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EVIDENCE GATHERING: WHATS NEW

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Accuracy of administration. Qualifications of individual retrieving data ... 143 did not reveal additional medical information ... – PowerPoint PPT presentation

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Title: EVIDENCE GATHERING: WHATS NEW


1
EVIDENCE GATHERINGWHATS NEW?
  • Session 24 February 27, 2006
  • Session Producer
  • Irene Juthnas
  • Director of Underwriting
  • MetLife

2
PANELISTS
  • Laurene Polignone, Assistant Vice President
    Risk Management
  • John Hancock
  • Amy Chambers, LTC Underwriting Manager, Genworth
    Financial
  • Cheryl Bush, Vice President Operations,
  • MedAmerica

3
Evidence GatheringWhats New on the Horizon
  • Laurene A. Polignone
  • John Hancock
  • Assistant Vice President
  • Underwriting Claims

4
Agenda
  • 5 Key Selection Factors
  • Developing Criterias
  • Current Protocols
  • Distribution of Protocols
  • John Hancocks latest tools
  • MCAS
  • MIB
  • Prescription Profiles

5
5 Key Factors in Selecting a Tool?
  • Ability to assess risk exposure
  • Reduces or eliminates need to request multiple
    requirements
  • Quality of results
  • Accuracy of administration
  • Qualifications of individual retrieving data
  • Ease of applicant administration
  • Cycle Time
  • Cost

6
Developing Criterias?
  • Age
  • Past Current Medical History
  • Benefit Structure
  • Date Last Consulted with PCP

7
Current Protocols
8
Distribution of Protocols2005
Percentage
9
MCAS Study
  • 1999 - 2005
  • MCAS utilized throughout time period
  • Compared cognitive claims on applications
    received 1999 2005 against 300,000 applications
    against all claims incurred between during the
    time period with a cognitive
  • Ages 65 - 72
  • Cognitive testing was not given to all applicants
  • Requirements guidelines and scoring criteria
    changed slightly during the 5 year period

10
MCAS Study
  • Early Results
  • Estimated prevalence of Alzheimers in the
    general population for ages 65 to 69 is 1.1
  • Our Prevalence for 300,000 cases was 1 in 13,000
    cases or .008
  • Results are well below our actuarial estimates
  • 5 individuals passed the cognitive screen and
    went onto claim during the period studied.
  • Allowed us to moderate our cognitive scoring
    criteria.
  • Validated our approach and use of cognitive
    screening in these age groups.

11
MIB Service
  • Clearinghouse of underwriting reports for gt500
    life insurance carriers
  • Provides for the exchange of confidential, coded
    medical and non-medical information among its
    members
  • Uncovers misrepresentations and omissions
  • LTC specific codes since 6/1999
  • ADLs, IADLs, Assistive Devices, Cognitive Test
    Results

12
MIB Study
  • 1,504 pilot size
  • Case Profile
  • 40 Preferred
  • 54 Select
  • 6 Substandard

13
MIB Study
  • Pilot Results
  • 184 matches
  • 177 analyzed
  • 143 did not reveal additional medical
    information
  • 34 provided information that lead to further
    investigation
  • 3 appeared uninsurable
  • 2 appeared to be risk class changes(preferred to
    select)
  • 29 appeared to be risk class changes (select
    substandard)

14
Prescription Profile Service
  • Detailed Information
  • Brand generic names, dosage, quantity
  • Physician name and contact info
  • Provides check on application / interview
  • Often reveals missing or forgotten conditions,
    physicians
  • Profile may indicate less severe condition(s)
    than physician reports
  • Upon signed authorization, provider queries
    multiple external Rx databases
  • Rx history ordered and delivered electronically
  • Turnaround time less than one minute
  • Displayed in easy-to read format
  • Shows underwriting relevance, drug indications

15
Prescription Profile Study
  • Sample size 4,080
  • Sample ages 40 84
  • 2,536 (62) were eligibility prescription
    hits
  • 1,976 (78) of the hits contained prescriptions
  • 1,769 (90) of the prescription hits were
    analyzed
  • Focused on uninsurable applicants
  • Ordered medical records on 84 applicants and
    declined 20
  • Actuaries cost benefit analysis revealed savings
    of 6 for every 1 spent

16
Evidence GatheringWhats New on the Horizon
  • Amy Chambers
  • Genworth Financial
  • LTC Underwriting Manager

17
What tools is Genworth Utilizing
  • Application
  • Phone History Interview
  • Medical Records
  • Face to Face Interview
  • Paramed Exam
  • MD Exam

18
Paramedical Exams
  • When used
  • MD not seen recently
  • Current blood pressure readings required
  • Validate BMI
  • Younger age clients

19
Paramedical Exams
  • Assists in obtaining current health information
  • Accurate height
  • Current weight
  • Current BP
  • High Level of Accuracy
  • TAT dependent on the client
  • Low Cost

20
MD Exam
  • When used
  • Indication of significant Health History
  • Diabetes
  • CAD
  • No recent follow up

21
MD Exam
  • Provides accurate, updated medical information
  • Lab tests
  • EKG
  • Special tests
  • High Level of Accuracy
  • TAT-client dependent
  • No Cost to the Company

22
Medical Summarization of Medical Records
  • When used
  • Any time we require medical records

23
Medical Summarization
  • Provides concise review of Medical Records
  • Accuracy
  • Sigma 4.5, consistently
  • Improves overall TAT
  • Health Professional

24
Evidence GatheringWhats New on the Horizon
  • Cheryl Bush, RN
  • VP, LTC Operations
  • MedAmerica Insurance Company

25
Evidence Gathering
  • Challenges of Younger Age Applicants
  • Value UW Tools Used
  • Application Value of Actively At Work
  • Phone History Interview
  • Medical Records
  • FTF personal interview
  • Rate Classes

26
Evidence Gathering
  • Challenges of Younger Age Applicants
  • FTF Requirements
  • When is Tool Used
  • Value of Functional versus Cognitive
  • Cognitive Screening Tool
  • Study of EMST versus DWR
  • Accept vs. Deny Ratios by Submitted Ages
  • Findings Of Medical Record Reviews/Audits on
    Denies
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