Fuzion: Excellence in Long-Term Care Insurance

CIO VendorBarry Staldine, President & CEO
What is your plan to pay for your long-term care expenses? As the baby boomer generation continues to march towards the need for long-term care, our collective answer to this question becomes increasingly important. According to a recent Genworth 2017 Cost of Care survey report, 70 percent of people aged 65 and older in the U.S. will eventually need some kind of long-term care. Increases in the cost of care, improvement in facility options and amenities, and increases in life expectancy have made funding one’s long-term care, over and above medical expenses, a relevant hot topic. Many have chosen to invest in long-term care insurance as a way to provide for these expenses. Carriers are carefully managing their long-term care insurance blocks, to ensure they are set to provide policyholder benefits if needed.

Making blocks of long-term care insurance viable was the spark behind Fuzion’s conception. The company’s core solution offerings include claims management and fraud mitigation—areas in which Fuzion observed gaps in some carriers’ ability to efficiently optimize processes and measure results in the long-term care space. According to Fuzion leadership, claims management is ripe for disruption and fraud, waste, and abuse is often rampant and undetected. Fuzion quickly discovered that improvements in these areas could be realized with analytical capabilities and customized solutions. “We are constantly working with our clients to come up with a menu of options and do not subscribe to the mentality of one-size-fits-all,” states Fuzion’s president and CEO, Barry Staldine.

When it comes to long-term care insurance, policies might have been sold from as early as 40 years ago. “Clients need to think about the evolution of even the data in that timeframe, which has gone through several conversions and many companies,” adds David Kincaid, the director of data analytics at Fuzion.

We are constantly working with our clients to come up with a menu of options and do not subscribe to the mentality of one-size-fits-all

They employ various techniques to make the data as complete and clean as possible and from there on, analyze those results to get a fully comprehensive understanding of the LTC block. Further, they employ in-depth analytical practices to closely monitor transactional behaviors, keeping track of what claims are being paid, who they are being paid to, the payment decisions that are being made, and the inputs that went into making those decisions. Data is captured in a way that can be utilized internally for a variety of purposes. Fuzion’s chief fraud officer, Jeff Ferrand, utilizes the results of the data analytics efforts in his fraud mitigation program. Fuzion connects data model results with unique and interactive training to provide their clients with new long-term care insurance specific tools to combat fraud, waste, and abuse.

Keeping all of the data and reporting tools secure and up to speed with evolving requirements falls on the shoulders of the CTO of Fuzion, Duane Anderson. Duane and his team of IT professionals meet the challenges of an evolving business by collaborating closely with internal business leaders and staying abreast of strategic priorities. The requirement from this point on is to operate on the foundation they've built, with the biggest step being to expand, in terms of the number of carriers for which they can facilitate positive change. Staldine believes there is ample opportunity for disruption in LTC insurance and the employees at Fuzion have the knowledge and expertise to be the leaders in the change movement. Given its proficiency, Fuzion is positioned to identify weaknesses in the long-term care block administration and make adjustments to improve the block’s financial performance. As more long-term care insurance policyholders are aging into a period where more claims are filed for their long-term care expenses, these efficiency gains will be a step forward for the industry.