The goal may be in sight for some life insurers seeking to tap electronic health records (EHRs) for data-powered underwriting, customer engagement, and health promotion. Increasingly robust access to EHR data is a significant factor in the unfolding digital transformation.
Clinical data can help chronicle a customer’s health journey.
Clinical data from various sources can help life underwriters chronicle a customer’s health journey with details on diagnoses, smoking status, vital signs, lab results, and family history. Data from EHRs and health information aggregators can be more current and complete than what’s available through traditional channels such as portals.
Still, unrefined clinical data poses significant challenges. Data from EHRs, health information exchanges, and aggregators is often incompatible, which can impede insurers’ efforts to reach the wealth of detail embedded in that data. It may be inconsistent and lack valuable context for life insurers. The sheer volume of codes, variety of coding systems used in EHRs, and frequency of changes can create confusion, compounded by errors or gaps in the information.
Verisk joined with Diameter Health, a leader in semantic normalization and clinical data enrichment, to tackle data-quality issues as part of a risk-adjustment solution.
Extracting clinical data from multiple formats and sources
The challenge was leveraging clinical data to support straight-through processing with less manual intervention in underwriting.
It was no longer viable to have underwriters abstracting information from 500-page Attending Physician Statements (APS) or the patient portal of a single medical practice. Reviewing an applicant’s EHR in the manner of an APS can be a waste of valuable assets within the EHR: Structured digital data, not documents, that can help drive automated underwriting based on the applicant’s entire relevant medical history.
Verisk released its EHR Triage Engine to help life insurers leverage digital data with automated data standardization, data validation, and risk scoring that’s scalable as data volume increases. Automating data aggregation and summarization can help insurers target their time and resources toward value-added activities such as risk selection and customer engagement strategies.
Building on better data quality
Verisk’s solution goes beyond mere data collection to tackle multisource clinical data’s complexity, volume, and frequent incompatibility.
Sophisticated, reliable underwriting analytics that could help mitigate customer risk would depend on an upstream solution that delivers both quality and speed for feeding data into insurers’ workflows. This capability, in turn, would be vital to improving consumer satisfaction and risk selection. Data need to be not only normalized but enriched with metadata to help underwriters identify associations and relations that aren’t evident in traditional APSs, patient portals, or raw data.
Verisk adopted Diameter Health’s Fusion to meet this upstream need for a unique, multipurpose data quality solution that helps lay the foundation for risk assessment. Fusion’s automated semantic interoperability engine provides broad functionality: Normalization, enrichment, reorganization, deduplication, and summarization to help generate usable, applicant-centric clinical data for the next generation of life underwriting systems.
Access a wealth of resources to learn more about EHRs and Verisk solutions.