Driving Success for GM
Al Gier, GM’s director of Global Risk Management & Insurance, felt so strongly about Elisa Black’s work in 2013 that he nominated her personally as a Power Broker®. That’s quite an endorsement. In fact, Gier and Frida Berry, GM’s manager of Liability Risk Financing, agree that not only did Black manage that critical global juggling act, but she did it with her professional, focused style.
“Elisa was instrumental in helping reduce collateral requirements and improving the efficiency of the global claims handling process,” Gier said. “Her client philosophy focuses on being prepared and setting the marketing standard at the forefront of the negotiation.”
Gier explained that any broker can negotiate with a carrier post-quote. More impressive is doing the legwork so you come to the table prepared to negotiate ahead of time, a Black trademark. Also, for a large global enterprise, he said, timing is everything. So finalizing financial negotiations early allows the time to fulfill the administrative and contractual obligations of an insured — the lifeline of most international programs.
Gier said Black is great at articulating obligations and time constraints.
Bermuda Excess Market Wizardry
With the automotive market continuing to recover, the Bermuda excess market is looking to boost premiums come renewal time. To help alleviate that pricing stress, Chris Heinicke and his Aon team do their best to negotiate with markets to keep premiums from climbing.
In 2013, Heinicke faced a specific challenge for a client that was in the midst of a claims issue with one market that had a sizable amount of capacity on the excess casualty program. The issue was on a completely separate line of business, but was enough of a problem that the client had made the decision to cut this market from all of their lines of business. That decision was made after the entire program had already been quoted at the expiring premium and there was little to no capacity left in Bermuda. Heinicke and his team worked quickly by increasing capacity with the only market in Bermuda that had something available, and then worked with the U.S. and London teams to get the terms, pricing and capacity needed to replace the market. In the end, the client was pleased with the results and impressed at the quick response.
“Chris’ knowledge of the Bermuda markets helped us structure a program with the broadest coverage,” said the liability risk financing manager from another large automaker. “We have a very good risk profile, and Chris ensures we aren’t being charged improperly.”
A risk manager from a third automaker credited Heinicke with doing a “fantastic job” in helping the company identify critical areas the Bermuda markets focus on, as well as what is needed to communicate those key areas to underwriters.
Marshalling the Marsh Resources
In this case, the product over-shipment would create a much larger balance sheet exposure than the client would normally face. Also, the client’s treasury department wanted to use the large shipment to enhance cash flow as well as its borrowing base. Kowalski found a solution involving both private insurance and governmental support to manuscript a program that not only provided vital risk mitigation, but also enhanced this client’s cash flow management needs.
To make things happen, Kowalski often collaborates with Marsh brokerage teams on a global scale — from Detroit, New York, and Chicago to Bermuda, London, Zurich and various offices throughout Asia. Along the way, he has successfully placed complex risk finance programs involving more than 73 global markets and billions of dollars of capacity for a single line of coverage.
“Michael is our client executive and we have worked together for a number of years,” said Al Gier, director, Global Risk Management & Insurance at General Motors. “He has the skills we like to see in a broker — mainly, responsiveness and delivering the proper resources quickly.”
Expertise and Knowledge
Key Air Inc. was getting ready to consider other brokers until Joseph Braunstein was assigned to their account, said Greg Kinsella, president and CEO of Key Air, which manages and operates aircraft owned by others. “We agreed that if we were going to Marsh that he would make the difference, and he definitely has,” said Kinsella. “It was really on the customer service side. He didn’t go through the motions and just offer minimum basic support. He really looked at our policies.”
Another major benefit Braunstein, Marsh’s General Aviation practice leader, offered Key Air is a user-friendly handbook the company can use to educate its clients on the various coverages available to them and how the policies would work when needed.
“Joe took the initiative to create that. It really gives me and my team a tool to sit down with our clients and educate them on aviation insurance,” Kinsella said. “It has helped us be more effective.”
He was able to transition the perception of insurance from a liability to an asset.
The director of operations for a large aircraft charter company praised Braunstein as “a fantastic resource.”
“When Joe and Marsh got our business, we immediately saw an increase in coverage and a decrease in premium,” he said.
In addition, Braunstein’s “expertise and knowledge in aviation insurance is quite evident. Joe is looking out for our interests and that’s something we did not have before.”
Sharing His Knowledge
John Geisen, senior vice president at Aon, has been an account leader in the aviation space for nearly two decades, and his clients have benefited from his in-depth knowledge.
“In the aviation industry, there are a lot of challenges that come up,” said Bill Hoyt, insurance risk manager at the Metropolitan Airports Commission, a public corporation that provides aviation services throughout the Twin Cities metropolitan area, including operating the Minneapolis-St. Paul International Airport.
“The issues change almost every day,” Hoyt said. “In this industry, you have got to have someone who has a significant understanding of the risks. That’s what John has and that’s what John brings to the table for us.”
In addition to the typical coverage, Hoyt relies on Geisen for unusual coverage challenges, counting on him to determine whether current policy wording covers such a risk or if an endorsement is required. One example, he said, involved determining liability issues associated with glare and other risks related to solar panels.
For Karen Erazo, manager, Legal Affairs, Sun Country Airlines, Geisen’s attentiveness, knowledge and ideas are as welcome as his focus on keeping costs down.
One issue Geisen has been focusing on this past year is the workers’ compensation impact of senior flight attendants, she said. “He’s come up with suggestions on addressing lifting and other ways to help our flight attendants reduce the risk of injury,” Erazo said.
“He’s very knowledgeable and very anxious to share that knowledge,” she said.
Customization and Confidence
From helping out a mom-and-pop airline to covering aviation risks in war-torn countries, Jason Hendrix does it all. A pilot himself, Hendrix furthered his knowledge at the Embry-Riddle Aeronautical University, a college designed for aviation professionals, and as an aviation underwriter prior to becoming a broker.
“You can ask him anything about an airplane and he will tell you,” said Chrissy McCreary, supervisor, Risk Management, KBR, which operates air bases internationally, including in Iraq and Afghanistan. “Our corporate program is pretty specialized. We have bits and pieces all over the world and every project is different,” she said.
For Jake Duplechin, president and owner of Executive Aviation Management, Hendrix, an assistant vice president at Aon, helped him make his dream of owning his own aircraft management business a reality by fostering relationships with the insurance marketplace and putting together a fleet policy that covers the seven airplanes owned by about 15 companies.
“It’s almost like calling a buddy of mine on the phone but he’s such a professional when it gets down to it,” Duplechin said.
A challenge this year for CGG was the acquisition of a fleet of 28 aircraft in four countries.
“We never had to insure planes before,” said Erin Obrien Link, CGG’s enterprise risk management and insurance vice president. The situation was complicated by the planes being registered in different countries and having numerous local policies that were in effect. “He was able to put together a global policy, which was extremely complicated,” she said.
A True Partnership
As Intrepid Aviation was looking to grow, they called upon Drew Johnston, a vice president at Aon. “We were able to pivot very effectively from two aircraft to now 10 aircraft with customers in nine countries, said Intrepid’s chief investment officer, Brian Rynott. “We were looking for help to manage the portfolio and help plot out the growth trajectory, and someone to support us in that growth from an insurance perspective.”
Johnston was also crucial in coming up with a risk solution for Frank Perryman, president and CEO of Perryman Co., who is passionate about being in the left-hand seat and flying the company’s fleet of jet aircraft.
“Our qualifications are no different than professional pilots who would fly for any of the airlines, but being the owner and operator takes it to a unique difference,” Perryman said. “He takes the time to have an intimate knowledge of what we do and how we do it.”
Johnston also helped Perryman communicate the company’s message to their underwriter, which created “a better bond,” Perryman said. It also resulted in the liability limit the company required at a very competitive price. “There’s nothing that is cookie cutter anymore,” he said. “You have got to design solutions for each and every client and that’s what he did.”
Johnston also helps Beechcraft navigate its way through its international risks and the demands of its business partners, said Cheryl Herbst, manager, Insurance and Risk Management, Beechcraft. “They will ask for the moon,” she said. “He helps us find a solution, sometimes at the last minute.”
Chris Taylor “worked his magic” as he guided Hawker Beechcraft through a management liability renewal process prior to entering bankruptcy and in the formation of Beechcraft, the new company.
“There are special issues that arise, and it can be a real challenge to secure insurance prior to entering Chapter 11,” said Cheryl Herbst, manager, Insurance and Risk Management, Beechcraft. “However, thanks to Chris, we went through Chapter 11 with full coverage and a run-off policy.”
Taylor “just went above and beyond my expectations,” and worked late into the night as negotiations regarding formation of the new company took place. “The day we emerged as a new company, we had a total insurance program in place,” she said.
Taylor, a vice president at Aon, also was able to bring innovative solutions to a defense contractor, related to its wage and hour coverage and D&O needs, especially international D&O coverage.
Among the challenges he was able to address were dealing with the contractor’s multiple internal stakeholders, changing compliance requirements in various countries and communication issues with non-insurance professionals.
At another organization, a plastics manufacturer, Taylor had to handle a complex transaction with multiple U.S. and international D&O policies during an acquisition, which required extensive communication and time management as he worked with the new company’s risk management team and broker to align coverage to protect both companies.
AerSale has multifaceted and complicated aviation risk exposures, but William Willer was able to find ways to create solutions that work for both the company and underwriter.
“He provides excellent information and frankly seems to be able to get the underwriters to come along and cooperate with us. That impressed me,” said Gary Eakins, vice president and corporate counsel of AerSale Inc., an aircraft leasing company that ferries aircraft.
Insurance is very expensive for ferrying flights, and it goes up astronomically depending on the number of flights, said Eakins.
“That never made a lot of sense. It’s the landing and take offs that get you, not the number of miles you cruise at altitude,” he said. “Bill was able to moderate those costs in a reasonable and effective way.”
In addition, Willer’s technical knowledge has been extremely helpful in drafting contracts, and he has been very responsive. “The aviation space is quite small in terms of people. They all know each other. I find Bill to be very effective in dealing with underwriters when unusual issues come up or when we need to explore an area where we hadn’t been before,” Eakins said.
Willer, an area president at Arthur J. Gallagher, also helped an airline through a Chapter 11 process, while correcting some serious and costly actions caused by a previous broker, and helped the risk manager of an aircraft leasing company overhaul the entire risk management process.
Beware of Medical Hyper-Inflation!
Historically, medical inflation rates nationwide have been fairly consistent. However, data is now showing that medical inflation is not a “one size fits all” phenomenon, with hyperinflation spikes occurring in some locations…but not others.
This geographical conundrum means hyperinflation can occur as narrowly as two hospitals having dramatically different charges on the same street in Anytown, USA. So, uncovering these anomalies is akin to finding the proverbial needle in a haystack.
“In recent years, workers’ compensation saw claim frequency decline, while severity rates went up. This basically means that increased job safety has offset increased medical costs,” explained Jason Beans, CEO of Rising Medical Solutions, a national medical cost management firm. “So, whenever a client’s average cost-per-claim went up, it was almost always caused by catastrophic, outlier-type claims.”
But beginning in 2013 and extending into 2014, Beans said, things changed. “I’ve never seen anything like it in my 20-plus years in this industry.”
“Our analytics made it very clear that small pockets around the country are experiencing what could only be described as medical cost hyperinflation. The big spikes in some clients’ claim costs were driven by a broader rise in medical costs, rather than catastrophic claims or severity issues.”
– Jason Beans, CEO, Rising Medical Solutions
Data dive uncovers surprising findings
On a national level, most experts describe medical costs increasing at a moderate annual rate. But, as often is the case, sometimes a macro perspective glosses over a very different situation at a more micro level.
“Our analytics made it very clear that small pockets around the country are experiencing what could only be described as medical cost hyperinflation,” explained Beans. “The big spikes in some clients’ claim costs were driven by a broader rise in medical costs, rather than catastrophic claims or severity issues.”
This conclusion is supported by several key data patterns:
- Geographic dependency: While many payers operate at the national level, only relatively small, geographically clustered claims showed steep cost increases.
- Median cost per claim: The median cost per claim, not just the average, increased greatly within these geographic clusters.
- Hospital associated care: Some clusters saw a large increase in the rates and/or the number of services provided by hospital systems, including their broad array of affiliate locations.
- Provider rates: Other clusters saw the same hospital/non-hospital based treatment ratios as prior years, but there was a material rate increase for all provider types across the board.
- Utilization increases: Some clusters also experienced a larger number of services being performed per claim.
One of the most severe examples of hyperinflation came from a large Florida metropolitan area which experienced a combined 47 percent workers’ compensation healthcare inflation rate. Not only was there a dramatic increase in the charge per hospital bill, but utilization was also way up and there was a shift to more services being performed in a costlier hospital system setting.
“The growth of costs in this Florida market stood in stark contrast to neighboring areas where most of our clients’ claim costs were coming down or at least had flat-lined,” Beans said.
An Arizona metropolitan area, on the other hand, experienced a different root cause for their hyperinflation. Regardless of provider type, rates have significantly increased over the past year. For example, one hospital system showed dramatic increases in both charge master rates and utilization. “Even with aggressive discounting, the projected customer impact in 2014 will be an increase of $773,850 from this provider alone,” said Beans.
ACA: Unintended consequences?
So what is going on? According to Beans, a potential driver of these cost spikes could be unintended consequences of the Affordable Care Act (ACA).
First, the ACA may be a contributing factor in recent provider consolidation. While healthcare industry consolidation is not new, the ACA can prompt increased merger and acquisition efforts as hospitals seek to improve financials and healthcare delivery by forming Accountable Care Organizations (ACO). ACOs, the theory goes, can take better advantage of value-based fee arrangements in existing and new markets.
“As hospital systems grow by acquisition, more patients are being brought under hospital pricing structures – which are significantly more expensive than similar services at smaller facilities such as independent ambulatory surgery centers and doctors’ offices,” Beans said.
Unfortunately, there is little evidence that post-consolidation healthcare systems have become more efficient, only more expensive. For example, a recent PwC study reported that hospital IT infrastructure consolidation alone is projected to add 2 percent to hospital costs in 2015.
Another potential ACA consequence is group health insurers may have less incentive to keep medical costs down. An ACA provision requires that 85% of premium in the large group market must be spent on medical care and provider incentive programs, leaving 15% of premium to be allocated towards administration, sales and subsequent profits. “Fifteen percent of $5000 in medical charges is a lot less than 15% of $10,000,” said Beans. “This really limits a group health carrier’s incentive to lower medical costs.”
How do increased group health rates relate to workers’ comp? In some markets, a group health carrier may use its group health rates for their work comp network so any rate increase impacts both business types.
In the end, medical inflation is inconsistent at best, with varying levels driven by differing factors in different locations – a true “needle in the haystack” challenge.
What to do?
Managing these emerging cost threats, whether you have the capabilities internally or utilize a partner, means having the tools to pinpoint hyperinflation and make adjustments. Beans said potential solutions for payers include:
- Using data analytics: Data availability is at an all-time high. Utilizing analytical tools to spot problem areas is critical for executing cost saving strategies quickly.
- Moving services out of hospital systems: Programs that direct care away from the hospital setting can substantially reduce costs. For example, Rising’s surgical care program utilizes ambulatory service centers to provide predictable, bundled case rates to payers.
- Negotiating with providers: Working directly with providers to negotiate bill reductions and prompt payment arrangements is effective in some markets.
- Underwriting with a micro-focus: For carriers, it is vital that underwriters identify where these pockets of hyperinflation are so they can adjust rates to keep pace with inflation.
“This trend needs to be closely watched,” Beans said. “In the meantime, we will continue to use data to help payers of medical services be smarter shoppers.”