The World Of Electronic Health Records (EHR) For Life Insurance Underwriting

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Electronic Health Records (EHR) are the hottest trend in life insurance underwriting today. The growing accessibility and innovation by solution providers is transforming the life underwriting process. Understanding Electronic Health Records and the benefits are important. We will also explore how you get access to EHR and who is offering EHR services.

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What is EHR and How to “Triage” the Data?

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I first reached out to Drake Livada, life sales, and Nicholas Irwin, director of underwriting, at Verisk to educate on EHR and how it has impacted the industry today. As the COVID-19 pandemic adds risk to countless business and personal interactions, ways of life are shifting toward the virtual world. Suddenly caught up in this transformation, life insurers are urgently seeking electronic sources of information to enable a digital customer journey, and electronic health data is coming to the fore.

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Electronic health data can be compiled from many sources and shared digitally through mechanisms such as health information exchanges (HIEs). Health data can be either structured data such as coded diagnosis (ICD), lab testing results with standardized values, and vital signs; or unstructured data, which often includes narrative style notes to document vital information such as visit summary, radiology results, or pathology results. Some types of electronic health data such as pharmacy, lab, and health claims are much more widely available and easier to use than electronic health records, but the latter can provide greater granularity to support a more refined view of mortality risk.

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The health data information available within the EHR can create opportunities for the digitization of life insurance underwriting. Unfortunately, the structure—or lack of it—in the EHR presents challenges. For starters there are 15 different medical coding systems representing over one million different codes that need to be handled and processed. Even if one built a system to handle these over one million unique codes there is still the challenge of numerous medical coding errors, duplicate values, and transcription errors which requires a robust data validation system to handle. Moreover, many key rating elements, such as cancer stage and EKG interpretations, are only available in unstructured format requiring natural language processing in order to ingest.

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Due to the incredible challenge of processing this data nearly all carriers are still treating EHRs like attending physician statements and reviewing the entire file manually. This can take one to two hours per case as the files are often over 1000 pages long with most of the information being completely useless from an underwriting perspective. To solve this challenge Verisk has made the upfront investment on behalf of the industry and assembled a massive team of seasoned life underwriters, medical professionals, biostatisticians, and IT professionals to develop a comprehensive system to ingest, interpret, and evaluate EHR data in real time. Nicholas Irwin, director of underwriting, explained, “Verisk’s EHR Triage engine is an API that ingests a batch of EHR files (CCDs) via API and generates a one to two page summary of the key underwriting elements in the file(s) as well as providing an overall underwriting score in the form of number of debits. Verisk’s tool is called “triage” as it rates the simple cases that underwriters would rate in their sleep, while referring the more complex cases to underwriters. Verisk’s tool presents substantial time savings even for the cases Verisk refers to underwriters by supplying a summary of the key data elements an underwriter needs to rate the case. The intent of the tool is not to replace underwriters, but rather to enable underwriters to spend more of their time on assessing mortality risk and less of their time on scanning 1000 pages to find the 10 nuggets of useful data.”

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An Easy Connection for Life Carriers and Distributors to EHR Data

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As I continued my research, I discovered all roads lead to Human API. I recently synced up with Nick Zambruno, solutions lead, and Anthony Chan in Product Marketing to learn more about their platform and services. Human API is a leading insurtech vendor in the electronic health records (EHR) category. The Human API platform helps life insurance carriers create better client and agent experiences by delivering health records from a variety of different health data sources, both online and offline. The company started by accessing medical records through patient portal integrations but has expanded their connectivity to health information exchanges (HIEs) and national EHR networks such as Epic ChartGateway and Veradigm, as well as strategic partnerships for the delivery of traditional APS. Over the last few years Human API has helped carriers such as Prudential, Allstate, John Hancock, AAA and Principal offer a streamlined digital underwriting process that relies less on traditional underwriting requirements such as exams, fluids and attending physician statements. Carrier customers have cited hit rates of over 40 percent with the EHR platform and are optimistic that the health data can be used to automate manual elements of the underwriting process. The new EHR data sources added to the Human API platform enable hit rates to exceed 50 percent, while the addition of offline medical record retrieval partnerships will drive hit rates to nearly 100 percent.

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Due to the final interoperability and information blocking rules from the Department of Health and Human Services going into effect in April 2021, Human API is increasingly surfacing more clinical notes in EHR data, positioning the platform to deliver comprehensive medical data access. “Access to comprehensive EHR data is foundational to innovation and transformation of the underwriting process. We’re encouraged by the progress made to date by Human API and look forward to working together to drastically improve the consumer purchase process and experience,” said Susan Ghalili, VP of Underwriting Transformation and chief underwriter at John Hancock Insurance.

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Over the past year, distribution firms have also found value in partnering with Human API directly in an effort to access health data more quickly to expedite the sales process. LIBRA and AIMCOR were two new organizations that announced partnerships in the last year with Human API. Through the Human API platform, a firm can access EHR records and digitally share the data directly with a carrier in a secure setting so automation can still be realized at the carrier level. “The insurance industry is ripe for innovation. We’re incredibly excited to be the ‘one platform for all health data’ that helps carriers create and deliver better customer and agent experiences,” said Andrei Pop, CEO of Human API.

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More EHR Services by Solution Providers You Work with Everyday

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I continue to see more solution providers who actively or plan to add EHR to their services for distributors and carriers this year. Those solution providers who play key roles in the life insurance new business process like Management Research Services (MRS), MediPro Direct, and Employee Pooling (EP) explained the value EHR brings to their clients.

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MRS is introducing Electronic Health Records to their suite of products with guidance from clients’ requirements. Their No Code platform will allow carriers to configure their relevant products workflows based on the data source. As carriers become more confident with their actuarial models with the onset of the data source, they will be able to regulate the data used in the process. They anticipate being able to deliver a searchable interface of CCDA (standardize the content and structure for medical documents)—information that will prioritize APS requirements to improve processing time and decrease non-placement issues.

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As healthcare needs become increasingly mobile or virtual, today’s EHR systems need to do more than track medical records in fixed clinical settings. MediPro Direct’s MedLink software works across all service models, from clinical to mobile to virtual, and ties into MediPro Direct’s network of several thousand mobile medical examiners nationwide. This means their systems not only track patient data but also connect service providers with ways to expand their service model and better meet patient needs.

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Employee Pooling’s (EP) value proposition is to remove obstacles that get in the way of sales and enhance the customer experience. When it comes to formal and informal underwriting, obtaining medical records can hinder the fluidity of the process. “The ability to obtain electronic health records (EHR) within hours versus the days and weeks it could take to retrieve traditional medical records is a game changer and surprisingly cost effective,” says Steven Lacher, VP of Business Development. “With formal underwriting still playing a vital role in our industry, it makes sense to try and whittle down the underwriting process time by getting health records to the underwriter and the carrier in an efficient and timely manner.”

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EP recently partnered with Human API (HAPI) to improve turnaround times related to obtaining medical records for both formal and informal underwriting. EHR has been fully incorporated into EP’s Accelerated Informal platform, which reduces the standard informal underwriting process from weeks to days. Lacher states, “The goal is to help agencies quickly and affordably put their important cases up to bid with conviction. Accelerated Informals stands true to its name with EP’s in-house underwriters, on-demand access to prescription drug and clinical laboratory data, and now rapidly obtained EHR data.”

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In 12-24 months from now, you probably can’t even imagine a world without electronic health records playing a key role in the life insurance underwriting process. The goal is always to arrive at an underwriting decision quickly and accurately. EHR data with innovative platforms are connecting solution providers with more carriers and distributors every month to accelerate the life underwriting process.

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