VitalityLife Simplify the Medical Screening Process

Historically in the UK market, the applicant’s underwriting experience is completed through questions and answers alone. The insurer may be able to offer coverage within minutes based on the responses. This creates a very positive customer experience. However, once the applicant steps off the “happy path,” and the application requires information that cannot be satisfied through questions and answers, the time to process the application becomes weeks rather than hours. Nurse screenings or doctors’ reports are scheduled, completed, and the results assessed by the insurer’s underwriting team.

The current industry standard is notoriously slow to book appointments; requires venous blood tests that need to be sent to a laboratory to process results; and results in a long process to make an underwriting decision. Client information can also be delayed due to the number of parties involved. In the UK, the collection of medical underwriting information is typically outsourced, which leads to a lack of control and a clash of interests in delivering results quickly and efficiently. It also means the insurer is not in control of the client journey and their brand experience. All of which adds up to a lengthy, and potentially frustrating client process.

To make it quicker and easier to gather the evidence necessary to determine an applicant’s underwriting status for coverage when medical screening is required, in February 2017, Vitality Life introduced a new team of Vitality nurses. The nurses are equipped with iPad-based medical evidence analyzers, developed in association with its technology partner Munich Re, to conduct the initial medical screening at the client’s home.

The service is unique to VitalityLife and the first of its kind in Europe. Available to book six days of the week on its specially developed Concierge booking system, nurses conduct a screening that includes: a near patient blood test using a simple finger prick, providing instant results. Additional screening includes height and weight, and gathering responses to lifestyle-related questions. The nurses capture all the relevant information on a specially developed iPad app, which is then uploaded directly into an evidence analyzer and the underwriting systems. This app produces one of two outcomes: it either refers the client for additional manual underwriting or produces an immediate underwriting result. Instead of an average of 14 working days, the underwriting process can now be completed in as little as two hours, even when medical screening is required.

To provide an extra layer of security to clients, all nurses wear a Vitality-branded uniform; use Vitality-branded equipment, and arrive in Vitality-branded Mini Cooper cars. Owning the end-to-end process allows VitalityLife to control turnaround times, improving the quality of the results and, ultimately, giving applicants faster access to coverage. A video describing the Vitality Nurse Service can be accessed at https://www.youtube.com/watch?v=GYRPWKlYUzs.

VitalityLife was able to take advantage of Munich Re’s experience and technology developed in the US for the auto-assessment of paramed screening and lab results, to identify avenues where it could improve the customer journey. The Vitality iPad-based medical evidence analyzers were created using the ALLFINANZ Evidence Analyzer module. This module was created by Munich Re for the North American market to automate the collection and processing of electronic requirements from third party data sources such as MIB, motor vehicle reports, prescription databases, and laboratory reports. The evidence to be collected is fully controlled by underwriters.

The nurse booking system is built in Microsoft Dynamics and includes a plug-in with specialized functionality to manage appointment scheduling. It uses geocoding to match the nearest nurse to the client’s location taking availability and travel time into consideration. If the adviser chooses not to do the booking themselves, the application is moved to the VitalityLife Concierge team to perform the booking instead.

The Concierge booking system is the one point of contact, support, and personalized relationship with the nurse. The hours of operations mirror those of the nurses’ working hours. It provides:

• A team of six highly skilled individuals.
• A dedicated hotline that lets a team member confirm, cancel, manage, maintain, monitor, and chase bookings.
• Immediate notification to advisers of bookings, cancellations, or amendments.
• Automatic reminder emails sent to advisers, clients, and Vitality nurses 24 hours before appointments.

When screenings are completed, the nurse keys results into the Nurse App, which will automatically send the cases to underwriting. The following video explains to the applicant what to expect during the nurse appointment. www.youtube.com/watch?v=vh_3SHrQhiY

An agile team was created in November 2016 to deliver a minimum viable product (MVP). A backlog was created and continues to be managed and added to with new functionality and refinements delivered in regular sprints.

Integrating a new data source needed a high degree of collaboration between the Munich Re project team; the IT team responsible for the iPad-based medical evidence analyzer; and the underwriters responsible for the rules used to request and process evidence. To bring this about, the Munich Re team worked closely with Vitality to identify the data to be collected at each stage of the underwriting process. This data was then configured in the ALLFINANZ Rules Designer, at which point underwriters began working on rules, while the IT team started on the web services needed to integrate the medical evidence analyzer with ALLFINANZ’s underwriting engine.

The MVP was built in six weeks and delivered in December of 2016. This allowed time for the Concierge Booking System and Nurse App to be piloted before going fully live on February 4, 2017.

The Vitality project team worked alongside the Munich Re project team to integrating the ALLFINANZ Evidence Analyzer for the MVP go-live. The Evidence Analyzer went live in December 2017.

From a business perspective, the new service has enabled Vitality to simplify the blood testing process; replace doctor medicals with nurse screenings (when no ECG test is required), and remove the need for microscopic urinalysis as a standard screening requirement. Bringing the service in-house allows Vitality to have control of the costs since it doesn’t rely on third parties.

While it is still early to give a definitive answer of cost savings over conventional paramedical exams, the service has been cost-neutral to date, including the setup costs. From an operational perspective, it has allowed Vitality to conduct higher-quality appointments, reduce underwriting workload, and produce better quality results, leading to more efficient turnaround times.

The Vitality nurses have also expanded into additional services which had been outsourced to third party providers. Examples of these services are medical teleinterviews where the nurses ask the medical questions and conduct wellness days where Vitality nurses meet with a firm’s clients and perform health checks.

Vitality Nurse has provided an opportunity to increase brand value in the eyes of clients. The latest customer feedback figures show Vitality’s Net Promoter Score improved from negative –13 in February 2017 to 34.8 in June 2017. It introduces members to the importance of health and wellness and enables Vitality to offer a superior service experience which brings four key qualitative benefits:

1. Clients enjoy the convenience of having their medical screening in the comfort of their own home at a time of their choice.
   
2. Because Vitality manages the service end-to-end, clients have the confidence of knowing their medical information is not managed by a third party.
3. The coverage can start sooner, giving peace of mind to the insured.
4. Advisers can get new business onto their books faster.

Currently 10% of the cases are scheduled by advisers. As awareness grows, Vitality expects this figure to increase rapidly.

The biggest challenge was the time to market. This was managed through implementing the project as an MVP, in order to deliver the minimum required functionality in the fastest possible time. Another benefit of using the MVP approach is that enhancements are made based on actual experience in the environment. Integration between legacy systems and new technology was also a challenge which was mitigated by extensive business testing before the go-live date.

Vitality Nurse is continuously improved based upon service reviews and monitoring of key metrics. This leads to the creation of new requirements/user stories that are brought to market using an agile methodology.

The service has received excellent feedback from applicants and advisors. The following video provides an overview of how the service has improved Vitality’s members’ experience, https://www.youtube.com/watch?v=Fcah4gZ2SN0.

Vitality is the first insurance company in Europe to reward people for healthy living. It is owned by Discovery Holdings, a leading global insurer with over 7 million clients (as of May 2017). Discovery joined the UK market in 2007, in a joint venture with the Prudential, creating two companies called PruHealth and PruProtect. In 2014, it bought 100% of the shares from the Prudential and rebranded the companies as VitalityHealth and VitalityLife.

VitalityLife offers comprehensive and award-winning life coverage in a range of different options to provide the right amount and type of protection for an individual’s needs. Its coverage comes in two forms: term life insurance or whole life insurance; and serious illness coverage that protects nearly four times as many conditions as other UK providers.

VitalityLife offers a unique approach to insurance, based on the scientifically proven principles of behavioral economics. It helps its members take a more active role in managing their own wellness, encouraging healthy long-term habits that are good for the individual, good for the company, and good for society. Along with improving and maintaining good long-term health, members can keep their premiums low by improving their Vitality status and receive rewards for healthy behavior.