Friday May 06, 2016

Exploring the Implementation of Prospective Bundling in Health Insurance

Prospective Bundling has gained much attention lately among health plans, mainly due to the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement initiative. In an effort to reduce costs for joint replacement and improve care, CMS is paying for a majority of these now as bundled cases. This means all providers who treat a patient have to share one bundled payment for that procedure. This includes any foreseeable complications and readmissions.

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Friday Mar 25, 2016

Real Stories of Self-Service Gone Wrong

What do you value more—time or money? According to the 2015 National Customer Rage study, the most widely reported damage that customers suffered was lost time. Lost money was the second most popular answer, according to findings from Customer Care Measurement & Consulting, W.P. Carey School of Business, and Dialog Direct.

As consumers, we’ve all experienced the frustration of wasting time resolving problems with service providers. On the other hand, if you’re reading the Oracle Insurance blog, you’re most likely familiar with customer experience from the provider side as well.

I recently conducted a significant amount of research to author the latest white paper, “Redefining Customer Experience Through Self-Service.” It got me thinking about my own issues dealing with my health insurance provider, Kaiser Permanente. The company’s poorly executed customer communications can offer learning lessons for all organizations—especially those with self-service offerings.

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Tuesday Mar 01, 2016

Innovate or Perish

The days of the status quo in the life insurance industry are over.  With increased competition through the arrival of new all digital carriers, a rapidly changing customer base with little long-term loyalty and high customer service expectations, and the realization that cost pressure will never be a thing of the past, Insurance executives are realizing that continuing to do business in the same way as they have in the past will lead to certain failure.

Dave Shively, Oracle's Senior Director of Life and Annuity Policy Administration, discusses the topic in today’s blog post.

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Tuesday Feb 23, 2016

Rules for Rules: Bringing Order and Efficiency to the Modern Insurance Enterprise

Business rules are everywhere throughout the enterprise. As insurers integrate their systems more tightly to support straight-through processing and other operational efficiencies, they also find themselves creating and managing an increasingly complex and interconnected web of business rules including enterprise processes, tasks, activities, or functions that are governed by rules. This web of rules spans insurers’ CRM, quoting, underwriting, policy administration, billing, document automation, and claims systems.

Many insurers need careful planning to manage their business rules efficiently as systems are becoming more and more complex and interconnected. Just because business rules are everywhere doesn’t mean you should treat them the same. Insurers need a framework to manage business rules in a way that all stakeholders can understand, and to enforce them within the IT infrastructure in a way that supports their traceability and facilitates their maintenance.

In many cases, the decisions to put what business rules in which specific systems are clear. For example, if the rules are associated with product rating such as premium calculation, then it makes sense to put this as part of enterprise rating engine especially if insurer has many policy admin systems. By putting the rules in one enterprise rating engine, instead of in many policy admin system, insurer can realize cost saving. However, there are rules where the answer is not as obvious and can vary depending on an insurer’s unique needs and environment. Effective navigation of such gray areas is essential to ensure consistency, avoid unnecessary complexity and optimize the power of business rules.

For more information on Oracle Insurance Insbridge Enterprise Rating, visit oracle.com/insurance.
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Wednesday Jan 27, 2016

Watch LOMA Webcast on Demand: A Progressive Approach to Insurance Policy Administration Transformation

Many carriers are embarking on a transformation journey to modernize their core policy administration systems in an effort to provide more flexibility, improve speed-to-market and increase revenue growth and profitability. However, there is simply nothing as daunting as a full policy administration system replacement project. These initiatives take multiple years to complete, and they are expensive and risky. There are many significant and high-profile policy administration system replacement programs that have ended in failure.

To reduce risk, some carriers are using progressive migration instead of full system replacement. These carriers implement some components of the system first – such as new business, commission or billing – then expand to full policy administration functionality once the technology is proven. This approach allows carriers to achieve incremental returns on the investment and minimize risk. It reduces the need for carriers to take a “big bang” approach to modernizing and gives the flexibility to implement the additional capabilities of the full policy administration system later, without having to rewrite all the rules, products and calculations.

In this webcast, Oracle and LOMA invite you to learn more about this approach and explore how insurers can use Policy Administration components to achieve enterprise agility while reducing risk.

For more information on Oracle Insurance Policy Administration, visit oracle.com/insurance.


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Oracle’s solutions provide the modern, rules-driven flexibility insurers need to support Digital Insurance transformation, simplify their IT environments, and innovate to keep pace with changing demands.

For more information, visit oracle.com/insurance.

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