NAILBA Perspectives - July/August 2014 - (Page 36)
agency resources
Underwriting Innovations 2014
HANK GEORGE, FALU, CLU, FLMI
T
his essay is a focused look
at underwriting innovations
in terms of where they stand
in 2014. One may disagree with one
or more of my observations. Good,
because we need dialogue on these
issues now more than ever, given
insurers' tight requirement budgets!
Paramedicals
The "smart" paramedical is eclipsing
the conventional version. They provide medical histories with drilldown
questioning of YES answers, yielding
vastly more protective value.
Will fixed-site paramedicals
reemerge as a viable option?
They have notable advantages
over the mobile approach such as
more accurate blood pressure, less
"variability" in the appearance/
demeanor of technicians, and so on.
Rx Records
Count on pharmacy record use
becoming essentially universal. It
has myriad advantages and virtually
no drawbacks.
Carriers need to let producers
know what their designated "red
drugs" are. These are medications
that raise our antennae and lead
to unfavorable actions. Companies
differ in terms of which drugs they
consider "red." Look for applicant
adherence/compliance in taking Rx
as prescribed to become a major
consideration. The evidence supporting this is overwhelming. One
provider now offers an algorithm
for measuring adherence, eliminating the tedium of doing it manually.
Hepatitis C Screening
The incidence of major complications of longstanding HCV infection-cirrhosis and liver cancer-
will peak in the next decade and
then decline. This is because the
highest risk group (those infected
via transfusions prior to universal
blood donor testing) is reaching the
point where their risk is substantial.
Insurers are responding appropriately with HCV antibody screening,
mainly at ages 45 and over. Look for
this to become more widespread.
NT-proBNP
This is the finest cardiac test in
underwriting history.
My third comprehensive NT-proBNP literature review, coupled with
a new mortality study by Swiss Re's
Dr. Mike Fox et al, have put an exclamation point on the huge payoff
from NT-proBNP at older ages.
NT-proBNP will catalyze the
demise of treadmills and resting
ECGs. The arguments for this are
indisputable. This is good news for
clients, given the rigors associated
with these obsolete entities.
You can access my NT-proBNP
papers for free at www.insureintell.com.
Cystatin C
Chronic kidney disease has profound
insurability implications.
The two tests we rely upon now-
creatinine and estimated glomerular
filtration rate (eGFR)-have major
36 perspectives JULY/AUGUST 2014
drawbacks at older ages, resulting
in misclassifying risks.
Cystatin C is a relatively new kidney test. Unlike creatinine, it is not
affected by loss of skeletal muscle
mass, a prevalent occurrence at age
70 and over.
Cystatin C has also been shown
to be a surprisingly credible marker
of physical frailty.
How many producers would lose a
night's sleep if insurers dumped the
Timed Get-Up and Go test in favor of
cystatin C?
Carcinoembryonic Antigen (CEA)
CEA is used clinically to monitor
patients with colon cancer but never
to screen high-risk individuals.
Some insurers now embrace CEA
screening. The logic is that if you
set the threshold for taking action
(as in, decline) high enough, a significant portion of these applicants
will have some type of malignancy.
This is a slippery slope.
The "C" word (cancer) is spoken in
hushed voices because it is the most
feared word a doctor can use with a
patient. When we decline for elevated
CEA, the attending physician tells the
client we should not be screening with
it (because it is not FDA approved in
this context), and after shelling out
thousands for further tests, the client
finds out it was a false positive.
Will that fear turn to anger?
Yes, based on several cases I have
seen. In the domain of the "C" word,
it is best to stick with the only FDA
approved screening test: prostate
specific antigen (PSA).
APS Summarization
There are service firms doing summaries of medical records on a fee basis.
The main overall drawback is
underwriters' reluctance to rely on
summaries in lieu of reading the
APS themselves.
http://www.insureintell.com
Table of Contents for the Digital Edition of NAILBA Perspectives - July/August 2014
NAILBA Perspectives - July/August 2014
Contents
Chairman’s Corner
CEO Insights
Social Skills
NAILBA 33 Preview
NAILBA Charitable Foundation
Life Happens
The Remote or Virtual Office
Member Profiles
Mooers Award Nominations
Agency Successor Networking Group
Agency Resources
BGAs Leading Technology Through Connections
Reading Ahead
Calendar of Events
Index of Advertisers
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