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Transitioning Collaboration – A “United” Example

Transitioning Collaboration – A “United” Example. Number of Past and Current Examples of Successful Collaboration Usually Targeted to a Specific Issue Focused on Past or Ongoing practices United HealthCare Settlement Moves Focus to Future Instituting a Different Collaborative Exam Dynamic.

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Transitioning Collaboration – A “United” Example

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  1. Transitioning Collaboration – A “United” Example • Number of Past and Current Examples of Successful Collaboration • Usually Targeted to a Specific Issue • Focused on Past or Ongoing practices • United HealthCare Settlement Moves Focus to Future • Instituting a Different Collaborative Exam Dynamic Lou Felice, NYS Isurance Department ICAE September 30, 2008

  2. Pulling the States Together • Using The MAWG Process • Committed Lead States • Present the Evidence • Present the Benefits Lou Felice, NYS Isurance Department ICAE September 30, 2008

  3. Collecting the Facts • Comparing Ongoing Exams and Past Findings • Defining / Listening to the Stakeholders • Policyholders • Providers • Regulators • Company Management and Board • Weed out the Anecdotal Noise • Hear what the Company Has to Say Lou Felice, NYS Isurance Department ICAE September 30, 2008

  4. Complaints are King • Use the NAIC Data • Augment with State Based Data • Compare Notes – Look for Patterns or Indicators of Systemic Problems Lou Felice, NYS Isurance Department ICAE September 30, 2008

  5. Making the Case – Part 1 • Present the Report Findings • Analyze Consumer and Provider Complaint Data • Compare Notes at MAWG • Focus on Common Areas of Concern Lou Felice, NYS Isurance Department ICAE September 30, 2008

  6. Two Sides to the Story • Evaluate Company Response • Can Things Get Better? • Design the Metrics and Benchmarks • Framework for Improvement • Framework for Accountability • Commitment to Change Lou Felice, NYS Isurance Department ICAE September 30, 2008

  7. Weathering the Storm • Hard for Both Sides to Change • Time Kills All • Keeping the Message Alive • Throw Down the Gauntlet • Three Become Five • Take the Olive Branch Lou Felice, NYS Isurance Department ICAE September 30, 2008

  8. An Ounce of Prevention • Process Improvement vs. Penalty • Remembering the Stakeholders • See the Goal and Bury the History Lou Felice, NYS Isurance Department ICAE September 30, 2008

  9. Making the Case – Part 2 • Get to the Best Deal You Can • Everybody Gets Their Pound of Flesh • Defining What’s In and What’s Out • What Do We get • What Do We Give Up Lou Felice, NYS Isurance Department ICAE September 30, 2008

  10. Carving Out Complaints • Complaints are Out • Resolution Unaffected • Penalties may be imposed including on Systemic issues arising from Complaints • Complaints are In • Use to Direct Monitoring Resources and as a Benchmark for State Specific and National Improvement Lou Felice, NYS Isurance Department ICAE September 30, 2008

  11. What, No Market Exams for Three Years? • Giving up the Power • Leveraging the Resources • An Expectation of Transparency • Building Compliance • Penalties Not Forgotten • Restitution Not Forgotten Lou Felice, NYS Isurance Department ICAE September 30, 2008

  12. There Is An Examination • Under a Selected State’s Legal Exam Framework • Supervised by Lead States • Using Independent Examiner • Interim Company Reporting • Interim Updates to Regulators • Annual Meeting with the Audit Committee • Annual Public Reports for All Stakeholders Lou Felice, NYS Isurance Department ICAE September 30, 2008

  13. Crossing the First Finish Line • Money and Atonement Matter • Process Improvement Catches On • 35 States / 50% of Premium • Not for Everybody Lou Felice, NYS Isurance Department ICAE September 30, 2008

  14. “Hybrid” Examination - IntegratingMonitoring and Examination Techniques • Reverse Engineering • Focusing on Risk from Data Sampling and Complaints • Evaluate Company Initiatives • Are they Identifying and Remediating Problems • Is their Plan working • Does it Cover the Problems being Observed • Adjustments to the Plan • Stakeholders Made Whole • Finding Errors and Fixing Problems Rather than Counting Violations • Long-term Commitment Lou Felice, NYS Isurance Department ICAE September 30, 2008

  15. Tracking Improvement • Improvement Related Penalties • Early Detailed Independent Review of Data • Feedback on Self Assessment and Improvement initiatives • Eventual Reliance on Company Internal review • Limited Data and Process Testing • Commitment to Compliance • Management Level • Board Level Lou Felice, NYS Isurance Department ICAE September 30, 2008

  16. Keeping the Stakeholders Informed • Periodic Meetings • Regular Reporting • Coordination of Message with Company Lou Felice, NYS Isurance Department ICAE September 30, 2008

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