LTC Bullet: Virtual Visit to ILTCI 2023

Friday, March 24, 2023


LTC Comment: Last week’s ILTCI conference in Denver had a hopeful theme and a promising new focus. Read on for a virtual visit to the program for those of you who were not there, but may wish to consider attending next year.

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LTC Comment: Steve Schoonveld chaired the 2023 ILTCI conference in Denver. He opened the program with a brief retrospective of its past iterations. The first was January 2001 in Miami with 500 attendees. Florida, Texas and Nevada accounted for 13 of the 21 total locations. The latest Denver conference had over 950 in attendance; 270 unique companies were represented including 66 exhibitors, 34 sponsors, and over 200 presenters and moderators. If you’re interested in the history of these meetings, have a look at our History of LTC Insurance Conferences (2021). It covers all of the major LTCI meetings for the previous two decades and contains pictures of LTCI’s leading lights over the years. (They’ve aged, but most are still going strong.)

This year’s planning and education committee focused on bringing in new speakers and topics and it showed. The meeting’s theme “Take the Lead” was evident throughout with a constant focus on innovation. Most evident was a special emphasis on wellness and finding ways to meet the needs of prospects and clients, especially people at risk or already in claim. It’s not just about selling policies and managing books of business anymore. It is more than ever about helping people age well and stay healthy. More on that as we describe some of the sessions below.

As usual, this ILTCI conference was ideal for networking. The exhibit hall offered free drinks and excellent food. Special thanks are due to the sponsors. Exhibitors included many who represented the meeting’s “Take the Lead” theme and its special focus on wellness and healthy aging. Check out lists of the exhibitors and sponsors so you can thank them. With this year’s conference in the rear view mirror, it’s not too soon to begin planning for next year’s ILTCI program in San Diego, CA – March 17-20, 2024 – at the newly renovated Town & Country resort.


Here is the distribution of this year’s attendees based on their self-reported tracks:

Track Title


Actuarial & Finance


Advisors, Agents, & Agencies


Aging in Place Solutions


Claims & Underwriting


Legal, Compliance, & Regulatory


Management & Operations


Marketing & Research


Technology & Eldercare Services


Behaviorist and humorist Jeff Kreisler delivered this year’s opening keynote address focusing on “why we do what we do.” He describes himself as just another typical Princeton educated lawyer turned award-winning comedian, best-selling author and champion for behavioral science. Kreisler is author of Dollars and Sense: How We Misthink Money and How To Spend Smarter and Head of Behavioral Science for JP Morgan Chase. The presentation was interesting, humorous and thought provoking. Margie Barrie, who covered the conference for ThinkAdvisor, reviewed the keynote in “What Can Help Clients See the Long-Term Care Cost Threat? Science.”

The App

This year’s conference smart phone app was excellent, the best so far. One could find all the attendees, plan a schedule based on searching all available sessions in each block, and review the handouts. The downside was that this detailed information was not included in the online version of the program. That makes it much more difficult to share session details as we were unable to cut and paste. Another problem was that the sound system in several of the meeting rooms was very poor making it impossible to capture some of the content. What follows nevertheless is a little information on each of several sessions. Hopefully, this will give you a good idea of what the conference was like and what you might expect if you come next year.

Some sessions

3/13/23 10:30am
: “The Impact of State Legislative Activity on our Industry - Friend or Foe?”
Producer: Melissa Bova
Speakers: Moench, Stephanie; Veghte, Ben; Bova, Melissa; Gugig, Mike; Simonson, Dawn
Topic: “How can public sector activity targeted at LTC services and supports help or hurt activity in the private sector?”

Much is happening in this realm in several states including California and Minnesota, but of course the biggest development is WA Cares in Washington State. Ben Veghte, WA Cares’ Director made the case for that program, about to start withholding payroll taxes in the Evergreen State July 1. He is an articulate advocate for a program that, at the least, has had its ups and downs. Claude Thau brought some balance to the conversation by pointing out that WA Cares’ website claims people no longer have to worry about LTC risk. Claude observed that such a statement is false and should be removed. Veghte said he’d look into it.

3/13/23 2pm
: “How are consumer needs influencing product development?”
Producer: Josh Falco
Speakers: Nisenson, Larry; Tell, Eileen; Falco, Josh; Walbrun, Dave; Haas, Mike
Topic: Discuss the new and innovative ways consumers are getting help with long-term care.

This was the first of several sessions I attended focused on the mission to serve prospects and clients better, to understand their needs, and meet them. Eileen Tell offered examples of what consumers think they know about LTC that is wrong. When researchers ask what people want in a product and what they would be willing to pay, they get untenable answers. There’s a disconnect between reality and expectations. Larry Nisenson spoke about Assured Allies’ quantitative approach to discern what people really want, healthy aging in place, and to help them achieve it with NeverStop.

3/13/23 3:45pm
: “The New Trend in Integrating Caregiving Benefits with LTCI Benefits”
Producer: Larry Nisenson
Speakers: Nisenson, Larry; McInerney, Thomas; Sikorski, Cathy; Martin, Todd
Topic: How are caregiving and LTCI linked and how can we leverage relationships with HR representatives to tighten the connection further?

This was another session aimed at better integrating long-term care insurance benefits with caregiving needs. Genworth CEO Thomas McInerney mentioned his company’s largest claim ($1.3 million) on an original premium of $1,500. Todd Martin asked how many in the audience have caregiving experience. Answer, 90%. He observed there is involuntary employee turnover due to LTC with serious ramifications for the organizations affecting their ability to acquire and retain top talent. Cathy Sikorski emphasized the importance of bringing LTCI into the workplace. 

3/14/23 9am
: “Leveraging Public & Private Insurances & Resources to Improve Health Outcomes”
Producer: Colleen Dennis
Speakers: O'Leary, John; Plaskon, Todd; Lillis, Maureen; Ludden, Beth; Dennis, Colleen
Topic: Join this session to learn how to leverage public and private insurances and companies like Medicare, Medicare Advantage, non-profits, and AAA’s to improve health outcomes and lower costs. We’ll specifically talk about what we can learn/utilize from Medicare (equipment coverage, use of the OASIS data for homecare claimants, use of the MDS data for facility claimants) and Medicare Advantage (meal delivered programs, transportation). Panelists will also discuss how to find resources in the area (e.g. life alerts, Meals on Wheels) to complement wellness programs and/or to reduce reliance on caregivers.

This was a fascinating session with its focus on integrating services, less so on financing. Beth Ludden of Genworth observed there are many critical organizations that elders who need them do not know about, including the Area Agencies on Aging. She observed we work in our insurance bubbles too much, unaware of services that are out there. Medicare and Medicaid are ahead of the LTC insurance industry in focusing on hands-on or supervisory care. Other panelists shared many examples of organizations that can help and ideas to enhance the cooperation and mutual effectiveness of public and private insurance sources. 

3/14/23 10:45am
: “Teamwork Makes the (LTC) Dream Work: Public/Private Collaboration”
Producer: Stephanie Moench
Speakers: Cain, Steve; Moench, Stephanie; Arland, Jamala; Mueller, Jamie
Topic: This session explores opportunities for the private LTC market to collaborate with state programs, e.g., through the development of supplemental insurance products, to meet consumers' evolving LTC needs. During this interactive discussion, panelists will delve into key considerations related to public/private collaboration with the goal of expanding industry awareness and sparking product innovation, such as:

• What challenges are impeding public/private collaboration?

• How will publicly funded LTC programs impact private LTC market dynamics and product designs?

• How can we proactively promote public/private collaboration while mitigating consumer confusion?

• What are some of the key supplemental (and substitutive) LTC product opportunities for insurers given the range public programs designs being discussed? What are the primary actuarial considerations that could impact the consumer’s decision? Providing consumers with a range of options (public and private) should better enable them to holistically plan for their future LTC needs--teamwork makes the (LTC) dream work!

This was yet another session aimed at making the collaboration between public and private insurance work better. Stephanie Moench, for Oliver Wyman, spoke of the landscape of public LTC programs, showing a map with 14 or 15 states highlighted that are in creative phases. Steve Cain observed the need to meet people where they are, the workplace.

3/14/23, 2pm
: “The Results Are In: Aging in Place/Wellness Programs Seem Promising for the LTCI Industry”
Producer: Jodi Anatole and Vince Bodnar
Speakers: Jacobs, Dave; Anatole, Jodi; Moore, Nate; Gal, Afik; Hu, Char; Henderson, James
Topic: One of the greatest reasons LTCI carriers hesitate to implement an Aging in Place/Wellness program is lack of actual results. While these programs are still new, results are beginning to emerge that seem very promising.  After a rigorous selection process, we have assembled a panel of  vendors who will share their strategies and results - with a focus on the bottom line. This session should give you a deeper understanding on why these programs are worth the investment and how they can help you manage your block.

Each speaker had 10 minutes to share their company’s approach and results. All were impressive.  Afik Gal of Assured Allies went first reporting that they work with people before they become claimants with an evidence based approach. They help people get their confidence back. Return on investment of 167%. Other speakers discussed their unique approaches and report similarly impressive results.

Bonus session reviews prepared by Damon Moses: 

Session: “Modernizing The LTC Customer Experience Using Technology”
Track: Management & Operations
Moderator/Producer: Jennifer Jones
Speakers: Jim DuEst, Duane Anderson, Kim Poulopoulos, Jennifer Jones
Description: “Please join this panel to hear more about how companies are leveraging technology to modernize the long term care customer experience throughout the policy lifecycle from underwriting to rate increases to claims.  Hear from carriers, reinsurers, and administrators on their strategies, success stories, and challenges, as well as learn about emerging trends in technology in our industry.”

Key messages:

  • Investment in technology to increase efficiency and automation is necessary for improving the LTC Customer experience.
  • Improve customer experience by employing technology such as Chat GPT.
  • Improve health outcomes by collecting personalized data through wearables such as Fitbit.
  • Some of the biggest challenges preventing technological progression are: resources, organizational issues and overcoming legacy systems.

Session: ”The LTC Renaissance: New Product and Market Opportunities”
Track: Actuarial & Finance
Moderator/Producer: Erik Wenzel
Speakers: Brian Vestergaard, MacKenzie Madsen, Erik Wenzel, Tom Riekse
Description: “This is an exciting time for the LTC industry—the confluence of rising interest rates, proposed public financing solutions, demographic shifts, post-pandemic focus on health and wellness, and technological advancement gives the industry an opportunity for an "LTC Renaissance”. This session is presented by those on the frontlines of the imminent renaissance and will cover:

  • New market opportunities presented by state-sponsored LTC programs
  • The growth of group and worksite distribution channels
  • Middle-market solutions
  • New market entrants and innovative features
  • Wellness programs on new business”

Key messages:

  • LTC is currently in a period of renaissance of renewed interest and product innovation.
  • State-sponsored programs are increasing interest in LTCi as a tax avoidance measure.
  • Accessibility, affordability and ease of premium payments are important to LTCi consumers.
  • Hybrid products linked to the market and products with variable benefits will be important.
  • Consumers should look at an LTCi policy as a valid component of a holistic financial portfolio and should be able to view the value of their policy easily online.

Session: “Caregivers need help too!”
Track: Aging in Place Solutions
Moderator/Producer: Robin Devine
Speakers: Ali Ahmadi, Karen Brown, Tracey Gendron, Timothy Peck, Robin Devine
Description: “Caregivers take care of us, we need to take care of them.  A Discussion on raising the level of awareness of the needs and wants of older adult and their caregivers.

“Caregiver burnout doesn’t need to be inevitable.  So, why do we so often associate caregiving with burnout? The caring relationship is one that has both joy and frustration - just like all other relationships. Join our panel discussion where leaders in Caregiving, Gerontology, and Innovation share methods, ideas and best practices to support care partners by breaking through their misconceptions and helping them increase choice, control, and independence. We will have a conversation around preventative vs reactive caregiver support concepts.”

Key messages:

  • Women tend to be default primary caregivers, often as a spouse or eldest daughter.
  • 24% of caregivers provide care for 5 years or more.
  • $470 billion is the economic value provided by informal caregivers.
  • LTC as ecosystem of care. Caregiving is a natural and normal part of everyone’s lifecycle and should be destigmatized. People fall into two categories: current caregivers or future caregivers.
  • Further support caregivers by improving care infrastructure and examining the health consequences of ageism.

3/14/23, 3:30 Closing General Session
Title: “Taking the Lead: Building Towards 2030”

The closing session was comprised of three panels and a poll.

The first panel, titled “The Future of Caregiving and Care Management,” engaged Karen Brown of the Colorado Commission on Aging; Noreen Guanci, co-founder CEO of Long-Term Solutions in Massachusetts; Maureen Lillis, COO of Independent Living Systems; and Robert Eaton, principal at Milliman in Tampa. They discussed caregiver shortages, poor caregiver compensation, and the importance of valuing caregivers. One idea: Train high school students to do caregiving so they have jobs when they graduate. The ILTCI conference has come a long way toward understanding and supporting caregiving since its Aging in Place track 10 years ago.

The second panel, titled “The Future of Care Financing,” engaged moderator Vince Bodnar of FTI Consulting; John O’Leary, president of O’Leary Marketing; Anna Frankowska, CEO of Graceful Finance; Shannen Logue, Deputy Insurance Commissioner in Pennsylvania; and Liz Christopher, COO of Home Care Genie. They discussed the public and private realms of LTC financing, how both involve many different aspects, and often do not understand each other. But all are trying to do the same thing, which is to find adequate financing to support the country’s caregiving needs. Shannen asked, “why are so many people qualified for Medicaid?” Vince asked “what is the best way to reach the middle market?” Both good questions the answers to which would wisely begin with a careful study of how Medicaid LTC eligibility determination actually works, enabling potential middle market prospects to access Medicaid when they need LTC late in life without significant spend down. A sense of optimism is growing as the profession is starting to focus on our customers and policy holders.

The third panel, engaged industry veterans Ron Hagelman, author of the long-running monthly column “The Last Word on LTCI” in Broker World and his long-time business partner Barry Fisher of Blaze ‘n Bear Insurance Services, Inc., in amusing, and informational back and forth banter about their perspectives on long-term care services and financing. Barry observed “people who need to be here aren’t” and that Medicaid crowds out private products due to the “elder law industrial complex.” He compared the moral hazard of letting Medicaid co-opt private insurance with the current travail in the banking system where government bailouts ensure even more irresponsible banking behavior in the future. He said “private insurance should be the first line of defense; public, second.” I’ll have more to say along those lines in my closing LTC Comment. Ron observed LTC is “all about control,” what can I do to assure best quality of care for loved ones and clients. As a fellow old-timer, this session was my favorite of the conference.”

Director’s Pitch: Conference director Steve Schoonveld closed the meeting with his “Pitch.” He said “So we have health insurance that protects or maintains your health. It’s called dental insurance and not tooth decay insurance. Vision insurance and not blindness insurance. Auto insurance and not crash insurance. Life Insurance covers the value of your life in case of death.

So, does LTC insurance and extended care insurance cover your care or should it insure your wellness?  I offer that this conference will be called the Intercompany Wellness Insurance Conference, or the IWIC by 2030.” Finally, he posed these questions to the audience:

  • In 23 years of ILTCI conference, what has surprised you the most?
  • What are the likely trends you expect in the next 7 years?
  • Predict the theme of the 2030 conference and explain why.
  • Rename Long-Term Care Insurance.
  • “Punt the pitch” and make the case for your preferred 2030 conference location.

Several audience members approached the microphone to share their answers.

A final electronic poll asked “How many ILTCI conferences audience members had attended.”

1. First, 34%
2. 2-5 times, 38%
3. 10 times, 14%
4. 11-15 times, 7%
5. 16-20 times, 5%
6. All 21 times, 1%

Supplemental content before and after the conference

CLTC delivered two classes the weekend before the conference - a Master Class and a pilot for their new Product Insider class. “Both were a hit!”

SOA Section Council Meeting (Open to All), Sunday, March 12

SOA Professionalism Course, Wednesday, March 15th

Alzheimer's Association Session, Wednesday, March 15th

Closing LTC Comment: I was moved and heartened by this ILTCI conference’s “Take the Lead” theme and its overwhelming focus on wellness and serving clients’ needs. Both were encouraging and inspiring. But as an attendee of nearly all of the meeting’s earlier iterations, I missed some of the former sessions’ broader content and fiery interactions. To my mind the biggest missing pieces are the absence of policy and provider tracks. It’s as though the LTCI industry has given up the battle, succumbing to Medicaid’s crowd out effect without further effort. It’s stuck in its silo lacking the former invitation to nursing homes, home health agencies, assisted living facilities to come, share, argue, and conceive together. I remember debates and challenging questions, that are less evident now. Harley Gordon and George Sherman, where are you when we need you? I hope the LTCI business does not subside into a go-along-to-get-along truce with government, ironically just as LTCI’s prospects are looking up and government’s, especially its entitlement programs, are going down.