Dave Goehrke:
Welcome to our latest podcast discussing electronic health records in underwriting. I'm Dave Goerhke of Munich Re, and with me today are my colleague Katy Herzog and, welcoming for the first time, a guest, Jas Abla from MIB. Welcome to both of you. Munich Re has, as of this year, a new relationship with MIB, and we thought it would be a good idea to get Jas's perspective on this underwriting evidence, as well as updates from Katy since our last podcast with her as a guest. Starting with you, Jas, tell us from your perspective, high-level, what is an electronic health record, and why is it so important for insurance?

Jas Awla:
Good to be here, Dave. From my perspective, EHRs are digital versions of patient medical records enabling fast, structured, cost-effective access to the most critical health data needed for risk assessment. They are very, very important in my mind because they streamline risk assessment and improve both operational efficiency and customer experience.

Dave Goehrke:
Katy, how about you, from your perspective? Could you tell us your thoughts around electronic health records?

Katy Herzog:
Thanks, Dave. I agree with Jas. As we hear Jas talk about what they are, we begin to understand what EHRs can bring and the benefits that they present for us in life insurance. As opposed to traditional attending physician statements, or APS, EHRs really can provide that quicker access to patient records containing longitudinal health data. So many view EHRs as simply a replacement for APS. We've seen that a lot, Jas and Dave, I'm sure, but they can do a lot more than that, like providing additional mortality protection for fluidless or accelerated underwriting and eliminating the need for a paramedical exam and labs. EHRs really can increase the accuracy of our risk assessments, and ultimately, they can provide a better customer experience through speed and less friction.

Dave Goehrke:
So much of underwriting now is digital. Jas, what would you see as the advantages of EHR data compared to these other digital data sources?

Jas Awla:
That's a great question, Dave, and one that we get asked a lot. When you say other digital data sources, I'm a big believer that every data source has its place, and there is a value in that. The EHR, however, stands out in my mind, just because it kind of has elements of all other data, digital data, at least for medical purposes, that are out there, such as Rx, labs, health history. It’s fast, like I spoke of in my earlier comment. For most EHRs that we see, we get same day response. For a great number of patients or applicants, it’s also complete; it's pretty comprehensive. We have a pretty wide network from where we pull EHRs and we grab a pretty complete view of a patient for the most part. So I do believe that while EHR has a certain leg up in terms of being real-time, improving completeness, great value at a reasonable cost. I continue to believe that the choice is with our members and insurers, and we continue to enable our platform to provide that choice.

Dave Goehrke:
Right. It's a big question. Katy, as an underwriter, from your perspective, how would you answer that question in terms of advantages of an EHR compared to other digital data?

Katy Herzog:
I think of it from a risk selection point of view. And I think about the accuracy and then our process, whether it's turnaround time or even cost like Jas mentions. Being digital means that EHRs can be integrated into our modern underwriting practices, and it really supports that automation and the integration with algorithms for improved underwriting decisions.

Dave Goehrke:
Great. So a lot of interest in this space. Jas, why did MIB enter the EHR space with the acquisition of Clareto and the strategic partnership with Munich Re? What might be the strategy behind this?

Jas Awla:
MIB actually got into the EHR space about five years ago, Dave. At MIB, we serve the life insurance industry at the behest of our board members and the industry. Five years ago, it was an interesting data source. But today it's not just interesting – it’s proven, it’s in the workflows. With Clareto, there was a very unique opportunity for the benefit of the life insurance industry. It was almost a no-brainer for a few factors. One of them is just the broad access to the network that both we have and Clareto has. It was siloed, and all of our member insurers had to pick and choose which one. And integration is not cheap. IT is not cheap. Creating workflows is not easy. So bringing that broad network on one platform, I think is a big win for the industry where members get the benefit of that.

Also, along the same lines, other features. We invested independently; MIB thought of what features on the platform would be interesting and useful for our members. I think equally, Clareto also spent the time, energy, and effort to think about what features would be useful and meaningful for the members. What we have brought all the features together. So I think that's another great benefit.

One of the things that I don't think gets spoken of much is the economic model and the feasibility and stability of a business. There are very thin margins. By virtue of bringing together the scale, I think it makes a much more viable business, both for the short term and the long term. That is also a benefit to the industry for the sustainability of the data that is provided through the platform. Five years ago, the question always was: Can we find an EHR? And now more and more, we get the question around: How do we make the data more actionable? Having that partnership with Munich, where we can leverage the ability to create some actionable aspects around the data with analytics, is very valuable as well.

Dave Goehrke:
It makes a lot of sense. Katy, you and I have worked very, very closely with the EHRs, especially since Munich Re acquired Clareto back in 2022. This does seem like a very natural progression, but what are some of your views on the MIB acquisition of Clareto?

Katy Herzog:
For me, it's exciting. It's really cool to hear the things that MIB has done and the work that they continue to do to improve and really bring EHRs to the forefront. As I think about Munich Re and what we do best, that's underwriting experience and risk expertise, and we'll continue to focus on those, and we'll look at and continue to work on advanced data analytics to enhance the value of EHRs for risk assessment. This partnership helps accelerate that.

Dave Goehrke:
Jas, I don't know if you use the term hit rates, but I'll use the term hit rates. Let’s talk about that briefly. This is a concern among carriers, or thought. I know numbers are improving steadily. Maybe not as quickly as we'd like, but steadily. How are we progressing on this front?

Jas Awla:
100%, Dave. But before I comment on the actual numbers, I do want to address that hit rate is a very vague term, and it's interpreted differently by companies. Some use it as a record retrieval metric, and others as a usability method. We prefer to use the term release rate, and release rate for us --the best way I can explain that is -- if a hundred people show up at my store and 40 of them walk away with the product, then we have a release rate of 40%. And the unfortunate part of that is 60 walk away without a product. But that's essentially what release rate means. And it is very meaningful. Five years ago, we were at a release rate of about 5 to 10%. Today we are at 50%, and we are very confident with the two platforms coming together, in ‘26 we'll be at about 60%. There are a lot of interesting questions that come to mind when it comes to release rate, and one of them is what will be the entitlement point for release rate, and at what point will it cap out. Nobody really knows that today, but my suspicion is at about 80 to 85% is when release rate will cap out. And I think we'll be at 60% in ’26, and then successively every year we'll be marching towards that.

Dave Goehrke:
85% –  that would be great. We talked about other digital sources, and that's getting up there with many of the others.

Jas Awla:
100%, Dave. One of the hypotheses we have always had is – at what point can members and insurers start using EHR in their workflows at scale? When you have a release rate of 5 to 10%, it's mostly a pilot. It's an experiment. It's really using it just to understand the value. But at 50%, we are seeing that it's becoming a very integral part of the workflows in production. At 60%, I think that everybody should be should be using EHRs. But really, anything beyond 60% is definitely a gift.

Dave Goehrke:
So acquiring the data or the hit rates or release rates is important, and you said using the data. Katy, that's a whole different topic. Are you actually using the data? How do we use it? Usability?

Katy Herzog:
I'll talk about usability, Dave, if I can go back to hit rates for one second, or release rates, as Jas likes to talk about it. I can corroborate; we've seen those increase as well. In the work that we've done with our clients and our carrier partners, we've consulted and partnered with them. We've done our own retroactive studies. Three or five years ago, when we did a study, hit rates were pretty low. They were what Jas mentioned, 10 - 20%. But now, as we've done it, they're moving into the 50s, 60%. It's really exciting to see that. So now as we move, we've got a meaningful amount of records being released digitally to us. Now, how do we focus on the usability of those records? Because they come to underwriters in sort of this different format. There's still quite a lot of information in there, including non-structured data. So our emphasis has really been on making EHR reviews more efficient for our underwriters, but also for those automated solutions that can effectively ingest and process this data using AI to create consistent and standardized outputs.

Dave Goehrke:
I want to touch on something - a topic that is interesting to us. It's been a topic since EHRs first came into the life insurance market, and that's APS. I hate saying APS for comparison because I hate thinking that way, but everyone talks about it still. So let's dig deeper into this comparison. There's debate in the industry as to whether an EHR can fully replace an APS. Jas, what’s MIB’s view on this?

Jas Awla:
You said it, Dave. I struggle with the comparison as well. It's a tough question when you’re asked to compare EHR and APS, because I believe they both have a place for being useful. It's almost like when somebody asks me, of the two kids I have, which one is better. I say both are great.

There is a place for APS. We have spoken about release rate in this conversation, and we are at 50 to 60%. So, there is still that gap that needs to be filled. And can APS fill that gap? Absolutely. It all boils down to the trade-offs, right? I do think EHR has some advantage in terms of being real-time or near-real-time. As time goes by, it is getting more and more complete – that’s getting to be a big advantage that EHR has.

Also, if you think about the value that EHR provides at a very reasonable cost, that's a big benefit for EHR as well. If you think about the customer experience, that's something I don't think we can ever speak of enough is that we live in a world where everyone experiences – at least the digital experiences – the bar is set by consuming information and getting decisions at the point of sale. If you think about Netflix, Amazon, and everything is about ease of use. In the life insurance industry, we are also trying to create better experiences for our customer. I think EHR has that promise of improving customer experience so that the policies – accelerated and automated policies – can be bound at the point of sale or, if not at the point of sale, in close to real time. I think in that aspect, EHR is very, very promising.

I always feel we don’t have to give up one for the other. One can embrace EHR and also reflex to APS if need be, which is why we have invested heavily on our platform for our reflexive abilities. We can very quickly reflex to an APS.

Dave Goehrke:
Yep– a lot of work going on in that direction right now. Katy, I know you've got opinions on, as a replacement for APS. What would you like to say on this topic?

Katy Herzog:
How do we reframe how we look at EHRs? Something that I really believe in, and something that Munich’s been working on and looking at is: Can we move beyond EHRs solely as that replacement and look at them more holistically as just another valuable digital third-party data source that we have in our tool belt? What if we moved EHRs up front in the underwriting process? We’re currently studying this and looking at this. Early indications are favorable, suggesting both cost and mortality slippage savings relative to traditional fluidless and fully underwritten, where medical records are ordered traditionally at the end of the underwriting review.

Dave Goehrke:
Katy, when you talk about moving an EHR up front in the process are we're really talking about: Is the data complete enough, or can we make a decision with the ER? What about that? Can you expand on that?

Katy Herzog:
We talked about release rates earlier, and I think we're at a point now where we can really move beyond that discussion and focus on that comprehensiveness, as you asked, Dave. If we look at EHRs, do they routinely include that information that we as underwriters need to assess the risk? Do they have physical measurements? Do they have all the medical diagnoses, the severity? Do they have the treatments? Really, the question is when is an EHR enough versus when do we need additional information that we can get from those other sources?

We're beginning to get a clearer picture based on our extensive experience, as well as the recent EHR retroactive studies that we've recently released results for. I won't go into too much detail here during this talk, but just at a high level, in those studies, we reviewed underwritten files provided by multiple carriers representing diverse distribution and markets, and we found clear benefits for both fluidless and traditional underwriting with that traditional paramed and laboratory results, including a net increase in the decision rates without sacrificing mortality. Even for the fully underwritten with those traditional medical records or the APS, we identified opportunities to realize that benefit to speed and cost while optimizing financial impact. So it really does underscore the advancements that we've seen and reinforces the value of EHRs in delivering efficient and accurate risk assessments, while delivering improved customer experience and really driving to ultimately better outcomes.

Dave Goehrke:
On the topic of decision-making, I know you're not an underwriter, Jas, but I know you and MIB are doing a lot of things to help with enhancing the usability of the data. Can you talk about that briefly?

Jas Awla:
Absolutely, Dave. At MIB, we believe in the ability of EHR to be a very, very credible source of data to enable underwriting. We absolutely believe in that, and we have believed in that for a long time. With every passing year, as the completeness of EHR improves, as more and more are released, those beliefs are not just our beliefs anymore. I think the industry also has backed us, and based on the research and all the things that Katy said, it's working out really well. Five years ago, we always asked, can you can you return me any EHR? The question now being asked is, and – I think it's a natural progression – first, it was about can you even just get the data. Now it's about: Is the data useful? Usable, not useful…well, maybe also useful. How do we consume it effectively?

We have spent a lot of time, energy, and effort in finding solutions for the usability aspect. We offer data consolidation, including cleansing and de-duplicating data and converting it into a standardized format, which optimizes it for ingestion into engines. We also offer EHR summaries that consolidate data and present it in an underwriter-friendly, streamlined format so underwriters know exactly where to find the most critical information that they need, each and every time they pull a report.

I'm not sure if I said this before, but I think it's important that clients can systematically reflex records for data consolidation or summarization and receive output back right within our system. This goes back to the conversation – Katy said it well when she said we need to reframe the conversation around EHR and APS. Here's the thing – you don't have to give up anything to embrace EHR. You can use EHR and you can also always use APS. That's why our platform provides the option to reflex. We are going to add more and more options in terms of the ability to reflex. So really, no one needs to give up any data that they like as they embrace EHR. I'm a big proponent of EHR-first, but you can always reflex to an APS or other data source, even a digital data source that you have used in the past.

Dave Goehrke:
It’s a really good point. You don't lose anything by trying it, and there are a lot of ways you can try it or get started. Katy, what advice would you have for organizations looking to expand their use of electronic data?

Katy Herzog:
I might sound like a broken record because I've said this before, but I think it's important, and it still rings true. Each carrier's business is unique, and we really do recommend that they complete their own analyses to determine the specific business impacts. I'd say as well – leverage the knowledge and expertise of your solution providers and, of course, your friendly reinsurers. We're happy to help and support you in exploring the potential benefits and effectively integrating EHRs into your programs wherever you are in your journey.

Dave Goehrke:
How about you, Jas, do you have any thoughts on that?

Jas Awla:
MIB and I personally absolutely believe in EHR, and I encourage anyone I talk to try it if they haven't tried it yet. I do believe the adoption is increasing by leaps and bounds. EHR product has been used consistently in production workflows for over five years now, so we are beyond the point of: Does this type of data hold value? It's been proven in several industry publications and studies. So what we really need to focus on now is enabling adoption for companies that don't know where to start. That’s where MIB customizes the approach for each customer to meet them where they are in their individualized meetings with either leadership or actual users of the product. This is where you know we excel in terms of product support and building and sharing tools to execute a strategy for success.

Dave Goehrke:
We've covered a lot, Jas. Anything else you'd like to say now about the future outlook for MIB’s EHR solution in the industry?

Jas Awla:
Dave, I think the future for EHR is very bright. Looking back to look forward, I think we have come far, leaps and bounds, from when we started. Looking ahead, we are going to go even further. The reason I'm very confident about that is, 1: because EHR is a proven data source now, and 2: because we are very focused on what our consumers, which are the insurers and members, need. So we are building more and more choice for them. We are providing them more and more options on our platform in terms of reflexing, flexibility, and we’re also going to keep introducing other data types. EHR in and of itself will also improve. So if you take all of those factors together, which are improving EHR, better adoption, and the focus on what our insurers need, the best days are ahead of us.

Dave Goehrke:
Katy, how about you? Any final words from you in terms of the future outlook for MIB’s EHR solution and the industry?

Katy Herzog:
I agree with Jas. I think the future is definitely on the up, and it looks very bright, and I’m excited for it. As we see the industry continue to invest in digital tools, EHRs will become integrated across all underwriting applications and even extend to other areas of the business, such as claims. At Munich Re, we are dedicated to supporting our clients and the industry as a whole, and we strive to deliver a comprehensive suite of solutions that empower our partners to unlock the full potential of EHRs, streamline their operations, and support strategic growth.

Dave Goehrke:
There's a lot of development and excitement around this data-rich underwriting evidence. Thanks, Jas, and thanks, Katy. We appreciate your time.

Jas Awla:
Thanks for having me, Dave. It was good.

Katy Herzog:
Thanks, Dave. It was great to be with you and Jas here today.

Dave Goehrke:
And thank you to our listeners. We hope you enjoyed the podcast. Coming soon, Greg Dewey will host an episode focused on EHR use cases. Thanks again, and take care, everyone.