Lachlan Tidmarsh

Mulling about #insurance health propositions comes from a private place. Sat through two relatives' death as a kid and also my own and son's #hospitalization events. Shared below how ✅ prioritization often puts customer experience at the back foot and why #digital #thirdpartyadministrators (#TPA) hold the keys to insurance customer's experience https://lnkd.in/gFQ98R72 ✅ and how new #insurtech doesn't solve any new problem statements on health https://lnkd.in/gvsCFWtw To add, without human assistance from a trusted agent, which is often called during emergency at the hospital on issues with the policy coverage; insurtechs will potentially receive numerous complaints unless there's an easy way for customers to get help. This is where #TPAs come in. Digital health propositions are also either - #prevention based. On some monitoring #app and #healthband. OR - #loyalty rewards based e.g. gym memberships or healthy shopping discounts. There's nothing wrong with that. But, Why the call for more focus on the moment of truth in claims? Is because of the emotional impact. The situation is emotionally charged as a loved one or yourself are in pain. And there's nothing that breaks a brand faster; than disappointing a loved one. I once asked a live poll to about 100+ folks, whether one would buy a critical illness insurance online.... ... 97% returned the answer - NO.

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Chubb’s Risk Decisions 360° Report is live! We surveyed more than 500 business leaders across North America to understand the biggest perceived risks to sustainable company growth. Find out what keeps executives up at night: https://bit.ly/4aaUEL1

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Price transparency MRF callout to be aware of. In the files, you could see for inpatient services MS-DRG's and/or APR-DRG's. These are different billing methodologies to be aware of when comparing network rates by NPI. See breakdown below. Diagnosis Related Groups (DRGs) are a patient classification system that relates the type of patients a hospital treats with the costs incurred by the care. Medicare Severity-Diagnosis Related Groups (MS-DRGs) classify a Medicare patient’s hospital stay into various groups to facilitate payment. These are typically used on the commercial side as well for inpatient services.   APR-DRGs are more comprehensive and include four levels of severity of illness or risk of mortality for each case. These are used on the commercial insurance side if MS-DRG are not chosen. Similar to MS-DRGs, an APR-DRG payment is calculated using an assigned numerical weight that is multiplied by an individual fixed dollar amount. APR-DRGs, however, consider severity of illness and risk of mortality instead of only a complication or comorbidity. More than one significant diagnosis, procedures, age, discharge disposition, and sex can add to the APR’s clinical severity. There are four levels of severity of illness or risk of mortality are: minor, moderate, major or severe.   APR-DRGs and MS-DRGs are both systems of classifying hospital cases based on diagnosis and procedure, and expand upon the basic DRG list by Medicare. #pricetransparency #employeebenefits #costcontainment

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Proactively defending against cyber attacks on our healthcare infrastructure must be addressed with the same urgency as attacks on any other part of our vital infrastructure. Hacks like the one that disabled Ascension's electronic health records can happen to any healthcare organization (see: Change Health), with potentially devastating consequences. #cyber #healthcareinfrastructure

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😕 Quarterly Earnings Call Transcript for UnitedHealth Group was not on my bingo card for google searches this morning. But here we are. If this isn't a great translation from #cyberrisk to business impact- I don't know what is. Transcript below from The Motley Fool gives play-by-play voice to the updates provided for United's investors and U.S. Securities and Exchange Commission (#SEC) "The #cyber impacts in the quarter totaled about $870 million or $0.74 per share. At this distance, we estimate the full-year impact will be $1.15 to $1.35 per share. Let me break that down into its key components. Of the $870 million, about $595 million were direct costs due to the clearinghouse platform restoration and other response efforts, including medical expenses directly relating to the temporary suspension of some care management activities. For the full year, we estimate these direct costs at $1 billion to $1.15 billion or $0.85 to $0.95 per share." They did their best to focus on the good, but you can't ignore the direct and visible impact that this incident has had on the entire healthcare industry. #changehealthcare

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The Next ER Visit - "You are now being recorded . . . " Here's a great post from Chris Deacon further illustrating how healthcare is an business first and foremost. Patients may be on the list of importance ut it's hard to say where. BTW - the cost of implementing this strategy will be added to your exhorbitant cost of health care. My other question is will this new technology interpret "I think you may need XYZ test done . . . " as it was done? Or, will it take all of the possible illnesses/ailments discussed and automatically up-code to the highest cost condition? Kind of like a Level II Er visit being up-coded to a Level IV ER visit.

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In this video series, listen in as Optum Advisory experts @Jeremiah Reuter and @Aaron Jurgaitis share their perspectives on how to adapt to constant changes in health care and leverage data to help care coordination. Watch part 1 here: https://optum.co/u8o7en Watch part 2 here: https://optum.co/owcy6y #payer #healthcare #OptumAdvisory #Optum #healthcareperspectives #carecoordination #healthcaredata #payeranalytics #healthcareconsulting

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The rapid integration of AI technology in the healthcare sector extends beyond automating manual and repetitive administrative tasks; it is poised to transform clinical practices, such as summarizing patient medical records or drafting diagnosis report. In this context, prioritizing patient safety and data privacy is essential when leveraging the technology. To address above, establishing guidelines for AI implementations will play a pivotal role in setting industry standards and best practices. These guidelines can provide a clear frameworks for AI development, deployment, and usage; thereby addressing potential risks such as biased decision-making and data privacy breaches. It will also promote consistency and interoperability across diverse healthcare systems. By adhering to established guidelines, healthcare organizations can confidently embrace AI solutions that meet stringent criteria for efficacy, safety, and reliability. This, in turn, stands to benefit patients and healthcare providers as a whole.

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Avoiding confrontation is in my DNA. It took me a long time to understand confrontation versus providing good feedback to my team are two vastly different things. There are some really good nuggets in this podcast especially for new and developing leaders. I hope you enjoy this as much as I did! Show them you care. #leadership #locktonlife

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🌟 “Focus on impact, and take risks when it’s for the greater good.” In this clip from our latest Silicon Heartland Sessions episode, Cindy Leavitt, former CIO and Vice President at The Ohio State University, shares her approach to leadership. Cindy emphasizes the importance of being intentional about making a positive impact and knowing when to take calculated risks to drive meaningful change for your organization. Her thoughtful perspective on balancing risk and reward offers invaluable insights for leaders striving to make a difference. 🎧 Stay tuned for the full episode, dropping this Friday! Subscribe here: https://lnkd.in/gSKEt2Cf #SiliconHeartlandSessions #SiliconHeartland #Podcast #CloudNirvana #TechLeadership #Innovation #IdeaToAction #Inspiration #ProfessionalDevelopment #AI #CloudComputing #TechCommunity Ben Blanquera Steve Gruetter Aaron Littlejohn Trent Taylor Nathan Case Jonathan Erikson James Gehring 🌥 Joseph Emison Matthew Randle Barton Murphy Robert Zwink Cindy Leavitt Bryan Mundy John Bishop Murali Sundararajan Warner Moore Srini K. Rehgan Bleile (Avon) Dan Manges 🗝Connie Matthews Reynolds 🗝 Chris Berry Cloud Nirvana

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In this video series, listen in as Optum Advisory experts @Jeremiah Reuter and @Aaron Jurgaitis share their perspectives on how to adapt to constant changes in health care and leverage data to help care coordination. Watch part 1 here: https://optum.co/wqeyrq Watch part 2 here: https://optum.co/00xw8i #provider #healthcare #OptumAdvisory #Optum #healthcareperspectives #carecoordination #healthcaredata #healthcareconsulting

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The impact of this breach will be far and wide: "RansomHub claims to have data from “tens of insurance companies,” including Optum, Medicare, and UnitedHealth. The hackers claim the full trove of data contains medical records, dental records, personal health information on active duty military, insurance records, and personally identifiable information on patients, including addresses and social security numbers. " Here’s what you need to know: · CHC is offering credit monitoring for all impacted individuals. CHC will provide two years of free credit monitoring and identity theft protections for those impacted. You can call 1-866-262-5342 or visit the dedicated UHG/CHC website at https://lnkd.in/gGDPZKqe to learn more. · The federal trade commission also offers resources to help protect your identity. For additional information about other precautions available to you, visit the Federal Trade Commission website at https://lnkd.in/gdahjKmz.

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Great explanation, which would be easy to miss. Thanks for pointing it out.

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If you're attending the 38th Annual Farm Bureau Actuarial Conference in Park City, Utah next week, be sure not to miss the session by Guidewire's Christopher Cooksey, "Generative AI market/opportunities and governance needed." #GuidewirePredict #insurance #innovation #insuranceinnovation #insurtech #insurancetechnology #pandcinsurance #propertyandcasualtyinsurance #generativeartificialintelligence #generativeAI #GenAI #analytics #data #predictiveanalytics

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Interesting article by Emily Olsen and Susanna Vogel listing over 40 healthcare organizations that have suffered data breaches in 2024, with the most recent occurring on November 13th. Included in this article are dates the breaches were reported, locations, potential data stolen and estimated number of individuals affected by the breaches. Having cyber liability coverage isn't enough. You have to know the policy and limits you've purchased are suitable for your industry.

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