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Risk Scenario + Webinar

The Curse of the Black Adder

A supposed data breach sends a regional grocer scrambling to do damage control.
By: | December 11, 2013 • 8 min read
Risk Scenarios are created by Risk & Insurance editors along with leading industry partners. The hypothetical, yet realistic stories, showcase emerging risks that can result in significant losses if not properly addressed.

Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.

One Fine Fall Day

Aaron Scott watched with pride as his German shorthaired pointer Sadie bulled her way through the switchgrass. Sadie was six, an age when most hunting dogs started to show signs of aging. But Sadie was as heavy in the chest and shoulders as some males, and just as tough.

Scenario_BlackAdder

Then suddenly Sadie was on point, her stub of a tail twitching frenetically. Seconds later, the male bird exploded out of the brush. Aaron swung his grandfather’s over and under Remington up and dropped the bird cleanly. Aaron smiled. It didn’t get any better than this.

Then his phone rang. He had to get it. As the CFO for Pinecrest Food Markets, which had 44 stores in four states, it was part of his job to take calls, all calls.

“This is Aaron,” he said.

“Aaron, it’s Christine.” Christine was Aaron’s older sister and the CEO of the company. Aaron knew that tone in her voice. The news wasn’t good.

“We just got a letter from Spendex that they’ve been hit by malware. It looks like we may have lost credit card numbers for about 600,000 customers.”

Aaron paused and again looked at the scenery and savored the diminishing scent of spent gunpowder. He wished he could turn back the clock to one minute ago, but all that was gone.

“You there?” Christine said.

“I’m here,” Aaron said.

“Can you please get those dogs in the truck and get back to the office? We got work to do.”

Christine preferred jumping horses to bird-hunting. On a fox hunt, she could ride with anyone in the state.

Aaron loved his sister, but he also bore a scar over his right eyebrow where she’d clocked him with a rock when they were preteens.

“I’m comin’. Be there in 30,” Aaron said.

Pinecrest had been founded by Aaron’s grandfather William in an 800-square-foot shop in Johnstown, Pa. It had grown to where it had stores in eastern Ohio, its native western Pennsylvania, West Virginia and the Maryland panhandle.

Scenario Partner

Scenario Partner

Aaron and Christine ran it now. The phrase “three generations — shirt sleeves to shirt sleeves,” was how old-timers described how quickly an inherited family business could fall apart. Aaron and Christine had vowed they would prove that old saying wrong.

Back at the office, Aaron read the letter from the credit card transaction processing vendor Spendex. Spendex was reporting that as many as 26 of its regional retail customers lost credit card numbers to The Black Adder, a malware that strips names, credit card numbers and expiration dates from the magnetic stripes of credit cards.

“Now what?” said Christine.

“Well, we’ve got to tell every affected customer what happened and we need to do it soon,” Aaron said.

“How much is that going to cost?” Christine said.

“Quite a bit, but we’ve got insurance for it,” Aaron said as calmly as he could as he looked down at his iPhone and started scrolling through his contacts.

Aaron was playing possum with his cool tone. He was the family peacekeeper and he knew that his role at times like these was to keep a lid on the much more volatile Christine.

Christine exhaled, and Aaron kept his eyes on his iPhone.

Poll Question

Do you currently carry cyber coverage in the event of a data breach?

View Results

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False Start

Part of the Pinecrest brand came from where it was based and who founded it.

Based as it was in a state that was home to almost a million military veterans, Pinecrest aligned itself with traditional values like patriotism, community, faith and family.

There was a picture of a local veteran who had given his life in armed conflict in every Pinecrest store.

Scenario_BlackAdder

So when it came to the data breach notification, Christine Scott — in what she felt was full alignment with the brand — didn’t shrink from responsibility.

In addition to letters and emails sent to Pinecrest’s 600,000 affected customers, Christine called local news stations to broadcast news of the breach and her promises to make good. She didn’t bother to ask Aaron whether he thought that was a good idea.

“Every one of our customers will be reimbursed for their time and trouble, including a year’s worth of multi-bureau credit monitoring services,” Christine said while the TV cameras recorded her.

“Well that’s what the policy says, doesn’t it?” Christine said when Aaron told her later that she probably shouldn’t have said that on television.

The very next day, a phone call from Pinecrest’s insurance broker was the second bad call Aaron got that month.

“Multi-bureau? No. The policy will cover services from a single credit monitoring bureau,” the broker, Robert Franz, told Aaron.

As Aaron spoke with Robert, he was multitasking and monitoring his emails. He saw an email marked “urgent” from Spendex. It was about the data breach.

“Hey Robert, can I call you back in a few minutes? I’ve got something hopping here,” Aaron said.

“Sure,“ Robert said, but in a tone that implied, “What could be more important than this?”

As it turned out, the email from Spendex was plenty important.

The notice from Spendex explained that although it was obligated to inform all of its customers that there had been a breach, in reality, only 14 of its 26 retail customers had been impacted. The clincher? Pinecrest wasn’t one of them.

Aaron pushed back from his desk and ran his hands through his hair.

“What the … ?” he said as loudly as he would say anything.

“What is it?” said Christine, popping her head into his office. She knew from the volume of Aaron’s voice that it was something big.

“We didn’t lose any data. We didn’t lose any data at all,” Aaron said.

“Great,” Christine said.

“No, not great,” Aaron said. “We just told about a million people that we did.”

“Now what do we do?” Christine asked.

Aaron felt that Christine had burned him before by going on television without seeking his counsel. That experience caused him to dig in his heels with Christine over what to do next.

“Slow down, just slow down,” Aaron said when the siblings met to go over strategy.

“I don’t know that we need to come out with an announcement just yet.”

Aaron’s reaction to his sister’s outspokenness had caused him to miscalculate. A full week went by until Pinecrest announced on its website and with another email blast that its customers had, after all, not been impacted by the Black Adder strike.

The company’s pause in making that announcement was as toxic as a rattlesnake bite.

The local media reacted negatively to the company’s week-long silence. News that the company sat on the knowledge that customers hadn’t lost data made the front pages of the Johnstown Tribune-Democrat and the Wheeling News-Register.

Poll Question

If you do carry cyber coverage, do you know if your coverage will pay for multi-bureau credit reporting?

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Pinecrest’s Pain

For the first time in its history, Pinecrest was dealing with the full brunt of a hit to its reputation.

Scenario_BlackAdder

The traditional print media was one thing, and no small thing in the markets Pinecrest served. But online commentary, ungoverned by journalistic ethics, pulled no punches. Commentators ridiculed the company for banking on the military sacrifices of previous generations, when it “didn’t have the guts,” in one poster’s vernacular, to tell people the truth.

The company’s broker, Robert Franz, phoned Aaron with even more bad news.

“You’re not covered for any of your breach notification expenses, or for any credit monitoring services,” Robert told Aaron.

“Please tell me why,” Aaron said, keeping his voice low because he was just not in the mood for any spontaneous crisis communications with his older sister.

“Under your policy, you’re only covered for notification and credit monitoring if there was an actual breach,” Robert said.

“No breach, no coverage,” he said.

“So we’re out about a million dollars,” Aaron said flatly. In the regional grocery business, where margins could sometimes be measured in the low single digits, a million dollars was a very big hit.

“I’m afraid so,” Robert said.

Sales at Pinecrest Food Markets were down around 10 percent in all four states that it operated in.

“Might as well shop at Supermart,”a grizzled Korean War veteran told Channel 11 in Charles Town, West Virginia.

With the company down a million out of pocket and with revenue hamstrung, Christine Scott and the rest of the Pinecrest team had some very difficult and expensive decisions to make.

Should they sue Spendex for its shoddy forensics? And what coverage did they have for the costs of that?

Rumors began to circulate in several state capitals that class action lawsuits were being prepared on behalf of the tens of thousands of Pinecrest customers who felt they were caused needless expense and worry because of the bad information Pinecrest put out to begin with.

Grandstanding attorneys general were probably not far behind. Pinecrest was possibly facing legal action on several fronts and it was unclear whether it had the coverage to pay for its defense.

*****

With the world seemingly against them, Christine and Aaron took a day in late November and went to their grandfather’s hunting cabin in Somerset County.

The grouse were out there, but the two of them just sat staring at the fire in the cabin’s stone fireplace, with Aaron’s two bird dogs stretched out in front of the fireplace.

Sadie looked up hopefully as Aaron got up to throw another log on the fire.

“No huntin’ today, Sadie girl. Daddy is not in the mood,” Aaron said as Christine nursed a bottle of local craft-distilled rye.

“May I have some of that, please?” Aaron asked.

“Get your own bottle,” said Christine.

Poll Question

Does your company have a crisis response plan in the event of a cyber breach?

View Results

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Summary

A regional grocery chain gets into hot water after it loses customer financial data. Making matters worse is that the company does not have a good grasp on the language in its cyber coverage policy. The company also suffers reputational damage when it notifies customers based on bad information.

1. Know your partners: Pinecrest sees its problems go from bad to worse because the company it uses to process credit card transactions has shoddy forensics and reports data breaches for customers that in the end had no data breach.

2. Know your coverage: Pinecrest suffers needless losses because key executives don’t understand its insurance policy when it comes to services available under the coverage for data breach notification and credit monitoring.

3. Be as transparent as possible: When it comes to notifying customers of substantial issues that could impact their expenditures, getting out quickly with the best information is extremely important. Pinecrest actually has good news to report midway through this story, but sits on it due to internal friction. The good of the team must clearly win out here.

4. Create realistic expectations: Coverage existed for Pinecrest officials to put together a reasonable response when customer data was lost. But a key executive broadcast inflated statements about what Pinecrest would be able to do, creating equally inflated expectations.

5. Hold vendors accountable: Given the volatile expansion of cyber risk, it makes good sense to require vendors contractually to indemnify you if they lose your crucial customer data.

The Webinar

The issues covered in this scenario center around crisis management and insurance pitfalls associated with loss from a cyber breach. This follow-up webinar focused on specific loss trends and cyber exposures, as well as presented steps to take to strengthen your crisis risk management program.

Presenters

Webinar_Data_Breach_Aon

Download a copy of the slide presentation here.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at dreynolds@lrp.com.
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Risk Scenario

A Dim View

An earthquake decimates a retailer's servers and its supply chain.
By: | August 4, 2014 • 9 min read
Risk Scenarios are created by Risk & Insurance editors along with leading industry partners. The hypothetical, yet realistic stories, showcase emerging risks that can result in significant losses if not properly addressed.

Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.

All’s Well That Begins Well?

Darryl Korn shook off his loafers and propped his bare feet next to an errant branch of rosemary on the stone wall that separated his patio from the long slope down to the Missouri River. As the light faded, he sipped the Provencal rosé in his glass and let the fruity dryness of the wine pucker his mouth into a happy grimace.

Scenario_DimView

Korn, the CEO of Heaven’s Gardens, a Midwestern retailer based in Jefferson City, Mo., specializing in high-end patio and lawn furniture and accessories, was literally in his element.

A wood fire burned not far away in one of his company’s stone pizza ovens. Just a few minutes now and the flatbread he’d made with his own hands would be in there bubbling.

With his wife and children in town seeing a movie, this was one of those moments he wished he could capture; peace of mind, how rare it was.

It was the sight of the dying light on the river that got him thinking about work again. River: flood risk.

Korn’s workday included a review of his company’s risk management program with his risk committee. Most CEOs wouldn’t sit in on such meetings, but Korn did.

Korn felt great about the meeting. He reflected on how the company documented and ranked all property risks, flood, named storm, earthquake and tornado on a matrix broken down by zip code.

The company also worked with its carrier on an engineering risk assessment that provided the carrier with crucial information such as the age of the buildings and the construction materials they were composed of.

Scenario Partner

Scenario Partner

With operations bordered by Idaho, Utah and Arizona to the West and Tennessee, Kentucky and Ohio to the East, the company was particularly keen on showing underwriters its crisis management and business continuity muscle in the wake of a tornado, flood or earthquake.

Transparency and good data, that was the way to good coverage at the best price, Korn told himself, secure that he had mastered risk management wisdom that people at the C-suite level, even in mid-2015, didn’t usually concern themselves with.

Equally satisfying to Korn was the risk committee’s report on the company’s financial and operational resilience risk management strategy. From interest rate swaps to alternate energy suppliers in the face of catastrophe, it was all there.

***

The underwriter for Heaven’s Gardens, Hammond Kresley of regional insurer Butte Mutual, was enjoying a similarly peaceful sunset from his deck across the river. Although, being an underwriter, Kresley had a single malt in his hand.

Butte Mutual’s property portfolio, which roughly mirrored Heaven’s Garden’s geographic focus, was also broken down and ranked by zip code and degree of risk. Just as it did with Heaven’s Garden, Butte Mutual worked with many of its property insureds to provide risk engineering services that provided a deeper dive in the underwriter’s quest for transparency and good data.

Butte Mutual’s confidence in the diversity of its book of business and its approach to risk engineering was such that it had aggressively sought out new property business in this rate-challenged environment.

The company considered its approach to data, engineering and underwriting a differentiator, something that allowed it to take on business that its competitors wouldn’t dare to.

Darryl Korn was setting down his glass of rosé to slide the pizza in the oven when it hit. As his wine glass fell and shattered and the plate glass windows on the back of his house cracked, Korn initially thought the region was being bombed. It took seconds until he realized that for the first time in his life, he was experiencing an earthquake.

The earthquake was a 6.9 on the Richter scale on the New Madrid Fault, severely damaging numerous regional companies.

Poll Question

Do you use a Geographic Information System (GIS) to map and analyze your property risks?

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Scrambling for Information

Thankfully, Korn and his family escaped injury in the rare Missouri quake, but his company didn’t.

Scenario_DimViewYes, everyone knew about the New Madrid Fault. But no one thought it would rupture, or at least not at this intensity.

One of the cruelest twists for Heaven’s Gardens was that the facility which housed its servers– which the company boasted to underwriters was well out of reach of a flooding Missouri River or any of its tributaries– was badly damaged in the quake.

Store managers and operations staff accustomed to digital communication with headquarters were knocked off line and were slow to get important information to headquarters.

Thus, exquisitely bad data clouded company leadership’s perspective for the first few days after the quake.

“I don’t think we lost a single major supplier, “the company’s logistics chief, Raif Heck, told Korn and other leadership the day after the quake.

But due to poor communications, the company learned two days later that Heck was wrong.

Two of the metal fabricating companies that supplied Heaven’s Gardens with its grills and additional oven hardware were severely damaged. Ten Heaven’s Gardens stores in Missouri and Illinois were also hit hard.




Two of the damaged stores were in St. Louis, which meant the loss of key sales producers.

After suffering a delay due to bad information, the company scrambled to identify alternate hardware suppliers, but the process dragged on and on. Even undamaged stores suffered delays in reopening due to overwhelmed municipal inspectors being unable to visit properties quickly enough to issue certificates of occupancy.

The inspection delays got so bad that Korn himself got on the phone with the deputy mayor of St. Louis.

“There’s not a single crack in those structures,” Korn said, in one of several instances where he completely lost patience with the chaos all around him.

“No way can we issue certificates of occupancy until we get those properties inspected and we are still days away from that,” the deputy mayor replied.

“Days?” Korn exclaimed.

****

“Days.” said Hammond Kresley, in a meeting with the Butte Mutual reserving oversight committee (ROC), as it tried to get a handle on what sort of reserves it was going to need to set aside to cover insured quake losses and business interruption losses.

That screeching sound they all heard was Butte Mutual’s aggressive underwriting program — that it built up and justified over years — grinding to a halt.

Until it could get a handle on its quake losses, the carrier wasn’t going to take on any new business that looked even remotely risky.

A month after the quake, Heaven’s Gardens was seeing double-digit sales drop-offs in its undamaged stores due to its supply problems. The company prided itself on locally sourced materials and simply didn’t have the backup suppliers to keep it going in a meaningful way.

Quake damage to retail sites and first- and second-tier suppliers was something the company had known was possible. What was so maddening was the fact the company had paid a good deal of money for a risk engineering assessment and now all of that looked like it was going to waste.

The risk engineering assessment was great from a premiums paid and eventual claims perspective, but not much use with business recovery. Not from this rare earthquake event anyway.

It was like the company was blind where it most needed vision. What exactly was down and how bad was the damage? That was the problem.

Poll Question

What measures have you taken to secure data and communications infrastructures to aid in business continuity and business recovery should you suffer significant damage in a regional catastrophe?

View Results

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Permanent Impairment

By the summer of 2016, a mere year after the ῀M 6.9 quake that rattled Missouri and Illinois, Heaven’s Gardens, from a revenue perspective, had lost 15 percent its pre-quake size.

Scenario_DimView

When it came to design and product execution, the company was spot-on with its approach to functional, rustic outdoor furnishings. Its “locally-sourced” mantra was also golden.

But that ended up mattering little to frustrated customers who couldn’t pick up the equipment they’d ordered due to supply delays. Brand loyalty still meant something in this country, but not so much that somebody who ordered a pizza oven in April was happy to get it in October.

A year after the quake, the company still hadn’t found the second of two grill and fittings suppliers that met its local sourcing and design criteria.

Competitors to the East and West, some of them whose design couldn’t hold a candle to what Heaven’s Gardens produced, moved in to pick up pieces of the company’s business.

***

It took Butte Mutual six months to determine something that should have been good news but wasn’t. It turned out that the carrier had more than enough reserves to comfortably withstand insured losses from what became known as the “Hannibal Cannibal,” the quake named for its epicenter in Hannibal, Mo.

But a lack of visibility into its property portfolio meant the carrier failed to take the aggressive action it needed to take in these market conditions.

Deprived of the fullness of its topline growth potential, Butte Mutual survived, but its tepid growth for the next three years was off-putting to shareholders.

The company should have been a regional carrier star and instead became a mediocrity.

Poll Question

How quickly do you think you can re-establish your supply chain in the event of a regional catastrophe?

View Results

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Bar-Lessons-Learned---Partner's-Content-V1b

Risk & Insurance® partnered with Esri to produce this scenario. Below are Esri’s recommendations on how to prevent the losses presented in the scenario. This perspective is not an editorial opinion of Risk & Insurance®.

1. Engineer success: Using GIS to determine property vulnerability on the front end of a catastrophe is a well-accepted practice. But what about the back end? Consider leveraging access to high resolution geographic information from ArcGIS that can provide disaster damage assessment on the back end, mitigating the chance of overwhelming field staff and supporting faster and more efficient response to your property customers.

2. Protect against data and communication losses: Depending on access to your own company’s physical data storage and communications infrastructure following a disaster could be severely shortsighted. Consider ArcGIS cloud and mobile solutions that house data and provide communications capabilities outside of your natural threat footprint.

3. Ask more of business partners: Using location information Heaven’s Garden constructed reasonably sound business continuity and disaster recovery plans for each of its facilities. But its network of suppliers lacked this same insight. As a consequence, the company suffered supply chain failures that greatly inhibited its ability to recover from the New Madrid earthquake.

4. Demand and ensure better transparency: Using ArcGIS post event data and imagery gives you visibility in real time to property damage and other crucial information in the aftermath of a disaster. Settling for a listing of possibly affected properties categorized by ZIP code is an outmoded method of assessment that will not be looked at favorably by underwriters and will be a boon to your unimpacted competitors.

5. Speed of recovery: Risk managers and their organizations cannot place enough emphasis on speed of recovery. Stories are emerging post-Superstorm Sandy and other recent disasters about risk managers who through preparation and boldness got on the loss scene and had their businesses back up in a fraction of the time that it took competitors. Nothing is holding you back but conformity.



Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at dreynolds@lrp.com.
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Sponsored: Rising Medical Solutions

Beware of Medical Hyper-Inflation!

Workers’ comp medical costs are spiking in hidden pockets across the country.
By: | August 4, 2014 • 5 min read
SponsoredContent_Rising

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.”

SponsoredContent_Rising“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.”

Contact Rising Medical Solutions: info@risingms.com | www.risingms.com

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Rising Medical Solutions. The editorial staff of Risk & Insurance had no role in its preparation.


Rising Medical Solutions provides medical cost containment, care management and financial management services to the workers’ compensation, auto, liability and group health markets.
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