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DATA DRIVES INNOVATION, BUT HOW?

Data flow is a core consideration for any organization, but insurance providers are discovering more and more that their data usage is affecting every aspect of operations. From underwriting to claims assessment, firms have to be able to optimize data analytics and gain actionable insights faster and more efficiently than ever before in order to remain one step ahead of the competition and provide the best service to clients. This is especially true in the medical professional liability field.

Optimizing data usage requires many considerations. According to ComputerWeekly, it is predictive analytics that is delivering the value that firms need, and as such, insurance providers have to invest in a core solution that provides swift, reliable and customizable reports on their data. The main goal here is to drive innovation toward identifying risks sooner and increasing the overall quality of service to customers by weeding out fraud and loss.

With a predictive analytics solution in place, more insurance providers will be able to adapt to the big data trend as well, in order to boost efficiency despite large volumes of information coming in at a faster pace, and the overall restructuring of how data usage has to occur in order to derive the most value.

What data should be used?

In order to optimize data usage with predictive analytics in light of the big data boom, companies have to consider the what, why and how, according to ITPRoPortal. When it comes to business analytics solutions, the first question that needs to be asked is, “What data should be used?” The short answer is “all of it,” but that doesn’t really provide any insights.

For most firms, the key will be to optimize insights by providing as much information to the predictive analytics solutions as possible when generating reports. The advantage is that these tools can handle larger amounts of this resource, as they organize, assess and utilize it faster and more efficiently.

Why go predictive?

With several advanced analytics solutions on the market, some firms may question why predictive is the best way to go. In the professional liability insurance market, being able to predict and avoid loss is far more useful than any other form of analytics, ensuring that firms are eliminating risk and fraud before it happens, rather than reacting to it after the fact. This optimizes the overall returns and helps boost the total quality of service over time, to increase the provider’s reputation and help bring in more clients as well.

With an optimized business intelligence platform, insurers won’t even have to worry about the data being used- simply define the parameters and develop complex, yet easy-to-follow reports every day.

How is the data and analytics trend changing?

This is almost a two-part question, because understanding analytics and big data trends requires knowing how they are evolving and how to optimize the tools used to adapt when necessary. With the right business intelligence solution in place, firms will be able to gain a level of sustainable action that will ensure smooth data usage over time and optimize the insights achieved faster. This leaves more time for assessment and tweaking of the processes as time goes on to ensure that a high standard of quality is maintained.

Modern analytics expectations are plentiful, requiring a strong approach to ensure optimized workflow at all times. Predictive analytics solutions provide that quality and promote growth and profit for long-term goals, not just the short-term demands of the market. By investing now, more insurance providers will have the tools in place and be ready to go when predictive analytics become a necessity rather than an advantage.

 

BUSINESS ANALYTICS DRIVEN BY 3 TRENDS, 1 MAJOR CHALLENGE

Within the insurance industry, the constant evolution of processes is driving growth and a need for improved tools. Underwriting practices have been growing in popularity and some firms are seeing a rise in claims fraud, increasing the need for high-end claims management software. These cases present opportunities to evolve by investing in powerful business analytics solutions and discovering the hidden potential that lies within these processes.

According to Voice & Data, the need for business analytics is being driven by three specific use cases: data trends, technology trends and business trends. Understanding these three areas and how they are affecting an insurance provider’s operations will allow that company to optimize it’s tools and workflow to it’s own unique needs and drive the largest ROI when implementing a business intelligence platform.

The right tech

Utilizing the right technology for business processes in general is becoming a critical consideration for every business in any industry. This is no less true for professional liability insurance providers, and in order to optimize workflow, the right IT infrastructure and analytical architecture are needed. According to the news source, this means finding a solution that increases a firm’s processing power- it’s ability to harness and utilize data faster.

Predictive analytics solutions offer the optimized balance between speed and power that helps providers use more data sooner in order to detect and eliminate fraudulent claims and other risks. Through this method of analytics, firms can optimize the foundation for data usage across the board and their overall BI strategy to reflect the current industry climate more accurately.

Evolving business strategies

When considering new analytics solutions, firms also have to take into account the evolution of their overall business strategies. No company remains the same forever, and for insurance providers, the key to constantly improving service and growing is to ensure that those strategies focus on providing stronger, faster service. A high-end business intelligence solution that helps identify and eliminate fraud sooner in underwriting and claims assessing processes will help firms achieve this goal swiftly.

Use more data

The big data trend is becoming increasingly frustrating for companies that haven’t already adopted the analytics strategies necessary to manage the volume and velocity of information. Predictive analytics will allow firms to organize, sort and use structured, unstructured and real-time data equally well. Optimally, an insurer will be able to incorporate this use in every aspect of operations, but ensuring that it’s benefits affect underwriting and claims management is key.

The big data trend is perhaps the most essential for any insurer to consider when exploring predictive analytics opportunities. According to Claims Journal, the big data and analytics trends present the largest opportunities to gain a stronger position on claims fraud. By being able to examine and put data to use faster and more efficiently, providers are able to consolidate data points and gain real-time, accurate results rather than relying on “judgement-heavy” methodologies that require more time and effort.

Being able to catch fraudulent claims faster doesn’t just reduce the risk of loss for a firm- it optimizes overall customer service by ensuring that honest clients get more attention. Ultimately, this will provide increased returns, boosting ROI from analytics adoption.

These trends and the constant threat that claims fraud presents don’t just provide a firm reason to invest in predictive analytics-based business intelligence solutions. They provide a clear advantage that can be gained by being able to create more thorough reports, assess data faster and move on more efficiently in everyday operations for any provider.

PAGING DR. MATCHBACK: A CASE FOR PREDICTIVE ANALYTICS IN THE MODERN PHARMACEUTICAL MARKETPLACE

The future of predictive analytics is practically written in stone. If any pragmatic organization sees the potential for its business intelligence to expand, the exploration of all tools capable of achieving any degree of marketing advantage is inevitable. Boundaries will be pushed, some broken, some disassembled and re-magined. Business analytics solutions depend on constantly questioning the nature of the data it collects and runs on.

Especially in modern medicine

If the right mile markers are reached – including proper investments in analytics technology – international consulting firm McKinsey & Co. projected a $300 billion annual increase in medical-related profits by 2021, $200 billion of which would be generated from predicted health care cost decreases. Possessing the capability to get ahead of an illness, injury, or surgical complication using predictive data mapping can return untold benefits to patients and doctors alike, benefits that have nothing to do with money and everything to do with the preservation of human life.

But combine predictive analytics solutions with the pharmaceutical industry, and the byproduct is the oft dreaded “matchback.”

What is “matchback”?

Matchback is a process by which pharmaceutical companies circumnavigate age-old patient data protections to optimize consumer-directed advertising strategies while keeping the identity of all parties involved under lock and key – sort of.

When a patient is either prescribed a medication or switches his or her medication, a record is created by the pharmacy that sells the patient in question said medication. Data brokers can purchase these records in bulk, but only if the information has been encrypted.

At the same time, drug manufacturers hire media platforms to distribute an advertising campaign to a target audience, of whom the media platform has already collected information like their name s, home addresses, or telephone numbers. Just like before, this information is encrypted, usually by a third-party IT firm, utilizing the same algorithmic method the data brokers used to code the pharmaceutical record.

The data brokers compare their encrypted records with the IT firm’s. When the brokers happen upon identical patterns from both sides of the aisle, it’s called a “matchback.” The pharmaceutical company can now fuel its marketing strategies and predictive analytics solutions with comprehensive data without ever exposing a patient’s personal information to the open air.

Oaths versus the bottom line
In the practice of medicine, there are certain foundational pillars even the average laymen can rely upon – the Hippocratic Oath of “do no harm,” for one. Arguably another tenet, the pact of doctor-patient confidentiality, may be even more recognizable.

But as big data merges with Big Pharma, have the limits of this restriction evolved with modern medical landscape? Should they? Is it morally reprehensible to fudge medical confidentiality for a better return on investment, or does matchback follow the letter of the law in an effort to provide pharmaceutical providers the same competitive edge predictive analytics solutions gives businesses outside the field of medicine?

A fuzzy consensus

The protection of a patient’s confidential prescription from public scrutiny is – and hopefully will forever be – an inalienable right in the U.S., regardless of HIPAA wording. Yes, the pervasive arm of predictive analytics marketing toes the line around the doctor-patient sacramental safeguard for the sake of advertising profit for an industry already worth more than $1 trillion. For that, plenty are skeptical.

However, if effective, user-tailored marketing is Big Pharma’s only crime, then any saving grace from this encrypted data line dance will have to come from increased public awareness, perhaps even a call for proper third-party regulation and oversight.

That may the hardest pill to swallow for the continued, long-term health of data analytics.

 

CHANNELING POSITIVE OUTCOMES FOR ENTERPRISE MEDICAL PREDICTIVE ANALYTICS

The best thing that companies can hope for when creating the positive situations they want to extract from their clients is a proactive situation that’s better for consumers than what they previously offered. As corporations continue to generate opportunities for enterprise assets in the corporate realm, it’s important for firms to consider the kinds of options that are possible for companies to consider in terms of their financial, personnel, personal and probable needs for business enhancement. When organizations are continuing to create the best options in the realm of corporate operations, it’s a trying situation for firms that want to create enhanced usability without encountering difficulties in the realm of corporate usability.

Tracking trends

According to Recode, there’s more to do these days with enterprise operations and big data options than there used to be with businesses on the best side of resources. That means, in layman’s terms, that there’s more to insurance operations these days than there used to be. The end result is that there’s more for firms to consider in terms of corporate ingenuity and enterprise operations.

As the source noted, there’s an ongoing drive for firms to ascribe to public medical provisions and healthcare needs. These systems help companies increase the prevalence of public insurance claims management as well as promoting more health care oversight. At the same time, such solutions offer merit-free options that can cloud the provisions of public coverage and create more complicated situations for companies to try and contend with. These kinds of situations make for enhanced difficulties in many situations, including medical management and big data analytics procuration.

Creating analytic opportunities

Going along with what Recode stated, the marketplace for diagnostic, analytic and data management options from enterprise information options, like Obamacare and HIPAA oversight, helps increase the need for superior IT insights. The presence of data resources in the corporate landscape allows for better business management and superior enforcement of enterprise safety mechanisms requiring the ongoing curation of corporate resources and financial control.

With public options making a more substantial impact on corporate operations than ever before, it’s important for private insurance providers to increase the viability and appeal of their enterprise offerings, so as to retain and attract target audiences. The end goal is for these firms to ensure that they’re making money while providing superior solutions to consumers than what other operators, be they public or private, can offer their clientele.

Increasing reliability

Rather than honing in on the weaknesses of operations, there’s a need for firms in the modern insurance landscape to look into what helps increase the strength and durability of enterprise operations. When companies are conflicted or required to inquire about what makes companies improve their resources, it’s necessary for firms to ensure that they’re offering the best options to employees without robbing them of the functionality that organizations can earn through targeted big data and analytics insights.

CNN added that the impact of big data and business intelligence in the consumer and corporate world is helping companies increase the effectiveness of their operations without reducing the efficacy of various enterprise opportunities.

Increasing reliance on direct marketing, claims management and business intelligence makes it easy for companies to produce possible and probable outcomes of corporate resolutions. CNN stated that there’s more momentum these days toward integrated solutions that help companies increase the availability of financial, intuitive and enterprise operations. The end result is a more positive corporate landscape that targets the best outcomes for enterprise success

 

PROTECTING ASSETS FROM THE WORST THE WORLD CAN MUSTER

As the global climate continues to shift, more businesses are becoming concerned with how this warming and cooling cycle will impact insurance and medical operations. Human capital requires ongoing investments, insights and ideas to keep it functioning properly, and when companies are looking for positive ways to improve on existing infrastructure, insuring the well being of personnel is the way to go.

Concerning climate

With the world beginning to change its overall composition in terms of seasonal weather and other environmental factors, companies of all kinds are becoming increasingly alarmed about the health and welfare of their employees. As Climate Spectator stated, proper protection against the worst the world can muster is important for firms to keep up with legislation and liabilities from within the corporate landscape.

In some instances, this requires that organizations are aware of what’s happening in the world around businesses. It also demands liability and claims management are aware of the worst that can happen in circumstances where individuals could increasingly fall into harm. In the insurance world, even an “act of God” can be a financial disaster for some corporations.

Learning how to anticipate these kinds of events requires that businesses make best use of analytics and business intelligence opportunities. Big data insights about changing environments, enhanced rainfall, aging infrastructure and potential problems all add up to a better chance for firms to understand what kinds of claims are most likely to occur depending on environmental factors.

Climate Spectator pointed out, for instance, how dozens of regions in Illinois could be facing some significant insurance liabilities and expenses. Due to climate change elements, there’s an increased risk in these areas for advanced rainfall and flooding problems, making it more expensive for insurers to handle these regional claims. Now class action suits are being presented to roughly 200 communities throughout the state, with insurers stating that local governments should have been doing more to prepare their citizens and infrastructure for rising waters.

Participation practices

In these instances, insurance companies can gain greater understanding of what’s likely to happen in a region before it occurs. This helps organizations anticipate the changes their clients need to make and allows for advanced policy management, learning how to best implement safety and infrastructure upgrades in preparation for predicted problems.

Preparing for the worst is an increasingly important policy for more insurers these days, The Huffington Post reported. Big data and business intelligence is having a huge impact on how organizations are able to upgrade their resources and generate stronger solutions to fit with emerging climate change trends. Vulnerabilities like flooding, blizzards and extreme storms can cause significant personal and property damage that insurers will be forced to cover. Knowing what parts of the world are most prone to certain kinds of forecasts can help limit policy changes so that regions and consumers can slowly see their payments ramp up to cover the potential for the worst in these areas.

According to the source, paying attention to public studies and other kinds of information help firms make well-informed decisions and generate stronger leads for how companies should proceed with engineering superior claims management. The Post also added that big data and analytics factors can help mitigate problems from major storms and other kinds of environmental elements. These factors are likely to take on increasingly critical importance as climate change keeps escalating, resulting in a more positive enterprise landscape. While some insurers still see analytics and climate change as substantial challenges, making headway in these areas is critical for enterprise success as the world continues to change.

CHANGE ALWAYS PRESENTS RISKS IN INSURANCE FIELDS

Early in May, 2014, the Louisiana House of Representatives passed House Bill 1069, focused on how average wages should be calculated for professional athletes. However, a side effect of the legislation, which was under review by the state Senate Committee, was a change in how workers’ compensation benefits are calculated.

According to Business Insurance, under the bill; a professional athlete who’s wages are received daily would see an average weekly wage of seven times his or her daily amount on the date of an injury. DeMaurice Smith, executive director of the NFLPA, noted that the bill would substantially reduce workers’ compensation benefits for these athletes. Furthermore, the change could cause the NFLPA to block a proposed NFL playoff extension plan because of the bill, due to a change in working condition for players.

This bill follows suit with one passed in California in 2013 that limited workers’ compensation benefits for out-of-state athletes, after a review found that 78% of the state’s sports-related trauma claims came from out-of-state athletes, resulting in about $1.23 billion in loss for insurers.

“Everybody has known that the problem has been out there, but the increasing number of cases has brought it to people’s attention,” Mark Sektnan, president of the Association of California Insurance Companies, told Business Insurance, at the time of the California bill’s consideration. He went on to note that “as more of these cases that are not appropriate come into the guarantee association … the assessment that employers are now paying might have to be increased to cover these claims.”

For insurance providers, these bills present significant risk. With any change in workers’ compensation laws comes a need to adapt claims management software and policies to insure optimized turn around and risk detection. Underwriting processes have been improving for insurers, but a change can introduce new challenges, and fraud detection and elimination will have to be improved.

Fitch Ratings reported that, despite improving underwriting environments, global insurer outlook was expected to be negative by the end of the 2014. Underwriting profits were solid in 2013, but the firm found that growth in capital and premiums was “muted,” reaching a mere 1.6 percent.

 “(There was) marginal growth in overall insurance premiums as underwriting opportunities are limited,” the report read.

“(However, the ratings outlook is stable,) as the majority of ratings will be supported by strong capitalization and continued declining profitability, with negative fundamental trends largely factored into current ratings,” the firm also noted.

For insurance providers in every field, managing services and optimizing workflow is key to reducing risk and strengthening the foundations that will lead to profit. In order to accomplish these efforts today, firms need to invest in predictive analytics solutions. An advanced business intelligence platform will help insurers focus their underwriting and claims assessment processes in particular, optimizing both fraud detection and overall productivity of staff in these roles.

The right tools for the job are critical in every industry, and for insurance today, these tools are advanced business analytics solutions that incorporate predictive modeling to better leverage big data and the major trends affecting workers’ compensation and other high-risk insurance fields. Such innovation and focus on data will help firms meet their goals succinctly and have room for further improvements over time as needed- enabling both scalability and reliability. The ultimate goal should be for loss prevention through fraud detection, and predictive analytics enhances these risk factors in many ways.

 

DELAWARE SEEMS TO BALANCE WORKERS’ COMPENSATION RATES

The ratio of workers’ compensation rates to medical costs has been off-balance for some time, but lawmakers in Delaware sought to improve the fee structure to help business owners and their employees. A press release noted that the strategy intended to reduce actual medical costs related to workers’ compensation by 33 percent over three years, with an initial 20 percent decrease in January 2015.

“It’s totally out of hand,” said Rep. Gerald Hocker, R-Ocean View, a small business owner himself, regarding the high-costs of workers’ compensation across Delaware. “It’s hurting the economic conditions of this state.”

The task force, designated by state representatives, based the new workers’ comp fee structure off of medical codes used for Medicare reimbursements, recommending that maximum reimbursements do not exceed200 percent of their Medicare equivalent, with some exceptions- 250 percent for radiology costs and 300 percent for surgery needs.

These changes were intended, primarily, to improve the workers’ injury rate and balance the cost of care, but secondarily to help small businesses compete with out-of-state firms for work. Finally, the task force hoped to increase regulations for insurance providers and set up a “ratepayer advocacy” panel that would play a key role in future reforms.

For insurance providers, these changes may seem like a major refocus of operations, but they are driven by a fairly basic evolution of the workers’ compensation insurance field as technology provides stronger risk and fraud protection for the provider. The expectation is that with advanced business analytics solutions, firms should be able to reduce their own losses and pass the savings on to the insured.

In order to achieve these goals and optimize operations around new fee structures, firms will need to deploy predictive analytics to optimize fraud detection, underwriting and other key areas of profitability. These changes will drive efficiency while promoting stronger workflow around loss reduction. From claims management software to the business intelligence platform firms utilize for a broader spectrum of uses, the right data infrastructure will play a critical role in the future success of insurance providers in any state. Delaware’s changes could see similar adoption in other areas, so insurers across the nation need to be prepared to adapt and optimize their offerings around current and future market needs.

DISTRIBUTION MAKING QUIET CHANGE THROUGHOUT INSURANCE INDUSTRY

The trends and technologies that have a major impact on insurance operations range from advanced business analytics to cloud computing services. However, these changes are resounding, being immediately identifiable and measurable. At the same time, there are more subtle influences occurring in insurer operations that are altering how firms approach underwriting, sales, customer service and other key processes. These changes are minor, but affect a major revolution throughout the insurance sector, Insurance Journal recently reported.

“A quiet revolution is underway,” said Kurt Karl, Chief Economist for Swiss Re, which recently published the “Digital distribution in insurance: A quiet revolution” report. “The statistics on e-commerce insurance mask the profound impact new technologies are having on the distribution process.”

These changes are occurring in direct marketing, policy management and sales, according to the news source, affecting nearly every vertical in the industry from professional liability to life insurance. For many, this movement is being driven by secondary trends, such as mobility, big data, cloud investments and more.

The key takeaway is that the models that insurance providers use for service distribution are being primarily affected, specifically the order of operations. Big data and predictive analytics is helping firms perform traditionally post-sales activities earlier, identifying high-risk clients and potential claims fraud swiftly, even signing on more new clients in some cases. This provides faster turnaround, allows providers to decline policies and claims and provide optimized service to the customers that it does take on.

Beyond the improvements being made to internal operations, these trends are affecting the distribution channels that firms have access to themselves. This helps providers reach broader audiences and expand their marketing potential, but it also supports underwriting and claims management software by optimizing the data pool that a firm can pull from and streamlining data into these areas of operation, supporting the risk and fraud detection efforts that will save firms money and improve their customer-facing processes.

These innovations and improvements are directly customer-centric, the news source reported. Through increased transparency and advanced predictive analytics solutions, firms will be able to ply the growth enabled by these trends for more inward-facing growth as well, and ensure that all areas of operation receive adequate attention as technology and workflow are enhanced.

 

DEMANDS OF ANALYTICS CHANGING BUSINESS INTELLIGENCE LANDSCAPE

Advanced business analytics solutions are helping companies in every sector optimize their workflow and ability to drive value from big data. However, as these tools are adopted they are influencing business intelligence architecture, changing the demand placed on systems and data storage, as well as the personnel in charge of these resources. According to TechTarget, these trends are changing the face of business intelligence across the board and influencing new deployments as well as an evolving mindset in analytics operations.

Data warehouses: a center of operations

In the traditional office environment, the water-cooler, or coffee maker, is often the “center” of workflow. Breaks, gossip and collaborative work takes place around it as employees meet on on their breaks. For predictive analytics software, the water-cooler is the data warehouse. All aspects of a business intelligence platform center on where data is stored and managed, making it critical to support the data warehouse as other investments increase. Whenever a firm adopts new analytics solutions, it should ensure that its storage solutions can keep up with the demand being put on them.

Data management determines efficiency

While one major benefit of an advanced analytics solution is the ability to handle raw data more effectively, improving data management resources to “refine” that information can still be advantageous. Speeding up analytics and helping staff assess their data sets more efficiently will drive workflow and expedite business intelligence processes to keep these processes running smoothly even as data volumes increase and analytics grow in power.

The future of insight

With predictive analytics leading the way forward with data insights and value, insurers can already begin to see where the future of business intelligence is headed. Predicting trends isn’t the same as the future, however, and as new tools continue to be developed firms have to be prepared for anything. Investing in high-quality analytics means setting the foundation for that growth and ensuring that operations are prepared for the inevitable exploration and experimentation that comes along with new BI solutions.

Ultimately, analytics has already significantly changed the course of the future of business intelligence. As firms continue to evolve, their needs will expand, and having the right infrastructure in place to cope will be critical, not just for maintaining speed, but preparing for the next step in the evolution of insurance analytics.

DESPITE BALANCING ACT, CHALLENGES REMAIN FOR WORKERS’ COMPENSATION MARKET

Workers’ compensation markets may have improved by a 7 point ratio from 2012 to 2013, but experts expected many of the same challenges to remain through 2014. According to PropertyCasualty360, National Council on Compensation Insurance reported the general growth is a positive sign for the market, with premiums growing by 30 percent and an 8 percent market share. Yet, underwriting losses continued to increase, to reach about $98 million.

“We are finally starting to see an industry in balance with these results,” said NCCI President and CEO Steve Klingel in a statement released with the firms annual analysis of the market. “Today, industry costs are largely contained, claims frequency continues to decline, and the system in most states is operating efficiently. In short, the market is operating as it should on behalf of most stakeholders.”

“Overall, the workers’ compensation line showed a number of positive results in 2013,” continued Kathy Antonello, NCCI Chief Actuary. “Going forward, however, some challenges remain. Slow growth in employment is impeding robust premium growth. And, while investment gains are strong, current yields are likely not sustainable in today’s low-interest-rate environment.”

The optimization of underwriting and claims management software will help insurers continue this balancing trend and growth of the market, but in order accomplish this firms may need to take a second look at the tools they use in these processes. For many, adopting higher-quality predictive analytics may be a necessary step.

With net premiums increasing by 5.4 percent and an operating gain of 14 percent in 2013, workers’ compensation insurers may not feel the need for swift action, but many of the same challenges faced in 2013 remained in 2014, and firms will see that progress begin to slow again. Adopting a powerful business intelligence platform can help bolster operations around underwriting, reversing the loss trend and strengthening these processes.

Ultimately, the risks that insurance providers face are never going to go away. However, by investing in the tools that will enhance fraud detection and risk assessment, firms will be able to approach these risks from a stronger position and minimize the chances of loss. This will ensure a more stable future of growth and maximize the future opportunities the market will bring.

Continued growth and shrinking losses are what insurance firms need to see to around the bend, and start strengthening the economy from their end.