Tag Archives: football

Why InsurTech Should Be Like Football

A podcast I enjoy listening to is “Revisionist History” by Malcolm Gladwell, the author of five New York Times bestsellers, including “The Tipping Point” and “Outliers” (http://revisionisthistory.com/). Episode 6 discussed educational philanthropy and the $100 million gift by American Hank Rowan in the early 1990s to an almost bankrupt school in South Jersey, which at the time had an endowment of only $787,000. Gladwell discusses why no one followed Rowan’s lead. The vast majority of the 87 gifts of $100 million-plus since then went to elite schools like Harvard and Yale, which, arguably, do not need it. What has this got to do with InsurTech? Please indulge me.

Gladwell gives some insights from the book “The Numbers Game” by Chris Anderson and David Sally. The book argues that football is a weak link game—success depends not on how good your best player is but how good your worst player is. This is because, in an 11-player game, the result often depends on mistakes. It is, therefore, better to use your resources to upgrade your worst players rather than spend everything on a superstar player. Superstars like Lionel Messi finish off the efforts of teammates, but people forget about the 10 passes before the great through ball that Messi tucks away—still, those mundane passes are absolutely necessary.

Basketball is the exact opposite of football—it is a strong link game. What matters in basketball is how good your best player is. To deal with Michael Jordan, you might need three players, leaving yourself wide open to movement by his teammates.

See also: Matching Game for InsurTech, Insurers  

The strong link/weak link framework is very useful in thinking about certain types of problems. Efficiency of air travel is dependent on how good the poorest airports, not the best ones, are, as delays in the former have a knock-on effect and can disrupt even the most efficient. Air travel is a weak-link problem.

There are parallels in this framework to the accelerating amount of investment into InsurTech. Most business models I see are looking at addressing strong-link problems—i.e. taking existing products and making incremental improvements, most likely through taking out cost across what is currently a heavily intermediated insurance value chain. In contrast, business models that look at weak-link problems are focused on where that incremental dollar of investment could raise the bar, improve the average and make a real difference to society. These companies are seeking to address the unacceptable protection gap that exists today, using technology to make yesterday’s uninsurable risk insurable and providing solutions to vulnerable communities to help them become more resilient to catastrophes.

More football, please!

The One Thing to Do to Innovate on Claims

If you love football, then you know how frustrating it is to be a football fan. Every offseason, you get excited about the potential for the coming season. Before the season begins, you read all of the articles and watch the analysts.

They all say, “This is the year.” Your team added some of the top defensive players in the league. You’re convinced the team has solved its offensive woes, too. Your team added a star wide receiver, and the running back is looking great in training camp.

Then the season starts, and your team suffers loss after loss. You question how professionals can spend so much time and money on the sport yet fail to improve. As the season continues to sputter, more and more people call for the team to fire the coach. At the end of the season, they fire the coach and hire a new star coach from a great team.

“Next year,” you and the rest of the fan base tell each other.

The next season begins and your team still loses. Year after year, the cycle repeats itself.

When it comes to innovation, insurance company claims departments have a lot in common with your favorite underachieving football team. Top talent in every department. Great recruits from top companies. Lots of talk about the newest technology. But each year you get the same results.

How can you solve this problem?

The One Thing

In “The One Thing,” Gary Keller shares several lessons we should apply to the insurance claims industry. He does so by simplifying the decision-making process. Whether you’re the general manager of a football team or an insurance claims executive, you can apply Keller’s lessons to your situation.

The Six Lies Between You and Success:

  1. The idea that everything matters equally;
  2. Multitasking;
  3. Lack of discipline;
  4. The belief that willpower is always on will-call;
  5. A balanced life;
  6. The idea that big is bad.

These “Six Lies” insurance claims departments. Claims professionals will get what they put in each day. If that’s emailing about hundreds of claims, then claims professionals will get routine claim maintenance. They will not achieve innovation. By making routine claim maintenance the priority, claims departments are falling victim to the six lies standing between the claims department and innovation.

The Four Thieves of Productivity:

  1. Inability to say “No”;
  2. Fear of chaos;
  3. Poor health habits;
  4. An environment that doesn’t support your goals.

While I can’t make any assumptions about whether there are poor health habits in your claims departments (unless your claims professionals are gorging on the vendor-sponsored food!), I can assume that the four thieves should resonate with you.

Insurance claims professionals do what they do because that’s what everybody has always done. No one has ever been terminated for saying “yes” to a responsibility. People who follow the status quo feel safer than people who hinge their success on a business transformation. As a result, claims departments are productive at claims maintenance, but they often leave much to be desired when it comes to innovation.

The Focusing Question

Keller condenses the entire book into what he calls “The Focusing Question.”

What’s the one thing you can do now such that by doing it everything else will become easier or unnecessary?

Good questions are the path to great answers. By combining a small focus with a big goal, the “Focusing Question” provides you with the ideal starting point to achieve something great.

Claims innovation requires starting with “The One Thing” today: giving your best claims manager responsibility for transforming the claims department. While this may sound drastic, it truly is “The One Thing” that will transform an insurance company. I’ve seen it. With a strong leader dedicated to this project, executives will breeze through the process of selecting vendors, identifying key requirements, troubleshooting workflows and handling anything that stands in the way of true innovation.

Once “The One Thing” is addressed, many tasks will follow: assigning a good leader from the IT department, engaging an outside consultant and supporting the department with future-focused software. But until executives dedicate their best claims manager to “The One Thing,” claims departments will suffer from unnecessary obstacles.

Claims departments and football teams will keep underachieving until they get their franchise quarterbacks. You can hire all the star free agents and coach your teams to change, but if your quarterback spends his time focusing on the same old plays, get ready for another year with the same results.

Who will be your company’s Tom Brady?

4 Goals for the NFL’s Medical Officer

On the cusp of the 2015 Super Bowl, NFL Commissioner Roger Goodell surprised fans with an unusual focus for his annual state of the league press conference: player safety. He announced that the league would hire a chief medical officer to oversee the league’s health policies. This is good news. But first and foremost, Goodell must firmly plant the goalposts for this new hire. What does the new top doc need to accomplish to win? Here are four goals to start:

Goal One: Make Concussions Rare

In 2014, there were 202 concussions among players in practice, preseason and regular-season games. With approximately 1,600 players, my back-of-the-envelope math calculates one concussion for every eight players — in one year alone.

The new chief medical officer will have some momentum to build on to address this issue. In recent years, the league has implemented tough restrictions about when and under what conditions players can return to the field after an injury. The league has also improved equipment and changed the rulebook to penalize hits to defenseless players. The number of concussions is down by 25% from 2013, and defenseless hits are down by 68%. The new medical officer needs to accelerate that progress.

Goal Two: Research and Enforce Best Practices

To make a major impact on players’ health and safety, the new medical officer will need to rigorously examine the protocols in place to protect players. No one can argue with the notion that, at its core, football is a contact sport; injury is inevitable. However, some injuries are entirely preventable, yet they can easily topple the career of a valuable player. In my world, we’d call this kind of injury a “Never Event” — it should never happen.

The new medical officer needs to consider how the team functions as a whole, get solid research on best practices and create enforceable guidelines for prevention. To protect past, current and future players, he or she will have to shake up the entire enterprise and institute a culture in which making the play is balanced with protecting the player.

Goal Three: Demand Safety off the Field, Too

One in eight is a frightening statistic for concussions, but, surprisingly, players may be safer on the field than in a hospital. Players — and league employees and their families — depend on the healthcare system just like the rest of us. True, players often receive treatment at elite centers of care, at the hands of celebrated physicians. But our research finds that even places with big reputations can be equally unsafe. One in six admissions to a hospital results in an adverse event, and as many as 500 people die every day from preventable errors, accidents and injuries in hospitals. Even the most highly regarded institutions struggle to keep patient safety a top priority.

But some providers are much safer than others, and the new NFL medical officer has a role to play in helping players and employees pick the winners. He or she can demand data on safety of hospitals and physician practices and use that data in decision-making. The NFL can structure health benefits packages to favor safest providers, encourage performance-based payment models and give employees transparent and candid information on quality and safety to encourage them to select the safest care. Many other employers and unions are successfully deploying these strategies, and they have good tools to help.

Goal Four: Be a Champion

Championship  isn’t exactly a standard element on boilerplate job descriptions, but it’s critical to this one. The NFL knows how to spot champions, and it should expect no less from this new hire.

The new chief medical officer needs to inspire a good number of people: teams, to change the way they function; youth, increasingly wary about the game; retired players, whose health issues cast a shadow over the whole sport; and the millions of fans who love American football.

Being a champion is the most important goal, because the NFL has the opportunity to go beyond defending its safety record and start playing offense. As a top-tier brand, the NFL could be a national leader, ensuring that safety comes first in America, on and off the field. By taking the right steps to protect players and the league, the new medical officer can inspire all the fans, not only to embrace the game, but to champion a healthier America.

This article was originally posted on Forbes.com.

Workers' Compensation No Longer the Exclusive Remedy: RICO on the Radar, Part 2

Understandably, Part 1 of this article series has been met with some controversy and skepticism. The article is not designed to scare employers, as might have been suggested. Its intention is to educate employers about the many issues facing them when an employee becomes injured, that transcend the State Workers’ Compensation System and a workable solution to overcoming the challenges. Employers can no longer afford to bury their heads and rely on the exclusive remedy position. Yes, it may be here to stay, but it is becoming a bit frayed around the edges.

Coincidently, when Part 1 of this article was published, The National Football League (NFL) announced that it had reached a 765 million dollar settlement with players and their families for the settlement and consolidation of approximately 4,500 concussion claims. The players alleged that the NFL hid or ignored the facts that concussions caused brain injuries. Under the settlement, the NFL will pay 675 million dollars to retired players who demonstrate medical evidence of brain injury. Payouts of up to 5 million dollars each could go to players found to have Alzheimer's or Parkinson's diseases or other concussion-related conditions, or to their families. The settlement came just prior to the start of football season and will put an end to the mounting litigation that threatened the multi-billion dollar league.

United States District Presiding Judge Anita B. Brody appointed Judge Phillips to oversee the negotiations. Judge Philips said, “This is a historic agreement, one that will make sure that former NFL players who need and deserve compensation will receive it, and that will promote safety for players at all levels of football.”

 “This agreement lets us help those who need it most and continue our work to make the game safer for current and future players. Commissioner Goodell and every owner gave the legal team the same direction: do the right thing for the game and for the men who played it,” said NFL Executive Vice President Jeffrey Pash. “We thought it was critical to get more help to players and families who deserve it, rather than spend many years and millions of dollars on litigation. This is an important step that builds on the significant changes we’ve made in recent years to make the game safer, and we will continue our work to better the long-term health and well-being of NFL players.”

Once final documentation is completed, the settlement will be filed with Judge Brody, who will then schedule a hearing to consider whether or not to grant preliminary approval to the agreement. The retired players will then have the ability to file objections to the settlement.

One may ask what this has to do with Part 1 of this article.  An important component of this settlement is baseline testing. According to the settlement, baseline medical exams will be provided, the cost of which will be capped at $75 million. This will be a key element in ascertaining the conditions of current and retired players, gauging  the progression of any injuries they may have and having documentation of the medical status. This key component is the subject of Part 1 of this article. Baseline testing is not simply a self-promotion for the EFA-STM, but is a major part of helping injured workers, no matter what their occupations may be.

These cases are just the beginning, and it appears that the exclusive remedy provision for workers' compensation will no longer serve to prevent costly civil litigation as evidenced by the NFL settlement. An employer, insurance carrier/TPA and physician can take several steps to protect themselves. First, evidence-based medicine should always prevail. Objective medical evidence can help protect against claims for fraudulent denials of work-related injuries. Also, employers should accept only claims that arise out of the course and scope of employment (AOECOE). If an employer can objectively document AOECOE issues, fraudulent claims and fraudulent denials can be avoided and most importantly, correct treatment can be prevail.

A good approach to determining AOECOE claims is baseline testing, as it can identify injuries that arise out of the course and scope of employment. When a work-related claim is not AOECOE, as proved by objective medical evidence, such as pre and post assessments, then not only is there no workers’ compensation claim, there is no OSHA recordable claim, and no mandatory reporting issue. Conversely, if there is an injury, the injured worker can get the best site specific treatment and prevent inappropriate treatment and unnecessary progression of the underlying conditions.

The NFL recognized the importance of baseline testing with its recent settlement, and it is only the beginning. MSD for NFL players is also a significant problem. Why not baseline all football players, or, for that matter, all professional athletes, to address any injuries that may occur while playing and return them to the field sooner? This would promote better health and performance and might extend their careers. Professional athletes tend to play through their injuries, potentially causing more harm. An objective baseline test can assist all parties by providing objective medical evidence of an injury and outlining appropriate care. This truly is a win-win situation.

A proven example of a baseline test for musculoskeletal disorders (MSD) cases is the EFA-STM program. EFA-STM program begins by providing baseline injury testing for existing employees and new hires. The data is interpreted only when and if there is a soft tissue claim.  After a claim, the injured worker is required to undergo the post-loss testing. The subsequent comparison objectively demonstrates whether or not an acute injury exists. If there is a change from the baseline, site specific treatment recommendations are made for the AOECOE condition, giving the doctors more information and helping to ensure the injured worker receives the best care possible.

The case of the NFL settlement may not be a RICO claim, but, certainly, it tries the boundaries of the exclusive remedy provision of workers compensation. Baseline tests like the EFA-STM are a proven way to providing better work-related care. It is time for change and to think outside of the box to provide the answers so that we can become proactive, not reactive.