ADVERTORIAL: Discover the Advantages of a Hybrid EHR Strategy

April 2024

Today’s innovative life insurers are continuously looking for new ways to satisfy consumers’ needs for a streamlined purchase process — one that is both faster and offers the best possible pricing, without mortality slippage. Electronic health records (EHRs) are poised to play a significant role in achieving these goals. Current estimates indicate that, over the next several years, the EHR will become an essential data source for medical underwriting. EHRs are now standard in the health care system, and consumers are providing consent to carriers to access their medical data with a few digital steps.

There are two paths available to carriers seeking EHRs: Health Information Portability and Accountability Act (HIPAA)-enabled networks and consumer-mediated networks. HIPAA-enabled networks provide data that are authorized under HIPAA and include data from private electronic medical records providers, as well as regional health information exchanges (HIEs). Consumer-mediated networks provide data from patient portals or national public networks, allowing consumers to manage access to their health information, similar to using online banking to manage finances.

EHR Advantages

Leading carriers are already leveraging EHRs as an alternative to the attending physician statement (APS) since EHRs offer:

• Speed: EHRs are generally available within 24 hours, compared to the APS average of 19 to 21 days.
• Ease of use through automation: Because EHRs deliver health records digitally, underwriters can consume the data more quickly and easily.
• Greater insight: EHRs provide underwriters with deeper and more consistent underwriting insights.

Despite these clear benefits, the widespread adoption of EHRs as an underwriting tool has not yet occurred. If history is any indication, based on the industry’s adoption of prescription history and non-medical data (such as driving behavior and public records data), it is likely that widespread use of EHRs will happen when coverage exceeds 80 percent — meaning, for every 100 applicants, EHR results are returned for 80 of them. At LexisNexis Risk Solutions, we believe a hybrid approach that leverages both HIPAA-enabled and consumer-mediated networks is the only viable route to 80 percent coverage.

Current Challenges

Over the past five years, the rate of growth from HIPAA-authorized health networks has been quite modest, and these networks are projected to continue growing at about the same rate. EHR coverage provided via HIPAA-enabled networks is limited by the market share of its players.

The other type of HIPAA-enabled network, legacy regional HIEs, is also not expected to materially grow. One disadvantage to the HIEs is that, while they are designed to share medical data among health care professionals electronically, HIE-sourced EHRs have limited applications in medical underwriting, as they sometimes contain incomplete patient data.

The Hybrid Solution

LexisNexis Risk Solutions believes that the limited growth of HIPAA-enabled networks and regulatory pressure for consumer control means that a hybrid approach is the only feasible path to fully realize EHRs’ potential. We envision the prospect for significant and rapid expansion in electronic health data.

While life insurance carriers indicate they’re more comfortable obtaining EHRs from HIPAA-enabled networks, that only accounts for half of the EHR market. Consumer-mediated networks represent the only other way to access the other half and therefore make them an essential part of a successful hybrid strategy.

Supporting the need for a hybrid strategy is strong evidence that HIEs will be superseded by Qualified Health Information Networks (QHINs), a form of consumer-mediated network. QHINs are a network of organizations that work together to share patient health data. QHINs, which were established under the Trusted Exchange Framework and Common Agreement (TEFCA), are essentially the future of provider data-sharing in the U.S. TEFCA is the government’s latest initiative to support secure data exchange: a codified approach to sharing data that eliminates siloed data sources, such as HIEs and EHR vendor networks, enabling digital authentication and automated requests to be sent directly to the source providers.

We believe the groundwork already exists for more than 80 percent coverage through QHINs. The only thing missing is providers releasing them for patient access, which is mandated as part of QHIN participation.

The initial phase of TEFCA requires that patients have the same access to their data as their providers. LexisNexis Risk Solutions expects the government’s financial incentives to providers that participate in QHINs will drive more access to medical records for carriers. This access depends on the applicant completing a simple ID verification step that typically involves entering the last four digits of their Social Security number and a picture of their driver's license. There are no passwords or usernames.

Although many wish there were a path to materially increase EHR access using HIPAA-authorized networks, there is no equivalent market force driving material increases through that channel, so forward-thinking carriers should be prepared to engage with applicants through a hybrid strategy as the future unfolds.

Bottom Line

The best predictor of mortality is a person’s health history. And, while a well-documented APS can be the most thorough source, it can be difficult and time consuming to obtain. In today’s environment, where consumers have low tolerance for long wait times due to advances in many other industries, leading insurers are already answering the call through the expanded use of EHRs.

Certain innovative carriers have had great success with this methodology. Because it’s not something that can be implemented overnight, LexisNexis Risk Solutions urges insurers that have not yet embraced this approach to get started now so they can gain valuable experience and build their applicant engagement muscle. Not only will adoption of this hybrid strategy be extremely impactful in the future, but it will also significantly increase the value carriers receive today.

The bottom line is that life insurers that embrace consumer-mediated networks as part of a hybrid strategy to underwrite and assess risk will achieve the highest rates of electronic health data retrieval and decision rates. This leads to significantly reduced cycle times and a streamlined consumer experience, which ultimately lead to higher placement rates.

About LexisNexis Risk Solutions

At LexisNexis^® Risk Solutions, we are passionate about using the power of data and advanced analytics to help life insurers make better, timelier decisions in a world of hidden risks and opportunities. This is why we make it our mission to provide essential insights to advance and protect people, industry and society. Our life insurance solutions can help reduce the time it takes to obtain critical information from days and weeks to seconds and hours. Gain valuable insight for knowing your prospects and customers through every step of the policy life cycle with unique data and advanced scoring analytics while upholding the highest standards of security and privacy.  https://risk.lexisnexis.com/insurance/life-insurance-solutions