LTC Bullet: ILTCI ‘24 Virtual Visit
Friday, March 29, 2024
Seattle—
LTC Comment: ILTCI ’24 was another
successful industry convocation. Your “virtual visit” to the conference
follows the ***news.***
*** OUR OBJECTIVE in offering these
“virtual visits” to the conference is to give those who did not attend
some of the flavor of the experience. We’ve published dozens of these
reports over the years. You can find many of them by going
here and searching for “virtual visit.” Check out our
History of LTC Insurance Conferences (2021) for an overview of
LTCI industry conferences going back to ILTCI #1 in January 2001 at the
Hyatt Regency in Miami, Florida. If you know some of the leading lights in
the industry, you’ll recognize their younger selves in several pictures.
Happy reading! ***
LTC BULLET: ILTCI ‘24 VIRTUAL VISIT
LTC Comment: The 2024 Intercompany
Long-Term Care Insurance Conference convened March 17-20 at the Town &
Country resort in San Diego, California. This year’s theme was “We’re Up
to Something Good” and the program delivered in full measure.
For me, the meeting kicked off on
Sunday, the 17th with a visit to the Society of Actuaries
Long-Term Care Section meeting.
Discussion of the section’s 2024
initiatives covered their planned webcasts on international LTC programs,
standalone or combo products, and/or an update on state LTC programs.
Other topics included podcasts, past and future, and a proposal for a
Medical LTC Symposium, presented by Sally Leimbach.
The opening reception Sunday night
from 5pm to 7pm featured ample food and drink provided by conference
sponsors that fueled amiable networking, allowing participants to renew
old friendships and make new professional contacts.
The conference opened in earnest on
Monday morning, March 18. Karen Smyth, 2024 Conference Chair, welcomed the
950 attendees. She recognized and thanked the many staff, volunteers and
sponsors who planned and executed the program.
ILTCI Recognition Award
A highlight of the 2024 conference was
the renewed offering of the
ILTCI Recognition Award to “showcase the best of our industry and
acknowledge their contributions.” The honor was bestowed on Marc Cohen in
2018 and Stephen Moses in 2019, but had not been awarded since, due to
pandemic disruptions. To make up for those lost years, two individuals and
one company received the award, including a $1,000 honorarium and a
trophy. Receiving the ILTCI Recognition Award this year were:
Ronald R. Hagelman, “a teacher,
cattle rancher, agent, brokerage general agent, corporate consultant, and
home office executive” as well as the author of a long-running monthly
column in
Broker World.
Peter Goldstein of
illumifin received and acknowledged the award, presented a $10,000
donation check to the Alzheimer’s Association, and introduced the
meeting’s keynote speaker.
LTCI Partners received the
company award. Managing Director
Tom Riekse acknowledged the award on behalf of the company.
These exceptional individuals and
companies are a tribute to ILTCI and represent the achievement of its
“vision.” The Intercompany Long Term Care Insurance Conference
Association’s (ILTCI) vision is to create an environment for aging in
America that includes thoughtful, informed planning that takes into
account the most effective and efficient use of resources in addressing
the risks and costs of long-term care for all levels of American society.
Keynote Speech
Peter Goldstein introduced keynote
speaker:
Dr. Maria Carrillo, chief science officer of the Alzheimer’s
Association. She delivered a highly relevant and meaningful update on the
state of scientific research on Alzheimer’s disease, a welcome change from
more general motivational speakers in the past. Her key message was that
research considered only “hopeful” and “futuristic” as recently as a few
years ago is now a reality. Alzheimer’s is a disease, not normal aging, we
can do something about it. There are modifiable and non-modifiable risk
factors. Focus on risk reduction. Forty percent of cases could be
prevented or delayed by targeting modifiable risk factors. Onset is
earlier and slower than previously believed. Exercise, nutrition brain
exercise, aggressive cardio vascular activity are critical. There is no
ROI (return on investment) so big pharma won’t take this part on. Can
diagnose Alzheimer’s before death now. So much happening in this space.
Blood tests. New approvals for new drugs. Outcomes: slowing disease
progression; being able to do what I want longer. Only a beginning. But
Alzheimer’s research is on the move. Finally, there is reason to hope for
real progress.
March 18 Breakout Sessions
The first I attended was 10am: “Data
Science and AI in Action: Driving Modernization and Enhanced Outcomes.”
Presenters: Joe Long; Doug Elfers; Dan Marsh; and Paddy Horan
Discussion: The use of data science and AI, including machine
learning [ML] and innovative data sources, to improve outcomes in the
long-term care insurance industry.
Insights: What AI means to them. Everyone psyched up. Broad terms,
lot of different methods. Neural networks. Background of AI umbrella.
What’s out there? New products and different ideas. Machine learning
models. Around for a long time. More data, cheaper costs. Building a
model. AI about using a model. Trying to find associations; optimizing
outcomes. Supervised vs. unsupervised learning. Generative AI generates
new content that is similar to but not identical to data it has been
trained on. How can data science leverage AI/ML to improve outcomes of
wellness programs in the LTC industry? Get wellness programs to the right
people. How ML can optimize LTC insurance claim processes such as
eligibility or recertification. How can LTC actuaries use predictive
models to expand their analytic capabilities and improve their methods.
Policy holder experience side. Cost savings vs. customer experience. Don’t
let chatbot interfere with customer experience.
11:15am “Recent Research Findings”
Presenters: Matt Majewski; John O’Leary; Celeste Cobb; Trish
Shuhilo; Vince Bodnar moderated.
Discussion: Panel of experts shared findings from four recent
studies that cover emerging consumer sentiments about long-term care,
long-term care insurance, and the burdens of family caregiving.
Insights: Best research of the past year. 10 minutes each. Matt
from Lincoln. Trying to understand consumers; help them overcome
obstacles. Motivate advisors. Cost is main obstacle. Consumers
underestimate the risk of LTC to retirement savings. Medical and care
costs on the rise. More referrals from women 1.5X. Pandemic brought LTC
more attention. Consumers want to plan but need help. Family members in
conversation is win-win-win. Top barrier to purchase is affordability.
Take aways: hard to pinpoint when to bring to client. No life stage. When
to have need. Impact on portfolio. Think about emotional sale.
Celeste Cobb from Insurance Marketing Solutions. 2022
industry studies. Survey focusing on caregivers. How caregiving influences
decisions. Does caregiving induce future planning? Yes, 93%. What future
planning are they most likely to do. These are caregivers. Deferment
insight. 62% said take care of it themselves. 32% said talk to financial
planner or look into LTCI. Traits of caregivers who say they’ll do future
planning. Sandwich generation; owning a home; having planner; financial
products; higher education; familiarity with LTCI; assets to protect.
Caregivers more likely to consider buying LTCI: Men. Married. Higher
income. Homeowner. Higher education. Why hasn’t caregiving motivated
caregivers to plan? In a word. Denial. Message. People don’t get
it. Most people think health insurance will pay. Comes back to education.
Traits of people not interested in LTCI: Female, divorced, no children,
retired, no life insurance. Next study, middle America vs. affluent
America. Education is end all and be all.
Patricia Shuhilo from One America. Paying for LTC. 1. Cost of LTCI;
2. Medical support for LTC; 3. Not believe they’ll need it. Only 23% said
LTCI for payment source. More: self-fund; medicare. Biggest gap, only 18%
worked with a financial professional. Only 54% of financial professionals
talking about LTC. 25% said used to talk about it but don’t anymore.
John O’Leary’s from O’Leary Management Associates. Unfortunately, I
had to leave this session before John presented.
12:30pm “Center for Long-Term Care
Reform”
Presenter: Stephen Moses
Discussion: Stephen Moses (Center for LTC Reform president)
presented findings from two papers: “Long-Term
Care: The Problem” and “Long-Term
Care: The Solution” (both published by the
Paragon Health Institute. He explained why LTC financing reform has
languished since the Great Recession, but will flourish anew soon. He
previewed his forthcoming paper “Ending Structural Long-Term Care Racism.”
Insights: This presentation provided a retrospective on what went
wrong with LTC services and financing in the U.S. and a forecast of what
is likely coming next.
2pm “Projecting the 5th
Decade of LTC Insurance from its First 40 Years”
Presenters: Al Schmitt, Jim Glickman, Claude Thau, Bruce Stahl
Discussion: A lively discussion from industry experts sharing
thoughts of where the industry has been, where we are currently, and what
the future holds form an actuarial lens.
Insights: Advice to a new CEO? Bruce: always disagree.
Claude: avoid gotcha claims provisions. Don’t use provisions that
sound better than they are. Challenge staff to explain how product remains
good if interest rates go up. Assumption settings, missteps of past. How
to train actuaries. Claude has concern about genetic testing.
Underwriting: What learned over years: Jim: Doing rate
increases. How to get into the middle market. 25% miss rate both ways.
Distribution: Past v. future. Claude: Coming back to
specialists. Too complicated for financial planners. Liability. Paperwork.
Variety of products compounds problem.
3:30pm “LTCI 101 Family Feud”
Presenters: Steve Serfass, Karen Smyth, Sandra Jones and others.
Discussion: Modeled after America’s hottest game show, this session
featured Steve Serfass reprising the role of Richard Dawson as two
families showed off their LTC knowledge. Karen Smyth led the ILTCI Board
Member family facing off against a family populated by audience
participants led by Sandra Jones.
Insights: Questions and answers were derived from responses to
surveys completed by ILTCI attendees. A good time was had by all.
March 19, 2024 Breakout Sessions
8:45am “LTC Legislative Update”
Presenters: Diane Boyle (NAIFA), Leah Walters (ACLI), Carroll
Golden (NAIFA Limited and Extended Care)
Discussion: This polling-format session looked at Federal and State
LTC legislation and other initiatives, including wellness programs and the
use of external consumer data and information sources.
Insights: Leah: important to understand the states.
Governor, legislature, run by one party. Only 10 states with divided
government. 80% of country lives in one-party state. 25 insurance
commissioners have 3 years of experience or less. Can’t get their
attention. 11 elected; 31 appointed. 80% of all legislators up for
election in November. Lot of turnover. Have to go in and educate.
Background.
Diane: Little done in LTC space. Congress, Medicare for all has
greatest interest. 113 members and 14 senators signed on. Introduced. All
democrats. Divided government; hard to get anywhere. Other proposals not
getting any traction. The last time we had comprehensive legislation: Tom
Suozzi. CLASS act before that. Actuaries found would not work. Suozzi is
back. Maybe LTC will get traction. But he got Homeland for committee. No
groundswell. Bad news on federal side that anything will get done.
Leah: WA Cares. Collections started July 1. Initiative to make
optional. Hot issue for Rs and Ds in WA. Keeping lists of who supports and
opposes. Don’t want to be on that list. Initiative to make optional
expected to pass. Many other states looking at what WA is doing. CA well
along. Doing actuarial study. 5 or 6 other states, CT, MD, PA. Not moving.
Seeing more studies.
Diane: 64 bills in 29 states. Garnering interest.
Leah: should be actuarially sound, not depend on interest groups.
Diane: Some general health care bills that would include LTC.
Wellness programs:
Leah: Consumers want more direct, electronic access to life
insurance.
10am “State Tax Mandates: Selling
LTC in Face of Legislation”
Presenters: Stephen Forman, Gary Forman, Tom Riekse, Carolyn Olson
Discussion: What does it mean to you and your clients that states
are exploring publicly financed LTC solutions? Topics included: talking
points for client conversations; can the industry work with states to
develop supplemental products; what about a public/private partnership?
Insights: Gary Forman introduced the topic. Tom Riekse:
how do you want to position? Get in touch with associations. We didn’t
know what reaction would be for opt out. Details fuzzy. Didn’t know how to
prepare. Had relationships with brokers. Carolyn, first learned in
2019. Had to get ready. Changed business model to get more people
interested. Adjusted as things happened. Had infrastructure to handle it.
“Went to town.” Positioned website. Gary: spread like wildfire.
Much preparation. Tom: just laid out the facts. Kept our team
informed. Steve: Approached carriers. Told them this coming. In
couple years, things are going to get crazy. This will be tax avoidance
driven. People looking for smallest possible policy. You need systems in
place to handle volume. You can do this in other states coming up. Get in
front of state legislators. What opt out provision? Look around. If don’t
have a seat at the table, you’re on the outside looking in. We spent a lot
of time trying to educate. Try to be good educators. Get ahead of the
process. Tried to be in front of WA Cares. They were putting out
notoriously wrong information. We were getting more traffic to our
information than the state. That’s something you can do in other stages.
Tom, tried to show people better options. Look at more
comprehensive plan. People looking a smaller plans. How much of million
dollars place still in force. Carolyn: 1200 cases. 9% have
cancelled. $76K premium gone away. Gone back to people and upgraded 8%.
Tom, above average drop off. Gary: we work in regulated world.
Politicians back into decisions. Legislative process. Steve: WA
removed the cap on income. Very small group of high earners responsible
for supporting the program. High tech industry, all opted out. CA says we
can’t do that.
From audience, Joe Pulitano asked: what will happen with
initiative. Switch to voluntary program. Fear is would undermine solvency.
Milliman: death spiral. What we’ve heard. Scrap program flat. Sense on the
ground; overestimated popularity; tremendous opposition; genuine
expectation leaning toward passing. WA Cares goes down in flame. Lot can
happen between now and November. Could change. Gary: ship has
sailed, nothing happens in the other states. How did you talk about
uncertainty? Carolyn: acknowledged didn’t know. Tried to be logical
about it.
Steve: look at what these states are doing. Let me tell you what’s
happening and why you should be aware. All the urgency things apply. It
could be too late. Started 2019 in WA but constant changes. Steve:
great publicity. Everyone knows benefit not enough. So shows public need
to think about LTC. State of WA puts out information. That is awareness we
can’t afford to buy. People call us. Basic strategies. Sell with intention
of exempting yourself. Cooperate with us, need something in addition.
Maybe if own something at least get a break on the tax. Steve: CA
much more vigorously researched. WA eschewed the help of experts. Original
sin of WA was not accepting help from experts. Now they’re paying for it.
CA learned from that. Lots of creative ideas. Legislators can do anything.
Things take so long because elections happening all the time. Whole new
crop of legislators.
11:15am “Can WE Chat (GPT) Using AI
and Predictive Modeling to Engage with Customers”
Presenters: Robert Eaton, Doug Elfers, Karan Chawla
Discussion: How can we tap into the intersection of artificial
intelligence, predictive modeling and personalized experiences to
ethically and wisely improve engagement and ROI?
Insights: Robert: Large language model predicting next word
in a sentence. Generative AI does more. Using data, multimodal models.
Fill in the gaps, pictures, etc. Using models to predict the next thing.
Computer based. Chatbots engaging in conversation. Predictive Analytics.
Likelihood of future outcomes.
Karan: Customer experience. AI makes like talking to a social
worker.
Robert: We use AI to develop machine learning models. Perplexity.ai
is one of the best. Gets articles about a subject and summarizes them. How
were we 10 years ago vs. now.
Karan: Evolution of what we’re thinking. More simplistic before. At
one time, not having to do long form division was amazing. But now can do
so much more. Big data sources. Automation. Seeing now where it is going.
Robert: 2014 starting to see new actuarial models. Segmented many
ways. Morbidity. Models now much more complicated. More insight into the
data. Needed more computer power.
Why be optimistic?
Karan: Only going to make the world more efficient. Make better
outcomes for customers.
Robert: A lot of skepticism. He asked for a poem about superhero
actuary. Not copying, creating. Marketing LTCI, telling better stories.
Easier to get. Power of words. All going to have more access. Using these
tools opens new problems and solutions. Very optimistic.
Concerns? Legitimate. Misuse.
10 years ahead? Hard to think in years when changes are weekly.
Robert: All robots.
12:45pm, “Building LTC State Reform
Proposals for Collaborative Success”
Presenters: Stephanie Moench (Oliver Wyman) and Steve Schoonveld (FTI
Consulting)
Discussion: A brief “think tank” for LTC enthusiasts to speak their
minds and generate creative public/private LTC financing solutions.
Insights: Steve: Put CA and MN together. Want to be part of
the solution. Data. No names. What is needed; who are eligible? What are
current coverage options? Where gaps? Medicaid, Alternative care,
out-of-pocket costs, private insurance. By income. All based on
supposition of cost of care. High level ball park estimates. Looking at
projections of Medicaid use and payments. 10 year time horizon. Costed
services and projected increases. Nursing facilities going higher and
faster. HCBS and ALF are potential cost savings. Simulate changes in
population and other factors. What is new normal after Covid?
Second panel: CA and MN combined. Emily Smith; Stephanie Moench;
Peterson; John O’Leary
State approaches to innovation. Steve question: federal vs. state
role. Middle income reliant on Medicaid. More affordable financing options
for the middle class. John: systematic reforms. Stephanie,
culturally competent. Value proposition for all income levels. How to
evaluate options. Collaboration of groups in LTC space. John,
stakeholder input. Everyone citizen of MN. Expert witnesses too.
Interaction between, input process. Integrate data into discussion. WA
threw something at the wall and some stuck. Took more time with it in CA.
How to evaluate impact of proposals? Funding less of a problem than care
navigation. Some states are unprepared. Resistance to change. MN high LTCI
penetration. What is the value proposition? What are people expecting?
Provide quality LTSS. People don’t want to have to spend down. Go through
their assets. How to make it more equitable or all. Educating. Consumer
expectations are very low. Don’t think about until personal experience in
family.
3:30pm “Live Focus Group Session:
Engaging with LTC Policyholders”
Presenters: Winona Berdine, Rachel Kudler
Discussion: Watch a live focus group session of persons aged 75 to
85. Learn what it takes to engage with them on wellness, care coordination
and caregiver support programs. What services are they interested in? What
messaging resonates with them? How do they prefer to be reached? How do
they prefer to interact with us? This is the only session we have a
recording of from the conference this year. [Strongly recommended session;
link to the recording
here.]
Insights: Several LTCI policy holders answered questions about
their experiences with caregiving, why they purchased LTCI, what their
experience has been as policyholders, what they would like the industry to
do to improve the product. Typical responses: bought because of own
parents’ asset spend down; premiums way up; would like more communication
from carrier, but not clear about what; all trying to stay active and
healthy; their own challenging experiences with caregiving; frustration
with nursing homes, assisted living and caregivers; one respondent had
great experience with LTC in France; regarding wellness programs: very
little interest, even if free, carriers should stick to their knitting,
focus on good coverage, getting care when needed, many other sources for
“wellness,” marketed as free, but premiums already high and this will
increase them; no phone calls, no texts, rather prefer email or hard copy;
information needed about what to do, where to go to find and manage care;
no contact from agents after sale.
LTC Comment: I strongly recommend
watching the video of this session. It provides clear insights into what
this group of policyholders think and feel about their experience with the
coverage. What struck me most is their lack of interest in the kinds of
wellness programs the industry is promoting. Most of the respondents felt
that the carriers should stick to improving the product and reducing
premiums rather than promoting ancillary services that are available
elsewhere and would only add to costs if provided by the carriers.
Industry leader, actuary Vincent Bodnar shared this thought: “A good
analogy that I've shared with other attendees: The industry is like an
estranged father now wanting to have a relationship with his child after
being gone for decades. Based on the recording and other interactions I
listened to, the policyholders do want a relationship with the insurers,
but it will take time to gain trust. So far, all they've received from
insurers is rate increase notices. New efforts need to start with little
things and win over that trust over time. After the industry regains
trust, policyholders will be open to these programs.” |