Transitioning Collaboration – A “United” Example Number of Past and Current Examples of Successful Collaboration Number of Past and Current Examples of Successful Collaboration Usually Targeted to a Specific Issue Usually Targeted to a Specific Issue Focused on Past or Ongoing practices Focused on Past or Ongoing practices United HealthCare Settlement Moves Focus to Future United HealthCare Settlement Moves Focus to Future Instituting a Different Collaborative Exam Dynamic Instituting a Different Collaborative Exam Dynamic Lou Felice, NYS Isurance Department ICAE September 30, 20081

Pulling the States Together Using The MAWG Process Using The MAWG Process Committed Lead States Committed Lead States Present the Evidence Present the Evidence Present the Benefits Present the Benefits Lou Felice, NYS Isurance Department ICAE September 30, 20082

Collecting the Facts Comparing Ongoing Exams and Past Findings Comparing Ongoing Exams and Past Findings Defining / Listening to the Stakeholders Defining / Listening to the Stakeholders Policyholders Policyholders Providers Providers Regulators Regulators Company Management and Board Company Management and Board Weed out the Anecdotal Noise Weed out the Anecdotal Noise Hear what the Company Has to Say Hear what the Company Has to Say Lou Felice, NYS Isurance Department ICAE September 30, 20083

Complaints are King Use the NAIC Data Use the NAIC Data Augment with State Based Data Augment with State Based Data Compare Notes – Look for Patterns or Indicators of Systemic Problems Compare Notes – Look for Patterns or Indicators of Systemic Problems Lou Felice, NYS Isurance Department ICAE September 30, 20084

Making the Case – Part 1 Present the Report Findings Present the Report Findings Analyze Consumer and Provider Complaint Data Analyze Consumer and Provider Complaint Data Compare Notes at MAWG Compare Notes at MAWG Focus on Common Areas of Concern Focus on Common Areas of Concern Lou Felice, NYS Isurance Department ICAE September 30, 20085

Two Sides to the Story Evaluate Company Response Evaluate Company Response Can Things Get Better? Can Things Get Better? Design the Metrics and Benchmarks Design the Metrics and Benchmarks Framework for Improvement Framework for Improvement Framework for Accountability Framework for Accountability Commitment to Change Commitment to Change Lou Felice, NYS Isurance Department ICAE September 30, 20086

Weathering the Storm Hard for Both Sides to Change Hard for Both Sides to Change Time Kills All Time Kills All Keeping the Message Alive Keeping the Message Alive Throw Down the Gauntlet Throw Down the Gauntlet Three Become Five Three Become Five Take the Olive Branch Take the Olive Branch Lou Felice, NYS Isurance Department ICAE September 30, 20087

An Ounce of Prevention Process Improvement vs. Penalty Process Improvement vs. Penalty Remembering the Stakeholders Remembering the Stakeholders See the Goal and Bury the History See the Goal and Bury the History Lou Felice, NYS Isurance Department ICAE September 30, 20088

Making the Case – Part 2 Get to the Best Deal You Can Get to the Best Deal You Can Everybody Gets Their Pound of Flesh Everybody Gets Their Pound of Flesh Defining What’s In and What’s Out Defining What’s In and What’s Out What Do We get What Do We get What Do We Give Up What Do We Give Up Lou Felice, NYS Isurance Department ICAE September 30, 20089

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

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

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

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

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

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

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