insurance case study with solution

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Copyright © 2020, Galena Pisoni.

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Since the first insurance contract, dating from over 600 years ago, the basic model of how insurance companies work has remained unchanged. Companies compensate clients financially against loss or damage from a specified event. Customers pay premiums to obtain such coverage. The long history of insurance has proven that the model works. People and businesses buy insurance products and studies show that consumers have a high level of confidence in the industry.

While insurance companies continue doing business the same way they have for years, they have failed to innovate. This failure to improve is most glaring with the customer experience. For example, many customers have difficulty understanding the differences between insurance policies and complicated insurance contracts. Many do not understand the conditions of the contracts and they are not confident the insurance product offered will satisfy their needs completely.

Customer expectations have changed. In the past, when buying goods or services, customers had few possibilities to compare prices between local agents or dealers. With the emergence of the internet, this has changed and readily accessible information allows for 24/7 active comparisons and searches for the best price via different channels.

Because of digital transformation, insurance consumers increasingly want to interact with companies anytime and anywhere. Therefore, companies constantly search for new ways to engage consumers digitally and where they want to be engaged. Companies are now expected to engage via channels such as text, chat, voice assistants, websites and mobile devices for customer acquisition and service. If a company does not offer a positive digital experience, many customers, particularly younger people, will move to industry competitors that offer better customer experiences digitally or they may turn to adjacent industries that offer the service as an “add on.”

Most insurance companies are left with systems, processes and practices that would be still recognizable by those in the industry in the 1980s. Though the insurance sector has stagnated, changes across other industries have been groundbreaking (invention of smartphones, social media, YouTube, Google and Amazon). Changes brought by digitalization of other industries exert even more pressure to the insurance industry.

A new era also brings new risks. For instance, organizations are increasingly concerned about their cyber risk exposure. As a result, companies have increasingly turned to the insurance industry with a need for cyber risk insurance products to better manage cyber threats and any resulting legal liability from data breaches. These new risks are opening the doors for insurance companies to provide new products and services, but the industry is immature and takes considerable resources to develop products and services in this new market. New technologies such as big data, cloud computing and social media increase the risks resulting from cybercrimes and cyber risks are now one of the top concerns of business leaders. Every organization is vulnerable to potential losses resulting from electronic data theft. Organizations want to protect themselves and their reputations from cyber risks as well as the data and records of their customers. For this, they turn to insurance companies, which in turn may not be prepared to help a company understand its cyber security risk profile.

leverage the most advanced technologies, as the most innovative solutions are at the core of the company;

focus on improving the experience to foster a user-centric approach, for instance, some focus on improving the purchasing stage, the underwriting process or streamlining claims management; and

develop an agile culture and approach, along with leveraging analytics to make faster business decisions.

In this paper, we analyze what small- and medium-sized insurance companies can do to leverage new technology and describe digital transformation in an Italian company that used this approach.

The case study company

Assinord Verona S.R.L offers insurance products in five different lines of business (all types of insurance products) and functioning relies on 15 people in the company and a number of collaborators from all over Italy that contribute to the growth of the company. Now, the company has more than 10,000 clients across Italy.

The study of the adoption strategy of innovative digital insurance solutions to improve everyday operations of the company.

Understanding the needs of the company and the customers with one-on-one sessions with team members and the development of first prototype for a platform to better connect the company with the customers.

The study of different cyber risk policies to enrich the product portfolio and company offering.

We explored the company offers and the established company processes to understand how to implement effective digital transformation. We studied the differences in complex insurance offers for existing clients and the author talked with the owners to understand how to make the whole process smoother.

The paper is organized as follows: in Section 2, we present the analysis of the different strategies to approach innovation and the one chosen by the company; in Section 3, we present the platform for connecting the company with the clients; and in Section 4, we present the analysis of cyber risks and the kind of insurance policies the company enriched the portfolio with to offer more up-to-date products. We conclude the paper with Section 5, in which we present the takeaways from the process and recommendations for potential next steps.

Strategy for adoption of new insurance technologies

Based on the literature, we researched how other companies of similar size have approached the digital transformation phenomenon and which approach best fits this company. We summarize the different strategies used by companies in the past: internal innovation, buy from startups, partner with startups and invest in startups. A brief summary of the different methods and the reaction to these by the company is discussed.

Internal innovation

One strategy that companies have been using to embrace digital trends is to foster innovation and the birth of new ideas internally. Different tools and methods for internal innovation have been described in the literature ( Wilson, 2017 ; O’Brien, 2004 ; Kohli and Melville, 2019 ). We present a summary of the possible tools to use in Figure 1 . With internal innovation, the idea is to encourage employees to generate ideas from their everyday experience and rely on simple methods such as researching current trends, applying customer intelligence, identifying customer needs, applying design thinking and user-driven innovation to implement process improvements and redesign business strategies. Key to this process is using brainstorming techniques to come up with innovative ideas.

The company’s ability to implement the ideas is limited and that is why ideas generated internally are usually implemented by dedicated teams.

Buy from startups

Other companies partner with tech startups by purchasing their services, licensing their solutions or co-developing solutions. Companies usually partner with highly specialized startups on new technologies that insurance companies can purchase to improve operations. One such example is Cognotekt, which provides software as a service for insurers to automate claims. Another example is Insurify, a personal insurance company that compares car insurance.

Partner with startups

Another strategy involves partnering with other companies to offer services to customers by bundling offers between two companies or by providing customers new “white brand” products. New technologies require special knowledge and expertise that insurance companies do not usually have. Existing insurers can partner with technology companies to innovate along different parts of the customer value chain.

Invest in startups

This strategy is most common for big incumbents but is occasionally used by smaller companies. This approach involves investing in a startup that may rely upon one incumbent for funding. The majority of the world’s largest insurers (AXA, Allianz, AIG, MetLife and Generali) have established their own in-house venture capital (VC) funds and committed investment in startups. These insurers select the areas where they want to innovate, and then look for startups in the field. In 2019, more than 140 traditional and corporate VC firms invested in an InsurTech startup.

What did the company decide?

The objectives when partnering with an InsurTech startup should be clearly aligned with the expected impact, which should be incremental, adjacent or transformative.

Business objectives should determine the model of cooperation and help to prioritize solutions and types of relationships to have with the InsurTech startups.

When choosing the companies to collaborate with, the expected impact on the company operations should be quite clear.

The different options were presented to the case study company and the decision was to do both: to try internal innovation (and in the following section, we show some examples of this approach) and to look for startups to buy products from or partner with in cases where there are mutual benefits. For the latter, we decided to rely on Plug and Play in Munich.

Partnership with Plug and Play in Munich: Plug and Play accelerates and invests in startups. It runs over 28 stage agnostic programs a year and invests in over 260 companies. Plug and Play matches startups and corporations worldwide. Our company chose to get in touch with the headquarters in Munich to start collaboration. Plug and Play supports three main lines of program: product innovation (startups working on digital transformation, improving user experience and risk assessments), new sources of risk (startups working on cyber security and other modern concerns) and disruptive ideas (startups working on industry changing business models such as the shared economy that are transforming current markets). The company decided to continue looking into startups coming from the production innovation track. In sequential meetings, different solutions will be presented to the business owners and will be made available for future analysis.

Platform for connecting the company with the clients

In this section, we show the results from pursuing internal innovation efforts to come up with a platform for connecting the company with its clients.

We started with underlining the actors involved in the system (customers and people inside the company) by using design thinking ( Brown and Wyatt, 2010 ; Kumar, 2009 ) and creative facilitation ( Van Boeijen et al. , 2014 ) as methods. The author performed one-to-one interviews with customers of the company to understand what kind of technology can better serve their needs in terms of insurance and can bring a better understanding of complicated insurance terms and contracts. The author performed 15 interviews (each lasting 1 h) with loyal clients the company selected. The questions were intended to help us understand how customers make buying insurance policy decisions. It also mapped the user experience from the time the individual started thinking about buying insurance all the way through the actual purchase of the insurance policy. In our search for the best ideas, we also involved employees. The author had three brainstorming sessions (each lasting 1 h) in which all the employees participated. In the brainstorming sessions, the employees were asked to reflect on the needs and situations in which the customers usually buy products (the customer interview data were given as input for each session) and they were asked to develop ideas for design concepts that were used later to develop a prototype.

From the interviews with the customers and employee brainstorming sessions, it became clear that life insurance policies presented a clear opportunity to simplify the user experience. We pursued this further by working on a prototype. After all the data was gathered and analyzed, we developed a prototype that would advise the customer about the ideal amount of life insurance coverage they should purchase. The prototype was based on demographic data entered by the consumer (age, income, partner’s income and children). This data made it possible to better understand the consumer’s life situation to present them with a recommended amount of life insurance. With this information, the yearly premium could be calculated and presented to the customer for the suggested amount of life insurance.

The prototype also helped with understanding the operations of the company. Usually only one employee in the company performs these tasks, recommending the amount of life insurance a person should have. This employee makes recommendations based on his own experience. With this prototype, the idea is to create a tool that optimizes the process to recommend and quote life insurance, by enabling all employees to do life insurance quotes, eliminating the need to rely on or wait for a single employee with such knowledge. It also allows better productivity by making it faster to do estimates.

Does the idea enhance the existing product offering?

Is the solution compliant with regulatory requirements or are they unknown or undefinedat the moment?

Is the idea something the customer wants and needs?

Is the idea commercially viable? Does it bring potential commercial benefits for the company and is it feasible to implement?

This process has been adapted from different approaches for service design presented in Kimbell (2014) . The idea seemed to satisfy all the above-mentioned aspects. After several iterations of the design, we came up with the prototype shown in Figures 2 – 4 .

We tested the prototype with several customers and several employees. The initial comments from both of sides were positive and the prototype yielded recognition and enjoyment by all involved parties. The users were curious to find out about the recommended amount that was proposed to them and were very interested in reading the detailed descriptions on why the suggested amount was suited for their particular case. The employees appreciated the ease of use the prototype provided for generating life insurance quotes for customers and the detailed descriptions of why the particular life insurance amount was recommended to them.

It was difficult to change the internal mind-set of the company. It took time and patience to get all the members of the organization on board with using the technology.

It was important to spread the knowledge and competency of the tool across the different key positions in the company and “energize” them about the solution. By having a shared language and communication daily, it allowed for a better understanding of the tool features.

Including multiple stakeholders in the design phase of the prototype allowed employers and customers to bring different perspectives to what different features pffered/

Cyber risk and digital insurance policies

The last area we investigated was the growing need for cyber security by businesses. As the pace of technological change continues unabated, organizations’ reliance on technology has become critical to their ability to offer products and services. Technology is critical to help companies interact with customers and employees. The significant economic impact of cyber risks on companies as well as the recent attention of the media has led companies to look for solutions from available insurance products. Because of this and the increased frequency of cyberattacks, cyber risks are now widely accepted as one of the top emerging risks. Cyber insurance policies provide twofold benefits for the companies buying them: they create awareness that cyberattacks might happen and the company looks for options to reduce these risks. The act of buying cyber insurance makes the company put a price on the potential damage in case the company is compromised by a cyberattack.

Liability risk – It provides compensation and legal support in the event of third-party claims, resulting from loss of personal and/or business data.

Crisis costs – It provides compensation to undertake forensic investigations, reputation public repair, customer notification costs, IT services and cyber incidents.

Fines – It provides compensation for research costs, legal assistance and administrative fines.

Digital media breaches – It covers compensation and defense costs related to third-party claims against the client company arising out of multimedia activities (e.g. defamation, allegation or plagiarism).

Cyber risk – It provides compensations for attacks from malicious software.

Insurance policy for network interruption – It provides protection for loss of revenues or net profits associated with network downtime.

With these products, the company enriched its portfolio of insurance products covering cyber products. With these new products in the portfolio, the sales team started actively promoting these products to businesses. The initial results are positive, at the moment of writing of this paper, the SME has issued five cyber risk policies.

Conclusions and future steps

In this paper, we presented the steps a small Italian insurance company took to respond to the wave of digital transformation. The technology-based organizational transformation required the organization to be flexible and responsive to changes. The article describes how an organization can embrace digital innovation via internal innovation, buying from startups, partnering with startups or investing in startups. It also discusses how the company decided to respond to the challenge by partnering with Plug and Play, an accelerator connecting corporations to startups. The company found the first contacts promising when presented with a number of product possibilities.

The article shows how a company can apply for internal innovation and come up with a simple tool to bring insurers closer to their customers. The approach presented in this paper shows how different design-based approaches and tools can find ways to improvise in a rapidly changing environment, especially at a stage where the needs of users are uncertain. At the moment, the developed platform supports the needs of the company and their everyday work in the office. Future steps foresee full development of the prototype into a working application including the expansion and support of other types of insurance policies, especially car and home insurance policies. The idea will be passed on and developed further by a small separate company that already works on other solutions for insurance incumbents.

The company enriched the portfolio with new insurance products, tackling diverse digital risks. The company can offer insurance products to other companies that go through digital transformation and need to respond to cyber risk. The company has already started selling these products with positive results.

The management of insurance claims continues to be painful for customers – both retail and corporate. Well-managed claims can create a number of efficiencies for an insurance company and help with client retention. Yet at this moment, this area is still under-served by new technology. We see a great opportunity for driving change here and will be exploring startups offering solutions in this space.

The company can potentially increase retention rates by offering benefits for loyal customers or customers who have multiple insurance policies with the company. The company will look for a solution through digital channels to build a behavior-linked loyalty program that tracks people’s activities and rewards them adequately. We plan to study reward mechanisms as a future extension of this work.

Different tools and methods a company can use for internal innovation based on the literature review used in different insurance companies of similar size

In the first screen ( Figure 2 ), the user is asked to enter key personal data points such as age, profession, presence of a partner, children, possession of a house and the income levels as well as level of coverage they would prefer to have

In this screen, the user is shown the ideal amount of insurance, as well as the yearly fee for the coverage amount

Third screen explains the proposed amount for the user’s specific case

Brown , T. and Wyatt , J. ( 2010 ), “ Design thinking for social innovation ”, Development Outreach , Vol. 12 No. 1 , pp. 29 - 43 .

Greineder , M. , Riasanow , T. , Böhm , M. and Krcmar , H. ( 2019 ), “ The generic InsurTech ecosystem and its strategic implications for the digital transformation of insurance industry ”, 40th GI EMISA .

Kimbell , L. ( 2014 ), The Service Innovation Handbook: Action-Oriented Creative Thinking Toolkit for Service Organizations , BIS publishers .

Kohli , R. and Melville , N.P. ( 2019 ), “ Digital innovation: a review and synthesis ”, Information Systems Journal , Vol. 29 No. 1 , pp. 200 - 223 .

Kumar , V. ( 2009 ), “ A process for practicing design innovation ”, Journal of Business Strategy , Vol. 30 No. 2/3 , pp. 91 - 100 .

Nicoletti , B. ( 2017 ), “ A business model for insurtech initiatives ”, The Future of FinTech , Palgrave Macmillan , Cham , pp. 211 - 249 .

O’Brien , C. ( 2004 ), “ Product innovation in financial services: a survey ”.

Van Boeijen , A. Daalhuizen , J. van der Schoor , R. and Zijlstra , J. ( 2014 ), “ Delft design guide: design strategies and methods ”.

Wilson , J.D. Jr. ( 2017 ), Creating Strategic Value through Financial Technology , John Wiley & Sons .

Further reading

Menhart , M. , Pyka , A. , Ebersberger , B. and Hanusch , H. ( 2004 ), “ Product innovation and population dynamics in the German insurance market ”, Zeitschrift Für Die Gesamte Versicherungswissenschaft , Vol. 93 No. 3 , pp. 477 - 519 .

Acknowledgements

The author would like to thank the company host Assinord Verona S.R.L. and all the employees for their time and effort dedicated to this project.

Corresponding author

About the author.

Galena Pisoni is based at the Department of Information Engineering and Computer Science, University of Trento, Trento, Italy.

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N avigating large volumes of unstructured insurance claims data is a substantial challenge for any insurance company looking to automate repetitive yet complex tasks across its operations. The integration of advanced technologies such as automation and artificial intelligence (AI) has become a pivotal driver for the exponential transformation of insurance organizations.

A leading insurance firm in the Nordics wanted to modernize its claims management process. The current workflow required manual processing of each claim request, a time-consuming series of repetitive tasks which had to be performed by its agents. Amplifying the complexity was unstructured data from various sources, requiring detailed examination and categorization. The spectrum of claims data was also broad and varied, originating from multiple sources such as bills, invoices, cash receipts from pharmacies and local clinics, and medical treatment diagnoses with supporting documents.

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This strategy extended beyond a technological upgrade. It was about empowering their people, preparing them for a future where they can collaborate effectively with AI to drive impactful results. This initiative aimed to set the stage for the insurer's expansion into new markets, with their AI-powered claims management solution acting as a catalyst.

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Insurance Case Studies: The Ultimate Guide

How do you show your prospects exactly what your company can do for them? With a case study. Insurance case studies provide buyers with the solid facts, figures and performance examples they need to make a purchasing decision.

What Is a Case Study?

A case study is a powerful marketing tool that is often used in the middle or bottom of the sales funnel, to help buyers develop a preference for your offering. Case studies increase buying confidence and validate the buying decision. They prove that your product or service performs as promised.

Case studies change the conversation from telling to showing. Instead of just telling prospects how great your brand is, you can show prospects exactly what your brand is capable of achieving. This gives prospects a more concrete understanding of what to expect and enables them to step into the shoes of a satisfied customer.

The Elements of a Case Study

An effective case study contains key elements that align with the buyer’s journey:

• Who is the customer? If you don’t have permission to name the customer, describe the customer by industry, size and other relevant details.
• What problem were they trying to solve? When B2B buyers are shopping for a product, they’re trying to solve a specific problem. Identify this problem so other prospects with similar problems can relate. Sometimes, there’s more than one problem.
• What other solutions did they consider? B2B buyers usually consider multiple options before deciding. This is a key part of the process, and including the details can help emphasize why your company stood out.
• Why did they choose your solution? State exactly what your company offered that other competitors couldn’t.
• What was the implementation process like? Switching B2B vendors can be a major undertaking. Describe the process so your prospects will know what to expect. Of course, you want to put your company in a positive light and focus on the positives, but you can include hiccups that occurred in the process and how you handled them. Prospects know that things don’t always go perfectly according to plan, and this shows that you’re competent and able to overcome any barriers that arise.
• How has the company benefited? In the beginning of the case study, you described the client’s problem. Now touch back on this and show how the problem has been solved. Include specific information about how the company has benefited from your product or service. For example, how much time or money has the client saved? How are they better prepared? How have you helped increase their revenues?
• What are the key takeaways for others in a similar situation? Convince prospects that they should follow the client’s example and partner with your company. Summarize your argument with key takeaways from the case study.

Case Study Dos and Don’ts

To squeeze the most value from your case study, you need to follow some best practices.

• Don’t just list bulleted facts. You might be able to pull a list of bulleted facts from your case study to use in other types of content, such as social media posts, but your actual case study should be at least two pages long to tell the story in a meaningful way.
• Do use names. Your case study will carry a lot more weight if the featured customer is named. You can also use anonymous case studies, but they are not quite as credible.
• Do appeal to emotions. Think of your case study as a story. You’re showing your prospects what it’s like to work with your company, so you need to build a narrative. This is also a good place to build an emotional argument by showing how your company can help clients deal with pain points and reduce problems.
• Don’t make your case study longer than it needs to be. Your prospects are busy, and they probably won’t have time to read an overly verbose document. Provide enough information to create a compelling story, but don’t get bogged down with unnecessary details. An effective case study will often be around two pages.
• Do include quotes. You can say that your company is great, but it sounds more convincing if one of your customers says it. The featured customer may be willing to provide you with quotes and their logo to include in your case study. As a bonus, this is also free publicity for them.
• Do get permission. If you’re naming a customer, you will need to secure their permission and allow them the opportunity to review and approve the final piece before it is used. Be sure to save their written approval in case questions arise in the future.

Case Studies Should Be Part of Your Content Library

Creating a case study can take some time and effort, but they are worth it.

According to the 2022 Edelman Trust Barometer , 63% of people worry business leaders are trying to mislead people with false or exaggerated statements. If you just say that your company can help people solve their problems, your prospects might not believe you. You need to build credibility, and a case study that provides concrete examples can help.

A case study is also a fantastic way to differentiate yourself from your competition. As mentioned earlier, case studies are often used in more advanced stages of the customer journey, when prospects are already familiar with your company and need information that’s going to guide their purchasing decision. You want to create preference for your company so you can close the sale, and a case study can help you do that.

Your Case Study Can Convert Leads for Years

Some content has a short life, but not case studies. Although creating a case study will require some effort, once you have it, you can use it for as long as you continue to offer the featured products and services, and the featured company is still a customer.

• Feature your case study on your website. You can create a landing page for your case study or case studies so prospects can find them easily. They can be offered as instant downloads or you can generate leads by gating them with a form.
• Promote your case study in social media posts. Spread the word about your case study on social media. You can always just write a post and link to the case study, but also consider designing graphics for the case study. A LinkedIn carousel post is another great way to highlight your case study on social media.
• Encourage prospects to download the study as a call to action in your blog posts . This is a practical way to encourage your audience to learn more about your company.
• Link to case studies in email nurturing campaigns . If you’re nurturing a prospect that has downloaded other content, a case study link can entice additional engagement.
• Build case studies into your sales processes . Sales professionals love using case studies as handouts as they provide a great springboard for meaningful conversations.
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A Customer Experience Case Study: Lemonade

RevOps , or revenue operations, is a strategy for businesses to align revenue-enhancing teams and activities while improving the customer journey. When discussing RevOps, the emphasis is usually on overcoming silos and having departments such as marketing, sales, and customer service working seamlessly. However, it's equally beneficial from the customer's point of view. The insurance company Lemonade is an instructive case study to illustrate best practices for optimizing the customer experience.

How Lemonade is Disrupting the Insurance Industry

Lemonade is an innovative insurance company, founded in 2015, that offers products such as homeowners, renters, life, and pet insurance. Lemonade has similar services as other insurance companies but has radically changed the customer experience. Here are some features that set Lemonade apart.

• • Strong branding. Lemonade has carved out a distinct niche for itself. Clearly targeted towards tech-savvy younger customers, it promises "Insurance built for the 21st century."
• • Personalized service. One of the qualities that distinguish Lemonade from other insurance companies is the level of personalized service. Maya, the company's chatbot, makes it easy for website visitors to get information and sign up. Maya takes visitors through a questionnaire that guides them to the most appropriate services and provides quick quotes. Another chatbot, named Jim, handles payouts.
• • Flat fee. Pricing is often confusing for insurance customers. Lemonade also  appeals to millennials  and other younger customers, who tend to have less experience with insurance policies. The company takes a flat fee of 20% from their customers' premiums, which is simple and straightforward. As they point out, their fee structure also eliminates a conflict of interest with customers. The flat rate, combined with their Giveback program (see below), means that Lemonade doesn't lose money by paying claims.
• • Giveback program. When customers sign up for insurance, they choose a nonprofit to support. At the end of the year, any unclaimed money from an account is donated to the nonprofit.   Lemonade Giveback   provides customers with the satisfaction that they're performing a social good, something that's extremely relevant to millennials. A  Deloitte Global Millennial Survey  revealed that 42% of millennials would start patronizing a business with a positive impact on society, while 38% would stop supporting a business with a negative impact.

A Data-Driven Approach

Source: Lemonade is disrupting insurance. The incumbents will have to respond Lemonade vs Traditional Insurance Companies: Customer Experience

Lemonade claims that it  collects 100x more data points per customer  compared to other companies. In a blog post, Lemonade describes how collecting and studying data are helping to  improve its loss ratio . This is the ratio of losses to premiums. As the article explains, a very high loss ratio isn't sustainable for an insurance company, while a very low one is profitable for the business but not good for customers. Lemonade's system of charging a flat rate and donating leftover funds to charity allows it to maintain a stable loss ratio.

One of Lemonade's taglines is to turn insurance "from a necessary evil to a social good." The Giveback program plays a big role in this. But what does this really mean for the average customer? Let's explore if (or how) the customer experience differs with Lemonade when compared to traditional insurance companies.

Do Everything Online

At a time when  73% of millennials prefer to shop online  using their phones (the figures are 2x higher for Zoomers, or Generation Z), Lemonade has perfectly tapped into this target market. The traditional process for getting insurance information requires the user to contact an agent, fill out a form, and wait for a quote. With Lemonade, the process is streamlined to be much faster and more convenient. The system's built-in AI (Maya the chatbot) provides personalized service without the user having to talk to a live agent.

What really sets Lemonade's customer service apart is the way it seamlessly transitions customers from one function to another. A new user is presented with information tailored to their buyer persona as they see comparisons of data so they can choose the best service. They can just as easily access claims processing when needed. All of this is automated, without the need to wait on hold or fill out complicated forms.

For a thorough review of the UX advantages of Lemonade's landing page, see  A UX Review of Lemonade Insurance in Less Than 5 Minutes .

Image Source: Lemonade

Fast Payments

Another distinctive customer experience feature of Lemonade is guaranteeing fast payments without any paperwork. As with the application process, customers can complete everything online. Claims are approved in seconds.

Easy to Switch

Lemonade targets customers who already have insurance as well as people buying it for the first time. Their "Check Prices and Switch" guides users through the process. As with other tasks on the site, Maya the chatbot guides users through a series of questions to highlight the advantages of switching to Lemonade.

Mobile Apps

Speed and convenience are supported by mobile apps that customers can download. Customers can set up and manage their policies on their mobile devices.

Active on Social Media

Another way Lemonade taps into its millennial customers is by providing news and policy information on social media. Their twitter account  is frequently updated. They're also active on Facebook and Instagram. Social posts aren't simply ads for insurance, but links to news items and timely blog posts.

Lemonade posts stories that are educational and helpful to its audience. For example,  a recent post addresses concerns that renters may have about eviction and suggests resources to help. This type of post isn't directly related to Lemonade's services, but it establishes them as a useful source of information.

What Lemonade Has Accomplished

Is Lemonade actually disrupting insurance and stealing customers from more established companies? The Motley Fool, in the article,  Can Lemonade Disrupt the Insurance Market?  shares some impressive facts.

• • While 50% of renters are under 30, only 37% get renter's insurance. Lemonade is targeting this largely untapped market.
• • Customers who signed up with Lemonade three years ago have increased their spending on renter's insurance by 56%.
• • Between 2017 and 2019, Lemonade increased the number of premiums sold from $9 million to $16 million.

While the article goes on to question whether Lemonade can succeed at converting older and more affluent customers, in our opinion this innovative model will prove to be a clear competitive advantage for Lemonade. 

Lessons From Lemonade

Here are some lessons that businesses in any sector can take from Lemonade.

• • Long-standing products and services can be marketed in a new and fresh way.
• • Target specific demographics (e.g. Lemonade targets millennials and renters).
• • Today's customers appreciate speed and efficiency.
• • Provide simple and personalized services. AI tools such as chatbots can help improve the customer experience.
• • Use automation tools to collect and analyze data.

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Our collaboration to figure things out feels like more than a customer-vendor relationship. It genuinely feels like AWS is part of our team.”

Dave Anderson Director of Technology, Liberty Mutual

Building a Future-Proof, Agile Global Business

With $40 billion in annual revenue, Liberty Mutual is the world’s sixth-largest property and casualty insurance company and is an industry frontrunner in technological innovation. The company began exploring solutions for security and test data on AWS in 2013. In 2015, Liberty Mutual began its serverless journey on AWS when James McGlennon, the company’s chief information officer, pushed for Liberty Mutual to become more agile and customer-centric in the cloud. The company previously had on-premises systems, but using those to write event-driven systems proved too complicated. 

Serverless computing, however, enabled the engineers at Liberty Mutual to build event-driven systems faster because it sped up the feedback cycle so that the systems iterated more efficiently. “The light bulb moment for me was realizing that it’s not a good day’s work for a developer to write 10,000 lines of code,” says Anderson. “We started to use the phrase ‘Code is a liability,’ reminding our engineers and architects that they shouldn’t be writing code when they don’t need to.” The engineering team shifted its focus from the nuts and bolts of building to using the building blocks of serverless architecture to quickly add business value.

Liberty Mutual chose to use AWS in its modernization journey toward serverless infrastructure because AWS offered engineering experience, a customer-centric approach, and a strong focus on security—a top priority in the highly regulated insurance industry.

Transitioning to a Serverless Infrastructure on AWS

Liberty Mutual views its transformation to serverless infrastructure as a constant journey. During the initial phase, the company built the foundational elements of its infrastructure, such as network security and deployment pipelines. In the second phase, it modernized application development and layered on serverless-first principles. Now Liberty Mutual has a serverless-first policy, so engineers must first strive to build serverless software or functions. Many serverless-first projects have already been completed, all of which use AWS Lambda , a serverless compute service that lets companies run code for any type of application or backend service with zero administration. When using the serverless-first approach isn’t feasible, the engineering team looks for a cloud-native option or—as a fallback—containerized solutions, which Liberty Mutual relies on for its legacy workloads. “These are things we’ve spent 20 years developing, so we’re not going to simply rewrite those to AWS Lambda tomorrow,” Anderson explains. “There is a huge advantage to us having those workloads containerized in the cloud, where we can build serverless infrastructure around them.” Now more than 50 percent of Liberty Mutual’s workloads run in the cloud. 

In 2019, Liberty Mutual used serverless computing to consolidate its disparate lines of business from around the globe into a centralized general ledger known as Financial Central Services (FCS)—a job too complex for an on-premises system. It wrote an extract, transform, load process that uses AWS Step Functions , a serverless function orchestrator for sequencing AWS Lambda functions and multiple AWS services into business-critical applications. Using AWS Step Functions, Liberty Mutual created an event-driven workflow in which the data feeds from each line of business are transformed into a series of events, or financial transactions, that then move into FCS. Now FCS processes 100 million transactions in one run at the end of every month, which means that for the majority of the month, it is offline and therefore not accruing costs. Processing one million transactions costs just $60. The flexibility and resiliency of the serverless architecture virtually eliminates failure.

To help deploy new applications quickly, Liberty Mutual created a software accelerator using the AWS Cloud Development Kit (AWS CDK), an open-source software development framework in which engineers can use familiar programming languages to define cloud application resources. Engineers use the programming language TypeScript to create templates, or serverless patterns, in AWS CDK. These templates can then be used to rapidly build projects rather than writing the code from scratch. The patterns also give staff a common language with which to collaborate, and new hires and engineers with little cloud experience can use the patterns to hit the ground running. About 3,500 serverless patterns were deployed from 2019 to 2020. “As a large company, you don’t want to say to developers, ‘Just search online for AWS Lambda and code something,’” says Anderson. “You need to give more support.” So the company supports its engineers in earning AWS certifications and provides training and in-house workshops. Liberty Mutual also guides engineers using AWS Well-Architected , a framework that helps cloud architects build secure, high-performing, resilient, and efficient infrastructure for their applications and workloads.

Liberty Mutual has used serverless architecture to build several systems in just 3 months, compared to the 1 year it would take on premises. In one case, a team of four developers used serverless patterns in AWS CDK to build an equine and livestock insurance sales and administration application in 12 weeks—3 months ahead of schedule. The team used the extra time to create visual dashboards that added value to the application. “We can spend more time using the AWS Well-Architected Review to make a product extremely high quality,” says Anderson.

Continuing to Grow the Serverless-First Approach

Liberty Mutual plans to implement Amazon EventBridge , a serverless event bus that makes it easy to connect applications using data from one’s own applications, integrated software-as-a-service applications, and AWS services. Amazon EventBridge will enable the company to offload the complexity of building its own eventing backbone.

By using serverless architecture on AWS, Liberty Mutual has become more agile, releasing higher-quality solutions for customers on a faster time line while reducing costs and removing the responsibility of infrastructure maintenance from staff. Internal surveys of Liberty Mutual’s engineering teams have revealed that staff are happier and have fewer frustrations. “Their engagement lifted,” Anderson observes. “They feel more productive because they’ve got a better set of tools at hand.” 

Support from AWS has enabled Liberty Mutual to keep expanding and reaping the benefits of its serverless-first approach. “Our collaboration to figure things out feels like more than a customer-vendor relationship,” Anderson says. “It genuinely feels like AWS is part of our team.”

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Applications for BriteCore’s P&C insurance core platform

Project overview, client information.

BriteCore offers cloud-based software for enterprises to ensure high security, performance, and scalability. It is recognized as an established industry leader, offering world-class solutions, services, and expertise to over 50 insurance carriers, InsurTechs, and managing general agents. It helps companies enhance their time-to-market, become more competitive, and gain higher revenue.

Team composition

Client name

Expertise used

Cloud solutions , BI and reporting

Services provided

Software architecture , UI/UX design , Web app development , Mobile app development , Custom software development

United States of America

Insurance , InsurTech

Business challenge

BriteCore first partnered with DICEUS to build an internal administrative cash flow management and budgeting app for BriteCore. After the initial project was complete, BriteCore invited DICEUS to participate in BriteCore’s Community Code Contribution program where the team continues to provide overflow capacity and support to BriteCore engineers. Through the program, DICEUS engineers work alongside BriteCore engineers to develop multiple enterprise-level products (modules) including BriteQuote, BriteApps, and BriteDocs.

Technical challenges

DICEUS helped develop mobile and desktop solutions that seamlessly integrate with the BriteCore platform. All solutions had to be fully customizable to meet carrier needs and interoperable with other BriteCore products.

Solution delivered

First, DICEUS created an internal budgeting application in Python and adopted new data transformation processes according to specific customer needs. Next, we contributed to the development of three BriteCore products: BriteApps are mobile and desktop BriteCore products that can be tailored and branded according to the carrier’s needs. BriteQuote provides configurable pages, fields, and components to create quoting wizards for different lines of business. The solution is interoperable with other BriteCore modules. BriteDocs is a new, standalone document management system designed to handle documents throughout the insurance lifecycle.

Key features

BriteApps policyholder portal

Provides a new digital channel for policyholders. Available for mobile and desktop; it can be tailored by the insurer to reflect their logo and company color scheme. The portal itself has the following capabilities:

Claims management

Policy documents

Payment processes

View insurance provider

View messages

BriteApps administrative portal

Manages BriteApps administrative processes within the company including user settings, application monitoring, and control

Enrolled user management

Access rights management

Activity monitoring

Messaging to one or multiple users

Paperless document delivery

Customizing your applications

BriteApps message center

Enables insurers to send messages to a single user or to all users. Text can be translated into the user’s preferred language. Supports emails, in-app messages, and push notifications.

BriteQuote configuration

Enables the creation of quoting wizards that allow agents to perform a sequence of steps to make a quote. The quote wizards are fully configurable by lines of business, role, transaction type.

BriteQuote pages & components

Controls the display of information for agents over single or multiple pages and the ability to move through the pages and display data in pre-defined places.

BriteDocs stock & custom templates

Supplies stock and custom templates to use throughout the insurance lifecycle.

BriteDocs data aggregation

Acts as a data aggregator for claims, policies, quotes. This data can be transformed and inspected easily, as well.

Value to our client

Enhanced user experience.

The BriteApps portal equips policyholders with a new digital channel to access their documents and perform payments or enroll autopay, eliminating the requirement for in-person interaction.

Efficiency gains & cost savings

Self-service capabilities in BriteApps enable policyholders, agents, and the insurer to communicate and transact business more efficiently and conveniently, enabling more process automation, reducing cycle times, and driving costs down.

Higher mobile security

Instead of using passwords, mobile users are now able to use face recognition, touch ID, or fingerprints for authentication.

Improved communication

All the communication goes through the message center that provides capabilities for text messages, push notifications, in-app messages, emails.

Our tech stack

Client feedback

The DICEUS team has consistently supported the BriteCore team for many years. Their engineers are well-educated and highly invested in the ongoing quality of the BriteCore platform with sustained relationships that extend over four years. We appreciate everything the DICEUS team brings to the table as a development partner.

Phil Reynolds, CEO, BriteCore

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• Published: 10 September 2022

A case study of adapting a health insurance decision intervention from trial into routine cancer care

• Miles E. Charles   ORCID: orcid.org/0000-0001-8381-6803 1 ,
• Lindsay M. Kuroki 2 ,
• Ana A. Baumann 1 ,
• Rachel G. Tabak 3 , 4 ,
• Aimee James 1 ,
• Krista Cooksey 1 &
• Mary C. Politi 1  

BMC Research Notes volume  15 , Article number:  298 ( 2022 ) Cite this article

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This study adapted Improving Cancer Patients’ Insurance Choices ( I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions , however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (> 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact.

Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise.

Introduction

JL is a 66-year-old patient with progressive, recurrent ovarian cancer whose clinician recommended that she start on a targeted, oral cancer therapy based on genomic testing of her cancer. A month after receiving this recommendation, JL received a “summary of benefits” from her insurance company reflecting she owed a $3000 USD co-pay for a 30-day supply of this targeted therapy (the goal was to continue this therapy until her disease no longer responded to it, or she had intolerable side effects; her clinicians estimated this might take 1–2 years). As a full-time employed nurse, JL had health insurance. However, she did not qualify for the industry-sponsored financial assistance drug program because her annual income was slightly ($3500) over the allowed threshold. She would have to spend down 3% of her income on prescriptions that year in order to receive 100% coverage for the medication. Furthermore, because she had both government-sponsored and private insurance, her government-sponsored insurance made her ineligible for a “co-pay card” sponsored by the pharmaceutical company. JL was extremely distressed about this financial strain and considered whether and how she could take this therapy recommended by her doctor.

JL, like many under-insured patients, was inadvertently overlooked by her oncology team to be at risk for what scholars refer to as “financial toxicity,” or the material and psychosocial hardship from high costs of care. Yet, as many as 64% of patients report financial hardship following a cancer diagnosis [ 1 ], and many face barriers, like those described above, that prohibit affordable access to needed cancer therapies [ 2 , 3 ]. We use this case study to describe the critical steps we took to adapt and implement a health insurance decision intervention for cancer patients and survivors like JL, while balancing intervention testing and adaptation with real-world needs during a global pandemic.

Evidence supporting the intervention and the need for adaptation

Improving Cancer Patients’ Insurance Choices ( I Can PIC) is an interactive online decision tool originally designed to help cancer patients, like JL, think through their health insurance choices and identify ways to offset high costs of cancer and survivorship [ 4 ]. It provides tailored cost estimates across insurance plan types based on demographic and health characteristics and provides financial support resources.

In a randomized controlled trial of I Can PIC compared to an attention control group where participants were given an alternative intervention: a handout that lists financial resources along with brief definitions of health insurance terms, I Can PIC users knew more about health insurance and were more confident understanding insurance terms [ 4 ]. However, many I Can PIC users reported that their employer-based and marketplace insurance gave them limited choices [ 4 ]. This implied the potential to better align the tool within the current insurance landscape, even if it required adaptation before meeting all of its goals [ 5 ]. Therefore, the team elicited feedback from clinicians, patients, and policy experts on ways to emphasize using health insurance rather than focusing mostly on choosing health insurance (Additional file 2 : Table S1). This paper describes the adaptation process of I Can PIC to achieve these goals.

Intervention adaptation process

We used two guides to structure the adaptation process. The Iterative Decision-making for Evaluation of Adaptations (IDEA) decision tree informed the process of adaptation [ 6 ], and the Framework for Reporting Adaptation and Modifications-Expanded (FRAME) guided the tracking of adaptations (Fig.  1 ) [ 7 ]. To start the adaptation process, we first identified the core elements of the intervention that improved outcomes: health insurance educational resources, cost-of-care conversation guidance, and resources to offset costs which are critical to patients like JL (Additional file 1 : Fig S1). During this iterative process, we then added new elements to I Can PIC and made content, format, and functional improvements based on stakeholder feedback and the original trial results (Additional file 2 : Table S1).

I Can PIC as Tracked and Adapted Using the FRAME Approach

Assessment of the adapted I Can PIC tool

After we adapted I Can PIC , we assessed its effectiveness among newly-diagnosed patients with gynecological, colorectal, or lung cancer, examining their health insurance knowledge, financial toxicity, health insurance literacy, and delayed or forgone care due to cost. We conducted a historic control survey assessing these constructs as well as whether and how treatment costs were discussed with patients at their most recent visit with their physicians. Next, we conducted a brief virtual/video conference training with fifteen medical or surgical oncologists to talk about screening for financial distress and discussing costs with patients. After the training, we conducted a pilot intervention study where patients were sent I Can PIC , completed a survey after their upcoming oncology appointment, and a follow-up survey 3–6 months after recruitment. Once during the study, we gave the oncologists feedback and reminded them to screen for financial distress and refer patients to I Can PIC. This study was approved by the Human Research Protection Office at Washington University in St. Louis (protocol number 202003033).

The COVID-19 pandemic introduced unforeseen obstacles to patient enrollment that shifted in-person recruitment to virtual methods (e.g., phone calls and emails) from secured, Health Insurance Portability and Accountability Act (HIPAA) compliant university-affiliated phone numbers and emails. We also partnered with the institutional review board and streamlined the consent script to be more succinct and engaging [ 8 ]. Prior to these changes and even after, many newly diagnosed cancer patients did not want to add a research commitment to their already busy or overextended lives. With recognition of these challenges and others, the revised version of I Can PIC was made available to the public while undergoing testing so that patients outside of eligibility criteria, like JL with recurrent cancer, or patients not interested in research, could still benefit from its health insurance and care costs information and support.

Eligible patients for both the historic control and intervention groups were English speaking, at least 18 years old, eligible for insurance through their employer or the federal marketplace, and diagnosed with a new lung, gynecological, or colorectal cancer within five months. Participants were recruited from a single site, NCI-designated cancer center where fifteen oncologists (five gynecologic oncologists, three colorectal surgeons, two medical oncologists treating colorectal cancer patients, and five thoracic surgeons treating lung cancer patients) gave the study team permission to review medical records and approach eligible patients for study participation. Recruitment into the historic control group began in May 2020. Starting in October 2020, we conducted our first provider training, since health insurance open enrollment was beginning, and we wanted at least some patients to use I Can PIC while they had options of changing insurance. Between October 2020 and February 2021, we trained the fifteen oncologists to screen for financial toxicity and discuss care costs with patients.

After clinicians were trained, we recruited patients into the intervention arm. Patients were asked to review I Can PIC before their upcoming appointment. After they met with their oncologist, the research team sent them a survey that could either be completed online or by phone. A three-month follow-up survey was also sent to patients in the intervention arm.

Patient socio-demographics were self-reported. As in the original trial, participant numeracy and health literacy were assessed using validated scales [ 9 , 10 , 11 , 12 ]. Primary outcomes included health insurance knowledge, health insurance literacy, frequency, and type of care cost conversations (including topics and strategies discussed), financial toxicity, and patient referrals to resources to further discuss costs [ 13 ].

Statistical analysis

Descriptive statistics were calculated for all sociodemographic variables and compared between groups using chi‐square analyses or Fisher's exact test for categorical variables, as appropriate, and the Kruskal–Wallis test for continuous variables. Baseline surveys for both the control and intervention groups were compared for one-way analysis of variance, Fisher's exact test to determine if there were nonrandom associations between two categorial variables, and Chi-Square tests to determine if two categorical variables were independent. To compare the intervention at the baseline survey and 3–6 month follow-up survey, paired t-tests for continuous variables and kappa statistics for categorical variables (discussed costs or not, discussed cost strategies or not, referral made or not, etc.)

During our study period, there were 1512 total logins on the I Can PIC website, of which 1058 (70%) were guest users. Guest users were treated in other facilities, ineligible due to cancer type, or not interested in participating in the research study, but wanted to access the information. Among the 136 consented and surveyed participants (68 historic controls; 68 intervention group), socio-demographics were similar except that the intervention group was slightly higher educated (Table 1 ). The intervention group had slightly higher health insurance knowledge (mean score 77.02 vs 72.45) and slightly higher health insurance literacy (mean score 34.71 vs 33.03) compared to controls; these differences were not statistically significant. Knowledge and health insurance literacy was sustained at the 3–6 month follow-up.

The frequency of cost discussions related to cancer care was similar between the intervention and control groups (57.4 vs 67.7%, p = 0.22), with the most common topics involving insurance, time off work, and costs of medications. Specific cost strategies that were discussed are detailed in Table 1 . Overall, a small proportion of patients received referrals (eg., I Can PIC website or any outside agency/office such as government assistance, community agency or charity, or hospital billing) from their oncologist to learn more about cancer costs and did not vary by group (controls, 16.2% vs intervention group, 20.6%).

Financial toxicity was reportedly low in both groups (17.7% in the control vs 16.1% in the intervention group), though decreased slightly within the intervention group during the study period (first survey average score was 16.06 vs. 14.17 at the 3–6 month follow-up). Unfortunately, 18% of individuals in the control group and 13% in the intervention group reported delaying care due to cost (p = 0.41).

Throughout the adaptation process, it is important to ensure that end users like JL can benefit from effective interventions, even if interventions require refinement and continued testing. Using systematic decision trees and guides such as IDEA and FRAME, we described one way to systematically track intervention adaptations while ensuring real-world access throughout the process to benefit patients. Strengths of our study include our diverse stakeholders which included patients, clinicians and policy experts who provided advice on I Can PIC , including patients across several cancer types, and modification of consent processes and tool access to optimize patient engagement and minimize burden.

This case example provides a guide for deploying low-risk interventions in routine care while continuing to generate evidence and improve on their public health impact. Of 1512 total logins on the I Can PIC website, 70% were guest users outside of the research study, and we hope many of them, like JL, benefited from I Can PIC access even if they were reluctant to join a study. JL ultimately made an informed decision with her oncology team and the support of her family to only work part-time to optimize her benefits in order to receive the targeted, oral cancer therapy through the pharmaceutical company’s financial assistance program.

Despite growing awareness of financial toxicity on underinsured patients, more interventions are needed to better integrate cost conversations into routine cancer care. Systems-level changes are needed to address this burden of care on patients. Future work will continue to build on the frameworks discussed to adapt content and delivery of I Can PIC so that patient-centered outcomes, such as financial toxicity, distress, quality-of-life, and adherence to treatment, are improved. This case study can provide guidance for other implementation studies, including those that might be conducted during future health emergencies.

Limitations

Due to rapid changes as a result of the COVID-19 pandemic, it is important to note limitations of our study design and execution of our protocol. Given this unprecedented time when unmet social and health needs were and still remain under constant threat and turmoil, we acknowledge our non-randomized study design and recruitment of historic controls are critical limitations to interpretation and generalizability of results. The timing of their recruitment could have exacerbated health or financial strain, although the pandemic was still ongoing even at the end of the study with new waves of health risks emerging. Future health emergencies could introduce similar issues without addressing the larger social and societal needs. Furthermore, COVID-19 and rapid transitions to virtual recruitment presented other challenges to this project, which was initially planned to be in person. Despite modifications to the protocol, consent documents, and workflow to reduce burden on participants, systemic issues remained that reduced the diversity of our sample in the research component of intervention implementation. These challenges are likely to remain without addressing systemic barriers to research and care more broadly. Consequently, these results may not be representative of the experiences of lower income and/or racially diverse patients experiencing financial toxicity due to their cancer diagnosis. Ongoing feedback from stakeholders will continue to ensure that the needs of various populations, including oncology providers are considered.

Availability of data and materials

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

Improving Cancer Patients’ Insurance Choices

Iterative Decision-making for Evaluation of Adaptations

Framework for Reporting Adaptation and Modifications-Expanded

Health Insurance Portability and Accountability Act

PDQ ® Adult treatment editorial board. PDQ Financial toxicity and cancer treatment. Bethesda, MD United States: National Cancer Institute

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Acknowledgements

Not Applicable.

Financial support for this study was provided in part by a grant from the American Cancer Society (RSGI-17–018-01-CPHPS), the National Cancer Institute (P50CA244431), Washington University’s Institute for Clinical and Translational Sciences Dissemination and Implementation Research Core (UL1 TR002345) and The Foundation for Barnes Jewish Hospital. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Cancer Society, the National Institutes of Health, or Washington University. Ana Baumann and Rachel Tabak are funded by CTSA Grant UL1 TR002345 and P50 CA-19–006. Ana Baumann is also funded by 3U01HL13399403S1 and 5U24HL136790-02. LK was supported by the KL2 TR000450 and Doris Duke to Retain Clinical Scientists (2015215).

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Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus, Box 8100, St. Louis, MO, 63110, USA

Miles E. Charles, Ana A. Baumann, Aimee James, Krista Cooksey & Mary C. Politi

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, USA

Lindsay M. Kuroki

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Contributions

All authors contributed to writing, revising, and approving the manuscript. MP led the decision intervention development and adaptation process and critically evaluated and revised the manuscript. MC and LK led the writing of the manuscript, its revisions, and final submission. AB and RT led the evaluation of the adaptation process and critically revised the manuscript for important implementation content. AJ contributed to the design and adaptation of the intervention and critically revised the manuscript. KC led the discussion of the changes to the study as a result of the COVID-19 pandemic, assisted with data analysis, and contributed to revisions of the manuscript. All the authors read and approved the final manuscript.

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Correspondence to Mary C. Politi .

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This study was approved by the Human Research Protection Office at Washington University in St. Louis (protocol number 202003033). All individuals that participated in this study provided informed consent.

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Supplementary Information

Additional file 1: figure s1..

I Can PIC as Adapted and Tracked Using the Iterative Decision-Making for Evaluation of Adaptations (IDEA) Framework Steps.

Additional file 2: Table S1.

Stakeholder- and Participant-Suggested Adaptations to I Can PIC.

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Charles, M.E., Kuroki, L.M., Baumann, A.A. et al. A case study of adapting a health insurance decision intervention from trial into routine cancer care. BMC Res Notes 15 , 298 (2022). https://doi.org/10.1186/s13104-022-06189-8

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Innovation at progressive (a): pay-as-you-go insurance description.

Used as part of the second module of a course on Managing Service Operations, which addresses the design of sustainable service models (606-031).Consumer auto insurance is a price-sensitive industry in which customers rarely pay a premium to a provider even for additional service features. Progressive spends more on additional service features than its competitors do; consumers don't pay extra for these features, yet the company makes money on a product its competitors often do not. Central to Progressive's success is its ability (a) to turn operational savings into value-added service and (b) to capitalize on its unique competencies through clever service design. Progressive is considering a national rollout of Autograph, a pay-as-you-go insurance service offering that recently completed a successful pilot in Texas. A rewritten version of an earlier case.

Case Description Innovation at Progressive (A): Pay-As-You-Go Insurance

Strategic managment tools used in case study analysis of innovation at progressive (a): pay-as-you-go insurance, step 1. problem identification in innovation at progressive (a): pay-as-you-go insurance case study, step 2. external environment analysis - pestel / pest / step analysis of innovation at progressive (a): pay-as-you-go insurance case study, step 3. industry specific / porter five forces analysis of innovation at progressive (a): pay-as-you-go insurance case study, step 4. evaluating alternatives / swot analysis of innovation at progressive (a): pay-as-you-go insurance case study, step 5. porter value chain analysis / vrio / vrin analysis innovation at progressive (a): pay-as-you-go insurance case study, step 6. recommendations innovation at progressive (a): pay-as-you-go insurance case study, step 7. basis of recommendations for innovation at progressive (a): pay-as-you-go insurance case study, quality & on time delivery.

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Case Analysis of Innovation at Progressive (A): Pay-As-You-Go Insurance

Innovation at Progressive (A): Pay-As-You-Go Insurance is a Harvard Business (HBR) Case Study on Technology & Operations , Texas Business School provides HBR case study assignment help for just $9. Texas Business School(TBS) case study solution is based on HBR Case Study Method framework, TBS expertise & global insights. Innovation at Progressive (A): Pay-As-You-Go Insurance is designed and drafted in a manner to allow the HBR case study reader to analyze a real-world problem by putting reader into the position of the decision maker. Innovation at Progressive (A): Pay-As-You-Go Insurance case study will help professionals, MBA, EMBA, and leaders to develop a broad and clear understanding of casecategory challenges. Innovation at Progressive (A): Pay-As-You-Go Insurance will also provide insight into areas such as – wordlist , strategy, leadership, sales and marketing, and negotiations.

Case Study Solutions Background Work

Innovation at Progressive (A): Pay-As-You-Go Insurance case study solution is focused on solving the strategic and operational challenges the protagonist of the case is facing. The challenges involve – evaluation of strategic options, key role of Technology & Operations, leadership qualities of the protagonist, and dynamics of the external environment. The challenge in front of the protagonist, of Innovation at Progressive (A): Pay-As-You-Go Insurance, is to not only build a competitive position of the organization but also to sustain it over a period of time.

Strategic Management Tools Used in Case Study Solution

The Innovation at Progressive (A): Pay-As-You-Go Insurance case study solution requires the MBA, EMBA, executive, professional to have a deep understanding of various strategic management tools such as SWOT Analysis, PESTEL Analysis / PEST Analysis / STEP Analysis, Porter Five Forces Analysis, Go To Market Strategy, BCG Matrix Analysis, Porter Value Chain Analysis, Ansoff Matrix Analysis, VRIO / VRIN and Marketing Mix Analysis.

Texas Business School Approach to Technology & Operations Solutions

In the Texas Business School, Innovation at Progressive (A): Pay-As-You-Go Insurance case study solution – following strategic tools are used - SWOT Analysis, PESTEL Analysis / PEST Analysis / STEP Analysis, Porter Five Forces Analysis, Go To Market Strategy, BCG Matrix Analysis, Porter Value Chain Analysis, Ansoff Matrix Analysis, VRIO / VRIN and Marketing Mix Analysis. We have additionally used the concept of supply chain management and leadership framework to build a comprehensive case study solution for the case – Innovation at Progressive (A): Pay-As-You-Go Insurance

Step 1 – Problem Identification of Innovation at Progressive (A): Pay-As-You-Go Insurance - Harvard Business School Case Study

The first step to solve HBR Innovation at Progressive (A): Pay-As-You-Go Insurance case study solution is to identify the problem present in the case. The problem statement of the case is provided in the beginning of the case where the protagonist is contemplating various options in the face of numerous challenges that Service Progressive is facing right now. Even though the problem statement is essentially – “Technology & Operations” challenge but it has impacted by others factors such as communication in the organization, uncertainty in the external environment, leadership in Service Progressive, style of leadership and organization structure, marketing and sales, organizational behavior, strategy, internal politics, stakeholders priorities and more.

Step 2 – External Environment Analysis

Texas Business School approach of case study analysis – Conclusion, Reasons, Evidences - provides a framework to analyze every HBR case study. It requires conducting robust external environmental analysis to decipher evidences for the reasons presented in the Innovation at Progressive (A): Pay-As-You-Go Insurance. The external environment analysis of Innovation at Progressive (A): Pay-As-You-Go Insurance will ensure that we are keeping a tab on the macro-environment factors that are directly and indirectly impacting the business of the firm.

What is PESTEL Analysis? Briefly Explained

PESTEL stands for political, economic, social, technological, environmental and legal factors that impact the external environment of firm in Innovation at Progressive (A): Pay-As-You-Go Insurance case study. PESTEL analysis of " Innovation at Progressive (A): Pay-As-You-Go Insurance" can help us understand why the organization is performing badly, what are the factors in the external environment that are impacting the performance of the organization, and how the organization can either manage or mitigate the impact of these external factors.

How to do PESTEL / PEST / STEP Analysis? What are the components of PESTEL Analysis?

As mentioned above PESTEL Analysis has six elements – political, economic, social, technological, environmental, and legal. All the six elements are explained in context with Innovation at Progressive (A): Pay-As-You-Go Insurance macro-environment and how it impacts the businesses of the firm.

How to do PESTEL Analysis for Innovation at Progressive (A): Pay-As-You-Go Insurance

To do comprehensive PESTEL analysis of case study – Innovation at Progressive (A): Pay-As-You-Go Insurance , we have researched numerous components under the six factors of PESTEL analysis.

Political Factors that Impact Innovation at Progressive (A): Pay-As-You-Go Insurance

Political factors impact seven key decision making areas – economic environment, socio-cultural environment, rate of innovation & investment in research & development, environmental laws, legal requirements, and acceptance of new technologies.

Government policies have significant impact on the business environment of any country. The firm in “ Innovation at Progressive (A): Pay-As-You-Go Insurance ” needs to navigate these policy decisions to create either an edge for itself or reduce the negative impact of the policy as far as possible.

Data safety laws – The countries in which Service Progressive is operating, firms are required to store customer data within the premises of the country. Service Progressive needs to restructure its IT policies to accommodate these changes. In the EU countries, firms are required to make special provision for privacy issues and other laws.

Competition Regulations – Numerous countries have strong competition laws both regarding the monopoly conditions and day to day fair business practices. Innovation at Progressive (A): Pay-As-You-Go Insurance has numerous instances where the competition regulations aspects can be scrutinized.

Import restrictions on products – Before entering the new market, Service Progressive in case study Innovation at Progressive (A): Pay-As-You-Go Insurance" should look into the import restrictions that may be present in the prospective market.

Export restrictions on products – Apart from direct product export restrictions in field of technology and agriculture, a number of countries also have capital controls. Service Progressive in case study “ Innovation at Progressive (A): Pay-As-You-Go Insurance ” should look into these export restrictions policies.

Foreign Direct Investment Policies – Government policies favors local companies over international policies, Service Progressive in case study “ Innovation at Progressive (A): Pay-As-You-Go Insurance ” should understand in minute details regarding the Foreign Direct Investment policies of the prospective market.

Corporate Taxes – The rate of taxes is often used by governments to lure foreign direct investments or increase domestic investment in a certain sector. Corporate taxation can be divided into two categories – taxes on profits and taxes on operations. Taxes on profits number is important for companies that already have a sustainable business model, while taxes on operations is far more significant for companies that are looking to set up new plants or operations.

Tariffs – Chekout how much tariffs the firm needs to pay in the “ Innovation at Progressive (A): Pay-As-You-Go Insurance ” case study. The level of tariffs will determine the viability of the business model that the firm is contemplating. If the tariffs are high then it will be extremely difficult to compete with the local competitors. But if the tariffs are between 5-10% then Service Progressive can compete against other competitors.

Research and Development Subsidies and Policies – Governments often provide tax breaks and other incentives for companies to innovate in various sectors of priority. Managers at Innovation at Progressive (A): Pay-As-You-Go Insurance case study have to assess whether their business can benefit from such government assistance and subsidies.

Consumer protection – Different countries have different consumer protection laws. Managers need to clarify not only the consumer protection laws in advance but also legal implications if the firm fails to meet any of them.

Political System and Its Implications – Different political systems have different approach to free market and entrepreneurship. Managers need to assess these factors even before entering the market.

Freedom of Press is critical for fair trade and transparency. Countries where freedom of press is not prevalent there are high chances of both political and commercial corruption.

Corruption level – Service Progressive needs to assess the level of corruptions both at the official level and at the market level, even before entering a new market. To tackle the menace of corruption – a firm should have a clear SOP that provides managers at each level what to do when they encounter instances of either systematic corruption or bureaucrats looking to take bribes from the firm.

Independence of judiciary – It is critical for fair business practices. If a country doesn’t have independent judiciary then there is no point entry into such a country for business.

Government attitude towards trade unions – Different political systems and government have different attitude towards trade unions and collective bargaining. The firm needs to assess – its comfort dealing with the unions and regulations regarding unions in a given market or industry. If both are on the same page then it makes sense to enter, otherwise it doesn’t.

Economic Factors that Impact Innovation at Progressive (A): Pay-As-You-Go Insurance

Social factors that impact innovation at progressive (a): pay-as-you-go insurance, technological factors that impact innovation at progressive (a): pay-as-you-go insurance, environmental factors that impact innovation at progressive (a): pay-as-you-go insurance, legal factors that impact innovation at progressive (a): pay-as-you-go insurance, step 3 – industry specific analysis, what is porter five forces analysis, step 4 – swot analysis / internal environment analysis, step 5 – porter value chain / vrio / vrin analysis, step 6 – evaluating alternatives & recommendations, step 7 – basis for recommendations, references :: innovation at progressive (a): pay-as-you-go insurance case study solution.

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Capterra Risk Solutions

• Captive Insurance
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Capterra Experience

We work with a variety of businesses across many industries. here are just a few stories outlining how we’ve helped them efficiently manage their underinsured and uninsured risks., captives fill gaps for risk mitigation for construction firm.

Applied Construction Solutions (ACS), based in West Virginia, offers construction services to all sectors of the oil, gas, utility, midstream, and energy industries.

ACS was frustrated with higher premiums and gaps in its assorted risk-mitigation coverages-particularly in its employee benefits program.

Client Concern/Challenge

The rates from its traditional, fully-insured model continued to rise every year; the company believed its own claims were not high, but it had no visibility into the claims data. The firm found itself chasing lower rates annually by seeking competing programs from insurance carriers, with few benefits other than moderating the accelerating rate increases.

After research, ACS moved in 2022 to a self-insured group medical benefits captive that gave the team visibility into claims, group purchasing benefits, and the ability to share in insurance carrier profits through the size of the group.

After joining the medical benefits group captive, the ACS team began working with Capterra Risk on other ways to mitigate company risks.

ACS expanded into a single parent captive to cover risks around business interruption, cyber-attacks, excess pollution/environmental liability, deductible reimbursement, property, and crime/theft losses.

Andria Alvarez Wymer, Director of Strategic Initiatives and Planning at ACS, says “in the first year of our single parent captive, we were able to receive reimbursement from a claim related to employee theft related to fraudulent invoices. Without the captive plan, ACS would have faced that loss.”

She adds that setting up an effective captive program is not simple and requires a skilled partner. “There is a huge learning curve,” says Ms. Alvarez Wymer. “The Capterra team is highly knowledgeable; they keep the program simple with ‘layman’s terms.’”

“Capterra is a great team with whom to work and are always available.”

Avoiding Taking It on the Chin

Franjo Construction, a Pennsylvania-based general commercial contractor, faces a wide range of risks in its construction business. Claims erode profitability.

A big issue for construction firms is workmanship claims.  Joe Leonello, Jr, President of Franjo Construction, points that ‘we as an industry make a lot of mistakes.’ This can be costly.

However, there can be many limitations to coverage provided by commercial carriers. Because of these limitations, construction firms like Franjo must take on significant risk. Mr. Leonello points out that “when there are claims, our profit for the job fades.”

Capterra Solution:

Capterra put together a single parent captive that provided Franjo with the comfort to mitigate the risks as well as allow the firm to know its claim history to better price jobs and reduce future losses.

Results/Benefits:

“We built a hotel where select panels flew off the building a number of years after its completion,” says Joe Leonello. “We assessed the problem and fixed the issue but had to write off a substantial sum five years after the construction ended. This presented a challenge to our profits.”

With its captive program, the claim was fully paid by the captive – preserving Franjo’s annual profits.

“Franjo would have taken it on the chin had it not been for the captive insurance program,”

Captive Insurance Brings Peace of Mind to Houston Business

Client concern/issue:.

The principals of a Houston-area furniture retailer and interior design firm sought better control over potential business risks that its commercial policies were not covering.

The firm launched a captive insurance program in 2013 to mitigate these risks.

Over 8 years the program has been called upon to cover a number of such claims.  The policy not only covered damage and business interruption losses from Hurricane Harvey, but it also paid claims on lost business due to a key employee exiting the company.

Capterra Risk’s Exceptional Support

The principals value Capterra’s deep expertise in risk mitigation and understanding the retailer’s requirements of their captive program. “Capterra allows us to focus our attention on our business with the ‘peace of mind’ that Capterra has our captive program fully covered.  They rigorously track the program’s details, keep us in full compliance, and update us on regulatory changes that affect our captive insurance company.”

COVID-19: Illustrating the value of captive insurance

The captive program really showed its worth in spring 2020 when COVOD-19 shut down the United States economy. While US government programs did provide some payroll support, the business still suffered closures and significant delays, leading to lost profits. The captive’s Contingent Business Interruption policy paid a significant claim to cover these losses. This claim would certainly have been rejected under a commercial policy.

Comprehensive Management of 84 Lumber’s Captive Programs

In 2014, 84 Indemnity Co., part of the 84 Lumber family of companies, decided to transfer the management of its captive program to a new firm located in Western Pennsylvania.  After a thorough vetting process of multiple firms, 84 Indemnity Co. selected Capterra Risk Solutions, LLC.

84 Indemnity appreciated Capterra Risk’s flexibility and hands-on approach as well as its willingness to customize its proposal and services to meet the needs of the captives, while taking in to account 84 Indemnity management’s extensive insurance experience.

Capterra Risk Solutions, LLC provides comprehensive management to 84 Lumber’s captive including corporate governance, regulatory, and financial reporting.  Capterra also has a large network of 3rd party service providers with extensive experience working with captive insurance, which has been beneficial to the 84 Indemnity team.

From Product Recall to Insured Profit

A large, privately held food distributor, as a precautionary measure, conducted a product recall and pulled product off of grocery store shelves after a foodborne illness outbreak was linked to an ingredient within their product.  The client incurred the cost to remove the product and also incurred an interruption in revenue while managing relationships with their valued customer base, publicity issues, and legal expenses.

Due to the loss history of the food distributor, the traditional insurance market was unwilling to extend reasonable terms, conditions, and premiums to insure the product exposure of the food distributor in the event of a future claim. Capterra created a captive insurance company exclusively owned by the food distributor to insure their exposures, including product recall, product liability, and contingent business interruption.

Where there was once only unfunded, self-insured risk, now the food distributor owns a separate profit center in the form of a captive insurance company, designed to insure the risks of the business owner by funding for potential future liability.  The food distributor’s captive has created net after-tax profits to the owner exceeding $6 million over a four-year period.

Maximum Coverage and Profits for Healthcare Agency

A large, privately held home healthcare agency providing in-home skilled and non-skilled nursing and private duty care was concerned with the significant increase in their traditional insurance premiums at renewal. The agency had locations in more than four states with roughly 400 employees. As the home healthcare company continued to make acquisitions, expand facilities, and take on more employees, their insurance expense between property/casualty and medical was in excess of $1 million annually. The company wanted to explore their options of traditional methods of insurance, forms of self-insurance, and potentially consider creating and owning their own insurance company.

Capterra conducted a comprehensive market analysis and feasibility study to determine whether or not a captive insurance company was an economically viable option and an appropriate solution for the organization’s overall financial and strategic needs. Based on the company’s clean loss history, size, and annual insurance spend, it was ultimately determined that a captive insurance company would be designed around, and in synch with, the traditional insurance program to maximum coverage and capture profits.

The home healthcare agency first utilized the many benefits of a captive program by increasing their deductibles within their underlying traditional insurance program, thereby driving down the cost at their annual insurance renewal and, second, by insuring those higher deductible levels within their own captive insurance company. Additionally, the captive provided broadened coverage for risks endemic to the home healthcare industry, including breach of privacy data/cyber liability, crime exposures, employment practices liability, and reimbursement for medical deductible expenditures. By implementing the captive program, the company has decreased their traditional insurance spend by roughly 35% over a three-year period, has greater control over their annual underwriting renewal process, and has captured profits within their closely controlled captive of approximately $2 million over the same time period.

Filling the Holes in a Law Firm’s Coverage

A mid-sized law firm specializing in personal injury law purchased a lawyers’ professional liability policy to protect the law firm and the individual attorneys from errors and omissions. Discussions concerning alternative methods of insurance began after the collapse and bankruptcy of their professional liability carrier that had underwritten the malpractice liability insurance for the firm. Unfortunately, the law firm had a claim during the period in which the carrier was in run-off/liquidation and the partners of the firm found the experience to be an unpleasant one which left the firm with less than adequate insurance for both defense and indemnity coverage.

After a full insurance market study was conducted, it was determined that other, more financially stable and traditional carriers were unwilling to provide reasonable terms and conditions to bridge coverage from the prior carrier, which presented a significant gap in coverage. Having worked on the carrier side as underwriters, the team at Capterra has the underwriting expertise and depth of knowledge to understand and identify the coverages, potential gaps, and exclusions in the various policy forms available in the market. The Capterra team formed a captive program to provide coverage for unknown potential liability associated with the transitional time period from the prior bankrupted carrier to placement of coverage with the new carrier. Additionally, the captive provided coverage for other areas of exposure to the firm that historically had been self-insured including breach of privacy and cyber liability.

The firm ultimately experienced a claim that was denied and/or not covered in full by both the carrier in run-off and the current carrier. By this point, the captive had two years of surplus built up and was in a position to protect the law firm with reimbursement of claim-related expenses.

Insurance Premium Profits in Excess of $3 Million

A large real estate developer with controlling interest in more than 3 million square feet of office, retail, and mixed-use properties was interested in the merits of self-insuring certain of the company’s risks as the organization continued to experience growth and profitability. Over time, the developer had taken on more risk in the form of higher deductibles and/or decided not to renew certain traditional coverages and retain the risk within the business.

The Capterra team was engaged to provide a cost benefit analysis to the developer to identify the merits of establishing a captive insurance company and to collaborate with the developer’s attorneys and estate planners on the most beneficial ownership structure and optimal domicile jurisdiction.

In a purely self-insured environment, the developer was unable to harness certain financial and asset protection benefits that a captive may provide. By converting the pre-existing, self-insured arrangement into a formal insurance company, the developer was able to capture profits in the form of insurance premiums within the captive program and, after three years of profitable operations, had built surplus in excess of $3 million and exercised certain dividend options.

Building a School District’s Corrective Risk Management Plan

A school district was interested in an independent insurance analysis of the district’s existing risk management program. This included an evaluation of the district’s vendors that provided brokerage services, loss control services, and legal services for claims adjudication pertaining to workers compensation and employment practices lawsuits.

Capterra designed the insurance coverage specifications for a Request for Proposal (RFP) process, including development of underwriting data, determining the appropriate level of risk to be retained by the district in the form of self-insurance, and assistance in the completion of a strategic and effective bidding process.

By providing independent consulting services to oversee the insurance procurement process, including the interview and brokerage selection process, the district’s areas of deficiency within the risk management program were exposed, and a corrective plan of action was implemented.

“After my initial consultative meeting with Sandra Fenters at Capterra Risk, I realized how important her service as an independent risk management consultant could be for the school district. I found this independence allowed me to distance myself from historical relationships, take a fresh look at what we assumed was covered and test the competitiveness of our program and brokers. This process proved to be a worthwhile endeavor and we’ve already seen improvements in our risk management policies and procedures.” - Ira Weiss, Solicitor for Western Pennsylvania Schools

Connect with Us Phone: 412.802.2600 Email: [email protected]

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Advancing Health Insurance with AI: Omdena’s Impactful Solutions

April 2, 2024

At Omdena, we are at the forefront of leveraging AI technology to enhance the health insurance industry. With a global network of 20,000 developers and a track record of over 650 real-world projects, we are committed to driving meaningful change through innovative solutions. Behind those innovative solutions are localized developers who have been equipped with the necessary tools to craft localized solutions. Of course, this is only possible when using a grassroots AI approach . 

Our approach at Omdena is rooted in grassroots AI , where we train local tech talent and involve them in real-world challenges. Developers progress through a training regiment that focuses on foundational learning and a transition to real world projects. Once developers are trained in the latest AI techniques, they are then encouraged to take part in what are known as local chapter challenges. Although on a smaller scale, these projects allow newly-trained developers the opportunity to showcase their skills to help find solutions to the issues they face in their own localities. 

After successful participation in local chapter challenges, many of our developers move on to more sophisticated projects, including AI Innovation challenges . It is through these challenges that our developers enhance their skills further by working on challenges at a higher level. Again, once completed, a select few developers are able to showcase their learning even further by being chosen as Omdena’s elite. Through this process, we identify top talent who then collaborate on high-impact projects. This philosophy not only empowers local communities but also fosters the development of homegrown solutions to local challenges, driven by the people who understand them best.

In addition to our grassroots AI approach, we prioritize compassionate collaboration in all our endeavors. By bringing together diverse perspectives and expertise, we create compassionate AI solutions that address the needs of both insurers and policyholders alike. A typical Omdena project can include up to 50 collaborators. Each collaborator offering their own unique perspective on how to tackle challenges by bringing together ideas and varied approaches to solutions. 

Don’t just take our word for it, discover some of our recent challenges and how we used our AI expertise in the case studies below: 

Omdena Case Study 1: Fraud Detection in Insurance Claims

Fraud detection is a critical aspect of insurance operations. This operation oftentimes demands swift and accurate solutions. Teaming up with Turaco in the USA, our dedicated team of engineers and project managers embarked on a 12-week journey to tackle this challenge head-on. The result? An Optical Character Recognition Model that analyzes textual data from PDFs. This analysis tool translates documents into .txt format. From there we empower insurers to identify fraudulent claims in real-time while bolstering the integrity of insurance systems.

Source: Image from the document analysis tool

Omdena Case Study 2: Leveraging AI for Health Insurance Fraud Detection

In the realm of health insurance, combating fraud requires innovative approaches. Collaborating with a pioneering InsurTech company in Hong Kong, our team of AI engineers and product managers developed an AI model tailored to detect fraud patterns in health insurance claims within Saudi Arabia. 

This advanced model conducts lightning-fast eligibility checks in under 2 minutes. This enables insurers to combat fraudulent health insurance claim activities effectively. By leveraging AI technology, we redefined fraud detection, fortifying the security of health insurance systems for all stakeholders and their insurers.

Source: Claims Analysis Tool

Omdena Case Study 3: Detecting Drug Anomalies in Clinical Data Using Machine Learning

Source: live.staticflickr.com/2828/33833442616_c0e067697f_b.jpg

As clinical data continues to proliferate, ensuring its reliability is paramount. Partnering with FlaskData in Ireland, our global team of 50 AI Engineers and 1 Project Manager led an 8-week project to address the challenges of anomaly detection for drug safety. The outcome? A cutting-edge RESTful API service for automated detection of anomalies in clinical data . 

Using machine learning Omdena and FlaskData empowered healthcare professionals to identify and mitigate risks proactively, safeguarding the integrity of decision-making processes related to drug safety..

At Omdena, our commitment to advancing the health insurance industry through AI-driven grassroots innovation is of paramount importance. By collaborating with industry leaders and diverse talent from around the world, we deliver solutions that redefine insurance processes, ensuring a safer and more efficient future for everyone. From real-time fraud detection to automated anomaly detection, our solutions empower insurers to navigate complex challenges with confidence and clarity with minimal effort needed.

As we continue to push the boundaries of AI technology, we invite you to join us on this journey towards a brighter, more secure future for medical insurance. Let’s leverage the power of AI to transform the way we protect and manage healthcare resources.

If you are interested in learning more about the use cases we have provided please do not hesitate to contact: [email protected]

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Gibson Insurance Harvard Case Solution & Analysis

Home >> Harvard Case Study Analysis Solutions >> Gibson Insurance

Gibson Insurance Case Solution

Gibson Company was based in Kansas City, Missouri. Gibson Insurance’s key products include financial products, i.e. life insurance and annuities. The policies were directly sold by the in-house agents. The Gibson’s management was focused on the corporate acquisition strategy in order to grow the customer base as well as the overall assets, under the company’s management . The company had been using a simple costing method for the allocation of its product’s support costs. The controller (Rebecca Hampton) felt that the simple costing had been working well historically, however, it did not reflect the actual claim over the resources made by the several business units and product lines.

Moreover, it is observed that despite an increased level of sales ; the company’s profitability levels had declined. The company’s management was concerned about finding the key issues related to the incorrect pricing or out of control costs. The company’s controller was sure that a new cost allocation approach would help the company in improving its pricing strategy, whichwould lead towards a better resource’s allocation. The new costing method would enable the company to identify perform the divisions and to determine better product line costs, so that the company’s competitive position could be maintained.

The new cost allocation method is suggested to be activity based costing, whereby the costs are compiled and assigned to the activities based on their relevant activity drivers, unlike the simple costing method, which assigns the cost based on a single cost driver (i.e. number of policies initially). The new allocation bases included the policy acquisition, customer service, sales and marketing and other corporate overhead costs.

The unit support costs have been calculated using the new allocation bases (i.e. steps, calls, contacts and AUM) for all the four support costs. The total number of policies are multiplied with their relevant cost bases, on the basis of which cost drivers are calculated. The aggregate costs related to each cost pool is then divided by the cost drivers, which has resulted in the per units cost of $42.2 (policy acquisition), 44.06 (customer service), 10.02 (Sales & Marketing) and 0.003 (AUM).

Afterwards the cost per policy is calculated by multiplying the cost per unit with the driver use, for the new and in-force annuities and life insurances. The cost per new annuity and life insurance policy are calculated as: $221.52 and $438.22, respectively, while, the cost per in-force annuity and life insurance policy are calculated as $23.73 and $37.02. These costs per policy are used to determine the total cost for the three division i.e. $4,038,341, $4,781,457 and $5,100,202 for Midwest, Gibson and Compton, respectively.

The quantitative analysis shows that the simple costing method was not appropriate for the company as it lead towards the higher level of fluctuations in the total cost for each subdivision. The Midwest division had a high cost through simple cost allocation method; however, the activity based costing resulted in a lower cost. Similarly, the cost for Gibson was slightly less through the activity based costing method. However, the Gibson’s cost was much lower through simple costing method (as shown by graph).

The analysis concludes that the company should adjust its costs according to activity based costing method, as it gives more accurate costs related to each subdivision. Furthermore, the company is recommended to increase its policy prices for the Midwest and Gibson divisions and to lower the prices for the Compton division. These cost adjustments and price change would enable the company to remain competitive in the industry and to keep the operations smooth, efficient and productive..........................

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