Session 1: Future Technology. Moderator: Cindy Mitchell. Presenters: Traci Davis Mark Dion

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Session

1:

Future

Technology

Moderator:

Cindy

Mitchell

Presenters:

Traci

Davis

Mark

Dion

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The Underwriter Meets the

Quantified Self

Mark S Dion FALU FLMI

August 3, 2015

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Quantimetric self 1996

The term "quantified self" appears:

Gary Wolf and Kevin Kelly, editors at Wired Magazine, in 2007 proposed "a

collaboration of users and tool makers who share an interest in self

knowledge through self-tracking."

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While not universal, it is harder and harder to find unconnected areas in

developed countries.

Though the National Park Service still field numerous complaints about why

teens aren’t getting cell service in the back country

Is the day coming soon that we can get medical attention, advice, maybe

treatment any where on the globe through our smartphone or smartwatch?

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Smaller

Faster

Better

&

Connected

Medical Technology

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5

Medical

https://getreferralmd.com/2013/11/health-care-technology-innovations-2013-infographic/ Here now: Virtual dissection Real-Time diagnostics Robotic intervention

Artificial Intelligence decision support

In progress: Medical Tricorder Augmented Reality Optogenetics

Customized mobile apps

3D Printed biomaterials and drugs

Coming:

Full physiological simulation Holographic Input

Remote touch Virtual reality

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Here now:

Curated online information Digestible sensors

Personalized genomics Telemedicine

In progress:

Wearable and embedded sensors Artificial organs

Robotic nurse assistants

Coming:

Home diagnostics

Augmenting human capabilities Humanoid robots

Gamification of health

Patients (our potential clients)

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Micro-samples

Smaller samples preformed on demand at the pharmacy, same day as the application

Microchip modelling instead of animal trials

Could we speed up approvals, reduce costs, explore drugs for orphan diseases and solve some animal treatment issues?

3D Printed biological materials (The Replicator?)

What if prescription refills could be printed at home?

Digestible sensors

Tracking compliance anyone? Replace the colonoscopy?

Wearables

MDs, patients, clients, underwriters and actuaries

Electronic aspirin

Blocks signals in the sphenopalatine ganglion (SPG) to relieve migraine

Some New Technologies

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Wellness programs, Quantification, and Gamification

Is the wearable fitness tracker here to stay?

The second and third generation medical tricorder

The Qualcomm XPRIZE is just the beginning

The $1,000 Genome (what about the $200 genome?)

What happens when it is ordered in utero?

The Ultimate Quantified Self

Are we ready?

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Technology is moving a bit faster than our underwriting or actuarial pricing practices

After all we still need to know whether an “advance” actually results in better

outcomes

The promise is certainly there for improvement in quality of life, treatment and

monitoring of disease, and comfort for those who are ailing

But will those improvements significantly move he needle for the general

population? For the select underwritten population?

Will life span increase?

BTW: If the first person to live to 150 is already alive… who is going to sell them an annuity?

Stay tuned, we’ll be keeping an eye on results…

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11 Informed decisions.Improving lives.

Electronic Health Records

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Objectives



Drivers behind Electronic Health Record Revolution



American Recovery and Reinvestment Act



Health Care component/EHR focus



Timeline/Stats



Access to the Data



Impact to Life Insurance Industry



Impacts to current processes



How it impacts carriers, brokerages/agencies, Chief Underwriters, and

production underwriters



Personal Heath Record (PHR)

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Let’s Begin at the Beginning!



The driving force behind EHR



American Recovery and Reinvestment Act (ARRA) of 2009



Under the Health Information Technology for Economic and Clinical Health (HITECH ) act, $19.2B was allocated for incentives to healthcare providers for adopting electronic

health records (EHR)

− Up to $11M in incentives per hospital

− $44,000 in incentives per physician

− Medicare and Medicaid payment penalties for not achieving meaningful use start in 2015

Stage 1

2010-2012 Data Capture Structured Storage

Stage 2

2012 - 2015 Interoperability Standardized Data

Stage 3

2016 - 2018 Improved Care Advanced Interoperability

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Electronic Health Records



The driving force behind EHR



Objectives of HITECH

− Move physicians and hospitals to embrace change

− Establish a mechanism of exchange patient medical records

− Reduce waste in the healthcare delivery system

EHR – Rapid Adoption

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Provider Adoption



Dramatic increase in EHR adoption since 2009

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Authorization Request Collection Cycle-time Usage Cost Authorization Request Collection Cycle-time Usage Cost Paper-wet signature Phone, fax and mail Paper, fax, image 10-14 days average Extensive manual review Per page, copy and postage

Current

Future

Electronic patient release Query request

Structured data Near real-time Rules-based review

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PART I Application Completed

Day 0 Day 2 Day 3 Day 16 Day 18 Day 20 Day 21 Day 34 Day 40

PARAMED EXAM Ordered PART I Submitted to Carrier PART II Received by Carrier LAB RESULTS Received by Carrier INITIAL UNDER-WRITING REVIEW APS

ORDERED REQUIRE-MENTSADDITIONAL RECEIVED

UNDER-WRITING DECISION

Life Insurance Process – Current State

• Specimen shipped to lab • Specimen tested

• Specimen results

• Facility matched • Order sent to facility • Records verified • Payment issued • Records copied • Records mailed/faxed • Applicant contacted • Appointment scheduled • Exam completed Day 4 5 Po licy Issuance • Paperwork imaged,

reviewed and released • MVR Results

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Life Insurance Process – Future State “The Happy Path”

eApplication Requirements

Ordered Policy Issued

Part I and Part II

Completed electronically Automated Underwriting Decision Underwriting Engine eINFORM Cloud

Day 0

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Impacts-What will this mean to the players?



Carriers



Significant reduction in end-end CT



Reduced APS fees-move toward pure transactional basis “Say goodbye to the

copy service fees”



Increased ROI and Protective Value-increasing APS orders



Authorization changes/enhancements



Data, Data, Data

− Cracking the APS code for use in PR&D, mortality studies, enhanced underwriting risk assessments, and claims insight



Potential challenges



Not ready or planning for the future = missed opportunities



Transition phases-some electronic some “old school”

− Continued multiple requests on one applicant

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What does it mean to us?



Brokers/Field Force



Significantly reduced CT; closing the sale within days vs. months



ROI –time spent tracking down records and managing status’, facility nuances,

special auth woes will be time gained to sell more business, reduction in APS

retrieval fees thru EHR platforms

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Potential challenges;



Increased simplified workflows and scoring



Increased use of APS’ in underwriting processes



Reduced opportunities; CT and acquisition cost reductions, ability to leverage

data access and structured data unless partnered with an APS thought leader

that is prepared and leveraging EHR data

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What does it mean to the underwriters?

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Field and Home Office Underwriters



Pre-structured data ;

− Moving away from the handwritten notes

− CCD format;

• Getting familiar with formats /data • More reliance on CCD encounters

− Increased complete files on initial review

− Larger file reviews

• Productivity/Staffing model impacts



Post-automation (structured data access)

− Increased scoring systems; for the field this may mean more black box scoring

− Reduced ability to impact individual underwriting offers

− HO underwriters spending time understanding data output vs. developing data points-pure risk assessment process

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Next Generation-EHR Opportunities of the Future



Data, Data, Data



EHR data that is structured yet customizable

− Allowing for flexibility in formatting data feeds ; how and what we access

− Enhanced ability to determine impairment / lab / prescription/and diagnostic testing trends over years

− Increased automation ; risk assessment tools, automation that follows manual “thought processes”, and scoring opportunities

− Protective value –incorporation of the “gold standard” of medical risk assessment within minutes



The Future of Underwriting

− Paradigm shift-moving toward simplified workflows that will incorporate full underwriting standards

− Systematic methodology that will take the vetting process to a level never

experienced; underwriting professionals making final risk assessment by assessing data output .

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