Potential testing options in underwriting people over age 65 are on the move.
In the past year, for example, it has become clear that some combination of up to 5 blood tests will soon allow life underwriters to abandon chest x-rays and treadmill tests while also greatly reducing dependence on resting electrocardiograms.
Moving beyond 20th century underwriting relics is vital to achieve faster, less costly underwriting.
Embracing new options also means using objective tools in lieu of customer-unfriendly practices that are incompatible with the financial services industry.
The 5 tests under scrutiny in this context can all be performed on the same blood sample needed for a routine blood profile.
The anchor here is NT-proBNP. No test has ever afforded underwriters such an uncanny capacity for pinpointing impaired circulatory function. Rather than focusing on just one heart-related disorder, this test elevates significantly in presence of cardiac damage from all pathological causes.
The test that life underwriters currently use to assess blood sugar control in diabetics is designated HbA1-c, for glycosylated hemoglobin. It has a screening mandate as well because high levels in non-diabetics reflect increased heart attack risk. Moreover, its contribution is independent from that of NT-proBNP, which means using them together optimizes their value.
The Cystatin C test also shares the advantage of synergy with NT-proBNP. Intended clinically to replace the flawed kidney test for creatinine, Cystatin C is poised to contribute to insurance screening in more ways than “merely” as a red flag for renal impairment.
Further study of Cystatin C in an underwriting context is now underway. If findings corroborate initial impressions, the industry could have another readily-affordable tool for use in the burgeoning older-age market.
The two other testing candidates are distinguished by the fact that one has been a major element in healthcare for decades while the other is the latest laboratory resource to attract interest in the industry’s search for alternatives to the baggage-ridden ways of the past.
Hemoglobin (Hb) is the protein which transports oxygen in the bloodstream. Unlike most disease markers in the complete blood count (CBC), it can be performed within the constraints imposed by mobile paramedical specimen collection.
Hemoglobin defines the presence of anemia. Although too non-specific in terms of demarcating the cause of anemia to help underwriters in this regard, a growing volume of clinical studies show a powerful association between even borderline low Hb levels and significant older-age mortality.
Links between reduced hemoglobin levels and increased risk of death relate to various illnesses such as heart disease and cancer as well as to physical frailty.
The last of these, frailty, is particularly important because underwriters now appreciate the ominous risk impact of premature frailty. Adding inexpensive Hb determinations to other evidence of declining physical function should enhance the industry capacity to underwrite efficiently persons in their 70s and older.
The newest kid on the block is a blood lipid test with the imposing name of lipoprotein-associated phospholipase A2 (Lp-PLA2). In persons with (or at high risk for) coronary and/or cerebrovascular disease, Lp-PLA2 appears to be a strong indicator of future events such as heart attacks and strokes.
As with Cystatin C, further efforts are now underway to clarify how Lp-PLA2 might harmonize with the aforementioned tests to exceed by far the value of treadmills and electrocardiograms (ECGs) while also being 100% objective in how they relate to insurability.
A matter now under consideration on some quarters underscores the importance of defining a screening profile made up of appropriate components. Recent efforts to promote insurer deployment of a tumor marker known as carcinoembryonic antigen (CEA) pose a dire threat to underwriting credibility.
CEA, which is deemed clinically untenable to screen even high-risk subjects, could bring down the wrath of customers, physicians and others. The industry had a similar experience several decades ago with an ill-chosen marker dubbed TAA–a marker that resulted in healthy applicants being told they might have cancer and having to undergo expensive tests, to the dismay of their doctors. Those are sober realities the industry would be wise to dodge like the insidious bullets they are.