Podcasts about insurers

In this episode of the Debtwired! Podcast, Horst Fuerpass, partner at Falkensteg, joins Johannes Koch, restructuring reporter at Debtwire, to talk about the precarious and often overlooked role trade credit insurers play in financial restructurings.With a particular emphasis on cases in the automotive sector, a hotbed of restructuring activity in Germany, Horst unpacks how trade credit insurers operate, the potential risks you can run into if they are brought into a process too soon or too late, and how to manage this key stakeholder that has the potential to gate crash a restructuring if not appropriately managed.

While automation can dramatically boost productivity in insurance operations, it shouldn't come at the expense of human oversight. Michael Parcelli of Xceedance recommends a balanced approach—using technology to … Read More » The post InsurTech Summit 2025 Highlight: How Can Insurers Balance Automation with the Human Touch? appeared first on Insurance Journal TV.

In an evolving digital landscape, insurers face a key decision: should they build technology in-house, partner with InsurTechs, or pursue a hybrid model? John Spottiswood of Jerry suggests … Read More » The post InsurTech Summit 2025 Highlight: How Insurers Should Decide Their Tech Strategy appeared first on Insurance Journal TV.

The ASX 200 started strong but as news of the Israeli attack came through, we turned negative. The index fell 18 points to 8547 (0.2%) for a gain of only 31 points this shortened week. Performing much better than the US which had futures off between 1.5-1.8%. Stand-out sectors were not unexpectedly gold miners and oil and gas stocks. Crude and bullion jumping on the Iranian news. NST up 5.1% and EVN rising 5.5% with BGL up 4.3%. Resources generally were flat, BHP down 2.6% with FMG slightly firmer. MIN took a breather and PLS rose 0.4%. LYC rallied 3.8% on rare earth promise, WDS showed a clean pair of heels up 7.4% with STO up 3.7% and KAR the real star up 10.9%. Uranium stocks fell on attack news. Industrials slid, banks off slightly, CBA down 0.7% with the Big Bank Basket down to $281.21 (-0.5%). Other financials slipped, GQG down 1.4% and XYZ down 2.4%. Insurers gained a little, REITs fell, GMG bucked the trend up 0.2%. Tech stocks fell in sympathy with Nasdaq futures. XRO down 0.4% and WTC falling 2,4% with the index down 1.7%. Retail stocks dropped 24.7% on AX1 earnings warning, JBH fell 1.8% and travel stocks down, QAN off 4.9%. In corporate news, Brookfield sold a large parcel of its DBI holding, the stock falling 6.2%. Nothing on the economic front. Asian markets down on war worries. Japan down 0.9%, HK off 0.7% and China down 0.6%.10-year yields falling to 4.16%.Want to invest with Marcus Today? The Managed Strategy Portfolio is designed for investors seeking exposure to our strategy while we do the hard work for you. If you're looking for personal financial advice, our friends at Clime Investment Management can help. Their team of licensed advisers operates across most states, offering tailored financial planning services.  Why not sign up for a free trial? Gain access to expert insights, research, and analysis to become a better investor.

The average cost for health insurance has gone up €480 in the past two years.Insurers are saying it's down to an increase in medical claims, the higher costs of medicine and a big increase in people having procedures done in private hospitals.So, is there anything we can actually do about it?Andrea is joined by Dermot Goode, Health Insurance expert with Totalhealthcover.ie to discuss.

Kimberly Landry, associate research director, workplace benefits research, LIMRA and LOMA, discusses the need for greater awareness and education around disability insurance, and how insurers can help protect consumers from unexpected income loss.

Some of the sickest Medicare Advantage patients ran into problems getting end-of-life care. Ultimately many patients switched to traditional Medicare, costing taxpayers billions, according to an investigation by the Wall Street Journal. This is one of many Medicare Advantage practices that is now under government scrutiny. Both Congress and Medicare agency head Dr. Mehmet Oz are pushing for reforms to curb tactics that can boost federal payments to private insurers. The Department of Justice is also investigating major private insurance companies UnitedHealth, Aetna, Elevance Health and Humana. Jessica Mendoza discusses the investigations with WSJ's Anna Wilde Mathews. Further Listening: -Medicare, Inc. Part 1: How Insurers Make Billions From Medicare  -A Life-or-Death Insurance Denial  Sign up for WSJ's free What's News newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices

Medicare Advantage was designed to save the government money. But a Wall Street Journal investigation found that private insurers used the program to generate extra payments through questionable diagnoses. The investigation uncovered instances of potentially deadly illnesses like AIDS, where patients received no follow-up care, as well as diagnoses that were medically impossible. This happened in part when insurers sent nurse practitioners into Medicare Advantage recipients' homes. Jessica Mendoza discusses the investigation with WSJ's Christopher Weaver as well as a nurse who participated in the program.  Further Listening: -A Life-or-Death Insurance Denial  -Even Doctors Are Frustrated With Health Insurance  Sign up for WSJ's free What's News newsletter.  Learn more about your ad choices. Visit megaphone.fm/adchoices

It's not really a huge shock, is it? The news that homeowners will have to pay even more for home insurance to help the Natural Hazards Commission (formerly known as the EQC), is to be expected. Insurers have been warning for years that premiums will rise and will continue to rise, that they may have to put some of the cost of risky properties back onto homeowners and in some cases, they'll be declining to insure homes altogether. And we've already started to see that. In 2017, a then-record $242 million in weather-related claims was paid out. Just six years later, climate related claims were more than $3.5 billion due to the Auckland anniversary floods and Cyclone Gabrielle. It's incredible when you see the insurers' charts, 20 odd years ago they'd say this is a record year or this is a once in 100 year, then the next year, or three years later it would treble in terms of the cost of the claims that had to be paid out. So there's a pattern, you'd be a fool to ignore it, and the government is not doing so. Nor is the insurance industry. The Natural Hazards Commission provides cover for capped portions of residential buildings and land damaged by earthquakes, landslides, volcanoes, hydrothermal activities, tsunamis, storms, and floods (land cover only). Leaving private insurers to cover the rest. The NHC has struggled to recover following the Canterbury earthquakes and faces huge future claims costs. The new modelling lifts the likelihood of a big earthquake, with construction costs soaring post-pandemic and the reinsurance market hardening. The NHC is so underfunded that there's only a 37% chance the levy income will meet the costs over the next five years, according to the Treasury. And the NHC must cover the first $2.1 billion of claims related to a natural disaster before it can tap into its reinsurance cover. So just like any insurance claim, you must pay your excess, and then it will chip in. It's just in this case, $2.1 billion is your excess. Given there's only $500 million in the kitty, if there was a big disaster today or tomorrow, the government would have to find more than $1.6 billion to cover the claim costs before reinsurance cover could kick in. Associate Finance Minister David Seymour says levies will almost certainly need to rise, Cabinet's set to decide on the changes in the coming months. An insurance consultant told Ryan Bridge this morning it'll probably cost homeowners an extra $200 to $300 more a year. And if that sounds like a lot, well count yourself lucky, because there are some people who simply won't be able to get insurance for their homes. And it's not just people in the obvious places on cliffs or banks next to rivers who will be paying. Everyone is at risk. And those living up the top, who's homes are built on traditional drainage areas or water soak areas are part of the problem. We're all in this together. So, what are your options? If you have a mortgage you have to be insured, but it might mean that people take the bare minimum because that's all they can afford, meaning they are left underinsured and depending on the kindness of strangers to recover after disaster strikes. Will Give A Little be the insurer of choice for people who can't afford to cover themselves? I assumed Hamilton might be the safest place to live, and I was right. Volcanologists say Hamilton is probably the safest place to live. It's away from the coast which cancels out tsunamis. It's a safe distance from known fault lines, although there is the caveat that one could be lurking. It's far enough away from Auckland's volcanic field to be considered safe, and even if the Waikato River flooded its much lower than the houses around it. In the North Island, there's no real escape so should the north be paying more? Do we start pointing the finger at other areas? Can the people of the Waikato say “Hey, not us. We are living in a really safe area. If you choose to live anywhere outside of Hamilton, it's on you.” Do we ban the rebuilding? Make them no go zones of any area that's been flooded 2, 3, 4 times in the past 100 years. It's all very well and good for those who have not been flooded or have not been affected or haven't seen their homes turned to smithereens to say just move. But for most people, their home is their castle. It is their most significant financial investment. If they can't sell their home, they can't move. They have to patch it up and make do. So I would be really interested to hear your thoughts on this one. Do we go in this as “we're all in this together?” We accept that we're living on the shaky aisles, that we are a natural hazard magnet and that's the price you pay for living in a bucolic paradise. Should some areas pay more than others? Do you get the insurance companies whose business it is to gauge risk to set cover across the country based on the riskiness of each region.? Do we ban the rebuilding on known flood areas? What do you think the answer might be as we struggle to come to terms with living within our environment? We're not so far removed from early settlers really as we try to balance the advantages and disadvantages of living where we do. See omnystudio.com/listener for privacy information.

In this episode of the InsuranceAUM.com Podcast, host Stewart Foley, CFA, is joined by Fred Pollock, Chief Investment Officer, and Steve McMillan, Head of Credit Research at GCM Grosvenor, for a timely discussion on private credit secondaries. As insurers continue to expand their allocations to private credit, Fred and Steve outline where secondaries fit into the broader $21 trillion private credit market and why they believe this corner of the asset class is poised for long-term growth. They discuss how liquidity, diversification, and discounted entry points can make secondaries particularly attractive especially in today's uncertain macro environment.   The conversation also highlights GCM Grosvenor's differentiated approach, from deep underwriting discipline to leveraging its multi-asset platform for deal flow and risk evaluation. Fred and Steve explain why understanding the entire private credit landscape not just direct lending is essential for delivering alpha and managing downside risk. Whether you're an insurer evaluating secondary strategies or simply seeking market perspective, this episode offers insight into one of the most complex and compelling areas of institutional investing today.

Flooding is becoming an increasingly obvious mega issue in the world today. It costs anywhere between $200 billion and $500 billion in the US alone each year. They're 31% of natural catastrophes and 1.8 billion people, about a quarter of the planet, live under flood risk. This is a nightmare for insurers who are raising their premiums in response, 17% last year in the US alone. But what if you could change the cost structure of this issue - where possible, allow homes and businesses enough lead time to take high value items out of harm's way, take the cars off the parking lot of the dealership and the goods off the warehouse floor? This can transform the insurance economics around flooding and is exactly what Previsico is doing.  Jonathan Jackson is an exceptional entrepreneur now on his fourth company, and it was a pleasure to have him on The Fundamental Molecule to hear what he's building at Previsico and how he's building it. Please enjoy my conversation with Jonathan Jackson. Subscribe to The Fundamental Molecule here: https://www.burntislandventures.com/the-fundamental-molecule For the full show notes, transcript, and links to mentioned content, check out the episode page here: https://podcasts.apple.com/us/podcast/the-fundamental-molecule/id1714287205 ----------- Jonathan Jackson describes the growing challenges for insurers due to unpredictable floods, and how his company, Previsico, addresses this with precise, actionable flood warnings that utilize advanced forecasts and ground sensors. This enables businesses to mitigate up to 70% of flood damage and transform the economics of insurance. He discusses Previsico's origins as a UK university spin-out, its customer-driven US market entry, the significance of a clear ROI, and core company values such as fairness and purpose. Jonathan finishes by advising entrepreneurs to focus on their specific area of expertise. 00:00 - Why Flooding Is a Massive Insurance Crisis 01:59 - How Insurers Struggle to Price Flood Risk 07:04 - Key Differences in UK vs US Flood Insurance 08:47 - Why Businesses Are Forced to Self-Insure Flood Loss 09:58 - Provisico's Approach to Preventing 70% of Flood Damage 11:14 - How Forecasts and Sensors Enable Real-Time Response 14:52 - The ROI of Ground-Truthing Flood Data 16:24 - How a Government Grant Sparked Provisico's Founding 21:10 - Breaking Into Insurance Through Public-Private Partnerships 24:18 - Cracking the Insurance Market with Lloyd's Lab and Zurich 25:40 - How to Sell to Risk-Averse, Slow-Moving Enterprises 29:12 - Expanding to the U.S. Through Customer Pull, Not Push 31:11 - Building Culture Around Fairness, Purpose, and Creativity 37:18 - Why Water Entrepreneurs Must Stay Laser-Focused Links: Burnt Island Ventures: https://www.burntislandventures.com/ https://previsico.com/ https://www.linkedin.com/in/jonathan-jackson-a393102/ SM Material Key Takeaways: "Flood risk maps estimate property location risk. Insurers use them to determine underwriting." "A 1% flood risk every year means you could be flooded year after year. It's about communication." "Provisico's service, with a good flood plan, can achieve 70% commercial loss prevention." "We enable insurers to mitigate losses, improving their profitability through accurate flood warnings." "Our flood forecast prepares organizations for flood, while sensors provide high-confidence alerts." "Our vision is global. We aim to reduce flood loss by 50% or more, helping people worldwide."

In this insightful discussion with summit host and Deputy Editor of Carrier Management Elizabeth Blosfield, Alexis Vaughn of Off Course Consulting, highlights the key barriers insurers face when … Read More » The post InsurTech Summit 2025 Highlight: What's Holding Insurers Back from Tech Adoption? appeared first on Insurance Journal TV.

ASX 200 up 53 points to 8647 (0.6%). A solid rally driven by bullion and banks. The Big Bank Basket rallied to $278.81 (+1.2%). CBA up another 1.3%, with ANZ doing well up 1.3%. MQG rose 0.9% and IFL up 2.7% on a broker upgrade, Insurers better, SUN was out and up 2.4% with IAG doing well, rising 2.9%. REITs rallied too, GMG up 1.1% and CHC rising 3.1%.  Industrials in demand across the board, JBH up 1.9% with WOW and COL better, TLS continuing to push ahead up 1.0% with QAN up another 2.0%. Healthcare mixed, SIG up 2.3% and CSL off 1.0%. Tech stocks rose, with the All-Tech Index up 0.3%. In resources, iron ore stocks drifted lower as iron ore fell on Chinese PMI. Gold miners off highs, but still strong, NEM up 4.3% with GMD gaining 4.6% and OBM up 5.9%. Lithium stocks falling again, PLS down 0.4% and MIN hit 5.5%. Oil and gas stocks rose with crude, uranium still under pressure again. DYL down 1.9% and PDN off 1.3%.  In corporate news, IEL fell 48.1% on a massive downgrade and nasty outlook statement, TEA ran 8.6% on a special dividend, DMP fell 2.2% after a raft of executive changes. In economic news, the RBA minutes helped sentiment, Chinese PMI dropped to 48.3. Asian markets slightly higher, Japan up 0.1%, HK up 1.1% and China up 0.5%. 10-year yields steady at 4.26%.Want to invest with Marcus Today? The Managed Strategy Portfolio is designed for investors seeking exposure to our strategy while we do the hard work for you. If you're looking for personal financial advice, our friends at Clime Investment Management can help. Their team of licensed advisers operates across most states, offering tailored financial planning services.  Why not sign up for a free trial? Gain access to expert insights, research, and analysis to become a better investor.

Send us your feedback In this episode of the 2025 Litigation Forecast Podcast Series, Partner Andrew Horne, is joined by Senior Associate Hannah Jaques. They discuss the significant changes coming to the insurance industry as a result of the Contracts of Insurance Act 2024. The conversation covers the distinction between consumer and non-consumer insurance contracts, changes to the duty of disclosure, new remedies for breaches, and the impact on third-party claims.[00:33] Andrew and Hannah begin by discussing the introduction of the Contracts of Insurance Act 2024. They highlight the two fundamental changes: the distinction between consumer and non-consumer insurance contracts and the changes to the duty of disclosure for each group.[01:15] Hannah explains that the definition of consumer insurance contracts is based on the purpose of the contract rather than the policyholder. Consumer insurance contracts are for household, domestic, or personal purposes. She mentions the challenges in classifying certain products and the potential for certification and regulations to provide clarity.[02:50] Hannah discusses the practical steps insurers need to take, such as classifying their products as consumer or non-consumer. She also talks about the impact on policyholder certification and regulatory procedures.[03:45] Hannah elaborates on the fundamental change in the duty of disclosure for consumer insurance contracts, which now requires policyholders to take reasonable care not to make a misrepresentation. This shifts the burden to insurers to ask specific questions. For non-consumer contracts, the duty has changed to make a fair presentation of the risk.[05:57] Hannah explains the introduction of proportionate remedies for breaches of disclosure duties. Under the new act, insurers can address breaches based on what they would have done if the information had been disclosed at the time of policy entry. This change is seen as positive for maintaining good insurer-policyholder relationships.[07:18] Andrew and Hannah discuss the preparation required for the new regime, which comes into force by 15 November 2027. Insurers and brokers need to review and update all policies, communications, and IT systems. They note the risk of oversight due to the volume of material to be updated.[09:10] Hannah highlights the need for insurers to ask many more specific questions to comply with the new duty of disclosure. This creates a balance between thorough risk assessment and not overwhelming policyholders with too many questions.[10:01] Andrew and Hannah discuss the new direct right for third parties to bring claims against insurers. The changes eliminate the need for third parties to establish liability in advance, which is expected to reduce the need for separate defence costs cover.[11:26] Hannah provides historical context on defence costs cover and explains the changes under the new regime. The new legislation is likely to make it easier to settle claims as insurers will take a pragmatic financial position[13:13] Hannah outlines the specific regime for third-party information requests. Insurers and brokers need to implement new processes to comply with the 28-day timeframe for providing information.[15:30] In the short term, the industry will focus on compliance by November 2027. In the medium term, Andrew predicts disputes will test the new act's procedures. Long-term, case law will emerge to provide guidance, but there will be a period of uncertainty for the insurance industry as the new legislation bedsFor show notes and additional resources visit minterellison.co.nz/podcasts

Health care affordability isn't just a consumer problem—it's a system accountability issue. Consolidated health systems promised lower costs. Insurers and employers are demanding more value. This episode brings together health systems, insurers and business leaders to explore how each player in the health care system can do more—collectively—to lower the cost of coverage. From legacy partnerships to forward-looking value-based models, what does meaningful collaboration look like?Guests:•Tricia Keith•Brian Peters•Brian Calley

Health care affordability isn't just a consumer problem—it's a system accountability issue. Consolidated health systems promised lower costs. Insurers and employers are demanding more value. This episode brings together health systems, insurers and business leaders to explore how each player in the health care system can do more—collectively—to lower the cost of coverage. From legacy partnerships to forward-looking value-based models, what does meaningful collaboration look like? Guests: •Tricia Keith •Brian Peters •Brian Calley

The ASX 200 had a late surge to finish the month with a gain today of 25 points to 8435. ASX records best month since January. Up 3.8%. Banks yet again showed the strength as CBA rose 0.9% with the Big Bank Basket up to $275.55 (1.1%). WBC surged 2.7% and NAB up 1.3% with some month end window dressing. Insurers slid slightly, QBE down 1.3% with REITS up. GMG up 1.3% and VCX rising 1.2%. Industrials found a footing, BXB up 1.0%, WOW and COL firmed, and ORG up 2.1%. Tech slipped slightly with WTC down 1.5% and XRO off 0.8%. Healthcare mixed, In resources, mixed in the majors, BHP up 0.3% and FMG down 1.9%. Gold miners were better, NST up 3.2% with GMD up 4.4%, VAU up 3.5% as some window dressing helped. Lithium stocks slid on a broker downgrade to carbonate prices, PLS down 5.7% and IGO off 5.4%. WDS fell 2.1% and STO off 0.9%. Uranium stock eased back, coal miners fell, WHC off 1.8%. In corporate news, HCW leapt on rent relief for Healthscope, NWH up on a RIO contract and FND down nearly 9% on results. In economic news, retail sales slipped. Asian markets fell with Japan down 0.9%, China down 0.3%, and HK down 1.5%. 10-year yields at 4.28%.Want to invest with Marcus Today? The Managed Strategy Portfolio is designed for investors seeking exposure to our strategy while we do the hard work for you. If you're looking for personal financial advice, our friends at Clime Investment Management can help. Their team of licensed advisers operates across most states, offering tailored financial planning services.  Why not sign up for a free trial? Gain access to expert insights, research, and analysis to become a better investor.

Elon Musk is leaving the Trump administration. Why now, and what's next for the Texas-based billionaire. A bill that aims to plug the state's abandoned oil and gas wells – sometimes called “orphaned wells” – is headed to Gov. Greg Abbott's desk. Insurers in Texas are partnering with aerial imaging and AI companies to assess […] The post Oil companies face new deadlines to plug orphaned wells appeared first on KUT & KUTX Studios -- Podcasts.

Eleanor Bragg, a research analyst with Verisk Extreme Event Solutions, discusses how systemic risks including “forever chemicals” litigation, climate change liability and artificial intelligence are reshaping the insurance industry's approach to modeling and mitigation.

The ASX 200 limped along to close down 11 points at 8397 as a Japanese bond auction underwhelmed, and CPI came in a little hotter than expected. Blame eggs. Banks went a little squishy, with CBA falling 0.9% and the Big Bank Basket down to $271.48 (-0.9%). Insurers also fell with QBE off 1.6%. Other financials were mixed, XYZ rose 4.9% on better US consumer sentiment and bitcoin. REITs are better today, GMG is up 0.9%, and SCG is rising, Industrials started well but fizzled, WES is down 0.1%, and retail is falling slightly. Tech was better following US tech, and the All-Tech Index was up 1.3% with WTC up 0.4%. REA bounced 1.9% after its fall yesterday on ACCC News, and TLS slid 0.2% on some broker downgrades. Resources are under a little pressure, RIO off 0.9% and lithium stocks down, MIN downgraded guidance again, down 5.5% with gold miners a little mixed, NST off 0.8% and RMS up 1.1%. MAC rose 20.4% as it got the Harmony bid, uranium was a little mixed, BOE was off %, and LOT was up 5.1%. WDS jumped 3.2% on NW Shelf news, and finally, STO is up 1.9%. Coal stocks also rallied, WHC up 2.7%. In corporate news, WEB jumped 12.4% on much better than expected results, ALQ fell 7.6% after completing its capital raise, IFT disappointed, and FPH fell 4.8% despite a 43% jump in revenues. On the economic front, CPI was unchanged at 2.4%, the RBNZ cut rates again by 25bps. 10-year yields rose to 4.33%. Asian markets, as usual, mixed, Japan up 0.3%, China up 0.1% and HK down 0.8%Want to invest with Marcus Today? The Managed Strategy Portfolio is designed for investors seeking exposure to our strategy while we do the hard work for you. If you're looking for personal financial advice, our friends at Clime Investment Management can help. Their team of licensed advisers operates across most states, offering tailored financial planning services.  Why not sign up for a free trial? Gain access to expert insights, research, and analysis to become a better investor.

In this conversation, Scott Seaman of Hinshaw & Culbertson LLP, emphasizes that while legal risks around AI in insurance do exist, the bigger issue is ensuring that insurers … Read More » The post InsurTech Summit 2025 Highlight: Are Insurers Ready to Lead — or Be Led — by AI? appeared first on Insurance Journal TV.

The ASX 200 limped 12 points higher to 8361 (+0.2%) ahead of a long weekend in the US. For the week, we are up 17 points. Banks once again firm, CBA up another 0.7% with the Big Bank Basket up to $271.95 (+0.6%). ANZ outperforming. Insurers rose slightly, and financial services better, with XYZ up 5.5% and GQG bouncing 2.4%. REITs were firm, GMG up 2.2% and SGP rising 0.2% as 10-year yields steadied to 4.45%. Healthcare is flat, tech stocks are slightly better, XRO is up 0.7%, and the Index is up 0.9%. ‘Old Skool' platforms are doing ok, REA up 0.5% and CAR up 1.3%. TLS continues to push ahead. Retail better, JBH up 1.6% and MYR up 5.4% following a sales update. Utilities are under a little pressure on an ORG downgrade, off 1.1%. Resources were mainly weaker; iron ore stocks eased back, FMG was down 2.4%, with gold miners drifting slightly lower. Uranium stocks are on fire as Reuters reported that Trump will sign an order to benefit the uranium and nuclear industry. BOE up 12.1%, PDN up 6.7% and SLX up a huge 15.3%. Oil and gas are moving a smidge higher.In corporate news, BEN results out this morning, up 0.8%, and NUF continued to fall as one broker lost faith in the stock. Nothing locally on the economic front, Japanese CPI picked up more than anticipated, 3.5% excluding fresh food. Asian markets firmed, Japan up 0.6%, and HK up 0.3%. Dow futures flat, Nasdaq futures down 0.3%.Want to invest with Marcus Today? The Managed Strategy Portfolio is designed for investors seeking exposure to our strategy while we do the hard work for you. If you're looking for personal financial advice, our friends at Clime Investment Management can help. Their team of licensed advisers operates across most states, offering tailored financial planning services.  Why not sign up for a free trial? Gain access to expert insights, research, and analysis to become a better investor.

As Republicans consider major changes to Medicaid and Obamacare, we asked a leading economist about the shockwaves these sharp policy shifts could send throughout the entire health care system.Guests:Jonathan Gruber, Ford Professor of Economics, MITLearn more and read a full transcript on our website.Want more Tradeoffs? Sign up for our free weekly newsletter featuring the latest health policy research and news.Support this type of journalism today, with a gift. Hosted on Acast. See acast.com/privacy for more information.

We talk about Pope Le(t)o's striking critiques of AI and the needs for luddism to be an intersectional movement. Then we get into the Republicans' advocacy for AI rights over States' rights, which contributes to a greater hollowing out of government capacity at all levels in an attempt to usher in the great fracturing of society into zones of special economic interest. Finally we sketch a vision of a bold future of post-apartheid integration sparked by Grok's obsession with white genocide. ••• Will Pope Leo XIV be an ally against AI? https://www.disconnect.blog/p/will-pope-leo-xiv-be-an-ally-against ••• The Franciscan monk helping the Vatican take on — and tame — AI https://www.ft.com/content/1fa17d8b-5902-4aff-a69d-419b96722c83 ••• Republicans propose prohibiting US states from regulating AI for 10 years https://www.theguardian.com/us-news/2025/may/14/republican-budget-bill-ai-laws ••• Republicans Try to Cram Ban on AI Regulation Into Budget Reconciliation Bill https://www.404media.co/republicans-try-to-cram-ban-on-ai-regulation-into-budget-reconciliation-bill/ ••• AI agents: from co-pilot to autopilot https://www.ft.com/content/3e862e23-6e2c-4670-a68c-e204379fe01f ••• Insurers launch cover for losses caused by AI chatbot errors https://www.ft.com/content/1d35759f-f2a9-46c4-904b-4a78ccc027df Standing Plugs: ••• Order Jathan's new book: https://www.ucpress.edu/book/9780520398078/the-mechanic-and-the-luddite ••• Subscribe to Ed's substack: https://substack.com/@thetechbubble ••• Subscribe to TMK on patreon for premium episodes: https://www.patreon.com/thismachinekills Hosted by Jathan Sadowski (bsky.app/profile/jathansadowski.com) and Edward Ongweso Jr. (www.x.com/bigblackjacobin). Production / Music by Jereme Brown (bsky.app/profile/jebr.bsky.social)

Mark Popolizio, vice president of Medicare Secondary Payer compliance at Verisk, discusses key 2025 CMS policy updates, new reporting requirements and strategies insurers can use to stay compliant, reduce costs and mitigate liability under the evolving MSP framework.

The Friday Five for May 16th, 2025: Dunkin' and Starbucks Summer 2025 Menus Viral Music Charts for Content Creation Potential Heart Benefit in Shingles Vaccine Possible Hints at ACA Subsidy Direction for 2026 AHIP 2026 Certification Dates   Dunkin' and Starbucks Summer 2025 Menus: “Dunkin' Summer Menu.” Dunkindonuts.Com, Dunkin', www.dunkindonuts.com/en/summer-menu. Accessed 13 May 2025. Fink, Bailey. “Starbucks Is Bringing Back Customers' ‘Favorite Drink Ever' This Summer.” Allrecipes.Com, Allrecipes, 17 Apr. 2025, www.allrecipes.com/starbucks-summer-menu-2025-11717043. Baker, Nicolette. “Starbucks' Summer Menu Just Dropped — Including a Brand-New Iced Beverage.” Foodandwine.Com, Food & Wine, 15 Apr. 2025, www.foodandwine.com/starbucks-summer-menu-2025-11715175.   Viral Music Charts for Content Creation: “100 Top Trending Songs on TikTok.” Tokchart.Com, Tokchart, tokchart.com/. Accessed 14 May 2025. Bowe, Tucker. “Apple Quietly Gave Your Iphone a Simple yet Fun New Feature.” Gearpatrol.Com, Gear Patrol, 12 May 2025, www.gearpatrol.com/tech/apple-music-shazam-viral-chart/.   “Shazam Viral Global Chart .” Shazam.Com, Shazam, www.shazam.com/charts/viral/world. Accessed 14 May 2025. “Spotify Viral 50 - Global.” Spotify.Com, Spotify, open.spotify.com/playlist/37i9dQZEVXbLiRSasKsNU9?si=4zvmJR7bQnajf6_StIGfuw. Accessed 14 May 2025. “Viral Chart on Apple Music.” Music.Apple.Com, Apple Music, music.apple.com/us/playlist/viral-chart/pl.b127c05305ad413fb742e8585599ec84. Accessed 14 May 2025.   Potential Heart Health Benefit in Shingles Vaccine: McLendon, Russell. “Shingles Vaccine Can Reduce Risk of Stroke And Heart Attack, Study Finds.” Sciencealert.Com, ScienceAlert, 12 May 2025, www.sciencealert.com/shingles-vaccine-can-reduce-risk-of-stroke-and-heart-attack-study-finds. Rudy, Melissa. “Shingles Vaccine Has Unexpected Effect on Heart Health.” Foxnews.Com, FOX News Network, 9 May 2025, www.foxnews.com/health/shingles-vaccine-has-unexpected-effect-heart-health. “Shingles Vaccine Lowers the Risk of Heart Disease for up to Eight Years.” Escardio.Org, European Society of Cardiology, 6 May 2025, www.escardio.org/The-ESC/Press-Office/Press-releases/shingles-vaccine-lowers-the-risk-of-heart-disease-for-up-to-eight-years. Griesser, Kameryn. “Shingles Vaccine Reduces Risk of Heart Disease by 23%, Study of One Million People Finds.” Cnn.Com, Cable News Network, 12 May 2025, www.cnn.com/2025/05/09/health/shingles-heart-disease-vaccine-shots-wellness.   Possible Hints at ACA Subsidy Direction for 2026: Tong, Noah. “CMS Hints at Possible Cost-Sharing Reduction Payments for Insurers, Impacting ACA Enrollment.” Fiercehealthcare.Com, Fierce Healthcare, 7 May 2025, www.fiercehealthcare.com/payers/cms-hints-possible-cost-sharing-reduction-payments-insurers-impacting-aca-enrollment. “Explaining Health Care Reform: Questions About Health Insurance Subsidies.” Kff.Org, KFF, 25 Oct. 2024, www.kff.org/affordable-care-act/issue-brief/explaining-health-care-reform-questions-about-health-insurance-subsidies/. “Offering of Off-Exchange-Only Plans without ‘CSR Loading.'” Cms.Gov, Centers for Medicare & Medicaid Services, 2 May 2025, www.cms.gov/files/document/offering-exchange-only-plans-without-csr-loading.pdf. “Plan Year 2026 Individual Market Rate Filing Instructions.” Cms.Gov, Centers for Medicare & Medicaid Services, 2 May 2025, www.cms.gov/files/document/py-26-individual-market-rate-filing-instructions.pdf.   AHIP 2026 Certification Dates: “AHIP Medicare + Fraud, Waste, and Abuse Online Course.” Ahipmedicaretraining.Com, AHIP, www.ahipmedicaretraining.com/page/login. Accessed 13 May 2025.   Resources:   Follow Us on Social! Ritter on Facebook, https://www.facebook.com/RitterIM Instagram, https://www.instagram.com/ritter.insurance.marketing/ LinkedIn, https://www.linkedin.com/company/ritter-insurance-marketing TikTok, https://www.tiktok.com/@ritterim X, https://x.com/RitterIM and YouTube, https://www.youtube.com/user/RitterInsurance     Sarah on LinkedIn, https://www.linkedin.com/in/sjrueppel/ Instagram, https://www.instagram.com/thesarahjrueppel/ and Threads, https://www.threads.net/@thesarahjrueppel  Tina on LinkedIn, https://www.linkedin.com/in/tina-lamoreux-6384b7199/   Not affiliated with or endorsed by Medicare or any government agency. Contact the Agent Survival Guide Podcast! Email us ASGPodcast@Ritterim.com or call 1-717-562-7211 and leave a voicemail.

At RIMS RISKWORLD Chicago, Andrea Wells, Vice President of Content at Insurance Journal talks with Priscilla Pazmino-Vitela about how insurers are stepping up as true partners—not just policy providers. From traditional … Read More » The post RIMS RISKWORLD 2025: How Insurers Are Partnering With Clients to Navigate Risk in 2025 appeared first on Insurance Journal TV.

Remote work is driving a significant startup boom, reshaping the IT services market. A recent study indicates that companies with higher levels of remote work during the COVID-19 pandemic have seen a notable increase in employee startups, with an estimated 11.6% of new business formations attributed to this trend. Despite major corporations reinstating return-to-office mandates, remote work adoption in the U.S. has risen from 19.9% in late 2022 to 23.6% in early 2025, highlighting a growing demand for tools and services that support distributed teams. This shift presents both opportunities and challenges for employers, as they risk losing key talent to new ventures while also facing higher employee attrition rates.The insurance industry is beginning to address the risks associated with artificial intelligence (AI) by offering new products to cover potential losses from AI-related errors. Lloyds of London has introduced a policy that protects businesses from legal claims arising from malfunctioning AI systems, reflecting a growing recognition of AI as an operational risk. This development raises important questions about accountability and liability when AI systems fail, as seen in recent incidents involving customer service chatbots. As insurers start to underwrite AI risks, companies must adapt their service level agreements and governance structures to meet new requirements.The Cybersecurity and Infrastructure Security Agency (CISA) has announced a significant change in how it shares information, focusing on urgent alerts related to emerging threats while reducing routine updates. This shift, coupled with budget cuts that could reduce CISA's funding by 17%, raises concerns about the agency's capacity to respond to increasing cyber threats. IT services firms and cybersecurity vendors must adapt to this new landscape, as the responsibility for threat detection and response shifts more towards the private sector. Organizations that previously relied on CISA for support may find themselves facing increased operational risks due to reduced visibility and slower response times.In a related development, Microsoft has extended support for its Office applications on Windows 10 until October 2028, allowing users more time to transition to Windows 11. This decision reflects a broader trend in the technology sector, where companies are adapting their support strategies to meet user needs. By decoupling the upgrade cycles for Windows and Office, Microsoft acknowledges the resistance to forced upgrades and the importance of maintaining enterprise customer relationships. This extension provides IT service providers with additional time for operational planning while emphasizing the ongoing need for modernization in the long term. Four things to know today 00:00 Remote Work Fuels Startup Surge, Alters IT Talent Strategies Amid Growing Demand for Flexibility05:07 From Chatbot Lawsuits to Pontifical Warnings: AI Errors Now Seen as Business and Social Risk07:57 CISA Alert Shift and Budget Cuts Signal Rising Cybersecurity Burden for Private Sector10:08 Office Gets a Lifeline on Windows 10: Microsoft Decouples OS and App Upgrades Through 2028 Supported by: https://syncromsp.com/ All our Sponsors: https://businessof.tech/sponsors/ Do you want the show on your podcast app or the written versions of the stories? Subscribe to the Business of Tech: https://www.businessof.tech/subscribe/Looking for a link from the stories? The entire script of the show, with links to articles, are posted in each story on https://www.businessof.tech/ Support the show on Patreon: https://patreon.com/mspradio/ Want to be a guest on Business of Tech: Daily 10-Minute IT Services Insights? Send Dave Sobel a message on PodMatch, here: https://www.podmatch.com/hostdetailpreview/businessoftech Want our stuff? Cool Merch? Wear “Why Do We Care?” - Visit https://mspradio.myspreadshop.com Follow us on:LinkedIn: https://www.linkedin.com/company/28908079/YouTube: https://youtube.com/mspradio/Facebook: https://www.facebook.com/mspradionews/Instagram: https://www.instagram.com/mspradio/TikTok: https://www.tiktok.com/@businessoftechBluesky: https://bsky.app/profile/businessof.tech

ChatGPT & Jae Explain: POTUS Rx FixBrief DescriptionJae and Cass break down the explosive Most Favored Nation (MFN) executive order and its seismic threat to Big Pharma, PBMs, and the insurance industry. Learn why this isn't just price reform—it's a full-blown system shock, and why Jae saw it coming before the ink was dry.In This Video00:00:00 Cold Open – MFN Drops Like a Bomb00:00:35 Jae Predicted It – MFN Was Always the Domino00:02:15 What Most Favored Nation Pricing Actually Means00:04:00 Why the Benchmark Matters – Leveling the Global Field00:05:30 Graceful Exemption – Carveouts for the Poorest Nations00:07:00 Transfer Pricing – Cracking the Code of U.S. Drug Opacity00:09:00 MFN's Domino Effect on Employer Plans & Medicare Advantage00:11:00 PBMs in the Crosshairs – Toll Takers Face Transparency00:13:00 Insurers' Identity Crisis in a Post-MFN World00:16:00 Wall Street Panic & the Coming Industry Shakeout

Tuesday May 6, 2025 Justice Department Sues Big Medicare Insurers Alleging Kickbacks

Insurers are increasingly concerned about lithium-ion battery fires and what they may mean for home, contents and motor vehicle policies. 

Local councils and insurers are increasingly deciding which properties are at climate risk, in a legislative void. 

Fix It Radio: Are Your Assets Worth More? Secrets Appraisers & Insurers Won't Tell You 5-3-25 by John Rush

Brandon Nuttall, chief digital and AI officer for Xceedance, said generative AI is becoming more integral for insurance executives' technology strategy, but moving from “buzz to business value” remains a challenge.

Got questions? Send Ericka a Text!Insurance companies are using AI to evaluate dental x-rays, denying claims when specific landmarks aren't visible in the images. This shift means approximately 70% of claims are now processed through artificial intelligence systems that disqualify submissions based on technical deficiencies rather than subjective human review.• Poor quality x-rays with cone cuts or missing apexes give insurance companies legitimate reasons to deny payment• Clinical teams need training to understand what qualifying x-rays look like for different procedures• Billing starts with proper clinical documentation and supporting attachments, not in the billing department• Digital x-rays allow immediate quality assessment - retake poor images immediately• Even the best billers can't overcome insufficient evidence when appealing denials• Creating a list of procedures requiring x-rays and examples of qualifying images can help train staff• When benefits are available and evidence is sufficient, insurance companies should pay claims• Proper documentation creates leverage when fighting unreasonable claim denialsIf you need help training your clinical teams on how to improve x-ray quality for insurance submissions, I have a step-by-step process available. Send me a message to discuss what's happening in your office.Want to learn Dental Coding and Billing? Join here:https://tr.ee/efzYrY7mp-Would you like to set-up a billing consultation with Ericka? She would love the opportunity to discuss your billing questions and see how Fortune Billing Solutions may help you. Email Ericka:ericka@dentalbillingdoneright.comSchedule a call with Ericka: https://calendly.com/ericka-dentalbillingdoneright/30min Perio performance formula: (D4341+D4342+D4346+D4355+D4910)/(D4341+D4342+D4346+D4355+D4910+D1110)

As one of the largest investors in the world, insurers can have an outsized impact on markets and investment flows. In the latest episode of Goldman Sachs Exchanges, Goldman Sachs' Mike Siegel and Matt Armas, who share findings from their 14th annual Global Insurance Survey, discuss how insurers are adapting to economic challenges and opportunities. Learn more about your ad choices. Visit megaphone.fm/adchoices

Insurers are cutting benefits on health plans as they hike the price of premiums, meaning that customers are now getting less value for their money.Meanwhile, the government's take from taxes on home energy and motor fuels has topped €4bn for the first time, with Aontú leader Peadar Tóibín TD accusing the government of “cashing in” on the cost-of-living crisis.Charlie Weston, Personal Finance Editor at the Irish Independent spoke to Matt on Wednesday's The Last Word.Hit the ‘Play' button on this page to hear the conversation.

Four years ago, Chuck Chamness stepped away from his 18-year tenure as president and CEO of the National Association of Mutual Insurance Companies. He looked around at the state industry he'd long worked for and with, and he saw a mélange of strong businesses facing seemingly insurmountable headwinds: Inflation, catastrophe costs, regulatory uncertainty, public perception problems, and the poky pace of technology adoption all served as fiscal stressors for insurance carriers; particularly smaller, regional, mutual insurance operators. In this January 2025 interview, Chamness expands on what he views as pressing business issues facing the insurance industry and offers ideas about how to move forward.

David Worldon is the Founder of Accelerated Innovation, a boutique management consultancy specialising in insurance innovation. Last year they  saved  Australia's largest insurers half a million dollars in fees and shaved a full year off their growth timelines. David has recently published the 2025 General Insurance Innovation Report, assessing and ranking how Australia's largest insurers are innovating to address key industry challenges such as climate change, underinsurance, and rising premiums. His goal is to save leaders $20m in fees and 40 years of waiting to get shit done. David is also the host of Accelerated Innovation's Innovation Insider podcast, which is available at https://acceleratedinnovation.com.au/innovation-insider/ Episode SummaryThe video features a discussion centered around the Australian insurance market, highlighting its unique dynamics, challenges, and opportunities for innovation. Here are the key points: Market Dynamics: The Australian insurance market is characterized by a high level of concentration, with a significant portion of the market share held by a few major players. This concentration influences competition and innovation within the industry. Regulatory Environment: The industry is highly regulated, with recent interventions aimed at addressing systemic issues, particularly following a Royal Commission that scrutinized the sector for malpractice. This has led to a culture of risk aversion among insurers. Innovation Focus: There is a growing emphasis on innovation, particularly in risk mitigation and preparing for natural disasters. Insurers are shifting their strategies to not only rebuild after disasters but to enhance infrastructure and resilience for future events. Collaboration and Growth: Insurers are beginning to collaborate more effectively with each other and with government entities to address challenges such as underinsurance and protection gaps. This collaborative approach is seen as a pathway to strengthening the market. Future Outlook: The discussion suggests a positive outlook for the next five to ten years, with expectations of increased appetite for risk and innovation. The market is viewed as ripe for new entrants, particularly global digital players, which could disrupt traditional distribution models. Personal vs. Commercial Lines: Innovation is more pronounced in personal lines of insurance, particularly through direct sales channels. The commercial lines are slower to innovate, focusing primarily on enhancing broker experiences. This episode is brought to you by The Future of Insurance thought leadership series, available globally from Amazon in print, Kindle and Audible audiobook. Follow the podcast at future-of-insurance.com/podcast for more details and other episodes. Music courtesy of Hyperbeat Music, available to stream or download on Spotify, Apple Music, and Amazon Music and more.

In this episode of the InsuranceAUM.com Podcast, host Stewart Foley, CFA, speaks with Toby True, Partner on the Investment Strategy and Risk Management Team at Adams Street Partners, about the complexities and evolving best practices in private market portfolio construction for insurers. Toby shares how Adams Street tailors investment strategies to align bottom-up decisions with the unique objectives, risk tolerance, and liquidity needs of insurance portfolios.   The conversation explores how illiquidity impacts portfolio design, why data and historical patterns are increasingly valuable in modeling private market exposure, and what current market conditions—such as slowed distributions and resilient fundamentals—mean for capital deployment. Toby also offers insights on secondary markets, private credit underwriting, and key traits he looks for when building investment teams. It's a timely and insightful discussion for insurance investment professionals navigating today's private market environment.

Premiums are rising. Insurers are leaving markets. But people keep building in risk-prone areas, and the climate disasters just keep coming. Can insurance markets adapt? In this episode, Shayle talks to Dr. Judd Boomhower, an assistant professor of economics at the University of California-San Diego and a faculty research fellow at the National Bureau of Economic Research. He studies how insurance markets are reacting to climate change. Shayle and Judd cover topics like: Why insurers are limiting coverage in California, Florida, and other high-risk markets How disaster insurance, unlike auto or health insurance, faces a flood of claims all at the same time How catastrophe models (or “cat models” for short) work and why AI and other improvements struggle the solve the fundamental problem: a lack of historical data needed to predict future events The challenges of private “black-box” catastrophe models that can't be reviewed by third parties Reinsurance markets and why they're not attracting more capital to shore up insurers The pros and cons of parametric insurance, an emerging category of insurance products Undercapitalized “fly-by-night” insurers that risk insolvency and failing to pay out claim Recommended resources NBER: How Are Insurance Markets Adapting to Climate Change? Risk Classification and Pricing in the Market for Homeowners Insurance Brookings: “How is climate change impacting home insurance markets?” Credits: Hosted by Shayle Kann. Produced and edited by Daniel Woldorff. Original music and engineering by Sean Marquand. Stephen Lacey is executive editor. Catalyst is brought to you by Anza, a platform enabling solar and storage developers and buyers to save time, reduce risk, & increase profits in their equipment selection process. Anza gives clients access to pricing, technical, and risk data and tools that they've never had access to before. Learn more at go.anzarenewables.com/latitude. Catalyst is brought to you by EnergyHub. EnergyHub helps utilities build next-generation virtual power plants that unlock reliable flexibility at every level of the grid. See how EnergyHub helps unlock the power of flexibility at scale, and deliver more value through cross-DER dispatch with their leading Edge DERMS platform, by visiting energyhub.com.

While cyber is becoming more of an operational risk, increased severity trends and emerging technologies such as AI are raising concerns, said Ziad Kubursi, head of Financial & Executive Liability, Hartford Financial.

In this episode of The Accidental Landlord Podcast, host Peter McKenzie is joined by insurance expert Carl Bulloch to unpack one of the most stressful (and frustrating) parts of being a landlord in California - dealing with wildfire insurance claims. With the devastating January 2025 wildfires still fresh in everyone's mind, thousands of landlords are stuck in limbo, waiting on delayed payouts, battling claim denials, and facing rising premiums or non-renewals. Sound familiar? Carl brings firsthand expertise to help you make sense of it all - from what to look for in your policy, to dealing with stubborn insurance companies, to understanding why insurers are pulling out of California and what the FAIR Plan really offers. Whether you're mid-claim, underinsured, or just trying to stay ahead of the next disaster, this episode is packed with practical strategies to protect your investments and sanity.

Do you know your “remnant cholesterol”? It could be better than LDL for predicting your risk of having a heart attack or stroke; Vagal nerve stimulation for seizures—could adding a keto diet help? Exoskeletons that help runners, hikers, and cyclists have hit the consumer marketplace for recreational athletes; RFK Jr's HHS launches program to improve infant formulas; Insurers bilk taxpayers for billions by double-charging Medicaid.

March 31, 2025 - New York State Insurance Association President Cassandra Anderson makes the case for state to give car insurers more flexibility to retroactively cancel policies used as part of a fraud campaign.

In this episode of the InsuranceAUM.com Podcast, host Stewart Foley, CFA, is joined by Anwiti Bahuguna, PhD, Chief Investment Officer of Global Asset Allocation at Northern Trust Asset Management. The conversation explores Northern Trust's latest long-term capital market assumptions and the macroeconomic forces likely to shape insurer portfolios over the next decade—from AI-enabled productivity and energy transition to evolving patterns of globalization.   Anwiti shares how her team blends quantitative modeling with insights from asset class specialists to create actionable 10-year outlooks for insurance investors. The discussion spans implications for fixed income and equity allocations, real assets as inflation hedges, and the growing relevance of private markets—particularly private credit. With practical insights on capital formation, macro themes, and manager selection, this episode offers a roadmap for insurance CIOs and investment teams navigating the complexities of a shifting global landscape.

In this episode of the InsuranceAUM.com Podcast, host Stewart Foley, CFA, sits down with Dan Palone, Managing Director of Global Loan Operations at SS&C Technologies, to discuss the latest trends in the residential mortgage market. With rising interest rates, limited housing supply, and increasing investor interest, how are insurers positioning themselves in this evolving landscape?   Dan shares insights into the advantages of residential mortgage loans (RMLs) over traditional mortgage-backed securities, key operational considerations for insurers looking to scale in this asset class, and the impact of automation on mortgage investing. Tune in to learn how insurance investors can navigate the complexities of the Resi market and optimize their portfolios.

Here's my new idea for an episode. Welcome to it. I want to talk about a major theme running through the last few episodes of Relentless Health Value. And this theme is, heads up, going to continue through a few upcoming shows as well. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. We have Matt McQuide coming up, talking about patient engagement, and Christine Hale, MD, MBA, talking about high-cost claimants. And we also have an encore coming up with Kenny Cole, MD, talking about a lot of things; but patient trust is one of them. But before I get to the main theme to ponder here, let me talk about what gets selected to talk about on Relentless Health Value. I will freely admit, how topics for shows get picked, it's not exactly a linear sort of affair. And furthermore, even if it were, I can't always get the stars to align to get a specific cluster of guests to all come on like one after the other. So, for sure, it might be less than obvious at times where my head is at—and sometimes, admittedly, I don't even know. This may sound incredibly scattershot (and it probably is), but in my defense, this whole healthcare thing, in case you didn't know, it's really complicated. Every time I get a chance to chat with an expert, I learn something new. I feel like it's almost impossible to sit in a vacuum and mastermind some kind of grand insight. Very, very fortunately, I don't need to sit in a cave and do all this heavy thinking all by myself. We got ourselves a tribe here of like-minded, really smart folks between the guests and you lot, all of you in the tribe of listeners who are here every week. Yeah, you rock! And I can always count on you to start teasing out the themes and the through lines and the really key actionable points. You email me. You write great posts and comments on LinkedIn and elsewhere. Even if I am a little bit behind the eight ball translating my instinct into an actual trend line, it doesn't slow this bus down. It's you who keeps it moving, which is why I can confidently say it's you all who are to blame for this new idea I came up with the other day after the podcast with Al Lewis (EP464) triggered so much amazing and really deep insight and dot connecting back and forth that hooked together the past six, I'm gonna say, or so shows. Let's just start at the beginning. Let's start with the topics that have been discussed in the past several episodes of the pod. Here I go. Emergency room visits are now costing about 6% of total plan sponsor spend on average. That was the holy crap moment from the episode with Al Lewis (EP464). Emergency room volume is up, and also prices are up. In that show with Al Lewis, I did quote John Lee, MD, who is an emergency room doctor, by the way. I quoted him because he told a story about a patient who came into the ER, winds up getting a big workup in his ER. Dr. Lee says he sees this situation a lot where the patient comes in, they've had something going on for a while, they've tried to make an appointment with their PCP or even urgent care, they could not get in. It's also really hard to coordinate and get all the blood work or the scans and have that all looked at that's needed for the workup to even happen. I've spoken with multiple ER doctors at this point, and they all say pretty much the same thing. They see the same scenario happen often enough, maybe even multiple times a day. Patient comes in with something that may or may not be emergent, and they are now in the ER because they've been worried about it for weeks or months. And the ER is like the only place where they can get to the bottom of what is going on with their body. And then the patient, you know, they spend the whole day in the ER getting what amounts to weeks' worth of outpatient workup accomplished and scans and imaging and labs. And there's no prior authing anything down. It's also incredibly expensive. Moving on from the Al Lewis show, earlier than that I had had on Rushika Fernandopulle, MD (EP460) and then also Scott Conard, MD (EP462). Both are PCPs, both talking about primary care and what makes good primary care and what makes bad primary care and how our current “healthcare marketplace,” as Dr. Conard puts it, incentivizes either no primary care and/or primary care where volume driven throughput is the name of the game—you know, like seeing 25 patients a day. These visits or episodes of care are often pretty transactional. If relationships are formed, it's because the doctor and/or the patient are rising above the system, not the other way around. And none of that is good for primary care doctors, nurses, or other clinicians. It's also not good for patients, and it's not good for plan sponsors or any of the ultimate purchasers here (taxpayers, patients themselves) because while all of this is going on, those patients getting no or not good primary care are somebody's next high-cost claimant. Okay, so those were the shows with Rushika Fernandopulle and Scott Conard. Then this past week was the show with Vivian Ho, PhD (EP466), who discusses the incentives that hospital leadership often has. And these incentives may actually sound great on paper, but IRL, they wind up actually jacking up prices and set up some weird incentives to increase the number of beds and the heads in them. There was also two shows, one of them with Betsy Seals (EP463) and then another one with Wendell Potter (EP384), about Medicare Advantage and what payers are up to. Alright, so let's dig in. What's the big theme? What's the big through line here? Let's take it from the top. Theme 1 is largely this (and Scott Conard actually said this flat out in his show): Primary care—good primary care, I mean—is an investment. Everything else is a cost. And those skyrocketing ER costs are pure evidence of this. Again, listen to that show with Al Lewis earlier (EP464) for a lot of details about this. But total plan costs … 6% are ER visits. Tim Denman from Premise Health wrote, “That is an insane number! Anything over 2% warrants concern.” But yeah, these days we have, on average across the country, 200 plan members out of 1000 every single year dipping into their local ER. That number, by the way, will rise and fall depending on the access and availability of primary care and/or good urgent cares. Here's from a Web site entitled ER Visit Statistics, Facts & Trends: “In the United States, emergency room visits often highlight gaps in healthcare accessibility. Many individuals turn to ERs for conditions that could have been managed through preventative or primary care. … This indicates that inadequate access to healthcare often leads to increased reliance on emergency departments. … “ED visits can entail significant costs, particularly when a considerable portion of these visits is classified as non-urgent. … [Non-urgent] visits—not requiring immediate medical intervention—often lead to unnecessary expenditures that could be better allocated in primary care settings.” And by the way, if you look at the total cost across the country of ER visits, it's billions and billions and billions of dollars. In 2017, ED visits (I don't have a stat right in front of me), but in 2017, ED visits were $76.3 billion in the United States. Alright, so, the Al Lewis show comes out, I see that, and then, like a bolt of lightning, François de Brantes, MBA, enters the chat. François de Brantes was on Relentless Health Value several years ago (EP220). I should have him come back on. But François de Brantes cemented with mortar the connectivity between runaway ER costs and the lack of primary care. He started out talking actually about a new study from the Milbank Memorial Fund. Only like 5% of our spend going to primary care is way lower than any other developed country in the world—all of whom, of course, have far higher life expectancies than us. So, yeah … they might be onto something. François de Brantes wrote (with some light editing), “Setting aside the impotence of policies, the real question we should ask ourselves is whether we're looking at the right numbers. The short answer is no, with all due respect to the researchers that crunched the numbers. That's probably because the lens they're using is incredibly narrow and misses everything else.” And he's talking now about, is that 5% primary care number actually accurate? François de Brantes continues, “Consider, for example, that in commercially insured plans, the total spend on … EDs is 6% or more.” And then he says, “Check out Stacey Richter's podcast on the subject, but 6% is essentially what researchers say is spent on, you know, ‘primary care.' Except … they don't count those costs, the ER costs. They don't count many other costs that are for primary care, meaning for the treatment of routine preventative and sick care, all the things that family practices used to manage but don't anymore. They don't count them because those services are rendered by clinicians other than those in primary care practice.” François concludes (and he wrote a great article) that if you add up all the dollars that are spent on things that amount to primary care but just didn't happen in a primary care office, it's conservatively around 17% of total dollars. So, yeah … it's not like anyone is saving money by not making sure that every plan member or patient across the country has a relationship with an actual primary care team—you know, a doctor or a nurse who they can get on the phone with who knows them. Listen to the show coming up with Matt McQuide. This theme will continue. But any plan not making sure that primary care happens in primary care offices is shelling out for the most expensive primary care money can buy, you know, because it's gonna happen either in the ER or elsewhere. Jeff Charles Goldsmith, PhD, put this really well. He wrote, “As others have said, [this surge in ER dollars is a] direct consequence of [a] worsening primary care shortage.” Then Dr. John Lee turned up. He, I had quoted on the Al Lewis show, but he wrote a great post on LinkedIn; and part of it was this: “Toward a systemic solution, [we gotta do some unsqueezing of the balloon]. Stacey and Al likened our system to a squeezed balloon, with pressure forcing patients into the [emergency room]. The true solution is to ‘unsqueeze' the system by improving access to care outside the [emergency room]. Addressing these upstream issues could prevent patients from ending up in the [emergency room]. … While the necessary changes are staring us in the face, unsqueezing the balloon is far more challenging than it sounds.” And speaking of ER docs weighing in, then we had Mick Connors, MD, who left a banger of a comment with a bunch of suggestions to untangle some of these challenges that are more challenging than they may sound at first glance that Dr. Lee mentions. And as I said, he's a 30-year pediatric emergency physician, so I'm inclined to take his suggestions seriously. You can find them on LinkedIn. But yeah, I can see why some communities are paying 40 bucks a month or something for patients without access to primary care to get it just like they pay fire departments or police departments. Here's a link to Primary Care for All Americans, who are trying to help local communities get their citizens primary care. And Dr. Conard talked about this a little bit in that episode (EP462). I can also see why plan sponsors have every incentive to change the incentives such that primary care teams can be all in on doing what they do. Dr. Fernandopulle (EP460) hits on this. This is truly vital, making sure that the incentives are right, because we can't forget, as Rob Andrews has said repeatedly, organizations do what you pay them to do. And unless a plan sponsor gets into the mix, it is super rare to encounter anybody paying anybody for amazing primary care in an actual primary care setting. At that point, Alex Sommers, MD, ABEM, DipABLM, arrived on the scene; and he wrote (again with light editing—sorry, I can't read), “This one is in my wheelhouse. There is a ton that could be done here. There just has to be strategy in any given market. It's a function of access, resources, and like-minded employers willing to invest in a direct relationship with providers. But not just any providers. Providers who are willing to solve a big X in this case. You certainly don't need a trauma team on standby to remove a splinter or take off a wart. A great advanced primary care relationship is one way, but another thing is just access to care off-hours with the resources to make a difference in a cost-plus model. You can't help everybody at once. But you can help a lot of people if there is a collaborative opportunity.” And then Dr. Alex Sommers continues. He says, “We already have EKG, most procedures and supplies, X-ray, ultrasounds, and MRI in our clinics. All that's missing is a CT scanner. It just takes a feasible critical mass to invest in a given geography for that type of alternative care model to alter the course here. Six percent of plan spend going to the ER. My goodness.” So, then we have Ann Lewandowski, who just gets to the heart of the matter and the rate critical for primary care to become the investment that it could be: trust. Ann Lewandowski says, “I 100% agree with all of this, basically. I think strong primary care that promotes trust before things get so bad people think they need to go to the emergency room is the way to go.” This whole human concept of trust is a gigantic requirement for clinical and probably financial success. We need primary care to be an investment, but for it to be an investment, there's got to be relationships and there has to be trust between patients and their care teams. Now, neither relationships nor trust are super measurable constructs, so it's really easy for some finance pro to do things in the name of efficiency or optimization that undermine the entire spirit of the endeavor without even realizing it. Then we have a lot of primary care that doesn't happen in primary care offices. It happens in care settings like the ER. So, let's tug this theme along to the shows that concern carriers, meaning the shows with Wendell Potter (EP384) on how shareholders influence carrier behavior and with Betsy Seals (EP463) on Medicare Advantage plans and what they're up to. Here's where the primary care/ER through line starts to connect to carriers. Here's a LinkedIn post by the indomitable Steve Schutzer, MD. Dr. Schutzer wrote about the Betsy Seals conversation, and he said, “Stacey, you made a comment during this fabulous episode with Betsy that I really believe should be amplified from North to South, coast to coast—something that unfortunately is not top of mind for many in this industry. And that was ‘focus on the value that accrues to the patient'—period, end of story. That is the north star of the [value-based care] movement, lest we forget. Financial outcome measures are important in the value equation, but the numerator must be about the patient. As always, grateful for your insights and ongoing leadership.” Oh, thank you so much. And same to you. Grateful for yours. Betsy Seals in that podcast, though, she reminded carrier listeners about this “think about the value accruing to the patient” in that episode. And in the Wendell Potter encore that came out right before the show with Betsy, yeah, what Wendell said kind of made me realize why Betsy felt it important to remind carriers to think about the value accruing to patients. Wall Street rewards profit maximization in the short term. It does not reward value accruing to the patient. However—and here's me agreeing with Dr. Steve Schutzer, because I think this is what underlies his comment—if what we're doing gets so far removed from what is of value to the patient, then yeah, we're getting so removed from the human beings we're allegedly serving, that smart people can make smart decisions in theoretical model world. But what's being done lacks a fundamental grounding in actual reality. And that's dangerous for plan members, but it's also pretty treacherous from a business and legal perspective, as I think we're seeing here. Okay, so back to our theme of broken primary care and accelerating ER costs. Are carriers getting in there and putting a stop to it? I mean, as aforementioned about 8 to 10 times, if you have a broken primary care system, you're gonna pay for primary care, alright. It's just gonna be in really expensive care settings. You gotta figure carriers are wise to this and they're the ones that are supposed to be keeping healthcare costs under control for all America. Well, relative to keeping ER costs under control, here's a link to a study Vivian Ho, PhD, sent from Health Affairs showing how much ER prices have gone up. ER prices are way higher than they used to be. So, you'd think that carriers would have a huge incentive to get members primary care and do lots and lots of things to ensure that not only would members have access to primary care, but it'd be amazing primary care with doctors and nurses that were trusted and relationships that would be built. It'd be salad days for value. Except … they're not doing a whole lot at any scale that I could find. We have Iora and ChenMed and a few others aside. These are advanced primary care groups that are deployed by carriers, and these organizations can do great things. But I also think they serve—and this came up in the Dr. Fernandopulle show (EP460)—they serve like 1% of overall patient populations. Dr. Fernandopulle talked about this in the context of why these advanced primary care disruptors may have great impact on individual patients but they have very little overall impact at a national scale. They're just not scaled, and they're not nationwide. But why not? I mean, why aren't carriers all over this stuff? Well, first of all—and again, kind of like back to the Wendell show (EP384) now—if we're thinking short term, as a carrier, like Wall Street encourages, you know, quarter by quarter, and if only the outlier, mission-driven folks (the knights) in any given carrier organization are checking what's going on actually with plans, members, and patients like Betsy advised, keep in mind it's a whole lot cheaper and it's easier to just deny care. And you can do that at scale if you get yourself an AI engine and press Go. Or you can come up with, I don't know, exciting new ways to maximize your risk adjustment and upcoding. There's an article that was written by Sergei Polevikov, ABD, MBA, MS, MA

Bonus Episode for Feb. 7. California's wildfires caused an estimated $30 billion or more in losses to insurers. The state's insurance landscape is in a state of chaos, but the broader industry is faring better. Telis Demos, co-host of WSJ's Take On the Week and a writer for Heard on the Street, breaks down what's happening across the industry and explains why the impact of the catastrophe on insurance companies such as Allstate, Travelers and Chubb could depend on reinsurers like the Everest Group.  Chip Cutter hosts this special bonus episode of What's News in Earnings, where we dig into companies' earnings reports and analyst calls to find out what's going on under the hood of the American economy. Sign up for the WSJ's free Markets A.M. newsletter. Learn more about your ad choices. Visit megaphone.fm/adchoices

BUY CAST BREW COFFEE TO FIGHT BACK - https://castbrew.com/ Become a Member For Uncensored Videos - https://timcast.com/join-us/ Hang Out With Tim Pool & Crew LIVE At - http://Youtube.com/TimcastIRL Palisades Wildfire WORSENS, Insurers KNEW And CANCELED Policies WEEKS AGO, Democrats FAILED CA Learn more about your ad choices. Visit megaphone.fm/adchoices