With the flowering of “financial services,” life insurers are now seriously questioning the appropriateness of cumbersome, time-consuming and blatantly customer-unfriendly screening tests.
Once-heralded tools like chest x-rays, treadmill tests and even resting electrocardiograms have all been shown to have major drawbacks in these contexts. Concern for the continued routine use of these 20th century stalwarts is underscored by their high cost as well as the inherently subjective nature of how they are analyzed.
For all these reasons, efforts are underway to evaluate viable alternatives that are free of these encumbrances.
The importance of this for producers cannot be overstated. In survey after survey, agents and brokers have hammered home the message that insurers must find ways to make it easier for clients to do business with life insurance companies.
By replacing traditional application-taking with tele-interviews, using interview disclosures to cut attending physician statement orders and placing greater emphasis on rapid-acquisition resources like MIB codes, motor vehicle records and, above all, pharmacy profiles, the industry has made significant strides in this direction.
A recent joint study by a leading reinsurer and a pharmacy profile provider, driven by a huge population database, found that users of designated “high risk” medications experienced substantially higher mortality than those using either moderate- or low-risk pharmaceuticals.
This revelation should have a major impact on life insurers’ use of pharmacy profiles during underwriting.
That is good news for producers because pharmacy profiles are accessed electronically, contributing to faster, more efficient underwriting.
A new lab marker known as cystatin C, which is inexpensively measurable in specimens the industry already collects routinely for blood profiles, is now emerging as yet another good fit with this transformational process.
A comprehensive review of the burgeoning literature on this test suggests that the test will contribute significantly to older age underwriting. This is because cystatin C is independently correlated with key insurability issues such as:
o Premature loss of kidney function with aging.
o Kidney complications from longstanding diabetes and hypertension.
o Heart attacks, strokes and lower extremity arterial disease.
o Early frailty and hip fractures.
o Increased cardiovascular and all-cause mortality.
o Liver damage in chronic hepatitis.
Over the past year, many prominent life companies have started using another remarkable risk marker called NT-proBNP. Its forte is pinpointing heart damage, whether silent and symptomatic, due to virtually any potential cause.
On its own, NT-proBNP is a powerful predictor of cardiovascular risk in older ages and, like cystatin C, it can also be affordably done in context with routine blood testing. But the most compelling value comes when both tests are used together. Doing so should give a literal “one-two punch” sufficient to render resting and exercise ECGs redundant and thus, given their many other drawbacks, obsolete in life underwriting.
It goes without saying that, before serious consideration can be given to adopting any new medical tests, chief underwriters must have a sufficient comfort zone regarding the protective value of proposed alternatives to tests they have been using for decades. In other words, careful research and sufficient “field testing” are both essential prerequisites.
Thus far, the evidence for a synergistic contribution from NT-proBNP and cystatin C is quite positive. Hopefully, by using them together, life underwriters will finally be empowered to cut bait with the onerous ways of the past.
Doing this will dramatically streamline and speed up the underwriting process for producers, while at the same time conserve precious resources and enhance the positive impact of the risk appraisal process.
Hank George, FALU, CLU, FLMI, is president of Hank George, Inc., Greendale, Wis. His email address is firstname.lastname@example.org