Ask The Experts

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.

A prescription history (ScriptCheck®) report can provide underwriters immense detail into an applicant’s prescription drug use.* From identifying medication not disclosed in the interview to understanding prescription adherence, a prescription history report can help underwriters identify potential red flags when making underwriting decisions.

Marnie Vieselmeyer, ExamOne’s new Data Specialist Strategic Account Executive, answers some common questions about what to look for in your ScriptCheck report and how to interpret the results.

Reporting sections

Q. Which details does the ScriptCheck report include?
Your reports can be customized to fit your needs. The following components can be included under your results sections.

Prescription history report components

A few of the sections are summarized below.

Specialty summary: This summary displays a list of the providers and a high or medium score for their specialties. This view is designed to give you a summary of high-risk doctors’ specialties from the prescription fill records.

Drug summary: Underwriters can see an overview of all prescription drugs discovered for that particular applicant, including how long each prescription has been prescribed.

ScriptCheck drug summary table

Q. Is there a way to easily identify if an individual is taking opioid medication?
Yes, you can find this under the ‘Opioid Daily MME’ section. Our look-back graph will calculate a daily morphine equivalent. This calculation identifies all filled prescriptions that are classified in the opioid family of drugs and helps underwriters quickly identify chronic opioid users. 

ScriptCheck opioid MME graph
ScriptCheck opioid MME table

Q. Is there an easy way to sort reports?
Yes. This is configured during the account setup or can be changed through your Regional Account Manager after an account is already set up. The sections that can be sorted include the drug summary section (see image above) by any of the column headings, and the prescription detail section by drug name or filled date.

ScriptCheck prescriber detail

Scoring details

Prescription history report scoring

Q: What do the various colors, shapes and numbers mean in the ScriptCheck report?
Our score provides a number and a correlating colored shape for each score level. The ExamOne default scoring will display: zero (green circle) for low risk, five (yellow triangle) for medium risk, and ten (red diamond) high risk.

Q. What sections are scored?
Multiple sections may be scored within the ScriptCheck report, including the prescriber specialty and the drug summary. The drug summary scoring can be based on therapeutic class, drug level or drug rule. The client determines this and some implementation may be necessary.

Scoring is reported at the therapeutic class; customized drug-level and drug-rule scoring are available. 

Q. How do I customize the scoring for my requirements?
Customization and sorting are both handled during the account setup process. One of our specialists will walk through the sections that are available and work with the client to determine which sections should be included and which should be suppressed. Additionally, a client can request further customization through our Professional Services workflow.

We hope this answers any questions you may have regarding the prescription history reports you receive. If you have further questions, or would like to set up customized scoring, please email Marnie at Marnie.X.Vieselmeyer@ExamOne.com.

Look for our next article in this series where we will walk through our clinical laboratory history report, LabPiQture™, where you can access physician-ordered clinical test results related to preventive care, disease monitoring and diagnosis.

*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.

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