on a credit file or freeze credit lines.

  • Fraud alerts require potential creditors to contact individuals before opening lines of credit. To activate a fraud alert, individuals are required to notify one of the three bureaus (Equifax, Experian or Trans Union) and to repeat the process every 90 days to maintain the fraud alert status.
  • ƒFreezing credit can be accomplished by contacting all three credit bureaus and requires each one to place a freeze on an individual’s credit file. Each bureau provides a PIN # that can be used to lift the freeze later. There may be a nominal fee based on state of residence, which typically ranges from $5 to $15. Some states may require an additional fee to lift the freeze. A credit freeze may cost less than credit monitoring and identity theft restoration services. In fact, it has been widely reported that the Office of Personnel Management spent $133 million for three years’ credit monitoring for the 21 million individuals affected by their 2015 data breach.

Legal Ramifications of Offering Credit Monitoring

Offering credit monitoring can cost an organization even more than the dollars spent. In Remijas v. Neiman Marcus, the plaintiffs alleged that 350,000 payment cards were affected when hackers gained access to Neiman Marcus networks. Even though a small fraction of the cards were affected by fraudulent activity, the Seventh Circuit Court of Appeals granted the plaintiffs legal standing, allowing the class action to proceed, because card holders had a legitimate fear of future identity theft. Because Neiman Marcus offered credit monitoring to the card holders after the breach, the court concluded that it was conceding that future identity theft was entirely possible.

The state regulatory environment, coupled with recent appellate
court decisions, leaves organizations in a difficult position. States
are beginning to require credit monitoring following a data breach. Organizations that do not offer credit monitoring face scrutiny by attorneys general, potential fines for non-compliance and a public relations fiasco. Yet those that offer credit monitoring will incur significant costs and, as evidenced in Remijas v. Neiman Marcus, may actually hurt their defense in a class action lawsuit.

A Better Way to Protect Your Identity

A more rational approach is needed to identity protection. Organizations and state regulators reacting to data breaches involving sensitive data elements need to address ways to prevent identity theft. As of this writing, organizations cannot legally freeze a consumer’s credit for him, and have little means to prevent identity theft on his behalf. However, with the full support of state officials, a more efficient process to freeze credit can better protect identities and mitigate costs.

Credit Data Flash Yellow Alert on GDP

In the economic cycle of 2003-2007, one question we asked again and again was, “Is the U.S. running on a business cycle or a credit cycle?” How much of the growth was sustainable, and how much depended on an expansion of credit?

That question was prompted by a series on credit data we have tracked for decades, data that tells a very important story about the character of the U.S. economy. That credit data series is the relationship of total U.S. credit market debt relative to U.S. GDP.

Let’s try to put this in English, because the credit data is sending a warning signal about the U.S. economy.

What is total U.S. credit market debt? It is an approximation for total debt in the U.S. economy at any point in time. It’s the sum total of U.S. government debt, corporate debt, household debt, state and local municipal debt, financial sector and non-corporate business debt outstanding. It very much captures the dollar amount of leverage in the economy. GDP is a very straightforward number: the sum total of the goods and services we produce as a nation. So what we are looking at is how much financial leverage in the economy relative to the growth of the actual economy itself has changed over time. What is clearly most important is long-term trend.

From the official inception of this series in the early 1950s until the early 1980s, growth in this representation of systemic leverage in the U.S. grew at a moderate pace. Liftoff occurred in the early 1980s as the Baby Boom generation came of age. We believe two important demographic issues help explain this change.

First, there is an old saying on Wall Street: People do not repeat the mistakes of their parents, they repeat the mistakes of their grandparents. From the early 1950s through the early 1980s, the generation that lived through the Great Depression was largely alive and well and able to tell their stories. A generation was taught during the Depression that excessive personal debt can ruin household financial outcomes, so debt relative to GDP in the U.S. flatlined from 1964 through 1980. As our GDP grew, our leverage grew in commensurate fashion. Dare we say we lived within our means? To a point, there is truth to this comment.

Alternatively, from the early 1980s onward, we witnessed an intergenerational change in attitudes toward leverage. Grandparents who lived through the Depression were
no longer around to recite personal stories. The Baby Boom generation moved to the suburbs, bought larger houses, sent the kids to private schools, financed college educations with home equity lines of credit and carried personal credit balances that would have been considered nightmarish to their grandparents. The multi-decade accelerant to this trend of ever-increasing systemic leverage relative to GDP? Continuously lower interest rates for 35 years to a level no one ever believed imaginable, grandparents or otherwise. That is where we find ourselves today.

Why have we led you on this narrative? Increasing leverage has been a key underpinning to total U.S. economic growth for decades. Debt has grown much faster than GDP since 1980. For 3 1/2 decades now, in very large part, expanding system-wide credit has driven the economy.

Although U.S. total debt relative to GDP has fallen since the peak of 2008, in absolute dollar terms, U.S. total credit market debt has actually increased from $50 trillion to $60 trillion over this time. Moreover, U.S. federal debt has grown from $8 trillion to close to $18.5 trillion since Jan. 1, 2009, very much offsetting the deflationary pressures of private sector debt defaults. To suggest that credit expansion has been a key support to the real U.S. economy is an understatement.

By no means are these comments on leverage in the U.S. economy new news, so why bring the issue up now?

We believe it is very important to remember just how meaningful credit flows are to the U.S. economy now because a key indicator of U.S. credit conditions we monitor on a continuing basis has been deteriorating for the last six months. That indicator is the current level of the National Association of Credit Managers Index.

As per the National Association of Credit Management (NACM), the Credit Managers Index is a monthly survey of responses from U.S. credit and collections professionals rating factors such as sales, credit availability, new credit applications, accounts placed on collection, etc. The NACM tells us that numeric response levels above 50 represent an economy in expansionary mode, which means readings below 50 connote economic contraction. For now, the index rests in territory connoting economic expansion, but the index is also sitting quite near a six-year low.

In our April monthly discussion, we spoke of the slowing in the U.S. economy in the first quarter of 2015. We highlighted the Atlanta Fed GDPNow model, which turned out to be very correct in its assessment of Q1 U.S. GDP. While the Atlanta Fed was predicting a 0.1% Q1 GDP growth rate number, the Blue Chip Economists were expecting 1.4% growth. When the 0.2% number was reported, it turns out the Atlanta Fed GDPNow model was virtually right on the mark. As of now, the Atlanta Fed GDPNow model is predicting a 0.8% GDP number for Q2 in the U.S. (the Blue Chip Economists are expecting a 3.2% number).

Now is the time to keep a close eye on credit expansion in the U.S. We’ve been here before in the current cycle as the economy has moved in fits and starts in terms of the character of growth. Still, a slowing in the macro U.S. economy along with a slowing in credit expansion intimated by the NACM Credit Managers Index is a yellow light for overall U.S. growth. A drop below current levels in the NACM numbers would heighten our sense of caution regarding the U.S. economy.

Although no two economic cycles are ever identical in character, fingerprint similarities exist. At least for the last two to three decades, the rhythm of credit availability and credit use has been one of those key similarities. Although we know past is never a guaranteed indicator of the future, the NACM Credit Managers Index was an extremely helpful indicator in the last cycle. This index dropped into contractionary territory (below 50) in December 2007. In the clarity of hindsight, that very month marked the onset of the Great Recession of late 2007 through early 2009.

Again, for now we are looking at a yellow light for both credit expansion and the US economy. A further drop through the lows of the last six years in the Credit Managers Index would not be a good sign, but we are not there yet. As always, we believe achieving successful investment outcomes over time is not about having all of the right answers, but rather asking the correct questions and focusing on key indicators. September 2015 will mark the seven-year point of the U.S. Fed sponsoring 0% short-term interest rates in the U.S. If this unprecedented Fed experiment was not at least in part aimed at sparking U.S. credit expansion, then what was it all about?

The 0% interest rate experiment is likely to end soon. The important issue now becomes just what will this mean to U.S. credit expansion ahead? We believe the NACM Credit Managers Index in forward months will reveal the answer.

7 Common Issues on Property Claims

When a property claim occurs, with or without business interruption, it is very common to assume that it will be straightforward. Just submit your invoices, and your insurer sends you a check. You may think, “We can do it ourselves,” or, “We have it under control.” If this has been your approach, you need to read on.

There are many potential issues when preparing a property claim that are commonly overlooked or misunderstood. The challenge is even greater if there is a business interruption component to your claim.

From experience, my partners and I have identified the most common property claim issues that can slow down the claim process and have an adverse affect on recovery.

  1. Repair vs. Replacement

Repair vs. replacement comes up in almost every significant property claim. The issue arises when it becomes a battle of opinions and assumptions. We all know the humor on opinions and assumptions — but your property damage claim is no laughing matter, so let’s explore what can happen.

If you have a replacement policy, you have the option to repair or replace. If it makes more sense to replace with a new and improved item, then you should do what’s best for your business. However, if repairs are possible and at a lower cost, the adjuster will undoubtedly dispute the claim, and you’ll be debating a matter of opinion. When the adjuster’s experts recommend repairs that you know are not guaranteed to work, especially long-term, you face a challenge. As a business, you cannot afford to risk a failed repair, so you elect to go with new equipment with a warranty. The repair option will now be a theoretical scenario that your insurer can leverage to adjust your claim payment. Regardless of the adjuster’s position, you did what was best for your business, but there’s a way to neutralize this potential adjustment.

  • First, the worst thing you can do is proceed on a plan without sharing your logic with the adjuster. Include the adjuster in the initial assessment and decision-making process. While you have the right to do what is best for your business, the adjuster’s involvement and buy-in early on will make her part of the decision and can help to avoid an issue down the road.
  • Next, get several (at least three) independent quotes to repair or replace the equipment — these quotes should include the time, expense and predicted reliability of the repair. If you only get a quote from the original manufacturer, there could be a perception that it has an ulterior motive. Armed with data, you will have an easier time justifying your decision. For example, the repair option may be cheaper, but if it takes longer to complete, it will add to your business interruption claim and ultimately cost more.
  • Finally, perform a realistic analysis of various failed repairs scenarios and the potential impact on timing and costs. Discuss your findings with the adjuster to ensure any subsequent repairs and resulting business interruption would be covered as part of this claim and not a separate occurrence. After all, everything is technically repairable — it is just a matter of determining the most practical solution given all the circumstances.
  1. Betterments

Losses often present opportunities to make useful changes and improvements to operations. Adjusters anticipate this and will be prepared with reasons to limit recovery by labeling certain repairs, reconfigurations, and replacements as betterments. Most of the time, newer is better, and that is why you pay for a replacement policy. However, just because something is better does not mean you should not get full replacement value.

Let’s say you are replacing a piece of production equipment that was damaged as part of your loss. In searching for a replacement, you find that the as-was capacity replacement for your equipment is no longer available and that the alternative equipment has a 10% greater production capacity than the damaged property. In this case, the adjuster may argue for a credit for the increased capacity. Though the new equipment is clearly a benefit to your business, because the exact model that is being replaced is no longer available, you don’t have an equivalent alternative. If required to justify and validate your decision, simply compare the cost/time differential between your decision and a custom order built to spec. In cases like this, you should not be penalized for the betterment.

There are valid adjustments for betterments, but it’s important to understand the difference between a betterment and your rights to a replacement of like kind and quality.

  1. Property Damage vs. Extra Expense

From a policyholder perspective, the types of expenses related to the claim do not really matter because they are necessary to get back in business. The insurance company, however, needs to see expenses segregated into their proper insurance claim buckets. To ensure a smooth claim process, knowing how best to account for expenses is critical to the outcome of your claim. Let’s say you have payroll expenses for cleanup and remediation. If you consider that property and extra expense are subject to different limits and deductibles, it makes good sense to claim them according to your coverage limits. As a rule of thumb, look at the property bucket first for expenses related to cleanup and repair of the property because the extra-expense bucket will offset business interruption, thus allowing you to operate as normally as possible during the indemnity period.

As an example, assume you have production labor working overtime to keep production going and to clean up and repair damage from the loss. This time should be separated as normal labor, property damage cleanup and repair and extra expense. To complicate things further, both normal rates and overtime rates need to be factored into each calculation. Finally, you have to keep detailed records that document the who, what, when and where that is involved in the work being done.

Remember, when appropriate, it’s best to claim expenses as property damage, provided the costs can be documented. It is a more tangible approach and will avoid conflicting with the business interruption calculations for extra expense and inefficiencies, which are based on assumptions and subject to debate.

  1. Actual Cash Value

Immediately after a loss, you are entitled to recover the documented actual cash value (ACV) of your damaged property. You may claim ACV as the amount you are due before exploring replacement options. This is a good tactic if you want to get the cash flowing early in the process while the replacement values are being determined and decisions on replacement are made. However, accurately determining ACV can be challenging.

Typically, the starting point is the asset ledger that shows a depreciated value of the asset. However, this number is usually used for tax purposes and may not represent the actual value of the asset. Other options to value the asset include pricing based on what a willing buyer would pay or replacement less physical depreciation based on the actual life of the asset. These methods vary state by state. Do your research to value the asset appropriately under the circumstances and know that there is not one right answer.

Additionally, some policies allow you to recover full replacement value for assets even if you do not replace them. The policies usually require that you spend the money on a capital project that was not approved at the time of the loss. The capital improvement does not necessarily have to replace capability of the lost assets. If this is of interest, check with your broker about adding this option to your program.

  1. Period of Indemnity Impact

In general, the period of indemnity is the length of time it takes (or should take) to make property repairs. Once repairs are complete or should have been complete, the period of indemnity terminates. While you can, and should, attempt to settle portions of the property claim as you go, any agreements related to the property side of your claim can have a costly impact on the indemnity period for the time-element portion of the claim. It is critically important to address property issues in tandem with time element, to avoid unnecessary recovery issues.

This can be a little confusing. As an example, let’s assume you have a total loss to a piece of equipment, and the replacement cost is known. It would be reasonable to settle for the replacement cost of that equipment. However, the adjuster assumes an aggressive timeline to order and install the equipment, not considering how installation might affect continuing production. When this happens, make sure the timeline and assumptions for installation are clear and acceptable before settling on the cost to replace the equipment. Otherwise, you might get what you want on the property settlement and then lose on the time element.

If you have a separate team working on the property and time-element claims, collaboration is essential to avoid assumption-based adjustments, This becomes especially important when repairs are theoretical, as this will be the basis for the time-element recovery. Always remember to consider all assumptions needed for time-element claims as part of any property settlement.

  1. Residual Value Adjustment

If you have a significant property claim, you may need to purchase equipment or supplies on a temporary basis. The validity of these purchases is not in question, but their use once permanent repairs are made is. For items such as this, the adjuster may look to take a residual value credit. Essentially, the adjuster agrees that you needed that item, but when the permanent repairs are made (and paid for), you will no longer need it. This may be true, but this does not always mean you should not get full value for the item.

For example, you have an electrical loss that will keep you out of business for an extended period. You purchase a generator to provide basic power to areas of your business. When repairs are complete and power is restored, you no longer need the generator but still have the unit. Because you still have it, the adjuster takes a residual value credit. Is that fair?

The first question you need to ask is whether you want to keep the generator. If there is some value to you, a fair credit can be negotiated with the insurance company. If you do not want to keep the item or do not feel the credit is reasonable, you can have the insurance company take possession — after all, the insurer paid for it. If the insurance company thinks it can get value from the generator by taking possession and selling it, the company will probably take you up on this. More often than not, this is not cost-effective, and you can minimize or eliminate the residual value credit.

  1. Documentation

If you have never been through a significant property claim, you might not appreciate the level of detail that is required to document your claim. The general perception is that you gather some invoices and quotes on a sample basis, and that should be enough. Unfortunately, the requirements for an insurance claim are more detailed than most capital projects and audits. Quotes and estimates need to be extremely detailed, and proof of payment needs to be documented almost entirely — if you cannot properly document a claim, it will likely not be paid. It may not be acceptable to the insurance company to use a dollar threshold for charges because the company will insist on auditing 100% of the charges.

To demonstrate the level of scrutiny that claims come under, I refer to an experience I had on one of the largest claims I worked on. The property portion of the claim was close to $200 million. Months of work and tons (literally) of paper were presented to support this claim. During a meeting between the accountants and engineers, one of the engineers made copies for everyone of one invoice presented for payment. He adamantly pointed out that the invoice had been duplicated in our claim submission. It was for one $5 roll of duct tape.

The point is that handling and organizing all the documentation required to support your claim can be daunting. To avoid mistakes, it is advisable to assign a dedicated person or team to locate, scan, print and manage all the support documentation. Bringing in an expert forensic accountant is always a good option to consider, especially for larger, complicated claims or just to relieve your team from these tedious and burdensome tasks. Forensic accountants that specialize in claim preparation may be covered in your policy to work on your behalf. Though you will still have some work to do, your claim will go more smoothly, with fewer pitfalls.

Now you know why property claims are not as easy and straightforward as you might expect. After decades of preparing claims for policyholders, we can attest that what you don’t know comes at a cost in both time and money. We hope the information above can help you prepare for at least some of the issues you might encounter should you have a future property damage claim.