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Medical record retrieval

Traditional Attending Physician Statements (APS) have been a part of the standard risk assessment process for decades. However, it can be cumbersome, time-consuming and costly. It’s a common pain point for both home office underwriters and life insurance agents – extending the policy issue cycle time into weeks.  It requires multiple contact points with physicians and applicants to obtain the information from the medical facility.

The frustration we hear about the APS process has resonated through our annual Customer Satisfaction Survey. Over the past three years, APS time-service and service quality continue to fall short of expectations. As a result, we have made it a priority to identify ways to improve and invest in this process, to help make it a simpler and faster solution. 

Here are 4 ways we are investing in our medical record retrievals to improve the overall process  

Real-time medical record results – Through LabPiQture™ and medical claims data, insurers can receive up to seven years of historical laboratory testing results. These results are retrieved in near real-time, allowing insurers to make decisions quickly and confidently. From physician-ordered testing results to doctor specialties, insurers receive a comprehensive report detailing past laboratory tests.

The nature of LabPiQture real-time access provides our partners the ability to incorporate medical records in an accelerated workflow or a full underwriting workflow. Recently, during the COVID-19 pandemic, insurers have adopted LabPiQture as an alternative to a paramedical exam. If the LabPiQture report does not provide sufficient information, it can be triaged into a full underwriting workflow.

Electronic Health Records (EHR) – Now with a connection to leading EHR providers, ExamOne has direct access to electronic medical records. Through this integration, physicians listed in the EHR database will be identified and the APS request will be routed to the EHR system, reducing days to weeks off the APS request wait time.

Direct connection to copy service – One critical component of the process affecting the APS turnaround times is the copy services contracted to release records on behalf of the provider. We have secured direct connections that allow us to bypass the doctor/provider and reach out directly to the copy service. This reduces the number of calls and wait time in reaching out to the physician’s office and improves the overall communication/status process.

APS Summary – Through a partnership with Aosta Insurance Services, we are leveraging their technology to provide a summary of any medical file. This tool is directly integrated into our retrieval process, eliminating extra connections and reducing turnaround times. This summary service reduces the time spent reviewing each individual APS, allowing insurers to spend their time in other areas.

A few tips that could help improve time service and overall quality of the APS orders:

  • Provide the full name and address of the physician or medical facility where records are being requested
  • Provide the HIPAA authorization at time of ordering
  • Provide the applicant email address that can be utilized should the medical facility require a special authorization. ExamOne will forward the appropriate form directly to the applicant for signature

Our goal is to help alleviate some of the pain points insurers and agents feel when it comes to an APS. Applicants are making the important decision to purchase life insurance, and we want to make the process as easy and rapid as possible, for you and for them.

Note: ExamOne requires prior written consent from insurance applicants, which appears in the HIPAA- compliant authorization that is part of the insurance application. The authorization must be signed and dated prior to accessing the information.

Historical laboratory data is of unique importance to insurers because it provides a retrospective view of an applicant’s health. Insights from our LabPiQture report can help insurers build a longitudinal history of an individual’s last seven years.

historical laboratory data

Brian Lanzrath, our Director of Analytics and LabPiQture expert, answers some of the commonly asked questions we receive from our clients. 

Interpreting the number of encounters and hit rates in our data

Q. How far back does your database pull results?
Our database pulls up to seven years of historical laboratory data, and we are continually working to expand our data sources. Recently, we incorporated LabCorp data into our LabPiQture results.

Q. How many encounters are detected through LabPiQture?  
It’s important to remember that not all life insurance applicants have had a clinical testing encounter within the FCRA-mandated seven-year lookback period. By our best estimates, 75%-85% of the all-ages life insurance population has had an encounter in the past seven years.

More specifically, we estimate that only around 40% of males 18-29 have had laboratory testing performed in the past seven years. However, this increases to ~60% for ages 30-39, ~70% for ages 40-49, ~77% for ages 50-59 and up to 84% for ages 60+.

Our studies also show that close to 90% of women across all age groups have had laboratory testing performed in the past seven years.

Of course, not all encounters are captured in our product as it exists today. Conditional on a laboratory test having been performed in the last seven years, there is roughly a 60-70% chance that it will be present in our data.

Q. What is the current LabPiQture hit rate?
The all-ages raw hit rate is 53%. The residual 47% includes both applicants who have not been tested clinically within the previous seven years, and tested individuals who are not present in our data. Hit rates are positively correlated with age and female gender, with men under 30 exhibiting by far the lowest rates. There are individual regions (including D.C., New Jersey, Arizona, and Connecticut) where our hit rates exceed 70%.

Top diagnoses and doctor account specialties

Q. What are the most common diagnoses reported through LabPiQture?
The table below shows the top ICD-10 codes and the percentage of applicants that had this ICD code in their LabPiQture report. As users gain experience with the ICD system, and the subset of medical conditions most often diagnosed/managed though laboratory testing, more nuanced interpretations of the broad categories below tend to become routine.

For instance, Z01 hypothetically includes any specialist checkup – anything from a dental cleaning, to a vision exam, to a hearing test. In practice, though, few of these encounters prompt laboratory testing. OBGYN checkups, by contrast, routinely generate tissue pathology data in the form of Pap smears – and indeed, 90% of LabPiQture Z01 codes are associated with Pap and HPV results. Z11 (“Encounter for screening for infectious/parasitic diseases”) is similarly broad in principle and would historically have been associated with conditions as wide-ranging as tuberculosis and hookworm. In practice, though, for modern populations this almost always indicates STD (including HIV and HCV) testing.

You can find a list of the top five diagnoses codes among females and males here.

Q. What are some the leading account doctor specialties?
Below is a list of our top 25 specialties. Drug rehab (#10) is of particular note. As recently as five years ago, this specialty was not in the top 25. In fact, it was only barely in the top 50. The greater prominence of this specialty reflects both the demand-side effects of the opioid epidemic, supply-side changes in mandates for health plans to cover many forms of drug treatment.

Learn more about LabPiQture and how you can leverage it in your underwriting process

For more information on LabPiQture and the data included in this report, you can access a link to our previously recorded webinar.

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