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

NAILBA Perspectives - July/August 2014