Can real-world data impact long-term care insurance carriers?

Exploring the impacts and benefits of a real-world data strategy for long-term care insurance carriers

Written by Andrew Goldberg

I recently attended the Intercompany Long-Term Care Insurance (ILTCI) Conference and participated on a panel entitled “Big Data - Predictive Analysis Based on Bio Metric & Social Determinants”. Many thanks to Robin Devine of John Hancock for organizing and moderating the panel and to Doug Nussman of Montoux for inviting me to participate.

The ILTCI Conference is one of the premier gatherings for insurance carriers who actively offer insurance or re-insurance for long term care (LTC) policies. These policies provide for various levels of home care and assisted living care which can represent challenging financial burdens for most individuals as they reach the later stages in life. Carriers are considering all options to both keep their policyholders healthy as long as possible and to bend the claims curve to reduce financial reserves for future payouts. The use of real-world evidence (RWE) and real-world data (RWD) to inform these initiatives is critical to achieving both outcomes.

1. Impacting the time to claim

For many carriers, a policyholder claim begins a long process of payouts to support that individual until an end of life event. It is the rare carrier, however, that gathers insights about the policyholder during their life to attempt to bend the curve. Elderly Americans often prefer to stay in their own homes as long as possible, but loss of a caregiver, transportation or consistent access to healthcare can shorten the time to file a claim.

Carriers are only beginning to contemplate the use of social determinants of health (SDOH) as a means of better understanding these externalities. SDOH data such as car ownership or income might signal a care gap while financial data, such as credit card data, could indicate whether populations are active and embracing life or home bound and inactive. Certain SDOH factors can be very predictive of a propensity to claim and further work in this area would be invaluable. An appropriate data strategy is required, however, as managing which SDOH indicators are available on an identifiable versus de-identified basis can result in very different outcomes.

2. The power of policyholder interventions

Interventions are a powerful way for carriers to minimize or defer LTC claims. The problem is that most carriers have no contact with a policyholder once a policy is issued until the time of a claim. There is very little surveillance that occurs during that intervening time other than a direct mail approach to try and entice a subset of policyholders to voluntarily report on their health status. On occasion, sometimes a professional is dispatched to further assess the state of care. Rarely do carriers collect or take advantage of a patient's HIPAA consent to review a patient’s health status over time and to intervene in a constructive way.

Unlike life insurance where carriers aggressively review an applicant’s healthcare data or disability insurance where most identifiable data is manually retrieved upon a claim event, LTC carriers remain mostly blind to the health journeys of their policyholders until it’s too late. And even when a claim is submitted for home-based care, there is little effort by carriers to understand the policyholder’s progress and to avoid an escalation of that claim, let alone work with the individual to return them to health and to reverse it.

It is clear that the LTC industry needs to consider the power of a HIPAA consent and the ability to retrieve patient data as part of a long-term patient-approved surveillance program. This would provide for electronic retrieval of certain key health information and a better ability to identify health journeys that would benefit from intervention. This would be a positive step for both the policyholder and the carrier. Many carriers are unaware that this capability exists, aside from it being actively employed by other market segments within the same carrier, and others are unsure how to navigate the hurdles of their Compliance office. Regardless, the technique has been well proven in both insurance and clinical trials as a means to successfully implement a data strategy and to positively impact outcomes.

3. But who should own the intervention

While it seems logical that an LTC carrier would want to intervene to bend the claims curve, many carriers can’t get past their belief that health interventions should be the responsibility of the health insurer, not the LTC carrier. Given that most potential claimants are on Medicare, LTC carriers know that health insurers are often incentivized by Medicare to manage patient journeys and to minimize readmission for acute cases. Despite this fact, many patient journeys are not impacted sufficiently by health insurers to reduce LTC claims.

Meanwhile, LTC carriers are reluctant to spend on interventions which reduce their own claims but also reduce the health insurers claims as well. The lack of partnership between health and LTC carriers, and perhaps Centers for Medicare & Medicaid Services (CMS) as well, creates an interesting tension that results in a stalemate. Interestingly, evidence suggests that a healthier patient will claim at a later date, but may not materially extend their lives, thus not extending the time on claim. In layman’s terms, this means that keeping a patient living comfortably at home as long as possible bends the curve but doesn’t extend the time that claims need to be paid because a patient’s life span isn’t necessarily extended. The RWE and RWD data clearly exists to support active interventions, but the industry likely requires innovative partnerships and new risk sharing models to aggressively change current outcomes.

4. Advanced analytics are bending the curve

While HealthVerity is capable of driving actionable data strategies leveraging both de-identified and identifiable patient data at scale, most LTC carriers are overwhelmed by the torrent of data that this strategy could represent. Licensing access to RWE, RWD and SDOH is the right step, but finding an appropriate analytics partner is the only way for carriers to really profit from the data inflows and to extract the insights required to implement profitable outreach programs. We have seen very good efforts from both Montoux and Milliman in this space to support carriers, but there is much more work to be done around isolating the most predictive data elements and architecting next best actions that truly bend the curve.

I was very impressed with the discussions that occurred at the ILTCI conference and feel confident that HealthVerity can design a data strategy enhanced by the HealthVerity IPGE Platform (Identity, Privacy, Governance and Exchange) as well as by our creation of the nation’s largest healthcare and consumer data ecosystem. Let me know if you’d like to learn more about the conference or how we can help drive your LTC data strategy.