Keith Moore

Lots of insights here at Insurtech Hartford! Bob Frady nailed it once again in his latest round table: 🔹On the siloed nature of insurance: "Getting claims and underwriting together is like playing 23-and-me: Yes, you guys really are are related!"🧬 🔹About predict and prevent: "I mean, the best claim is the one that never happens at all ... right?"🔮 We couldn't agree more - let's work together as an industry and get claims under control. We can do this! #ihs2024 #customerengagement #claims #underwriting

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"What would happen if you got hit by a bus?" That was a question my old Chief Underwriting Officer (Matt Frazier) asked a lot. Classic underwriter, right? But he had a point. The real question is: What would happen to your operations if you—or someone else critical to your team—suddenly disappeared? Most operations teams think they’re prepared, but when it comes down to it, they’re one unexpected absence away from chaos. Here are 3 ways I've learned to “bus-proof” a team: 1️⃣ Simplify everything. Complexity is the enemy of resilience. If a process feels like a maze, break it down. 2️⃣ Document every process. If it isn’t written down, it doesn’t exist. SOPs keep things running even when people don’t. 3️⃣ Cross-train as many of the team as possible Teams that are cross-trained can step in without friction when someone is unavailable. And here’s a 4th way to truly “bus-proof” your operations: 4️⃣ Invest in automation. Digital assistants and automation tools handle repetitive tasks up to 80% faster than humans. They take time and effort to set up, but once trained, they can keep operations humming along without you. Insurance folks - want to derisk your operations? Make sure your team isn’t relying on any one person—including you.

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The importance of dedicated agents can't be overstated. Consumers need guidance to navigate the complexities of coverage beyond just price comparisons. The industry's move away from this model has indeed been problematic and short-sighted. Bill's analogy of "rebuilding bridges with matchsticks" captures the risks of prioritizing speed and simplicity over comprehensive coverage. The insurance industry needs innovation that enhances coverage quality, consumer education, and thorough risk assessment - not just transaction speed. The challenge lies in leveraging technology to support, not replace, the crucial human elements of insurance: exposure analysis, risk management, and informed customer advocacy. The goal should be disruption that improves both efficiency and effectiveness in protecting consumers.

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The #MedicareAdvantage landscape is set for a significant shake-up in 2025 due to a confluence of factors. These changes have led several insurers to pull back, resulting in product closures and market exits that will affect over 1.8 million members. This new #OWHealth article examines the impact on the Medicare Advantage market and explains why it is crucial for insurers to reassess their strategies to ensure long-term viability. Read more here > https://owy.mn/3Y6tjnA

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Some exciting rounds of insurer earnings releases recently. GEICO turned in a Q3 underwriting profit (about $2 billion compared to about $1 billion for Q3 2023). The company has also increased marketing spend by 122% during Q3'24 (Y/Y) (Source: Comperemedia Omni). Allstate saw decent results as well and is bullish about growing...homeowners? Root Insurance had its first profitable quarter, ending Q3 with a net income of $23 million. Some quick thoughts on the above: GEICO's results indicate the firm is poised for a rebirth after a few years of shedding policies. But I still see them growing cautiously. Similar story for Allstate, who is also positioning itself to be competitive in the market again. During its earnings call its leaders were bullish on the homeowners opportunity, which on the surface sounds strange, but when you consider better personal auto results across the industry, it makes sense carriers are thinking strategically about white space opportunities in home (particularly by bundling). As for Root, good for them. After being the butt of insurtech jokes the last couple of years, they are turning a corner. I'd still be cautiously optimistic, however.

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If you sell Medicare, wouldn't it be nice to be taking calls from consumers who are already convinced to buy a plan YOU sell? At Inspire Health Tech, we align consumers to plans - which then allows marketers to better-align consumers to agents (1-1 match). Our claims-based predictive AI recommends the right plan for each Beneficiary, based on their personal situation - lifestyle, medications, health conditions. Then, they can call or set an appointment with an agent who sells that plan. Yes, we help Lead Generators create ENROLLMENT-READY INBOUND CALLS. So - If you're 1) a lead generator who wants to create a better inbound/xfer/lead, or 2) a lead buyer who wants to know who is offering these - Shoot me a private message here on LinkedIn. Our AI is making connections to fuel a brave, transparent, personalized new world for Medicare leads. Mark #InspireHT #AI #MedicareAdvantage #MedicareSupplement #MedicareInbounds #Transparency #CMS

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You are right on point Tony Schueth. And the CMS-0057-F isn't the only efforts out there trying to empower interoperability and improve prior authorization. We are tracking over 90 bills at the state level relative to UM, PA, reporting and more and just recently Congress introduced another piece of legislation relative to PA that impacts commercial, ERISA, etc. If you want to be in the know and ensure you hit the varied implementation timelines, reach out to [email protected] and inquire about the Prior Authorization Navigator subscription solution.

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The next shoe has dropped, following Aetna's announcement, Anthem has also now pulled commissions on new business for a number of their plans effective 11/1, right in the middle of AEP. Every business ecosystem has major fault-lines, structural weaknesses and points of tension between dynamic elements. In the Medicare market, the tension between agents and carriers has started to reach a boiling point. If you look at any other segment of the economy, you can see the fault-lines clearly. Manufacturers have tension with wholesalers, wholesalers have tension with retailers, multi-family real estate has tension with retail, and on down the line. In healthcare, the providers have tension points with the carriers and the carriers have them with agents and brokers. Inside every business there exists similar structural tension, this is often felt between sales and account management, or sales and operations or operations and customer support. The general rule around fault-lines is that when the stress gets high, or the funding dries up, that’s when the cracks get much more significant. Inside your own business, it’s critical to understand the fault-lines and yet we have high agency to give them the consistent attention that they need. When the fault-lines are external, it’s much more challenging. It’s clear to me that the MA markets are facing a generational stress to the foundations of the carrier, distributor, regulator inter-reliant ecosystem. Seismic change always brings opportunity along with the challenge, lots of smart leaders in the Medicare space are focused on these shifting sands with a lot of intensity, it will be very interesting to see what shakes out.

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New #Primarylit alert- https://lnkd.in/gSV9Rzpj Data from this study has been previously shared but now we have the full report. Patients don't continue on GLP-1s. It does vary by agent, but even at the top end, the persistence did not reach 50% at one year. In order to appreciate the impact of GLP-1 in obesity, they have to be continued as a maintenance medication or weight rebounds. Employers who cover for weight loss struggle to absorb the cost as is. With this, 50% of that cost, at least, might be waste? #GLP1 #Pharmacists #Pharmacybenefits #research

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Recent Medicare carrier decisions are disadvantaging seniors and threatening the viability of independent insurance agents whose public utility is easily taken for granted. Several Medicare Advantage carriers have abruptly stopped paying sales commissions on certain plans, removed those plans from comparative shopping websites, and/or added new rules (like mandatory paper applications) that discourage agents from presenting options to their clients. These plans are often among the richest (best) in their respective markets, especially with respect to Rx costs and access to care. These actions raise important questions for policymakers and industry leaders, including: * What value comes from a competitive MA bidding process when an insurance company can use compensation changes to effectively rescind a bid mid-AEP? * How can agent impartiality be saved when, in some cases, nearly 50% of an area’s plans are made uncommissionable and actively obscured from the shopping public? * What value should be assigned to non-captive independent insurance agents? Has it been overstated? * How can regulation, enforcement, and free-market dynamics be used to keep things from unraveling? What is the right balance that will be effective but not heavy handed? * What alternate methods of compensation would preserve or better encourage agent impartiality? Is this the right time to revisit fee-based client arrangements? NABIP KFF The Commonwealth Fund

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As they work to fortify the integrity of its insurance market, Georgia legislators are modeling the policies implemented in Florida to mitigate the frivolous claims litigation that has begun to permeate throughout the Peach State. Their goal is to curb the inflationary pressures on insurance premiums which can be attributed in no small part to frivolous lawsuits and disproportionate jury awards, termed 'nuclear verdicts.' In particular, GA legislators hope to emulate Florida's HB 837, which eliminated the option for nuclear verdicts and reduced the incentive for claims lawsuit abuse that is ultimately paid by consumers in the form of higher insurance premiums. https://lnkd.in/edWCHZaA

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Reports are coming out stating 2025 Marketplace insurance premium increases will rise ~7% on average. Likely to be similar on the self-insured and fully-insured side, if not worse. Isn't time to think differently about how your enterprise can approach this differently and much more effectively? It can be done and it can be done scientifically, with a plan, and with proven return on your investment. Creating a culture of health, safety & well-being where your employees and their families can thrive is complicated, takes time, but most importantly, deserves a plan of action that takes that guesswork out. HealthNEXT has nearly two decades of published research supporting our best practices. We build effective strategic plans for you and your organization to achieve benchmark cultures of Health, Safety & Well-Being. Let HealthNEXT help you take the guesswork out! https://lnkd.in/eyzntrtF https://lnkd.in/exgqfJgH #healthnext, #cultureofhealth, #wellness, #wellbeing

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Thanks, Whitney and Zaira for a great conversation and the opportunity to discuss the work and courage it takes to bring an idea from inkling to actualization. Thanks to Brett, CoVerse Communications, and Insurance Nerds for your dedication to showcasing wave makers and all people bringing forth positive change and action in the insurance/ #insurtech industry. Could you listen to the episode and comment below about the last time you brought an idea into reality? Nassau Re/Imagine

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The National Association of Insurance Commissioners just sent a letter to OCR begging for any kind of guidance. The complicated regulatory ecosystem for Medicare Supplement plans has some real problems coming to further light with no resolution in sight. As they point out, the section 1557 rules on Medigap Plans, Short-Term, Limited Duration Plans, and Excepted Benefit Plans could completely upend the Medicare Supplement market and they have no idea how to enforce it. OCR, the Office of Civil Rights under the U.S. Department of HHS has primary responsibility for interpreting the HHS rules that impact the non-discrimination regulations. However, “the issue is that OCR does not approve Medigap and other plans for sale in states – state regulators have this responsibility” National Association of Insurance Commissioners (NAIC) has repeatedly attempted to get responses to some of the big unknowns around age-rating, gender rating, medical underwriting and other major factors that impact the Medicare Supplement market and responses have not been forthcoming. The letter says “Since the final rule was posted in May 2024 the NAIC has reached out to OCR seeking further enforcement guidance. To date, we are still waiting for any communication from OCR to discuss this issue, and time is at premium. The new rules become effective in PY 2025 and carriers are now beginning to submit PY 2025 plans for approval. We need answers to some key issues immediately.” They are also concerned with the unlevel playing field that these regulations create, they only apply to carriers who receive Federal funding for other plans (there is no direct federal funding for Medicare Supplement plans). Expect to see a flurry of divestitures if companies like Bankers Fidelity Life Insurance Company®, Globe Life, Allstate, ManhattanLife that do not receive Federal funding do not need to comply and companies like Mutual of Omaha, Humana, Aetna, a CVS Health Company, Cigna Healthcare, Centene Corporation, UnitedHealth Group and others do have to comply. Some of the NAIC's other specific questions include: What is the role of state regulators in enforcing Section 1557 rules? The final regulation says OCR will enforce the rules on a case-by-case basis. Are states expected to review rates and plans for compliance prior to their use? How are the Section 1557 rules to be applied to Medigap plans? May rates be based on age if permitted under state law? Will the interpretation and implementation of rulemaking regarding Section 1557 preempt state law(s) regarding certain restrictions? Do the Section 1557 rules apply to Short-Term, Limited Duration plans sold by carriers who receive federal funds? If so, are state laws that allow for age rating or benefit/access limitations preempted? Although overshadowed by the MA environment, these are issues that should be keeping many in the industry up at night The letter wouldn’t attach, feel free to email me for a copy [email protected]

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12 notes on the McKinsey & Company report on the Future of Medicare Advantage Lots of discussion about E-brokers driving a meaningful amount of production, suggesting a need for investment in digital tools. Its worth noting that the vast majority of leads that turn into E-broker sales are generated offline from mailers and TV The increase in MLR was not predicted and there is as much chance that it goes down this year as it going up, and it’s not nearly as predictable as the carriers desire Provider consolidation means an increase in the amount of fights between MA plans and providers, which could be an additional drag on retention. Providers owned by Private Equity use increasingly sophisticated means of pressuring carriers on their contracts Discussion about carriers investing in more direct sales seems on target, look to also see carriers take more ownership of driving retention as the single biggest lever to pull, as it not only benefits the reduced CPA, but also generates more cost of care savings as they can invest more in prevention-oriented spend Brokers are working on increasingly sophisticated monetization strategies to offset the cost of acquisition including ancillary sales, RX programs, RPM, disease specific programs etc.. Besides for owned distribution, carriers are increasingly in the market for E-brokers to handle overflow calls in back-office deals, Fran Soistman mentioned a few of these on earnings calls and there seemed to be an arms race to secure more of these at Medicarians Star rating lawsuits have proliferated since Elevance Health won theirs. SCAN Health, Hometown Health, and Zing Health have already filed similar lawsuits Their stated E-broker CPA’s in the $2,000 range seems high, Jared Strock does great work in pulling the actual numbers from the quarterly filings. It's worth noting that the CPA for carriers is higher than reported by the E-brokers as they have their own distribution costs and not all of the E-broker expense gets attributed to the Medicare sale Carriers have to invest in health equity for the new star rating system, but there is some political risk that those rules will be walked back with a change in administration New 1x1 marketing rules will drive E-broker consolidation which will force the carriers to find other ways to compensate them or lose their access to high-volume distributors Humana and UnitedHealth Group both own significant “internal” distribution and they still write a lot of brokered business, provider access limits how much direct distribution they can do NCD is seeing a lot of questions about coordination of stand-alone plans with MA dental, when stand-alone and embedded together cover most or all the cost of major services, expect to see a rise in utilization, also driven by the new benefit notification rules Report from Gabe Isaacson. Cara Repasky, Dan Jamieson and Sonja Pedersen-Green

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This morning our office released the approved rates for Washington state's 2025 individual insurance market. Congratulations to our rates and forms team for their due diligence in reviewing all carrier submissions, questioning the submitted information and projections, and determining the justification for the 2025 rates. #insurance #healthinsurance #ACA #healthinsurancemarket #healthpolicy #healthinsurancerates #healthinsurancepremiums #washingtonstate #healthcare #insurancerates #individualmarket

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Typically when surveyed about 1/3 of dentists will say they are considering dropping insurance contracts in favor of some form of fee for service model. The ADA cites 36% dropped from networks in the last year alone. With the growing focus on dental benefits as a component of whole-person health and the increase in coverage for Medicare Advantage beneficiaries, this will result in access challenges. In addition to addressing concerns over reimbursement, plans need to consider what they can do to minimize the administrative burden to busy and often overwhelmed dental practices. Payers that have embraced provider integration, including advancements in AI based predetermination will lead the way in removing friction from the provider and patient experience. This will in turn allow the dental provider to focus on delivering quality care and growing their practice.

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When you get to partner with a team deploying cutting edge technology to practical use cases you just know it’s something BIG and IMPACTFUL! Love seeing this highlighted feature on #notarizedproofs that Lindsey Strong, CIC and team are deploying for E&O compliance within the IRYS Insurtech platform!!!! Lets geaux Lindsey Strong, CIC Margeaux Giles 🚀🚀🚀 #insuranceinnovation #web3 #insurtech #makingpossiblehappen #doingbigthings

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