OpsDog Health Insurance KPIs

• Fortune 500 consulting agency OpsDog identified the top 5 health plan KPI metrics for health insurance companies in the US.
• OpsDog leverages 25 years of consulting expertise and business improvement services to Fortune 500 companies.
• First is Medical Loss Ratio (MLR), which is a percentage of premium dollars a health plan spends on medical claims and quality optimization instead of administrative expenses.
• Second is Claim Settlement Cycle Time (Medical) which indicates the average number of days needed for a health insurance payer to process and payout a claim.
• Third is Claims Denial Rate which has an average rate of 5-10 percent across the healthcare industry.
• Fourth is Provider Contracting Cycle Time or turnaround time for an insurance company to enroll a new healthcare provider in its network.
• Fifth is First Contact Resolution Rate (Member Services) or the percentage of resolved calls/mail/contacts by the Service Desk on the first customer interaction.

Strategy2Act Retirement Process KPIs

• KPI resource Strategy2Act lists around 20 KPIs for companies' Retirement process.
• Strategy2Act is a commercial library of KPI measures where businesses can obtain Balanced Scorecards with 12 to 15 KPIs.
• The top KPIs for retirement process include retirement planning estimate which factors in sources of income, expenses, savings program, and management of assets and risk.
• The percentage of employees aged 50 years old and above is also included as a top KPI for the retirement process.
• The percentage of senior executives and management officers nearing retirement age are also included.
• Lastly, the percent of voluntary retirements per year are included in the top 5 KPIs for retirement process.
•  Other KPIs include distribution of organizational workforce, breakdown of employees into part-time and full time workers, and male to female ratio among others.

Strategy2Act Health Insurance KPIs

• Strategy2Act also lists around 20 KPIs for health insurance for companies.
• The top KPIs include health insurance and financial perspective which indicates whether the firm's strategy and operations deliver value to their shareholders.
•  New business premiums is another KPI which measures the premium acquired from new policies for a specific year.
•  Internal rate of return (IRR) on new business represents the interest rate at which net present cash value flows from an investment or project equal zero.
• External funds management of cash flow sourced outside the company completes the top 5 KPIs for health insurance.
•  Other KPIs include operating profit, operation, number and value of policies sold among others.

Additional Findings

•  KPI Library Pension Fund also indicates the following KPIs: Number of investments above 5% of net assets, cost of risk benefits, number of days to pay out exit benefits, and market value of pension fund.
• IBISWorld reports that the US Retirement and Pension Plans market size will reach $669.5 billion this 2020.
• The market grew by 6% per year from 2015 to 2020.
• The US retirement and pension plan market is the 4th ranked Finance and Insurance industry by market size in the country.

Public Pension Low Returns Impact

• IBISWorld's report "Retirement & Pension Plans in the US Market Size 2003–2025" states that low yield/returns on public pension is a primary negative factor affecting the industry.
•  MarketWatch reported in 2019 that low returns on US public pensions impacts the future of retirees.
• Public pension returns have seen better days, with recent years' low returns expected to be the new normal.
• According to Market Watch, market research firms are forecasting even lower returns in the next decade.
• False confidence in the market, rash expansion of benefits and the 2008 -2009 recession have all contributed to public pension funds' lackluster performance today.
• The article stated that public pensions have roughly $1.5 trillion in unfunded liabilities in 2019, and that the huge funding gap will only continue to grow if adjusted expectations are not further lowered.
• According to MarketWatch, the government will foot the bill to fund future pension obligations by raising taxes and cutting public development spending.

Revenue Volatility and Risk

• IBISWorld also identified very high revenue volatility as a major negative factor affecting the US retirement and pension industry.
• The report stated that public pensions' revenue is heavily tied to investment returns on various asset classes such as the equity market and broad indexes.
•  Wall Street Journal reported that state and local pension plans are shifting into US stocks and "piling on risk" to cover recent years' low returns and shortfalls.
• As of 2019, 47% of pension plans' assets are in US stocks, the highest since 2007.
• While public pensions have historically benefited from the equity market, a turn for the worse could also put pensions and future retirees in dire straits.
• A decline could be followed by massive benefit cuts for government workers hired from that time.
• Again, when a city or state shoulders the bill for pension fund returns, government budget is diverted from other public services and development.

Health Benefits Cost Controlling

• Gallagher & Company's survey identified cost controlling as the biggest challenge to the US health benefits industry in 2014.
• WSJ reported that courts have blocked several government efforts to cut down benefits for current workers.
• According to the Gallagher & Company survey, controlling benefit costs was ranked number one by US employers with 100 to 1,000 full time workers as well as non-profit organizations.
• The most popular method of cost containment was to increase employee liability.
• This was accomplished by increasing employees' plan contributions, deductibles, out-of-pocket maximums, and co-payments.
• Another method was to change plan carriers for lower-cost options.
• Controlling health benefit costs has remained as employers' top concern in 2019.
• According to the survey from HR consulting firm Willis Towers Watson, controlling healthcare costs as well as increasing affordability were top concerns for 93% of surveyed US executives employing over 11.3 million workers collectively.
• Health benefit costs are projected to rise 5% in 2019 alone.
• Around 66% of surveyed executives said healthcare affordability is their most difficult challenge.
•  89% said growing health benefit costs are a "significant source of financial stress for their employees".
• Employers looking for full-time employees are under pressure to offer competitive health benefits.
• One way employers have coped is to address cost of pharmaceuticals as well as to explore "site of care" options such as outpatient facilities rather than hospitals.
• Companies are also trying to add to the value of their insurance programs by motivating employees to seek preventive care as well as emotional wellbeing.
• By doing so, health issues are both spotted early and prevented from becoming long-term and more expensive problems for both employers and employees.

Additional Findings

• The American Management Association (AMA) has identified additional challenges for companies and workers' retirement plans.
• First, many workers are postponing full retirement even as governments extend retirement age, impacting retirement plan coverage.
• Second, defined contribution plans are increasingly adopted but employers are not moving fast enough to meet employees' expectations for portable benefits.
• Third, employees themselves lack a complete understanding on how to secure desirable retirement even as companies increase employee liability.
• Fourth, retirement benefits are considered inadequate for many employees and may need to be supplemented with personal savings.
• Fifth, global governance is increasing to ensure compliance in benefit and retirement programs.
• AMA also outlined 5 health and welfare challenges for companies and workers.
• First, the private sector is in conflict with the workforce over rising expectations for state-of-the-art health care due to ballooning costs.
• Second, workers have individual preferences for health benefits depending on age and circumstances.
• Third, lifestyle diseases and chronic as well as psychological conditions are pushing healthcare budgets to the limit.
• Fourth, a greater understanding of changing health risks and how it affects employer liability is needed but often neglected.
• Fifth, global tracking and good governance of health benefit costs remain a cross-border challenge for many companies.

Greater Emphasis on Technology

• Clients are seeking greater ease and convenience through technological solutions, changing the way in which technology is leveraged and administered in the health and benefits industry.

• The trend is also characterized by a greater investment in new technologies to provide better user experience.
• This trend is being driven by the proliferation of digital health tools coming into the market, which are designed to help consumers manage their health care spending and decision-making. These range from the emergence of easy-to-use mobile applications to paperless coverage enrollment, which are meant to help save both time and money.
• Online tools also allow brokers to foster relationships with clients and provide faster and more personalized advice through streamlined communications systems.

The Rise of Voluntary Benefits

• Voluntary benefits are becoming more crucial to workers and employers despite "healthcare and retirement savings remaining a staple of benefit packages."
• This trend is being driven by the need to reduce costs for employers and accelerate value by offering flexibility to an increasingly diverse workforce.
• It is also further driven by the fact that voluntary benefits offer superior pricing, plan design, and underwriting support than what may be found in the individual market.
• Additionally, it is characterized by the rise in the adoption of voluntary benefits by employers and its use by workers. As brand-new voluntary benefits arise every year, it leads to additions to perks packages.

More Concerns About Cyber Security

• There are growing concerns relating to the security of healthcare data in the health and benefits industry.
• This trend is driven by the exposure of data to new cybersecurity vulnerabilities which leads clients to become concerned over the security of their personal information.
• It is further driven by the fact that breaches in the system can endanger human life, hinder health systems, diminish patient trust. Therefore, this makes cybersecurity very vital to the safety of patients.
• Confronting the problem involves understanding the threat and being proactive with combating it, which means not only solving old issues but racing to protect against new ones.

Research Strategy: