Car Insurance

Everyone talks (and advertises) about the personal approach of their companies, organizations and practices, but they are empty words. In the final analysis, it seems everyone is too busy to really care. The doctor is too busy, which reflects on the doctor’s assistant, who thinks she’s too busy and depends on the receptionist, who doesn’t have the knowledge or authority to respond, even if she isn’t busy. So, the calls go to voicemail, which is also busy!

Did you ever try to get through to your utility company or your airline on a bad weather day to speak to a real person? You know how frustrated you get when your electric, water or cable goes off. Well, try calling a physician’s office, or perhaps your own office, and see how the process works. Sometimes, these new gadgets that are supposed to increase efficiency are really promoting antipathy.

Yes, it’s frustrating not being able to communicate regarding a business issue, but it’s even worse when the person has pain and has no one else to go to for relief and counsel, considering that the health care practitioner is the one with whom the patient has entrusted their life and well-being.

I mentioned receptionists and assistants. Let’s talk for a moment about them. They are the very heartbeats of a physician’s practice, and God bless them. I don’t know what most practitioners would do without them. However, I have always believed that the attitude of an underling reflects that of the owner, boss or supervisor. As President Harry Truman used to say, “The buck stops here,” meaning the person in charge has to take responsibility for what the people below them do.

Thus, if a health practitioner has an impatient, curt, unsympathetic or rude person working in their office, the practitioner is responsible. In most cases, the staff will copy the attitude of the practitioner. Show me a caring doctor, and I will show you a caring staff. Show me a doctor who is “too busy,” and I will show you a staff that is “too busy.” Show me a doctor who takes an “ownership” role, and I will show you a staff that takes an “ownership” attitude. Show me a doctor who recognizes their moral responsibility, and I will show you a staff that fosters professional accountability. You can’t make it happen just by talking about it. It comes as a result of actual conduct through training, empowerment and the personal involvement of the physician.

I always get a kick out of companies, particularly banks, that advertise how personal they are in their relationships with their customers. Then when you call, they treat you as if you were a creature from outer space.

I am not telling you anything new about the fallacies of customer service as it is practiced by industry, particularly retailers. But what bothers me is that it has seeped over into the profession and now is manifesting in all the health professions. Perhaps it is the result of an automated society. Perhaps as computers and voice-activated electronics have made office management theoretically more efficient, they also have made communications less personal and people less accountable.

I sincerely believe that somehow, health care professions have lost touch with the public and many individual practitioners have lost touch with their patients. This is tragic because it has caused a great divide where communications, understanding and compassion are all-important as a conduit to better health.

As I thumbed through a book, The Essence of Leadership, I thought to myself, “I could easily juxtapose the word chiropractic for the word leadership.” The essence of chiropractic, in its purist and most admirable form, is exactly what the author saw as the essence of leadership. Among the characteristics is having what the late Vince Lombard! called “heartpower.”

Even in sports, this great coach knew it worked. He believed that when you captured the heart, you captured the person. He felt trust was closely aligned with honesty and integrity. He saw it as a cornerstone of relationships. Gaining trust, he visualized, was like filling a bucket one drop at a time with water. That trust grows by one’s actions, slowly one step, or drop, at a time. Drip by drip, it takes a long time to fill, but with one swift kick, it can be knocked over, the contents spilled, and all can be lost.

So true! Except, it’s not water we are talking about - it’s the spirit of a patient relationship and in the final analysis, the lifeblood of a practice. I’ve seen young doctors go into practice and do everything by the book because they had the time and perhaps good intentions to do it. They start out thoughtful, deeply committed and caring for their patients. But then success overtakes them and their values are drowned by their expectations. Soon, they are driv-. ing an expensive car, paying for a big house, and hiring staff to do the things they should be doing themselves. They start delegating, taking themselves away from the little caring things that drew patients to them and built trust and confidence.

Abstract

A single case study involving a 58-year-old female, short stature, overweight, who presented to a chiropractic office 24 hours after a frontal-collision accident in which she was the driver. Her son captured the scene of the accident on his mobile phone and digitally uploaded this to my facility via HyperSend, a HIPAA private e-mail system commonly used by insurance companies for record protection. The patient had a post-accident history of regional-chest-wall and breast soft-tissue trauma, and head, neck, and torso complaints, without any apparent cervical radiculopathy.

Objective The objective was to present this unusual case’s clinical rationale using an evidence-based approach to critical thinking and differential diagnosis. A critical method of thinking prior to actual physical examination is necessary and is commonly used in the emergency department, while awaiting the arrival of critically injured patients. This method is utilized in order to determine an algorithm of care. The doctor of chiropractic is asked to review the images provided of the scene of the accident while evaluating the various phases of forces that the occupant experienced.

Mechanism of Trauma and Phases in a Restrained Occupant Typically, in a frontal crash the vehicle will crash into another moving or stationary vehicle, lose control and strike some object. The striking vehicle’s front end will be pushed inward, directing forces into the structural area of the struck vehicle’s body frame, usually off-center. If pre-braking occurs in the frontal crash, the nose of the striking car will dive downward. If the restrained occupant is aware of the impending crash, attempts at bracing will occur. As the crush proceeds, forces will continue to be transmitted from the firewall into the seat frame, dash floorboard and steering wheel, as rapid deceleration forces occur within the occupant’s cage. The front of the car typically will crush inward 2 feet, allowing the vehicle to move forward by about 2 feet before stopping suddenly. The vehicle stops before the occupant does and the occupant literally will run into the slowing car’s interior as the seat belt tightens.

Once the vehicle reaches maximum deceleration, the 2 feet of frontal crash ends with the driver’s head, neck, torso, hips and knees moving forward faster than the seat beneath them. The restrained driver’s left shoulder moves forward until the shoulder harness reaches its limits, holding back the left shoulder while the right shoulder moves forward. The right shoulder and torso may continue to move forward, causing head rotation and increasing the probability of a closed-head injury (concussion, etc.), intercostal sprains and other torso soft-tissue injury.

The driver’s head, neck and torso reach peak deceleration levels, by which time the vehicle has stopped all forward motion. The shoulder belt harness may load up to 2,000 pounds of force, depending on collision speed. The pelvis moves forward and upward about 6 inches, depending on the lap-belt slack. While the torso is restrained, the entire neck is pulled forward, causing axial stretching.

The vehicle now goes through recoil. Most frontal impacts have about a 10 percent recoil velocity. The driver’s head, neck and torso rebound backward into the seat. This causes deflection, which then springs the occupant forward again.

Just as important as the mechanism of trauma and its phases in collision injuries are the significant factors that play a role in a patient’s prognosis, symptoms and disability, which have been documented in the literature. In this case, the other factors are the gender of the driver and their seating position. Most important, besides whether or not the driver is restrained, is if they sustain injuries. Seventy-two percent of drivers develop chronic symptoms.

By combining various off-the-shelf products, agencies create custom solutions that meet their unique needs

Car salespeople sell cars. Broom salespeople sell brooms. And insurance agents and brokers sell insurance. That’s just what they do. Well that’s what some insurance agents and brokers do, anyway.

Others differentiate themselves. More and more, they’re achieving distinction through the delivery of risk management services. And they’re tapping technology to help.

Focus on risk Scott Addis, CPCU, president of The Addis Group, based in King of Prussia, Pennsylvania, has built a process that he’s dubbed “The Risk Management Audit.” “This lets us, very efficiently, uncover an organization’s risks, prioritize and measure them, and then set a strategy to mitigate those risks,” he says. Addis’s staff also evaluates related tools and processes that the entity has in place, including claims management systems, insurance program design, risk management procedures, and any training initiatives.

The whole task requires some heavy lifting. “We go in, typically, nine months before renewal and go through this process,” Addis says. This raises a slew of eyebrows among his peers. They’re convinced the work, while beneficial, just can’t be cost effective.

Addis disagrees. “It’s just the opposite,” he says. “When we go through the audit process, which typically takes from two weeks to two months, we literally become the broker on the account instantaneously.” He’s adamant that the audit process is less time-consuming than traditional agent practices. Plus, his hit ratio hovers around 90%.

To help deliver, Addis and his team use automation-from customer relationship and management tools to robust risk management software. He’s also developing and refining technology to make the process more efficient, something he sees as necessary for agents and brokers who want to, as he says, “get away from the commodity trap.”

The name works literally-short for reconnaissance, which Tyler says agents should be ready to perform every day-or as an acronym: Research the data, Examine the risk, Collaborate on solutions, Organize the players; and Neutralize the risk. Either way, it features a service timeline that covers the entire policy period, spelling out exactly what the agency will deliver each month. “It’s been unbelievably successful,” Tyler says. “We’re able to renew many of our accounts two months before renewal date. That keeps a lot of our competition out.”

Effective use of technology helps drive RECON 365. In creating the program, the agency bought commercial software where it existed and built tools to fill gaps. The piece-meal approach came, in large part, because Tyler wasn’t satisfied that any product on the market at the time would meet all of the agency’s requirements. RECON 365 does.

A key element is automated communication between agency and insured. Included in this are electronic newsletters the agency sends clients, addressing risk management issues that businesses face.

Online claims viewing is also included. “For companies interested in managing their claims, we create regular reports, using proprietary software, and then hold quarterly review meetings,” Tyler says. “We take carrier claims information and present it to clients in graphical format, complete with analysis.” These meetings can take place in person but often are done online using Web conferencing software.

The agency also uses off-the-shelf and proprietary software to deliver OSHA logs and other safety and wellness information. And clients can perform online policy selfservice through InScope, a feature of the agency’s management system. “They can go in and look at their policy whenever they want,” Tyler explains. “They can print out certificates of insurance, automobile ID cards and dec pages on their own schedule,” Tyler notes.

Higgins and his staff use proprietary software, along with products from two Australian firms. The process involves a thorough examination of the types of events that could affect the firm’s people, income, reputation, and objectives.

Visa USA today announced significant changes to its Visa Consumer Credit Card Platform that will provide Auto Rental Insurance (ARI), also known as Collision Damage Waiver (CDW), coverage to all Visa consumer credit cardholders, a benefit previously reserved only for select cards. Visa issuing financial institutions will also have greater flexibility to define additional benefits that distinguish their Visa Classic, Gold and Platinum card products - or other self-defined products - to better meet the individual needs of their cardholders.

“Auto Rental Insurance is one of the most popular credit card benefits among cardholders today,” said Al Banisch, senior vice president of consumer credit products at Visa USA. “As a result of these changes, an additional 75 million Visa cardholders, and more than 185 million in total, will now benefit from Auto Rental Insurance when paying for a car rental with their Visa credit card.”

Visa estimates that cardholders who utilize the benefit will save on average more than $10 per day compared with paying for the same type of coverage provided by car rental agencies.

These increasingly differentiated products will continue to be supported by all of the Visa core brand promises, including worldwide acceptance, convenience and unsurpassed reliability.

The new Consumer Credit Card Platform reflects Visa’s commitment to adapt to the changing needs of both its cardholders and it Issuers. Visa’s vision is to lead the payments industry by helping foster the relationship between each Issuer and its cardholders in order to develop the best consumer credit programs possible.

About Visa

Visa is the world’s leading payment brand and largest consumer payment system, enabling banks to provide their consumer and merchant customers with a wide variety of payment alternatives. Nearly 21,000 financial institutions worldwide rely on Visa’s processing system, VisaNet, to facilitate $2.5 trillion in annual transaction volume with virtually 100-percent reliability. Consumers in more than 150 countries carry more than 1 billion Visa-branded cards, accepted at millions of locations worldwide. Within the United States, nearly 14,000 financial institutions issue 429 million Visa cards, accounting for more than $1.1 trillion in annual transaction volume.

This volume presents an enormous amount of information that will take students of consumer-driven health care a very long time to read and digest. It will be tempting for both advocates and opponents of the movement for greater consumer control to browse through the work and pick out and trumpet those nuggets of information that suit their predispositions.

This would be unfortunate because the information that runs counter to our biases is the most important information to understand. Good policy can be developed only when we listen closely to honest criticism and respond accordingly–as difficult as that may be.

Still, the work presented here requires some context. Consumerism in health care is in its infancy. We do not yet know what the optimal approach is and we are in a period of experimentation and trial and error. Like most other new ideas, the initial models will need to be revised and improved. Prototype designs are almost never without flaw.

One of the marvels of any market-based system is the ability to make those corrections and revisions quickly as more information becomes available.

Too many health policy analysts take a governmental program approach to design questions–the model must be irrefutably effective before it is ever implemented. Once a program is “the law of the land” it is nearly impossible to change. Witness the protracted debate over adding prescription drug coverage to Medicare.

Fortunately, consumer-driven health care (CDHC) was born in the market and will be revised in the market. To the extent there has been governmental involvement (such as the IRS guidance on Health Reimbursement Arrangements), it has been extraordinarily flexible and permissive.

Vendors and employers are free to refine their products in accordance with changing conditions and growing knowledge. In that context, identifying problems is seen not as an attack on cherished ideas, but as a welcome opportunity to improve the product offerings. Criticism is valued as product feedback. A company that wants to succeed in the market is eager to hear what the problems may be.

Market approaches have some other advantages over a governmental orientation, as well. Government programs are essentially political. They are aimed at pleasing 50 percent+1 of the population. Opinion surveys are conducted to see how close a new idea is to achieving that goal.

Few companies in the private market think in those terms. If a new product or a new company feels it can reasonably attract even just 10 percent of a market, it views the prospects as very promising. Hertz is not the only success in the rental car business. Avis and National and Budget and Alamo and many others manage to succeed without being Number One.

Readers of the papers in this volume will likely conclude that the experience at Humana was not very favorable, the experience of the Definity-covered University of Minnesota was more favorable, and the large, unnamed Definity-covered employer was very favorable. What does that mean? Clearly different locations and different designs lead to different results. If CDHC were a government program, this might be worrisome–have we chosen “the right” model? But because CDHC is a market-oriented approach, it is not discouraging at all. Definity is doing something right and will build on it. Humana may revise its approach or drop the program altogether. It does not matter in the slightest. Humana is not disadvantaged because Definity is succeeding. And Humana’s problems do not detract at all from Definity’s Success.

Certainly there are things to be learned in both cases, and market-oriented companies will study these experiences closely. But no company–including Humana–is stuck with a problematic design. Humana’s product did not allow rollovers and the funds in the “allowance” could be spent only on in-network provides and for covered services. These features remove the most promising elements of consumer-driven health designs–consumer choice and the opportunity to save money for future needs. It is simple enough for Humana to incorporate those features in its next round of offerings.

Market-oriented companies also know that early adopters are different than the rest of the market. The people who are the first to sign up for a new product or service tend to be risk-takers. They accept risking the unknown for the privilege of trying something new. They also tend to be younger and better educated than the rest of the market. They volunteer to be “test cases” and product developers rely on them to refine their offerings. People oriented toward government programs may view this as a selection problem, but innovators expect this to occur in the first couple of years of new-product roll out. If the product is successful at this stage, word gets out and the new idea attracts a wider market segment.

The research presented here does not address the “early adopter” phenomenon very effectively. We are told that the enrollees in the Humana program tended to be actuaries and financial service personnel. These individuals are presumably better educated than most Humana employees, and they certainly know their way around a benefits program better than the average person. It is interesting, for instance, that the studies report no end-of-year rush to consume unspent dollars in the allowance, even though Humana included a use-it-or-lose-it provision characteristic of flexible spending accounts (FSAs). This contrasts with the Countrywide Financial experience that did have an FSA-type year-end rush, even though those employees were able to roll over unspent balances. It is possible that the self-selected Humana employees understood the dynamics of forfeited balances and did a better job of spending their money through the course of the year, while less-savvy Countrywide employees stuck to their FSA-induced spending habits.

Most of the studies report income disparities between CD-selectors and nonselectors. It will be interesting to see if this difference continues over the years, but it is also possible that income is a proxy for education. This should certainly be the case at the University of Minnesota where educational attainment should correlate closely with income. If it is true that early adopters tend to be more highly educated, we would need to control for differences in education before concluding there is an income effect unique to CD health.

We also think of early adopters as being younger, but that does not seem to be the case here. If anything, CD-selectors appear to be somewhat older than nonselectors (though age is another underreported variable in these studies). Is it possible that early adopters for electronic gadgets are different from those for health insurance programs? Perhaps younger people pay so little attention to their health care needs that a choice of benefits plan is of little interest to them.

Since we cannot yet distinguish between the behavior of early adopters and a more mature market for consumer-driven health, the research presented here is of limited (but not unimportant) value. Most of this work looks at baseline information in 2001, first enrollment in 2002, and renewals in 2003. That means there is only a single year’s worth of data. Given that the IRS did not issue guidance until June 26, 2002, the products were very tentative and in some cases did not incorporate the more attractive features of the approved health reimbursement arrangement (HRA) model. It was not at all clear at the start of 2002 that the IRS would allow year-to-year rollover and buildup of unspent balances.

Even more importantly, none of the pioneer models anticipated that postemployment access to the funds would be allowed. The prospect of saving money for future needs even after leaving one’s current employer could very well skew enrollment decisions from what this research presents. Lower-income workers in particular might find that prospect more attractive.

The body of research presented, then, is looking at a moment-of-time of an extremely fluid and dynamic environment. Much of the experience studied predates the IRS guidance. And, while Humana and Definity are both very serious and credible players, they are not the only vendors, nor the only models available. Destiny Health, for instance, takes a radically different approach to the market and to product design. It distinguishes between “discretionary” and “nondiscretionary” spending and applies the cash account only to the former, It also requires portability for account balances. Its market targets fully insured smaller companies, rather than the larger self-funded employers studied in this research, It would be worthwhile knowing the experience of this different design and different market segment.

It is impossible to know ahead of time if the Destiny model is superior to the Definity model or the Humana model (or the models from Aetna, HealthMarket, Lumenos, or dozens of other variations). Clearly, behind each design are a number of credible and serious people who believe their approach is superior to all others. It will not be academia that answers the question of which approach is best, but the market.