Dave Goehrke:
Welcome everyone, to Munich Re's winter edition of our EHRs podcast series. I'm your host, Dave Goehrke, and today we have a very special guest, Neal Halder. Neal has over 30 years of experience as an underwriter. He's currently vice president and chief underwriter at John Hancock. Thanks for joining us today, Neal. Tell us a little bit, if you could, about your first exposure very early to electronic health records.

Neal Halder:
I would say my first exposure would have been sometime in the 20-teens, clearly prior to COVID. And you know, the exposure was to, I would say first, the patient portal information, which, depending upon who you talk to, a patient portal record may or may not be an electronic health record, but for me, it's all some form of digital medical data. But the patient portal, I would say certainly was probably the first exposure to this type of information.

Dave Goehrke:
In terms of what it's been like to work with electronic health records over the years, how's that been going for the users, and compared to... early days compared to today?

Neal Halder:
Yeah, I think certainly in the early days, and I referenced the patient portal, the challenge with the patient portal, I would say has been twofold. One is it required the applicant, or the patient, to either provide the credentials to the carrier to access the patient portal site, or for that individual to sign in and make that connection. And I would describe it as a clumsy experience. The true electronic health record where we can use the HIPAA authorization that they've previously signed is a much cleaner process, and I think is better from a client experience perspective.

As it relates to the information itself, that has been interesting, because there are some patient portal sites out there that have very good information, and, and what we would conclude to be complete information on the individual. And there are other patient portal sites that have very limited or scant information. They might have the vitals and the labs, but they don't have any of the chart notes or any of the other, you know, observations from the attending physician. And I would say that the same is true relative to that true electronic health record. There’s been variability in the information.

Now, the good news is, I do think in the last year or two, we've started to see improvement in it. We've started to see improvement in the hit rates, if you will, which means if we go out and we try to access a record, first, is there even a record available, and then two, does that record have that information that we need to underwrite? And so, we're making progress. I would tell you that we probably have some work to do.

Dave Goehrke:
So at John Hancock today, I know you're big, very bullish on electronic health records. How are you using them today? When you think of underwriting scenarios, whether fully underwritten, large case, small case, accelerated – how is John Hancock using electronic health records today?

Neal Halder:
So today, we're using those electronic health records predominantly on smaller face amount cases and trying to use that electronic health record information in lieu of the traditional insurance exam. So, we have our accelerated program called ExpressTrack, and we're trying to take those individuals who maybe don't qualify through the traditional ExpressTrack route, and instead of immediately pivoting and getting the insurance exam requirements, we're trying to see if we can get information through an electronic health record, to allow that individual to still get a non-examined experience from us. But we're looking to expand that capability further, and so we've been doing some testing in using the electronic health record in lieu of the traditional APS, and see if we can leverage the electronic health record so that we don't have to wait that normal 20 to 30 days for a medical provider to get that information back to us.

You know, I would say on a one-off basis, so clearly not with a particular program in mind, but on one-off basis, we are starting to look at using the electronic health record on larger face amount cases, where we believe that the electronic health record would be the equivalent of the traditional APS, and so, I would say we're using it on a spectrum, most of it at the lower face amount, we'll say younger, healthier individuals, but we're certainly looking at the opportunity to go further.

Dave Goehrke:
And I know you're aware, and the listeners are aware Clareto became a Munich Re company about 18 months ago or so. What was your reaction when you first heard about that acquisition?

Neal Halder:
Well, I would say excitement first. You know, we've worked with Clareto for several years now, when they first started with the focus on health information exchange information. Which again gets into this whole conversation about digital medical data and what's an EHR, versus patient portal, versus HIE, again, health information exchange, and so, we're excited about Clareto becoming a part of the Munich family, and I would say part of that excitement really is because what we've seen Munich do is really invest in some data capabilities, data analytics, and trying to leverage that information to help us make better underwriting decisions. And so, we think the partnership, if you will, between Clareto and Munich Re, is one that makes perfect sense.

Dave Goehrke:
Yeah. I, we, obviously agree, and that's exactly what we had in mind at the time of the acquisition. In terms of that collaboration and the progress that we've made so far, have you had a chance to see that, and what do you think of the progress to date?

Neal Halder:
I think the progress to date has been good. Again we could probably spend a fair amount of time talking about where that progress is relative to what we expected and where we want it to be, but I think we're making progress, and again, what excites me about that progress and where we're at on this journey, and in particular with Clareto and Munich Re, is one of the challenges we have with the digital medical data, the electronic health record, is just the amount of data that's coming in, and the fact that it's not always organized for the underwriter. Depending upon the source that it comes from, it's not always in the same format. And so what we've seen early on with the work between Clareto and Munich Re is this effort to try to organize the data and put it in a way that's useful to the underwriter, so that the underwriter can work more efficiently with the information.

And I think at the end of the day, what we'll also see is more consistency in the decision-making that the underwriter is able to make. Ultimately, I think where we're going to go is we're going to have some of these cases where the underwriter may not even have to look at the information that's come in, because the capability to take the data, to organize it, to understand the significance of it can be done within an algorithm, a rules capability, AI, you know, whatever we define that capability to be. But that could also go the full spectrum of going through that exercise but still having the underwriter ultimately look at it. So, that's what excites us, really, about the relationship between Clareto and Munich, and the capabilities of both is the ability to take this information and really put it in a way that's very useful to us and we can leverage.

Dave Goehrke:
Thanks, Neal. You know, we can stray a little bit off of EHRs, specifically, but maybe just about the future of underwriting, future of underwriting in general. How do you see that playing out over the next two, three, five years?

Neal Halder:
I mean, the future of underwriting is going to be absent of an agent amount routine requirement chart, where you can look and see that an individual, 50 years old, buying $5 million of life insurance, has to do A, B, C, and D. That's not going to exist in the future, and instead, what carriers are going to do is they're going to look at the information available to them, and they're going to figure out, "What do I need to underwrite this individual, who's 50 years old and wants $5 million of coverage?" And there could be four individuals who are all 50 years old, 5 million, who have four different underwriting paths that they go down.

One of them may have a traditional insurance exam, but they may not. The others may not, rather. And it's because we're going to leverage, again, this digital medical data more broadly, which gets beyond the EHR and gets into, you know, clinical labs, claims information, leveraging the prescription information that we're already getting, and leveraging the electronic health record.

And so yeah, I mean, I think the future of underwriting is going down that path. And the reason that I think that electronic health records or digital medical data is so important in this is because that information is going to be what we're going to lean into the most to move away from those routine agent amount requirements that we traditionally get. You know, as it relates to the electronic health record, unlike the insurance exam that we're trying to replace with new information, all the electronic health record is doing is replacing the traditional APS that we've been getting. And the beauty of the electronic health record is we can get it faster, and it's structured data. 

Now, we need to normalize that data and make it consumable for us, but the electronic health record is really just a mimic of the traditional APS that we've been getting for years. And so, it's different in that respect versus that, this accelerated, but I think to your point, Dave, we've talked about accelerated underwriting and we talked about traditional underwriting. I think in the future, we're just going to talk about underwriting, because there is not going to be accelerated and traditional in the sense that we used to know them.

If we were still relying on the traditional APS, it just doesn't work to try to use that in lieu of the insurance exam, because of the 20 to 30 days on average that it takes to get that traditional APS out of the doctor's office, and the fact that yes, you might get an electronic document, but it's just a PDF, and there's nothing you can really do with it, other than view it, right? So it's not consumable from a data perspective. The reason that EHRs are so attractive is because of, A, the speed with which we can get that information, what, hours, maybe three to five days at worse.

Dave Goehrke:
Yeah.

Neal Halder:
Compared to 20 to 30. And, it's data that we can do something with.

Dave Goehrke:
Okay, Neal. Thanks for, for that. That's great to hear. So, in terms of what you've seen, where the industry's going, you're speaking to other chief underwriters that are listening today. What would you recommend to them?

Neal Halder:
Well, you know, again, I would say to them, look through a broad lens relative to the capabilities that are out there, and I think we are too early to eliminate any capability at this point in time, and then also make sure that not only are you looking broadly, but that you're looking further down the road to what could be the capability. And again, I think to that end, what Clareto and Munich Re are doing together is absolutely critical to our future success. You know, the biggest challenge we have today with electronic health records is the ability to take that information and make something meaningful of it, and so I think that, you know, again, the work that Clareto and Munich are doing is  clearly on the path that we need to be on as an industry so that we can leverage that information, and figure out how it will work for different scenarios.

Again, we talked earlier about the accelerated case. We talked about the higher face amount case. You may have somebody who has a more impaired history than another individual. I think what we want to eventually get to is a point where any of those types of scenarios that we might run into from an underwriting perspective can be effectively addressed through the capabilities of the electronic health record, and the support mechanism to take that record and turn it into something that's really usable for the underwriter.

Dave Goehrke:
Well, this has been great, Neal. we've covered a lot here, from the history of electronic health records, to John Hancock today, and looking forward. Anything we missed, any concluding thoughts that you'd like to share?

Neal Halder:
You know, I think the concluding thought really is to go back to what I talked about earlier. And I think this is kind of indicative of what we've experienced. We started working with electronic health records pre-COVID, and when COVID hit, I think it really became a moment for us to try to figure out how we could take what we had been experimenting with and put it into a live production environment. And some of us were scrambling to do that. Some of us were further ahead on that journey than others. And that's okay. I would tell you that I thought, during COVID, we would accelerate more quickly than what we have, and that we'd find ourselves in a position today, further down the road than what we are.

Am I disappointed by that? Yes. Am I discouraged by it? No, because I still think that we're further ahead than where we had been previously, and I think we're heading down the path that we need to go to. And I still believe that we're going to have what I call the hockey stick effect, where we've been a little flat, with hit rates and utilization, and I think we're going to start a very fast upward trajectory very soon. And again, what I would say to my peers out there is you don't necessarily want to be at the front end of that because that makes some people really nervous. I don't think you want to be at the back end of that, and you don't want to be one of the laggards.

So again, what I would say to you is continue to pay attention, find your opportunities to start to work with this information, figure out where it fits in your practice, and find the partners that you can work with and really develop a capability that I think's going to be a game-changer for the industry. 

Dave Goehrke:
Well, this has been really great, Neal. We appreciate your insights and your forward-looking view as well, and again, we really appreciate you coming in and taking time with us. I'd like to thank everybody for listening, and we will chat with you next time.