Summary

Guardian, a Fortune 250 company founded in 1860, gives 27 million Americans security through insurance and wealth management products and services. In October 2018, Guardian made the strategic move to partner with Human API for its enterprise health data platform.* By engaging consumers in the sharing of health data, Human API enables carriers to use digital records, when available, to streamline underwriting, improve consumer satisfaction, and create competitive differentiation in the marketplace.

Challenge

For any disability or life insurance provider, gaining access to medical records for underwriting poses a significant challenge. Insurers must rely on healthcare providers to photocopy, scan, and fax a mix of handwritten and typed records. These APS (attending physician statement) records can be lengthy and redundant, making them difficult to review with a critical eye. Underwriting requirements such as an APS, paramedical exams and lab test results can cost anywhere from $100 to $250 per case. Satisfaction among applicants and agents suffers. There’s little transparency as applicants are unable to see the records that potentially threaten their ability to secure insurance. Plus, the lengthy process requires applicants to undergo medical exams and wait several weeks to learn of underwriting decisions. The longer this process takes, the greater the likelihood that an applicant decides against the policy altogether. Delays in underwriting prevent agents from making a quick sale. In fact, a LIMRA study shows that 31% of agents surveyed said that life insurance is not a larger part of their practice because the sales process is too burdensome. For agents, the process results in lower placement rates, dissatisfied customers, and limited ability to grow their businesses. In addition, when speedy processes are so important to agents, carriers relying on the antiquated medical record procurement model stand to lose business to innovative competitors.

"Retrieving medical records can be painful for everyone,” said Elaine Costigan, Director Underwriting for individual disability insurance for Guardian. “For our underwriting team, traditional APS files are slow, manual, and difficult to analyze. Agents have a greater chance of losing cases, and applicants lack visibility into the process.”

Solution

With the growing use of electronic health records and patient portals in today’s healthcare system, Human API is accelerating the pace of innovation by enabling consumers to share their medical records digitally. Capitalizing on the healthcare consumerism trend, Human API empowers consumers and businesses to engage in new ways. For Guardian and other insurers, the technology enables greater automation which has the potential to reduce overhead costs and enable underwriters to gain the efficiency and productivity needed to manage increased sales. “Human API will allow us to achieve our strategic vision of closing business online and meeting the ‘buy now’ expectations of our consumers,” said Nick Volpe, Vice President and CIO for Life and Wealth Management for Guardian. “It doesn’t require us to change our methodology or the types of data we use. It only changes how we access the data. Human API delivers the same data sets we need but in a digital format to help us achieve our ultimate goal of rapid, digital underwriting for both life and disability.” Acting as a conduit between the insurer and applicant, Human API lets Guardian gain quick and efficient access to the medical records they need for underwriting, when available. Enabling applicants to connect their data takes only minutes and requires no integration work to get started. First, Guardian introduces Human API to applicants during the application process. The applicant then connects using their patient portal credentials, and the underwriter receives the records just minutes later. On average, authorizing and connecting data takes just three minutes of the applicant’s time. “We were happy to find that the majority of electronic health records are sufficient for underwriting,” said Costigan. “Previously, our underwriters would sometimes have to pore through hundreds of pages of records in a short timeframe. It’s like reading a book in a day. When that happens, their critical thinking skills go out the window. Now, they can look clearly and holistically at the case.” By engaging with Human API, applicants can get an approval decision on their applications in days instead of weeks. They may be able to avoid intrusive lab tests and time-consuming doctor visits, and they can view and download a copy of their information. “Behind the scenes, the system eliminates redundant data and pulls out only what we need,” said Costigan. “It includes diagnoses, medications, treatment dates, blood pressure, and tobacco or alcohol use. We were concerned about the ability to access clinical notes which are important to our process. It varies by provider, but we’re finding more and more that we’re getting the clinical notes we need.” Agents appreciate the rapid responses which enable faster commission payments, and the ability to sell more policies. The streamlined process also enables agents to improve the client experience.

“One of the reasons we appreciate working with Guardian is their willingness to be on the front of technological advances in the insurance industry where most companies move pretty slowly,” said Dustin Karas, a broker at Pattern Life. “Guardian’s partnership with Human API is very important to us,” said Karas. “Every day a policy remains in underwriting, our likelihood of placing that policy goes down. Human API’s solution to collect medical data reduces one of the largest time variables and frustrations in the underwriting process. Our total time from application submission to finalizing policy delivery has been reduced dramatically, and our policy placement rate has increased.”

Results

One important measure of success for Guardian lies in the number of applicants and providers who participate in the program. Costigan noted that 77% of applicants indicated that their healthcare providers were found in the Human API network. Costigan also measured engagement, noting that approximately 40% of applicants who were introduced to Human API succeeded in connecting their data. Among all applicants who required an Attending Physician Statement (APS), approximately 30% successfully connected their patient portal accounts and shared their Electronic Health Records (EHRs).

Costigan expects these numbers to only increase as providers and applicants continue to improve their use of EHRs and patient portals. Additionally, Costigan shared two cases that demonstrated benefits of using Human API: 29-year-old female: APS files arrived in 43 days while Human API records were retrieved in just three days. The policy was issued within 72 hours of the medical records request. 27-year-old male: Human API records were 22 pages. The APS arrived ten days later with more than 340 pages of records and the same decision was reached. (Guardian ordered attending physician statements for comparison purposes) Commenting on the program’s success, Volpe said, “What does this mean for Guardian? It differentiates us and offers significant cost reductions. But most importantly, it lets us keep pace with the rest of the world in the speed at which we operate, which is important to us given our attention to regulatory compliance. Every other industry uses technology to quickly bring products and services to market. With Human API, we can meet the expectations of our consumers.”