Expanding the use and value of clinical data for life insurers

Digitally available electronic health records (EHRs) hold the promise of improving the quality and completeness of medical reviews for life insurers. While there is a rapid increase in the availability of digital EHR records, they are inconsistent and fragmented – each practice, hospital, and specialist has their own version of the patient history. Insurance innovators are looking to enhance the medical record review process and other applications like data science, analytics and risk management.

Mass adoption of analytically ready, harmonized clinical data has been limited by solutions that lack the automation and economics needed to accommodate the ever-expanding volumes of clinical data. Value can be created for life insurers if interoperability solutions can scale to enable expansion for current and new use cases.

The growing need for data management solutions

Life insurance companies are challenged with managing vast amounts of data from multiple sources and formats, with inconsistent coded data or a lack thereof, and duplicate information. The sheer number of documents and pages reviewed by life insurers, with data dispersed inconsistently across many files, requires the reviewer to embark on a laborious data hunter-gatherer expedition to conduct their review.

Medical record data is often received in different formats from multiple sources, including hospitals, clinics, HIEs, aggregators, and individual practitioners, making it challenging to locate critical information quickly, which is problematic for life insurance use cases that require completeness and accuracy.

Modern API technology for digital medical record enrichment

Clareto adopted CareEvolution’s Convert™ API to automate the conversion, standardization, and analytic readiness of its raw EHR clinical data into an enriched, consolidated patient record. With the Convert API inbound formats CDA, HL7, FHIR, and X12 are processed to a single unified patient centric view for the reviewer.

A unified patient record view

Convert organizes data into categories such as medical encounters, diagnoses, treatments, medications, and laboratory results into a single patient record view. With patient data consolidated in one place, Clareto’s life insurance customers can more efficiently analyze medical history and process applications and claims with greater speed and accuracy.

Conclusion

As an innovator ‘Bridging the gap between Healthcare and Life Insurance’, Clareto saw CareEvolution’s technology as a key enabler to expanding the use and value of clinical data for its life insurance clients.