Friday Sep 26, 2014

Utilizing a Centralized Calculation Repository for Increased Business Agility in Life and Annuity Insurance

There have been different strategies adopted to contend with the many challenges facing life and annuity insurers today, from tactical product and service offerings through more strategic programs involving significant front and back office developments to support them. The use of a centralized robust calculation capability can be a key element in the life and annuity product supply chain.

David Punter, Global Product Specialist at Oracle, discusses the topic in today’s post:

I’ve been looking at market trends recently, around Insurance specifically, around Life and Annuity even more specifically. There is growth and there is contraction, it all depends on where you look, what cannot be denied is that it is sometimes a disappointing experience. But beyond that last bit, I see a realization amongst insurance carriers that in order to do more than survive in this capricious market, some significant investment in revitalizing their infrastructure is in order.

This is not the now classic tinkering around the edges with a spot of workflow here, a code conversion there or some productized patch from another insurer’s system to deal with enrolment from somewhere else. There seems to be something more to it this time. The image below outlines some statistics to substantiate this view.

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Wednesday Sep 17, 2014

The Need to Shift to Oracle Health Insurance Alternative Reimbursement

Kathy McCarthy, Director of Sales Consulting for Oracle Health Insurance, discusses the topic in today’s post:

The healthcare system is dramatically changing within the United States – both out of necessity and want.  In the current economy, the US spending on healthcare is more than any other nation, more even than this country can sustain.  With the fastest rate of growth compared to any other nation on gross domestic product, the US does not have the best action plan to solving this dilemma. Consumers are left with higher costs and decreased attention to their care, when the focus should be primarily on their well-being. 

The Affordable Care Act (ACA) is putting consumers back in charge of their health by requiring the government to ensure that payers improve outcomes, lower cost and increase access to care.  This application of value-based reimbursement will have four plans that will be implemented by 2015.

  • Physicians in group practices of 100 or more who participate in Fee-for-Service Medicare will be subject to the value modifier in 2015, based on their performance in calendar year 2013.
  • Physicians in group practices of 10 or more provider who participate in Fee-for-Service Medicare will be subject to the value modifier in 2016, based on their performance in calendar year 2014
  • For 2015 and 2016, the value modifier does not apply to groups of physicians in which any of the group practice’s physicians participate in the Medicare Shared Savings Program, Pioneer ACOs, or the Comprehensive Primary Care Initiative.
  • The value modifier starting in 2017 will affect all physicians who participate in Fee-for-Service Medicare.

The value-based payment models are aligned with better outcomes for the consumers and the healthcare providers are forced to work more closely with their patients.

  • Capitation payment is managed by care organizations to control the cost of healthcare.  The fixed amount of money per time period is determined on age, how many individuals and services provided in the geographical area. 
  • Shared Savings Program is services established for Medicare and Medicaid (CMS). This program simplifies communication among providers to improve and ensure optimal healthcare for those using CMS. 
  • Pay for Performance is an incentive payment used to improve the quality of healthcare through a collaboration of measuring the overall care of the patient, resources used and other factors.
  • Bundle Payment is a single payment made to providers or healthcare facilities based on treatments and conditions given.  This method was designed to focus on improved care that providers have clear metric to follow in order to maximize their payments.
  • Fee-for-Service is a specific reimbursement for an individual service done to a patient. Payment is based on formula and funding levels by what the consumer wants to pay, the cost of service and type of service provided.

As a result, healthcare payers need to have better access to data, tools, efforts and a significant increase in time to carry out the implemented models. Therefore, there will be an emerging need for payers to have agile and open systems to meet the new market demand.  Data will need to be merged by payers, in order to provide crucial information that will accurately determine payment.

As the models change so will the need for flexibility and delivery methods.  Cloud-based solutions that have insight, agility and operational efficiency will be the game changers. The Oracle Health Insurance Alternative Reimbursement solution supports a wide range of models that formalizes and automates data. Oracle Health Insurance holds accountable details for contracts, products, providers and members to create financial messages.

To learn more, download and read the white paper, Emerging Healthcare Value-based Payment Models for Improving Patient Outcomes and Cost Efficiency.

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Tuesday Sep 09, 2014

What’s New with Oracle Insurance Insbridge Enterprise Rating 4.8?

Insurers today face many challenges such as competitive pressure, aging IT systems, and inefficient business processes that make it difficult to achieve profitable growth.  Among all of the processes that insurance carriers must focus on, rating and pricing is arguably the most critical process to ensure business success.  Rating impacts revenue, is fundamental to new product offerings, and is the key to carriers’ competitive differentiation.  For insurers to maximize the benefits of their rating technology, they must deploy stand-alone, best-of-breed systems, such as Oracle Insurance Insbridge Enterprise Rating (OIIER) 4.8—giving carriers increased flexibility and the ability to handle more advanced rating methodologies.

Oracle Insurance Insbridge Enterprise Rating 4.8’s latest enhancements include:

  • Increased Understanding of Premium Calculations:  OIIER 4.8 includes a new rating worksheet that provides a detailed, step-by-step view of all premium calculations insurers might use in a policy.  To meet various format requirements, users now have the flexibility to include or exclude program elements from the rating worksheet—providing clear visibility into the rating process and allowing users to manage risk more effectively
  • Reduced Integration Cost:  OIIER 4.8 now includes a mainframe adapter that is specifically designed to integrate with an IBM mainframe running zOS 1.12 or later to reduce the development effort needed to integrate the system with mainframe applications.  Further, the new version adds batch capability for IBSS for Java and offers five different options for batching large volumes of policies—improving batch performance and scalability.  Finally, Extended Services Interface (ESI) capabilities has been expanded to enable users to build a tree view of the application—making it easier to integrate OIIER with other custom built, front-end interfaces
  • Improved Usability:  New sequencing features help users to increase productivity with better sorting and searching, capabilities to add and delete elements, and the ability to reorder algorithms.  Additionally, new naming standards allow for insurers to enforce a uniform naming structure on system elements and programs—improving consistency and making records easier to locate
  • Increased Security:  Oracle has added a new security feature to its Insbridge SoftRater Server (IBSS) engine, ensuring user authentication based on the users’ preference (i.e., a user may choose to set up a password, if desired)—limiting access to IBSS to authorized users and enabling maximum security

Through its advanced rating features as well as its open and integrated architecture, Oracle Insurance Insbridge Enterprise Rating 4.8 can quickly consolidate and modernize a carriers’ rating and pricing strategy.  This provides business agility, reduces total cost of ownership, and increases speed to market.

For more information, visit the Oracle Insurance Insbridge Enterprise Rating product page.

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Tuesday Aug 12, 2014

Accelerating Speed to Market with Product Templates

To drive competitive advantage, life insurance and annuity carriers must continuously innovate within their product portfolio to move new products to market rapidly and efficiently. However, traditional lengthy product lifecycle management processes are still slowing the time required to launch new products to the market. Around 70% of small and mid-sized insurance businesses are still using manual or partially automated methods, taking several months to launch new products. This drives up development costs, delays ROI and leads to the loss of potential new business.

What if you could accelerate development and launch products to market in days rather than

By extending each predefined product template (also called a chassis), insurers can quickly define custom products, create user-defined transactions, and add new business processes and regulatory requirements at the product, product line, and company levels.

Use of templates can help reduce time by providing a vision of what is possible within the policy administration system. Also, it provides a starting point of common best practices that can be adapted to business - so the carriers do not have to start from scratch, allowing them to better align business processes to get the most value out of new IT investments.

Product Templates:

Templates are documented, predefined set of product definitions built out to demonstrate a particular way to address policy life-cycle processing. The template specifications include the definition of the underlying features, transactions, calculations, tables and business processes. This will help carriers to get a jump start of the product life cycle for implementation of traditional and non-traditional life products, increasing the ability to help reduce the time and cost to launch new products.

Key components to look forward from a

  • Wide variety of products need to be available as part of Templates
  • Pre-Configured (Reusable) calculations to support standard regulatory calculations
  • Pre-Configured (Reusable) set of standard life cycle events/transactions
  • Clear documentation for Product specifications and implementation design
  • Utilities to easily copy these templates to new plan/product

This template-based approach gives insurance carriers several benefits

  • Faster product life cycles with enhanced speed to market
  • New sources of ROI, delivered faster.
  • Efficient product management cycle.
  • Increased productivity with reduction in efforts for product-development stage.
  • Build better relations with distribution partners due to greater flexibility and market responsiveness.

Oracle Insurance Policy Administration (OIPA) Template Library

Template Plan Name Availability
NBU Term Life GA
Level Premium term GA
Indexed Universal Life GA
Group Disability GA
Group Term Life GA
Whole Life Will be available soon
Life Bonus Variable Annuity Will be available soon
Term Life ROP Will be available soon

*GA – General Availability

For more information on Oracle Insurance Policy Administration for Life and Annuity, visit oracle.com/insurance.

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Thursday Jul 31, 2014

IT Modernization, The Key to Success in the Private Health Plan Market in Brazil

Brazil has undergone significant political, economic, and demographic changes over the years, and today faces historic transformation with regard to its healthcare system. While Brazilians have free access to healthcare through a public system – the Unified Health System or the Sistema Único de Saúde – the private healthcare system is growing at a rapid pace.

Kathy McCarthy, Director of Sales Consulting for Oracle Health Insurance, discusses the topic in today’s post:

Individuals are increasingly seeking care in the private sector. Over the next few years, Brazil expects that more than 20 million additional individuals will purchase insurance through a private health plan, bringing the total number of participants in the private system to more than 75 million. This projected growth presents significant opportunity for private health plans, but are they ready?

Brazil’s budding economy, up-and-coming middle class, and progressive policies toward managed care make it a high-growth market, and the public system is struggling to keep pace. The private system, by and large, operates much more efficiently, with shorter waits and quality care. As the population becomes wealthier as the result of economic growth, more Brazilians – approximately 55 million individuals totaling a quarter of the population − are choosing to enter the private healthcare system.

The influx into the private healthcare system opens significant opportunity for Brazil’s health plans. It also presents several challenges:

  • Healthcare payers must deal with regulatory and contractual complexities that are unique to the sector, such as waiting period requirements, co-pays, and the negotiation of in-network versus out-of-network agreements.
  • They must also have the scalability required to process a much higher volume of claims than in life and P&C lines of business.
  • Healthcare payers can expect to handle dozens of claims per member, adding up to tens of millions of claims annually, and they must do so rapidly and cost effectively.
  • Processing these large volumes of transactions can place tremendous strains on payers who continue to adhere to manually intensive systems.

Healthcare payers – which for the most part employ decades-old core technology – have limited business process scalability in a fast growing market, and struggle to keep pace with change. Payers seek greater agility to address their specific business requirements and adapt in real time to ever-shifting market conditions.

By consolidating legacy systems onto a single health insurance-specific platform, payers can support core business processes and emerging opportunities in the private sector, while establishing critical flexibility in their IT infrastructure that increases visibility, reduces operational costs, and drives innovation within the business.

For this reason, Brazilian payers need flexibility as a central IT platform design component. They require applications that support core business processes in Brazil’s increasingly blended public and private systems, in which people may choose a private plan as a supplement to, or in lieu of, public insurance – ultimately supporting business innovation and rapid growth.

Payers need to do three things to be successful:

  • Get Agile - Invest in an IT infrastructure that can respond to the rapidly changing market
  • Amplify Business Intelligence - Business intelligence and analytics will make the difference for payers. It will aid in determining risk, provider effectiveness, fraud, market trends and more
  • Help Members Help Themselves - Employ self service options that make it easy for members to sign up, pay premiums, obtain information

While Brazilian healthcare payers’ challenges are complex as they seek opportunities in a growing market, they are not unique. Oracle Health Insurance is focused on helping healthcare payers around the world with their modernization challenges by providing applications that support payers’ business processes, enabling them to implement changes and provide consumers with tailor-made products while using uniform administrative processing.

Learn more by reading the strategy brief, Prescription for a Healthier Tomorrow: Considerations for Health Plan IT Modernization in Brazil.

The Oracle Health Insurance suite of applications have proven their scalability at customers with sizes ranging from 100,000 to 4,200,000 members (with approximately 10 million product enrollments) in a single instance. In addition, Oracle offers engineered systems or hardware, software, and storage tuned to address specific health insurance challenges including high availability, performance, and scalability.

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Oracle's flexible solutions can help insurers navigate the change necessary to meet today’s challenges and have the business agility to be prepared for the future.

For mor information, visit oracle.com/insurance.

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