Claims Documentation – Modernizing Insurance Platforms

TSG is partnering with Alfresco and Claimwire to host a morning event on May 4^th entitled Modern Insurance Platforms for Claim Documentation.  Compared to our first 15 years of our ECM practice when Life Sciences and other compliance applications like manufacturing and plant operations drove most of the innovation in the ECM space, we have been seeing an uptick in financial services over the last 5 years and particularly claims management for the Insurance industry.  This post will highlight some of the big changes we see on the horizon.

Security is Paramount – Records Management is Coming

In regards to Claim Management, and particularly medical information, any new capabilities (cloud, mobile…) have to be considered with secure access as a critical, non-negotiable requirement.  There are plenty of instances of security breaches including Target where financial information was stolen.  For Insurance companies, the risk is far greater in that one piece of private information could easily become available and splashed via social media or the 24 hour news network inappropriately.  For a cynical public always looking for another reason to distrust Insurance or any large company, the potential damage to brand could be large.  In recent news, United Airlines comes to mind.  Taking queues form the consumer companies, some thoughts regarding specific security for insurance claim documentation include:

• Strict enforcement of user ID and password standards
• Enforcement of IP address checks and other methods to prevent external access
• Notification when new devices attempt access the first time and blocking without email or cell phone confirmation
• Encryption of documents at rest and potentially metadata as well
• Redaction of confidential information from documents (ex: Social Security Number, etc)
• Security roles in the repository with restrictions of access to certain documents or un-redacted documents.

While not a current concern for US based customers, we would also predict efforts in North America similar to the General Data Production Regulation (GDPR) where the European Union intends to strengthen and unify data production for all individuals.  Of interest, the regulation updates the right to be forgotten with a more limited right to erasure and specifically that the “data subject has the right to request erasure of personal data related to them on any one of a number of grounds”.

The requirement for keeping documents not only secure but to also delete when appropriate will have a direct consequence on claim documentation.

Impact of Software as a Service

In the past, companies would purchase and host all claim related software behind their own firewall.  With security still a big focus, rather than have to purchase all software and hardware, the ability of vendors to provide more of a rentable Software as a Service (Saas) model via the Internet can help improve claim service as well as reduce costs.  We would predict two possible avenues around claim documentation:

• Keep the content and outsource selective services – Clients have a concern about giving away too much of their infrastructure to a third party vendor. Valid concerns include vendor lock-in as well as multi-tenant concerns around medical/PII and other sensitive information.  Some SaaS vendors give clients the ability to “shop” content services to reduce internal IT costs while quickly improving their capabilities and branding, particularly with external parties.  Some easy examples of SaaS for external parties are Docusign for document signature and ShareFile for secure document delivery.  Internally, services like Claimwire can provide automation of state form completion to allow the client to reduce their own internal knowledge and upkeep of state filing forms, updates to those forms and intelligence about how to complete the forms.
• Outsource not just the claim software but also the claim processing – In talking with clients, the desire to move the entire claim to the third party administrator seems to be more reasonable than keeping the people and processing internally while outsourcing only the claim software. Third Party administrators are already well established for the self-insured and we would expect other claim processing clients to want to leverage their capabilities on a claim by claim basis.  We would expect additional integration with the TPA’s to easily push and pull claims back and forth.

Impact of Infrastructure as a Service

Infrastructure as a Service (Amazon Web Services, Microsofte Azure and Google are the best examples) represents a bridge between business and IT for claim documentation where business and IT realize substantial advantages from the cloud without the all or nothing approach of a complete SaaS model for all content.  Business users get the reduced pricing and some of the capabilities of the cloud while IT users get the reduction of data centers along with flexible and scalable infrastructure on demand.

We do see client’s wanting to leverage the power of IaaS for all of their internal IT needs including Claims Processing.  The ability of vendors to provide a private cloud eliminates the concern about multi-tenancy solutions with an eye to security.

Video from Everywhere

Whether it is the proliferation of more and more security cameras, cameras in vehicles or personal phones, the upward trend for additional video at higher and better resolution will continue.  Some great examples:

• Any retail location can have complete coverage with a variety of different cameras. No longer is the slip and fall type insurance claim something that needs to be written out and debriefed, the video serves as the ultimate proof rather than he said/she said.
• Commercial trucks already have multiple cameras and real-time transmission to a central location in the event of an incident with services like Drivecam. It isn’t that difficult to see this technology being embedded in passenger cars.
• Drones with video are being used for roof inspection and other damage inspection to avoid the potentially unsafe practice of an inspector on the roof or in a damaged home.

More than just manage videos as a separate file to be stored in ECM, modern systems need to relate the associated videos to form a complete story of what has happened without each viewer needing to hunt through multiple (potentially lengthy) videos.  The ability to tie snippets of videos together for a quick summary without disturbing the evidence rules is something that our clients are looking to address and will be shown at our event.

With additional video, we would predict standards around video/audio formats and annotations would emerge similar to how PDF has come to dominate document formats.

Bandwidth Everywhere

With the continued evolution of cellular data access and fiber (and most places having high band wireless), we would predict that the capture of video and other content from mobile devices be more real-time rather than the standalone application and synch required when bandwidth was not always available.  Like client/server applications, we are predicting that app development for one time access to upload or view digital content will shift back to the web browser exclusively.  Users do not want to have to install and application when doing a simple function like submit a claim.

Summary – Interfaces to address all of the above

Claim document systems grew up in the 1990’s and many still have some of that early image processing feel.  Old school systems include proprietary viewers with ties to old document formats like TIFF and proprietary formats such as COLD.  Many systems were built when memory, CPU and storage was expensive.  Modern interfaces can take advantage of all of the newer capabilities while addressing the challenges of today to include:

• Focused User Interface – Claims specific interface to reduce complexity and empower the user.  We have focused on browers based solution with quick and convenient access to multiple format types and capabilities. Expect many capabilities to avoid printing like combining documents and sending/receiving directly from the system.
• Device Neutral Support – of a variety of PC and mobile/tablet devices. One interface should be able to be leveraged across platforms.  As mentioned above, we would predict that browser based interfaces will push client/server and mobile apps to the side as network and wireless bandwidth continues to improve.
• Content Neutral Support – new interfaces should be able to address the different formats. We would predict that moving unsupported formats to a consistent format (example PDF for Documents, MP4 for Video) from the content repository rather than rely on the viewer/interface to be able to support multiple formats.
• On Premise or IaaS – Successful interface should allow for on premise or within one of the major IaaS vendors, depending on clients specific security and cloud vendor requirements.
• SaaS Integration – Successful interface should have the capability and flexibility of the client to add different SaaS solutions at their discretion based on capabilities, pricing and consistency with security standards.

If you are interested in hearing more of our thoughts and benchmarking with some companies from the insurance industry, sign-up for our event on May 4th.