From the March 2012 issue of Claims Magazine •Subscribe!

An Ounce of Prevention…

Western medicine has long been criticized as reductionist for what some perceive as egregious oversights in preventative or holistic care. As Americans, we find ourselves in a precarious situation. With the proliferation of health information online, we are bombarded with an array of diagnoses and prognoses, as well as screenings and procedures that we may or may not need at some point.

However, our insurance policies often cover only a portion of these screenings or, in many cases, none of the bill at all. This can present us with an unfair decision: to opt for fiscal health in favor of wellness. This year’s campaign trail and ongoing reform mandated by the PPACA, which is already enshrouded in confusion and controversy, will serve to ignite underlying healthcare debates already at the forefront of our collective consciousness. It will also, I predict, lead to the oversharing of some very personal information, with health ailments woven into the fabric of ordinary water-cooler conversations.

In that vein, it bears mention that March is National Colorectal Cancer Awareness Month. Colorectal screenings, also known as dreaded colonoscopies, save lives. In fact, they have already saved mine, at least once according to a premature calculation. I had my first colonoscopy at 21 and will undergo a fourth next fall. Had I not done some Internet sleuthing of my own, listened to my body, and, yes, assumed a financial burden of several thousand dollars while finishing college, then I would be very sick today. During my first procedure, the gastroenterologist removed five adenomatous polyps, or as I would later learn from the second gastroenterologist, “the yucky kind that turns into cancer within 3 to 5 years.” He made a concurrent diagnosis of inflammatory bowel disease, which requires careful monitoring and some specific preventative care.

Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. and is also becoming one of the most commonly diagnosed cancers in America. The risk of developing this type of cancer increases with advancing age. More than 90 percent of cases occur in people aged 50 or older.

I blame my placement in the 10 percent to bad luck and, well, bad genes. But I am also profoundly grateful. There is a silent shame that goes along with the disease, especially when one’s outward appearance belies the internal war the body is waging.

Who should determine necessity of these tests or ongoing measures to ensure that a chronic condition is not exacerbated to the point of placing the patient’s health in jeopardy? On some level, I feel that deficiencies in foresight and “preventative care” are fundamentally applicable to business in general, including P&C claims. When adjusters are not up to date on current developments in the practice, the consequences can seem less dire, but are they?

When facing a daily deluge of conflicting priorities, we may primarily focus energy on damage control, rather than positioning ourselves—and the policyholders whom we serve—for optimal outcomes. That’s because by the time unsatisfactory customer service numbers arrive and retention declines, the bottom line has already been impacted.

So what is your claims organization doing to prevent a disgruntled claimant or policyholder from infecting the already dismal perception the public has of our field? What about that other sources of profit seepage, namely mishandling claims? John Postava of Simsol Software discusses common miscalculations in property losses, along with training and other preventative measures, beginning on page 26. He also enumerates why technology is only as good as those who adeptly employ it. How are you diagnosing and treating counterproductive processes and ways of thinking?  More importantly for the Baby Boomers among us, have you scheduled your colonoscopy?

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