Ask anyone — from a random person on the street to an investor at one of the largest Silicon Valley VCs — if data is changing the way we interact with the world, and they will say “yes.”

Data is a powerful tool, shaping innovation in every facet of every industry, and life insurance is no different. Health information is a critical part of the life insurance product structure. A policy is priced and issued based on the risk a person’s health history presents. Before the digital age and presence of health histories in electronic form, this data needed to be collected by people, fax machines and even at home visits.

Over the past few years, the U.S. government has made a conscious push on the healthcare system to digitize and electronically store people’s health records, meaning people’s health information in digital form is widely available and only becoming more prevalent. These digital records are called electronic health records (EHR). Now, the U.S. healthcare system is nowhere near its final form of digital efficiency, but it will only continue to get better as time goes on.

Life insurance carriers have started to ask - “how do we incorporate this new, widely available data into our processes in innovative, exciting ways?”

As a leading provider of health data, Human API is obsessed with finding and helping carriers find new ways to use and incorporate digital health data. Whether it is improving an existing process or using data in a novel way, we built an entire system of sourcing, structuring and delivering health data to change the world.

Here are our top picks for ways we’re seeing health data being used currently and where we believe it can be used in the future.

Traditional APS Replacement: Using digital records as a 1-to-1 replacement of traditional medical evidence
Lab/Exam Replacement: Using the lab and test results within EHRs to prevent in-person labs and exams
Accelerated Underwriting Kickout Triage: Using digital health data to quickly determine AU eligibility
New Accelerated Underwriting Data Source: Using digital health data as an additional source of data in the AU process
Accurate Field Underwriting: Using digital health data to make more accurate risk classifications in the field
Part 2 Elimination: Using digital health data to eliminate consumer provided medical information during the application process
Additional Face Amount Pre-Approval: Using medical information to qualify policy holders for additional benefits
Auto Adjudication & Auto Identification for Claims: Using digital records to automatically identify and notify policyholders of claim-eligible events
Post-Issue Engagement: Engaging with policyholders to improve their health and mitigate risk

Traditional APS Replacement

The world today is much different than 30 years ago. The age of the internet has changed almost every interaction we have with the world around us. However, some industries have been slower to adapt than others. Healthcare and life insurance are two of those.

APS records are the original form of medical evidence. And the life insurance industry still relies on these records heavily to evaluate risk. While they are excellent at getting specific medical information directly from a person’s doctor, they leave a lot to be desired in other areas.

APS’s:

Take a long time to receive (sometimes upwards of 30 days)
Are all formatted differently and rarely show an easy to follow, chronological history of a person’s medical history
Don’t support analysis or automation due to their format (PDFs or paper documents)
Vary widely in price

Using EHRs solve all of the above problems and provide a fast, digital 1-to-1 replacement of the same information.

EHRs:

Are typically retrieved within a day or less
Can combine medical data from multiple providers, hospitals and other sources
Have a consistent price structure - no extra provider fees
Can be transformed into structured data for analysis or automation

Since EHRs contain almost the exact same data included in an APS record, but are attainable quicker and cheaper than an APS record, life insurance companies have already begun to replace, at-scale, their traditional records with EHRs. We believe that as time goes on, electronic records will become the de-facto in the insurance industry, leaving APS records as a relic of the past.

Lab/Exam Replacement

Labs and exams are frequently prescribed activities in healthcare. Many of the records we collect have some sort of lab results included. Once we start drilling down and analyzing specific conditions, we see that a large majority (65%-85%) of the time, the labs required by an underwriter to underwrite a case for that specific condition are present in the records. With the timing of these labs typically within 12-24 months of the record pull, we see the need for labs and bloodwork, instigated by an insurance company, almost obsolete. Why make an applicant go through a lengthy, cumbersome process when the data the underwriter really needs is already present?

Take for example an A1C lab result. We see A1C results in our records 38% of the time. That seems low, right? One may look at the presence of that lab result and come to the conclusion that digital records do not have test results at the frequency necessary to be able to consider digital records a viable replacement for in-person labs.

However when we segment these records based on conditions diagnosed and called out in the medical records, we see that A1C tests are present 74% of the time when there is a diabetes diagnosis in the medical record. Considering when an A1C result would be needed during underwriting (hint: it's when the applicant is diabetic), the frequency that A1C results are present in the digital records almost doubles compared to when examining the frequency of A1C results across the population of records in its entirety. Now those lab results are in the range that could be considered sufficient to replace the need for in-person labs the majority of the time.

Accelerated Underwriting Kickout Triage

Accelerated Underwriting has swept the industry off its feet. It allows carriers to quickly pass ideal, low-risk consumers through streamlined underwriting and consumers love the shortened, easy process.

What do consumers not love? The promise of an easy, quick underwriting process only to begin and find out that they are not eligible.

With structured health data that is quickly returned and uniformly formatted, carriers can quickly check to see if the applicant meets the necessary health requirements for the AU track. This keeps non-AU eligible applicants from wasting any time in the AU process, they can start immediately on the full underwriting track.

New Accelerated Underwriting Data Source

To facilitate the speed of accelerated underwriting that consumers love so much, these programs have structured them in such a way that medical evidence is limited or eliminated for their preferred risk applicants. But what if medical evidence could be collected and used for AU applicants, without slowing down the AU track? This could blow open the pool of AU-eligible applicants, all while evaluating mortality risk similarly to full underwriting.

The speed, availability, and maturity of digital health data is at a point now where it is possible to incorporate digital health records into an AU process. Over half of applicants have data available, 50% of digital health data is returned within one day and carriers utilizing Human API digital health data have seen north of 70% decisioning ability on the data they get back. These types of numbers illustrate that digital health data is at a point where integration into an AU process is feasible.

Sound like a lot of data to fit into the AU model? Human API’s Health Intelligence Platform allows carriers to control which data elements are retrieved and shared for each case so you only get the data you need and nothing more.

So you only want to check a person’s BMI or recorded tobacco usage? We can do that

You only want to see how a person’s blood pressure has fluctuated over the past two years? We can do that

You only want to see if someone has a specific lab result? We can do that

The beauty of structured data allows only predetermined data elements to enter the hands of the underwriting department. And another reason our carriers have loved this - it eliminates contestability concerns. If your underwriting department was only given an applicant’s BMI and tobacco history, other health issues are not contestable.

Accurate Field Underwriting

Underwriters are good at underwriting… field agents? Not so much.

Without the extensive underwriting training that underwriters get, field agents do a lot of guesswork when it comes to properly assigning the correct health class to their customers. Inaccurate health classes can lead to unhappy customers and fall out if the premium comes back higher than quoted after underwriting.

Since digital health data can be retrieved so quickly and provides a massive overview of a person’s health situation, it could allow carriers or technology partners to build field underwriting tools that do a pre-emptive check on a customers health information and assign them the health class they are most likely to end up with after going through underwriting. This leads to a more transparent buying process, creating satisfied customers more likely to place and agents motivated to sell more of your policies.

Part 2 Elimination

Who wants to spend time remembering and filling out all of their health info into pages and pages of a life insurance application? With a person’s health history data available, there should be no need for applicants to take time out of their busy schedules to write down the portions of their health information they can remember when it can be systematically queried out.

Imagine no superfluous info from applicants, only the medical information you need and no medical history conveniently “forgotten”, all while improving the buying experience for consumers. This is the future that health data in digital form allows. With all of your applicant’s health data digitized into an API, health info can be easily mapped to part 2 fields, removing the need for applicants to fill out the long and cumbersome form.

Additional Face Amount Pre-Approval

What if your dream policyholder knew they could get more coverage from you?

Engaging with your policyholders to evaluate their health status allows you to continually offer them additional benefits that they might not have been aware of. With your policyholder’s health information available to you, you have the ability to evaluate policyholders currently eligible, pre-approving them for more coverage. And pre-approving them allows your policyholders to obtain additional benefits without going through a strenuous application and underwriting process. Who would turn down more benefits with no app process?

Auto Identification & Adjudication of Claims

People buy insurance products for the protective benefits.

However, many policyholders who are eligible for supplemental health benefits never realize they are eligible to receive benefits. This severely limits the value of the policy to the policyholders facing difficult health issues during periods in their life where they could use the benefits of their policy.

By leveraging digital health data, updated in real-time, carriers could automatically monitor the health of their policyholders and notify them of health events that would be eligible for claims. Ultimately, carriers could extend this to auto-identify and auto-adjudicate these claims without the applicant having to do anything.

Auto identification and adjudication would allow policyholders to receive benefits faster and for events they may not have realized would be covered, making supplemental health benefits incredibly beneficial to their holders. In addition, the client’s experience being notified automatically of potential claims would be incredible - leading to loyal policyholders and employer group clients.

Post-Issue Engagement

How many products can you name that a person holds for 20, 30, 40, 50 years+? Life insurance is unique in many ways, one of them being how long the product is held by the buyer. The typical life insurance policy is held for many, many years - and almost more surprising than the number of years a policyholder holds on to their policy is how often they interact with their carrier. Hint: it’s almost never.

Platforms in the industry have begun popping up, aimed at helping carriers engage with their policyholders on a more frequent basis. Engaging with policyholders helps carriers with retention, risk management, client satisfaction and building a stronger brand. Consumers are accustomed to sharing health information with other insurance providers, like their health insurance, and getting access to current and ongoing health data allows you to better understand the risk profile that your company currently holds and even implement programs to mitigate mortality risk.

One might ask - “Why would our policyholders be willing to share their health information?”

Although this interaction with policyholders is new to life insurance, it’s common practice for health plans and integrated health systems who engage in a host of programs focused on managing and improving the health of the highest risk populations. For example, companies like Omada Health and Livongo offer services to improve the health outcomes of people with chronic conditions and reduce their cost to health plans. These health plans have found material financial benefit from actively managing the risk in their book of business and the policyholders themselves have the life changing experience of improved health

Is data changing the way we interact with the world around us? Yes.

At Human API we are excited for the future that digital health data is helping actualize. We believe that health data has tremendous potential in many different use cases and we are excited to be a part of making that future a reality.

Talk to our team and learn how Human API can power your future.

How Digital Health Data is Changing Life Insurance