Leveraging health data to drive underwriting efficiencies

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By Simon Spurr, Managing Director, Alula Health Technologies

Given the myriad of stakeholders along the healthcare journey – from doctors and pharmacists to nurses and hospitals, and health insurance – integrating the almost countless, disparate data sets to get a singular view of a consumer is a complex undertaking. Fortunately, this is something SilverBridge partner HealthCloud has overcome. For the past four years, the two organisations have combined their respective strengths and have applied the technology to speed up the health and life insurance underwriting process while modernising traditional practices.

Fundamentally, HealthCloud delivers a platform where multiple disconnected stakeholders can integrate their data sets into an overarching, intelligent data structure. All the heavy lifting is done in the background with healthcare organisations and insurance partners able to adopt APIs to transact health record data in a more meaningful way.

Traditionally, the insurance underwriting process is a complex undertaking requiring agents getting the potential client’s health information from several different sources involving a significant amount of manual work. Not only is this prone to human error, but it is a complex and inefficient undertaking. However, this information is essential for the insurer to determine the associated risk, which further enables more accurate pricing and product offering.

Thanks to HealthCloud, it is now possible to plug structured health record sets directly into an insurer’s underwriting process. HealthCloud is a platform that integrates insurer data with electronic health records, medication usage, pathology results, remote diagnostic devices, wearables, and facial scanning (rPPG) to provide a full overview of a consumer’s health profile. This empowers the insurer to understand risk more cost-effectively and accurately, and faster than what is currently happening.

Health learnings

The potential this technology can have on the underwriting process is thanks to the learnings of the healthcare sector. With health data all over the place, unstructured, in different formats, and in different databases if at all, developing a platform that can integrate this has been a significant undertaking.

The HealthCloud technology has evolved over time with API architecture now in place that enable even basic IT systems, as are often found in medical practices, to integrate with the platform. This also enables such stakeholders to share and exchange enriched data sets which, outside of the insurance vertical, enhances care, diagnosis, and clinical decision-making.

Insurers face similar challenges. Claims and underwriting must instantly harness all sorts of first and third-party data, including health data, identification verification and industry risk screening with company-specific business rules, to drive quicker and better new policy applications and claims processes. This requires smart underwriting and claims solutions capable of integrating advanced technologies like intelligent automation and machine learning enabling life insurers to come to a decision in minutes for the majority of cases.

This sees underwriters saving time on the more ‘routine’ day-to-day decisions – allowing them to focus on the aspects of their role where they can add most value. This can be applied across both open and closed book providers. There are real value efficiencies in reducing decision making time for underwriters. It comes down to making each company’s unique underwriting process more efficient and more accurate, with reduced costs.

Making it real for insurance

For insurers, the HealthCloud Platform connects to an entire ecosystem of data, solving data interoperability and providing a unified view of a consumer’s individual health profile. The HealthCloud Platform integrates insurer data with electronic health records, medication usage, pathology results, remote diagnostic devices, wearables, and facial scanning (rPPG), to provide a full overview of a policyholder’s health profile.

Proprietary algorithms using artificial intelligence (AI) and machine learning (ML), means that insurers are instantaneously provided a Health Risk Score to better understand and manage new applicant and existing policy holder risks – including fraud / non-disclosure. Access to this fully consented data sharing provides greater accuracy for insurers as they manage their portfolio and risk profiles. It is this technology-driven approach to data analysis that has been deeply embedded in the South African life and health insurance industries for many years.

HealthCloud provides real-time health data for new policy applications, ongoing claims management, and policyholder engagement. For its part, SilverBridge delivers sophisticated automation technology. This combines to deliver the Smart Underwriting solution which provides insurers with the intelligent automation of the insurance underwriting process by securely integrating health data and medical records to assess the risk of onboarding individual customers more accurately and consistently. This providers insurers with the means to benefit from intelligent automation of the underwriting process. The platform does so by securely integrating relevant internal and external data used for underwriting and enabling automated decisions.

The improved accuracy that automating these processes bring by eliminating the chance for human error result in financial savings. For instance, the technologies can reduce the cost of underwriting a policy (where medical reports are required) by almost 80%. With more than 2.5 million unique Health Risk Scores generated to-date, insurers have access to a significant database of information to further strengthen their value proposition.