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Accelerated Life Insurance Underwriting with a Physician’s-Eye View of Electronic Medical Records

Health Gorilla's Guide to Healthcare Interoperability Resources (FHIR)

Health Gorilla allows access to complete records so insurers can see them the way they were intended and use them to generate improved risk assessments

The ability to retrieve medical histories electronically has been transformational for the life insurance industry. Unfortunately, the current state of data acquisition is usually a patchwork approach – in which underwriters stitch together limited and sometimes inconclusive applicant information – that is less than ideal. Laborious and time-consuming, this approach often leads to tracking down either the traditional attending physician statement (APS) or the electronic health record (EHR) anyway. 

To get a picture of an applicant’s mortality risk, the underwriter must use separate, standalone data from a variety of sources such as lab results, prescription profiles, diagnostic codes, and more. This patchwork of requirements may still fall short of what’s needed to thoroughly evaluate the risk, triggering more questions to the applicant, or sometimes, often inevitably, leading the underwriter to request medical reports – guaranteed to stop the process in its tracks.  

Imagine having the full health history, with information from all providers, immediately at your fingertips. Imagine seeing this history on the screen with data organized the way it was designed to be viewed. What if this could replace all other sources in one fell swoop?

Digital Life Insurance Underwriting

True transformation of the digital underwriting process will only be achieved when reliable, complete medical data can be accessed quickly and in a format that’s deduplicated, organized, and easy to digest, says Val Munchez-van der Wagt, a consultant with more than 40 years of life insurance underwriting experience with major carriers. 

With accelerated or “fluidless” underwriting the new mandate, the insurance industry has been challenged by existing data retrieval tools that provide, at best, only a keyhole view of an applicant’s complete medical history. The COVID-19 pandemic further increased the demand for policies written without paramed exams or fluid draws. In order to assess risk without any of these standard tools, and to do it quickly, underwriters need an all-in-one record source.

Ideally, that source to replace all other records and tell life insurance underwriters everything they need to know is the APS. But the issue is that the time involved in getting a traditional APS delays coverage, making customers unhappy. Worse yet, it can also trigger requests to additional providers and turnaround times are unpredictable.

The proliferation of EHRs resulting from the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act has helped speed up the response time somewhat, but the format changed from a relatively small, photocopied record into voluminous reams of electronic output. The underwriter must tackle hundreds of pages for a handful of visits. Underwriting departments can hire summarizers to boil the extremely repetitive information down to three or four pages of data, but this adds time and expense to the already expensive and lengthy process. 

EHRs were designed to be looked at on a computer screen, not in reams of paper or pdf images. The goal was to make relevant information easy for doctors to find when meeting with a patient, diagnosing, creating a treatment plan, ordering tests, or prescribing medicine. 

What Health Gorilla does is provide online access to the consolidated clinical data so you are looking at the same data as the providers. “You are getting the record exactly as it was meant to be seen,” says Munchez-van der Wagt. 

The Patchwork Approach and Serial Underwriting

Without a direct view into the EHR, underwriters must employ other ways of getting information and gleaning insights into an applicant’s mortality. Underwriters become detectives, searching for clues about their applicants’ medical history from ancillary sources. This includes prescription profiles, lab records, and diagnostic databases of billing and reimbursement codes that can also validate information or flag areas that must be further investigated due to less-than-candid representations provided by the applicant.

But these alone may not give the underwriter a complete picture. For example, a patient’s lab records might show that a CT scan was performed but it doesn’t tell the underwriter why it was ordered or what the results were so further investigation is needed. So the underwriter has to order the patient’s medical record, which they then have to wait for before sifting through the pages to find the information about the CT scan. Sometimes this necessitates more record requests, from specialists for example, and even more time elapses. This is known as serial underwriting and can lead to impatient applicants abandoning the sales process, mounting costs, and other undesirable consequences.

“Currently most mainstream carriers are using a disjointed collection of data bits in an attempt to literally piece together a risk profile,” Munchez-van der Wagt said, adding that cost pressures and the need for timely delivery of decisions mean that speed is essential. 

“As good as the gold standard of medical record review may be, it is not a viable strategy for volume underwriting because of the immense delays inherent in the process and the now unwieldy records that an EHR produces,” she said. “True transformation requires equivalency in some important respect, not a reduction or removal of the most important aspect, reliable medical data. Health Gorilla allows an insurer to maintain the protective value in a single requirement, at a reduced cost.”  

The 30 percent average hit rate for patient record queries hasn’t moved in years, but leveraging Health Gorilla’s Health Interoperability Platform (HIP) will result in retrieving  available information on applicants at a much higher percentage. This kind of immediate access to a complete history with labs, vital signs, and prescriptions, eliminates the need for repetitive underwriting evidence or fluid testing. 

“Clearly, no company can forge into the future without digitized data, for both risk selection and mortality studies,” Munchez-van der Wagt said. “Health Gorilla provides a customized digital medical record that has immediate and future value.”

Clinical Data Uses for Life Insurance 

On its own, a medical record is often challenging to understand, redundant, or incomplete. Raw clinical data has a limited utility, but when insurance organizations have access to aggregated and normalized data, there are a variety of ways to use it for improved processes and a more seamless consumer journey. 

By leveraging Health Gorilla's data retrieval and enrichment services, life insurers can benefit from:

Streamlined Underwriting. Access to normalized and deduplicated clinical data allows insurers to decrease time spent reviewing applications and obtaining a medical history, and significantly reduce the amount of time it takes to issue a policy. Our solutions also enable rules engines to carry more of the burden of adjudicating routine cases

More Informed Risk Assessments. A complete view of an applicant's medical history allows insurers to create more comprehensive and granular risk assessments for their applicants, enabling them to improve underwriting risk classification.

Improved Insurer Experience. Effective use of clinical data provides maximum protective value, decreases cycle time, and increases a policy’s staying power for the best classes of risk. Metrics on producer and carrier performance improve measurably.

Better Risk Modeling. Clinical information in the form of structured data – not simply summaries, text, or images – serves as the basis for the underwriting decision and enables the underwriter to perform analysis and experience studies more richly.

If your new business process is in need of a better way to query patient data for underwriting and risk modeling, the Health Gorilla team can help. We will work with you to configure the connection between our library of APIs and your application based on your organization's unique needs and workflows and provide access to the Health Gorilla API development sandbox. Our team of experts is available to answer any questions throughout your journey. Read about our life insurance solutions here or contact us to learn more.