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

Transcription

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

2 The Underwriter Meets the Quantified Self Mark S Dion FALU FLMI Vice President, Strategic Underwriting Innovation August 3, 2015

3 Origins 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." 2

4 A Connected World 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? 3

5 Medical Technology As you might expect Smaller Faster Better & Connected 4

6 Medical 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 5

7 Patients (our potential clients) Technology is moving fast, connecting faster 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 6

8 Some New Technologies Their impact on life & health insurance 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 7 7

9 A Few Other Things to Consider 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? 8

10 Promise or Pipedream? 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 9

11 QUESTIONS? 10

12 Electronic Health Records Tutorial on the What? Why? What s Next? 11

13 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 Next Generation-EHR Opportunities of the Future Data, Data, Data The Future of Risk Assessment 12

14 A New Lingo-What s What? 13

15 Understanding the Lingo Health Care Reform (HCR) vs. American Recovery and Reinvestment Act (ARRA) Reform vs. Stimulus Health Information Technology for Economic and Clinical Health (HITECH) Framework and Incentives around EHR adoption and meaningful use Meaningful Use & Continuity of Care Document (CCD) Electronic Medical Records (EMR) vs. Electronic Health Records (EHR) Current process vs. Future Health Information Exchanges vs. EHR Platforms Subscription requirements vs. transactional/full solution vs. Cloud based Personal Heath Record (PHR) 14

16 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 Stage Stage Data Capture Structured Storage Interoperability Standardized Data Improved Care Advanced Interoperability 15

17 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 Improve patient care Improve Patient Care Increase Patient Safety Simplify compliance Help cut long term healthcare costs Reduced errors Increase Productivity Doctors get quicker access to patient information Quicker and more accurate diagnosis Improve patient satisfaction 16

18 EHR Rapid Adoption Provider Adoption Dramatic increase in EHR adoption since 2009 EHR Adoption rates are expected to reach 85% in

19 Authorization Request Collection Cycle-time Usage Cost Current Paper-wet signature Phone, fax and mail Paper, fax, image days average Extensive manual review Per page, copy and postage Future Electronic patient release Query request Structured data Near real-time Rules-based review Query-based transaction fees 18

20 Life Insurance Process Current State Paperwork imaged, reviewed and released MVR Results CheckRx Records scanned Day 0 Day 2 Day 3 Day 16 Day 18 Day 20 Day 21 Day 34 Day 40 PART I Application Completed PARAMED EXAM Ordered PART I Submitted to Carrier PART II Received by Carrier LAB RESULTS Received by Carrier INITIAL UNDER-WRITING REVIEW APS ORDERED ADDITIONAL REQUIRE-MENTS RECEIVED UNDER-WRITING DECISION Day 45 Policy Issuance Applicant contacted Appointment scheduled Exam completed Specimen shipped to lab Specimen tested Specimen results Facility matched Order sent to facility Records verified Payment issued Records copied Records mailed/faxed 19

21 Life Insurance Process Future State The Happy Path Day 0 eapplication Requirements Ordered Policy Issued Part I and Part II Completed electronically einform Cloud Automated Underwriting Decision Underwriting Engine 20

22 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 Larger files containing white space / redundancies 21

23 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 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 22

24 What does it mean to the underwriters? 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 pointspure risk assessment process 23

25 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. 24

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