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EVIDENCE GATHERING: WHAT’S NEW?. Session 24: February 27, 2006 Session Producer: Irene Juthnas Director of Underwriting MetLife. PANELISTS. Laurene Polignone, Assistant Vice President – Risk Management John Hancock Amy Chambers, LTC Underwriting Manager, Genworth Financial

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evidence gathering what s new

EVIDENCE GATHERING:WHAT’S NEW?

Session 24: February 27, 2006

Session Producer:

Irene Juthnas

Director of Underwriting

MetLife

panelists
PANELISTS
  • Laurene Polignone, Assistant Vice President – Risk Management

John Hancock

  • Amy Chambers, LTC Underwriting Manager, Genworth Financial
  • Cheryl Bush, Vice President – Operations,

MedAmerica

evidence gathering what s new on the horizon

Evidence Gathering“What’s New on the Horizon”

Laurene A. Polignone

John Hancock

Assistant Vice President

Underwriting & Claims

agenda
Agenda
  • 5 Key Selection Factors
  • Developing Criteria’s
  • Current Protocols
  • Distribution of Protocols
  • John Hancock’s latest tools
    • MCAS
    • MIB
    • Prescription Profiles
5 key factors in selecting a tool
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
developing criteria s
Developing Criteria’s?
  • Age
  • Past & Current Medical History
  • Benefit Structure
  • Date Last Consulted with PCP
mcas study
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
mcas study1
MCAS Study
  • Early Results
    • Estimated prevalence of Alzheimer’s 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.
mib service
MIB Service
  • Clearinghouse of underwriting reports for >500 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
    • ADL’s, IADL’s, Assistive Devices, Cognitive Test Results
mib study
MIB Study
  • 1,504 pilot size
  • Case Profile
    • 40% Preferred
    • 54% Select
    • 6% Substandard
mib study1
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)
prescription profile service
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
prescription profile study
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
evidence gathering what s new on the horizon1

Evidence Gathering“What’s New on the Horizon”

Amy Chambers

Genworth Financial

LTC Underwriting Manager

what tools is genworth utilizing
What tools is Genworth Utilizing
  • Application
  • Phone History Interview
  • Medical Records
  • Face to Face Interview
  • Paramed Exam
  • MD Exam
paramedical exams
Paramedical Exams
  • When used
    • MD not seen recently
    • Current blood pressure readings required
    • Validate BMI
    • Younger age clients
paramedical exams1
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
md exam
MD Exam
  • When used
    • Indication of significant Health History
      • Diabetes
      • CAD
      • No recent follow up
md exam1
MD Exam
  • Provides accurate, updated medical information
    • Lab tests
    • EKG
    • Special tests
  • High Level of Accuracy
  • TAT-client dependent
  • No Cost to the Company
medical summarization of medical records
Medical Summarization of Medical Records
  • When used
    • Any time we require medical records
medical summarization
Medical Summarization
  • Provides concise review of Medical Records
  • Accuracy
    • Sigma 4.5, consistently
  • Improves overall TAT
  • Health Professional
evidence gathering what s new on the horizon2

Evidence Gathering“What’s New on the Horizon”

Cheryl Bush, RN

VP, LTC Operations

MedAmerica Insurance Company

evidence gathering
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
evidence gathering1
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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