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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


Current protocols

Current Protocols


Distribution of protocols 2005

Distribution of Protocols2005

Percentage


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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