Core systems

Denver - Despite some challenges, the health insurance industry continues to focus forward on initiatives that will enable patient-related data sharing in order to help eliminate errors and reduce overall costs. Anthem Blue Cross and Blue Shield in Colorado announced its participation in a voluntary data-sharing program developed by the Council for Affordable Quality Healthcare (CAQH), the company reports. The program, based on rules drafted by CAQH's Committee on Operating Rules for Information Exchange (CORE), is designed to link the data collected by health plans, providers, and vendors so that doctors can electronically verify their patients' insurance information in twenty seconds or less, significantly improving communications between providers and insurers. A report issued in February 2006 by Dublin, Ireland-based Research and Markets notes that insurers will benefit from a trend in widespread adoption of electronic capture of patient data. With solid benefits predicted, there still remain challenges, however. Alluding to the routine capture of documents and data for both regulatory and business intelligence purposes, the Research and Markets holds that "health care in the clinical setting has resisted this industry-transforming technology for nearly 20 years. The reasons: the lack of user-friendly interfaces for busy health care providers, lack of workflow understanding on the part of vendors, the expense and complexity of implementation and maintenance solutions, and the lack of transparent ROI for providers." Empirical data on long-term benefits for a program such as this may not be available yet, but carriers such as anthem BCBS nevertheless have high hopes for initiatives designed to create incentives for providers that will help improve communications between parties and create a "healthier" patient base in the process. The fact that the CORE program is a voluntary, industry-wide collaboration facilitated by Washington-based CAQH, may help the cause. Anthem has been certified as a CAQH CORE health plan and has already completed the Phase I implementation of the CORE rules, which allows for standardized data transfer and quicker response times. Physicians who link to the health plan through electronic data interchange (EDI) will be able to use EDI for this quick verification. EDI is a method for two organizations to confidentially exchange data from one computer to another using standard formats that are HIPAA compliant. Currently, Anthem's EDI is used for claims filing, claims status checks, eligibility verification, electronic remittance advices, and electronic fund transfers back to health care providers. "Anthem is committed to employing the most advanced information technology solutions available to improve both our members' experience and their interactions with physicians," said John Martie, president, Anthem Blue Cross and Blue Shield in Colorado, a subsidiary of WellPoint, Inc. "CAQH has developed an excellent framework for simplifying the administrative side of the health care system, and Anthem has worked diligently to ensure that we are capable of bringing the benefits of CAQH's efforts to our members." "These programs have the potential to transform the way that health care providers and health plans communicate," continued Martie. "But most importantly, they will take much of the confusion out of the health care system for our members." Sources: Anthem Blue Cross and Blue Shield, INN Archives

Washington - A new report calling for a review of the McCarran-Ferguson Act is troubling, said the National Association of Mutual Insurance Companies (NAMIC), Indianapolis. While the report - created by the Antitrust Modernization Commission - does not recommend repealing the antitrust exemption provided to insurance companies under the Act, its suggestion for Congress to carefully review it and other exemptions could ultimately lead to higher costs for consumers. "Many of the statements in the report indicate a lack of understanding of the business of insurance," said Carl Parks, NAMIC's senior vice president for federal affairs. "There are several statements that incorrectly characterize the McCarran-Ferguson antitrust exemption." For example, the commissioners contend that McCarran-Ferguson and other exemptions lead to higher prices, reduced output, lower quality, reduced innovation, and less competition. They also argue that a decision to provide an exemption is a decision to sacrifice competition and consumer welfare. "The exact opposite is true in the case of the nation's 5,000 insurers," Parks said. "It is the presence of the exemption that has fostered a vibrant and competitive marketplace affording consumers greater choice, lower prices, higher quality and more varied products and increased innovation, while ensuring a sound and stable marketplace." The report incorrectly contends that immunities and exemptions benefit relatively small special interest groups and spread their costs to the broad consuming public. Actually, McCarran-Ferguson benefits all insurance consumers and serves to safeguard consumer welfare, Parks said. NAMIC found other problems with the report. The commissioners state that solvency should not serve as justification for antitrust exemptions. In fact, solvency is an integral component of consumer welfare and protection in the property/casualty context, Parks explained. The report also discounts fears of litigation and legal uncertainty. "Essentially, the report says that insurers have nothing to fear from being subject to the antitrust laws as long as the cooperative behavior in which they're engaged has pro-competitive effects," said Robert Detlefsen, NAMIC's vice president of public policy. "The report is unduly confident that courts with little or no experience adjudicating insurance issues would be able to distinguish clearly between pro-competitive and anti-competitive practices. We are not nearly as optimistic about this prospect as is the commission." Detlefsen further said the report does not address the negative consequences for insurers and consumers that would result from the legal uncertainty and expense of private antitrust litigation to settle such questions if the exemption were to be repealed. "The main problem with the report is that (a) it assumes that courts applying a rule of reason analysis to alleged antitrust violations by insurers will actually make reasonable decisions; (b) it discounts the impact that costly and protracted antitrust litigation would have on companies and consumers; and (c) it ignores the extent to which the threat of litigation would inhibit insurers from acting cooperatively even if they thought that eventually their actions would survive antitrust scrutiny by the courts," Detlefsen continued. Ironically, Commissioner Jonathan M. Jacobson, who wrote a separate statement calling for the repeal of the insurance antitrust exemption as well as exemptions applying to three other industries, also opined that "the Commission would have better served the country through a more focused review of these four [exemptions] than by relying purely on the generalist overview reflected in our official recommendations." "We couldn't agree more," said Detlefsen. "Had the Commission more carefully examined the implications of repealing the limited insurance antitrust exemption, it's likely that Commissioner Jacobson would have reached a different conclusion." NAMIC, which today announced its membership in the Insurance Research Council, a public policy research organization providing objective analysis on a broad range of issues of vital interest to insurers, consumers, and public policymakers, opposes any changes to the McCarran-Ferguson Act. The organization reports that it will continue to work with members of Congress to inform them on the effects of the limited antitrust exemption on the insurance industry and America's insurance consumers. Antitrust Division's Statement The Antitrust Division of the U.S. Department of Justice made the following statement regarding the release of the Antitrust Modernization Commission Report. "The AMC has made many specific recommendations in its report, and the Division is in the process of reviewing all of them. The Division commends the AMC for its three primary conclusions: * Free-market competition should remain the touchstone of United States' economic policy. The Commission's conclusion in this regard is a fundamental starting point for policy makers. Over a century of experience has shown that robust competition among businesses, each striving to be increasingly successful, leads to better quality products and services, lower prices, and higher levels of innovation; * The core antitrust laws -- Sherman Act sections 1 and 2 and Clayton Act section 7 - and their application by the courts and federal enforcement agencies are sound and appropriately safeguard the competitiveness of the U.S. economy; * New or different rules are not needed for industries in which innovation, intellectual property, and technological innovation are central features. Unlike some other areas of the law, the core antitrust laws are general in nature and have been applied to many different industries to protect free-market competition successfully over a long period of time despite changes in the economy and the increasing pace of technological advancement. One of the great benefits of the Sherman and Clayton Acts is their adaptability to new economic conditions without sacrificing their ability to protect competition." To view the complete report visit www.amc.gov. Sources: PRNewswire/USNewswire, NAMIC, U.S. Department of Justice

Kansas City, Mo. - Security, developing Web portals, and going paperless are among the top focus areas for IT staff at surplus lines insurance companies, according to a survey of NAPSLO members conducted in February by the association's communications & technology committee.

Needham, Mass. - The time is right for U.S. property and casualty claims insurers to aggressively exploit the business benefits of an enterprise mobility strategy, according to new research from research and advisory services firm TowerGroup. TowerGroup's report, "Mobile Solutions for US Property & Casualty Claims: Life in the Fast Lane," maintains that while using mobile solutions for settling claims is not new to the U.S. insurance industry, adoption for claims processing has been haphazard at best. Insurance carriers have been slowly bringing on mobile technology solutions to assist field workers with claims operations, yet the process has lacked focus and forward momentum. Given the strides made by mobile technology vendors in functionality, bandwidth and devices, mobility solutions for the insurance industry are increasingly reliable - and can yield significant value if developed within a coordinated strategic initiative, says the report. "Customers are increasingly expecting real-time, any-time service from their insurance carriers," said Karen Pauli, senior analyst in the TowerGroup insurance research practice in Needham, Mass., and author of the research. "While many insurers have various mobility irons in the fire, catastrophes like Hurricane Katrina quickly exposed the limits of the haphazard solutions that are in place. It's time for carriers to step back and create an enterprise strategy for mobility that encompasses all aspects of the claims process." Highlights of the research include: * Mobile initiatives will yield significant value for carriers when the implementation directly impacts the most critical business issues facing carriers today, including: disaster response; business continuity; and meeting regulatory and compliance mandates. The report also highlights the key actions carriers must take in order to create an effective mobile strategy. * Carriers can improve day-to-day claims operations, gaining competitive advantage and saving costs, by using predictive analytics to direct activities in a mobile environment. * Before carriers jump into an enterprise mobility plan, they must carefully review the needs and workflow of their claims personnel. "Today, few carriers leverage the breadth of available mobile technologies that could contribute to claims process efficiency," continued Pauli. "Instead, it's more common to see stand-alone applications that have little to no integration with other claims applications or services. Stand-alones don't scale well, usually lack extensibility and cost too much. Carriers must develop a more holistic approach to claims mobility, one that arms the adjuster with the key devices and applications necessary to get the job done in the most efficient and effective way possible." Source: TowerGroup

Fayetteville, Ark. - Blue Cross Blue Shield will partner with the University of Arkansas and Wal-Mart Stores Inc. to create a research center that will focus on using information technology to improve the health care delivery system, the companies report. The center's creation was announced today during a health information technology meeting -- hosted by Wal-Mart -- of business, IT and health care leaders held in Rogers, Ark. The Center for Innovation in Health Care Logistics will conduct research designed to identify and address gaps and obstacles in the application and delivery of health information technology. The center will also serve to highlight and replicate proven applications that are working to benefit patients and providers. The goal of the center's work is to put the right materials in the hands of doctors and nurses where and when they need them; it also aims to eliminate the threat of medical errors arising from wasteful and unreliable practices in health care supply networks. The Center's initial work will address information technology-based innovations for bringing visibility and tracking to every level of health care procurement and distribution processes. Experience shows that such transparency leads to significant cost savings by eliminating duplication and confusion, enhancing collaboration among participating organizations and avoiding mistakes that can lead to dangerous errors. "Blue Cross Blue Shield is proud to join Wal-Mart and the University of Arkansas in this worthy venture," said Bob Shoptaw, CEO, Blue Cross Blue Shield Arkansas, Fayetteville. "We look forward to contributing to the advancement of health care technology through the creation of this research center." In making the announcement, Wal-Mart Vice Chairman John Menzer said the center's work will help fill a large information gap in the health care system. "The best example of this need was Hurricane Katrina. Medical records, property records, court records were lost. Entire family histories -- medical, cultural and otherwise -- were gone in an instant, and the entire region is still recovering from this massive loss of information," Menzer said. "The University of Arkansas has a strong track record of success with industry-university research collaborations in the ever-changing realms of information technology and logistics," said University Chancellor John White from the University's Fayetteville campus. "A fundamental purpose of any flagship university is to stimulate economic success and enhance quality of life. We are well positioned to leverage our logistics center experience to ensure success in identifying real solutions for transforming health care processes, which holds benefits for the State of Arkansas and the entire nation." Professor Ron Rardin will be the center's executive director. Before joining the University of Arkansas, Dr. Rardin led the National Science Foundation's efforts to foster research in health care delivery and later played a key leadership role in Purdue University's Regenstrief Center for Health Care Engineering. Wal-Mart, Bentonville, Ark., will pledge $1 million over five years to fund the center. Blue Cross Blue Shield of Arkansas, Alabama and Illinois have joined Wal-Mart as partners. The Center will also raise money from other private sector companies, government agencies and foundations to help conduct its research and demonstration projects. Source: PRNewswire

SITE SELLS POLICIES ON GROWNUP TOYSMarkel American Insurance Co., Waukesha, Wis., launched a Web site that provides a single access point to customers seeking to insure motorcycles, boats, personal watercraft and ATV.

AGENTS AND BROKERS ADOPT NEW RPOST E-MAIL SERVICELos Angeles-based RPost U.S. Inc. says independent insurance agencies and brokerages are adopting RPost as a service platform for outbound e-mail. Confronted with errors and omissions (E&O) liability exposures, agents and brokers need technology that enables them to optimize electronic communications while minimizing risk. By shoring up the security gap, RPost Registered E-Mail messages offer speed, security, accountability and personal liability protection in a cost-effective solution that can be used for an average cost of 59 cents per message. The company's services provide the e-mail sender with legally valid evidence of what e-mail content and attachments were sent and received, by whom and when.

MASSMUTUAL UPGRADES PRODUCT MACHINE SOFTWAREThe disability income insurance area of Massachusetts Mutual Life Insurance Co. (MassMutual), Springfield, Mass., upgraded to version 3.1 of Product Machine, a set of tools designed to enable users to build, design and publish products.

Hartford, Conn. - The surety business has recovered from a slump that began with the 2001 recession, according to a new study by Conning Research and Consulting Inc. "The combined ratio climbed more than 40 points and stayed there for the next three years," says Mark Jablonowski, an analyst at Conning, which has headquarters in Hartford. "While the recession and tightening credit resulted in skyrocketing losses, the property-casualty underwriting cycle also contributed to the problem." Those views are examined in a study called "The Surety Market: Taking Care of Business." It's Conning's first analysis of the surety segment, a business the company says has iinfluence well beyond its size because of its importance to construction and regulatory compliance. According to the study, a huge increase in losses during the 2001 to 2003 period wasn't just from claims reported but also from claims that developed badly and a falloff in recoveries and other claims mitigation, says Stephan Christiansen, Conning director of research. The situation turned round in 2004 and 2005, Christiansen observes, adding that 2006 showed continued improvement and the future looks good, too. Capacity is returning to the market but with a renewed appreciation for underwriting discipline, says Christiansen. "That new-found discipline, along with attention to automation and technology [that is]driving cost control," he says, "lead us to a positive forecast for the surety line over the next few years, with premium growing at least as fast as GDP." Source: Conning Research and Consulting Inc.

Washington - America's Health Insurance Plans (AHIP) has collaborated with The Centers for Disease Control and Prevention (CDC) to develop a checklist insurers can use to prepare contingency plans for a flu pandemic.

Rochester, N.Y. – Many Americans are satisfied with how their personal health information is used, but a substantial number express reservations about the confidentiality and security of their health data, a new survey shows.

Washington, D.C. – America needs a public-private partnership to protect families from a devastating, massive hurricane or earthquake, the head of a coalition that includes insurers said in testimony this week before Congress. Such catastrophes have dulled the industry’s appetite for insuring against such events, said another witness, a representative of an agents’ and brokers’ association.

Washington - The National Association of Professional Insurance Agents (PIA) has asked its members to challenge the U.S. Chamber of Commerce’s recent endorsement of optional federal charters for insurers.

Phoenix, Ariz. - Insurance industry groups have banded together to create eight data initiatives and a central data repository to combat fraud, according to the keynote speaker at an industrywide meeting here of property/casualty claims and special investigations executives.

BELLEVUE, Wash. - Symetra Financial has appointed Tommie Brooks as vice president and chief actuary. He will assume leadership of the Actuarial Division from Margaret Meister, who is relinquishing the post but continues to serve as executive vice president and chief financial officer.

San Francisco - Woodruff-Sawyer & Co., an independent insurance brokerage based here, has acquired Northwest Benefit Planning in Portland, Ore.

Unitrin Direct insurance cos., subsidiaries of Chicago-based Unitrin Inc., are offering a $50 discount in 17 states for customers who use Esignature, an service that lets customers sign policy documents online."One of our main goals at Unitrin Direct is to continually seek new ways to provide a terrific value on outstanding car insurance coverage," says Unitrin Direct President Scott Carter. "With Esignature, consumers not only save money instantly, they do it with the knowledge that they have a trusted company behind them that prioritizes customer service."

Branchville, N.J. – Selective Insurance Co. of America, a Branchville, N.J.-based subsidiary of Selective Insurance Group Inc., appointed three information technology services (ITS) managers.

Johannesburg, South Africa – Insurers looking to enhance their contact centers may want to consider convergence, primarily driven by the increased acceptance of internet protocol (IP) and improved reliability, scalability and proven benefits that come with maturing product sets. According to the latest findings in Dimension Data plc's "Global Contact Centre Benchmarking Report 2007," more than 60% of contact centers—representing a number of industries across 42 countries and five continents—have introduced IP-based or hybrid IP private branch exchange (PBX)/automatic call distribution systems (ACD), which is an increase from the 50% recorded last year.

London - Senior executives and risk professionals consider data loss the most significant threat and key issue to address in operational risk management planning, according to a global risk briefing report conducted by the Economist Intelligence Unit (EIU) and sponsored by London-based ACE European Group Ltd. (ACE).More than 40% of the 181 respondents said their organization focuses more on loss of data than other issues—including systems failure, human error and even natural disasters.