Some views and opinions expressed on this podcast may not reflect those of Munich Re Life US or its affiliates. Commentary provided in this podcast should not be construed as legal, underwriting, financial, or other type of advice.

Greg Dewey: 
Welcome to our latest podcast discussing electronic health records in underwriting. I'm Greg Dewey with Munich Re Life US. Today we're talking about what it means to lead with EHRs, how carriers can sequence evidence differently, capture more clinical insight earlier, and improve both underwriting economics and mortality protection.

Joining me are Clinton Innes from Munich Re Life North America and Caroline McAvinn from MIB. Thank you for joining me.

Carolyn McAvinn:
Thanks for having me, Greg.

Clinton Innes:
Thank you.

Greg Dewey:
Together, we'll break down the current underwriting challenges, the practical realities of EHR-first workflows, and where this space is headed next. Clinton, let's go ahead and start with you.

Clinton Innes:
Carriers have spent nearly a decade refining accelerated underwriting, but the core challenges – cycle time, applicant experience, mortality, and expenses – are still the same. Instant offer rates are stuck around 12%, and cycle times often stretch to four weeks or more. 

So even with more data sources, the added data sources don't necessarily add more clarity; sometimes they just bring complexity. So how do we make faster decisions without losing mortality protection? And how do we choose the right evidence for the right cases? Accelerated underwriting reduced reliance on traditional evidence like labs, vitals and APS. But it created gaps that third-party data couldn't fully replicate.

EHRs are uniquely positioned in that they really fill these gaps by having the risk attributes needed for underwriting decisions. In fact, Munich Re retrospective studies show that when you add an EHR, this enables not only more decisions without reflexing to additional labs and this type of evidence, but it also means that these decisions have greater mortality protection.

Using EHRs in accelerated underwriting workflows reduces overall evidence costs and speeds up the applicant journey, all while capturing much of the protective value of full underwriting.

Carolyn McAvinn:
What I see from the MIB side of the house is that our industry challenges have been, and remain, what they have been for years. Maybe they were under more of a highlighted microscope starting in about 2014 when accelerated underwriting really came into our space. But the continuous improvement of cycle time, meaning from when an application is received until a decision is made, and the overall customer experience for both the end consumer and the distribution partner, are still highly in focus, as well as the quality and quantity of data, the reduction of operational or underwriting expenses, and minimizing mortality slippage.

So, we've always been challenged with this; it's just in every single conversation now. The good news is that we're consistently seeing improvement in the accessibility of the data, and improving both the quantity and the quality of the data. The studies that I've seen come in through Munich Re are showing that, and referring to the fact that the mortality protection is still there, we can all start to use this type of data more comfortably and not have to supplement it with more third-party data, APS records – just to make sure everything is fine.

I think ten years in now we are getting to a place where we've proven that there’s value in this data; there's quality in this data. We can trust it for mortality. We even see that, at MIB, when we do random samplings of this data that the individual categories, some of which Clinton touched on, are showing up in the records – vitals, medications, smoking status. We are seeing it 80% of the time. 

Even clinical notes that give you that nuance and severity, or compliance information – that ‘s showing up 60% of the time. Even if people go and have diagnostic tests or clinical tests, that type of information is showing up more and more as the technology is getting better at both the record source level, the data source level, and then to aggregators such as MIB, we are delivering more because the technology is getting better.

Greg Dewey:
Thank you both for the insight. That's really great. So when we move forward, how often are EHRs enough on their own? Carolyn, let's start with you for this question.

Carolyn McAvinn:
This is a great question. To really answer it requires a lot of context in terms of use case. How often is it enough? Sometimes it's always enough. If you're looking for a disclosure solution – after underwriting, you just want to make sure – the trust and verify. You want to make sure what the client told you is accurate. I say it almost always works there. For an APS replacement or traditional medical record replacement at a time of new business, whether it's age and amount requirements or for cause requirements, it clearly is working half the time.

The release rates we're seeing are north of 50%, sometimes higher for some of our individuals. So you, minimally, can get directional support there. If you can't fully decision, you can minimally get strong support of where the case should go, directionally. So it really, really matters.

But I like to say – don’t listen to what your neighbors are saying or what they're experiencing. Your block of business might be really different. Your distribution might be different. Your target market might be different. So, just in terms of what we hear for feedback, sometimes 70% of the time it's enough.

But let's think about what you're using it for. Are you using it for a contestable claim review? Are you looking at it just to see how much you want to spend on additional requirements? The value is really, really hard to put one number around.

Clinton Innes:
That's a great point, Carolyn, on the use case mattering a lot. In terms of how we think about how often EHR is enough in the context of accelerated underwriting, we've seen in our research that 75% of typical underwriting cases can be decided with an EHR. To put that differently, about three-quarters of the time for accelerated underwriting, if you have a valid EHR, you're going to be able to support an accelerated underwriting decision without reflexing to the full underwriting evidence.

We're developing more automated rules to evaluate EHR sufficiency based on more defined and quantitative metrics. But as EHRs continue to grow, we think this is also an opportunity for carriers to really rethink how they view more thin EHRs in the context of accelerated underwriting.

Think about how early accelerated underwriting programs made use of eligibility-only cases for prescription drug records. Cases that come back with no data were treated quite differently than those which indicated that a person had prescription drug coverage but just hadn't made any claims yet. So today, EHRs don't yet have the equivalent framework for identifying those healthy individuals who have a family physician but haven't produced too many medical records because they've simply been too healthy to do so.

Establishing a clear framework to, for example, identify younger individuals who do have a family physician and don't have any adverse health conditions will be key to tracking mortality on these cases to help the industry gain confidence in using EHRs to identify healthy individuals based on the absence of records, not only based on the records that they do have.

Greg Dewey: 
Very good. How should carriers think about the sequencing of underwriting evidence in order to get the most value out of the EHRs? Carolyn?

Carolyn McAvinn:
This is a question that we get a lot at MIB. A lot of times, we're posing adoption of EHR in workflows, and sometimes our customers just don't really know where to start. I am a huge proponent of the EHR-first strategy, especially if you're using a vendor that doesn't have a search fee, so you're not harmed by searching, even if you don't find a record or there's no minimums required. I really think, what's the harm in casting that net? To see if there's an EHR, you can get the information you want quickly, for less cost, and then simply pivot to what's missing. 

We recommend, or I recommend, a state-level view. First of all, you can just send it everywhere. What's the harm? But if you really want to be more strategic, why not use a state-level view, which we supply to our users? We update it monthly. We're really on top of it. We go after states where the application activity is high, which we can see through MIB Checking Service data. So why not start there?

I really discourage customers from doing an impairment-level search strategy. I think that's outdated thinking. It was popular 5 or 6 years ago when maybe the data was a little bit lighter, but now it is becoming so robust, as we talked about before – of how often it's showing up – that why not just go where the data is rich, go to the states where it's rich, and start there if you want to start slower, if you don't really want to be all in in searching.

That is my advice; that's how I would construct it. Release rates – we’re still dealing with perception issues with release rates being low, even though they're north of 50%. I just looked at some of our customers that are searching at scale, like in the thousands per month. They're hitting 60%, especially with all the data sources that that we've brought in. 

Combine that with the hit rates, of the data that's showing up in the records, and you don't always need to get an APS – that's really shifting as to how often you have to pivot for that. In fact, in our last metrics I just looked at, we had 12 states that we are seeing a consistent release rate over 60%. Colorado was actually at 84%. I mean, we're getting up to prescription-level release rate territory. We had New York, Virginia, and Maryland all at 70%. So those old perceptions of “the data’s not there, “the release rates aren't enough,” it's really just outdated.

If we have customers that did pilots, even let me say 12 months ago, that's too old. That's too old if you're using that data to really think about your search strategy. So personally, again, I am all about the state level and remove that impairment-based strategy because it's just not accurate anymore.

Clinton Innes:
That's a great point. There is a lot of variation by geography and hit rate, so definitely leveraging that in your strategy makes a lot of sense. In terms of how we see the best way to really leverage the sequence of evidence, as Caroline mentioned, it depends a lot on your use case. We think, for purposes of an accelerated underwriting program, ordering an EHR early captures that protective value really upfront for a larger share of applicants.

When EHRs come first – ordering an EHR and then ordering medical billing codes, insurance labs, in cases when you don't have the necessary evidence – you’re able to make more decisions and also reduce total evidence cost overall. That's a little unintuitive, but we're going to go into that more later.

When we make EHRs the first piece of evidence it significantly reduces the number of cases that require full underwriting or an attending physician statement. And it also leads to much better cycle time since EHRs arrive in a day or two, which is much, much faster than insurance labs or attending physician statements.

Carolyn McAvinn:
Or minutes…or minutes.

Clinton Innes:
In minutes.

In our upcoming retro study, in fact, we're going to see that not only do you get much better mortality protective value from EHR, but you're actually able to make a decision on 80%+ of applications provided that you have an EHR. So exciting progress we're seeing in this area for sure.1

Greg Dewey: 
Great insight from both of you. I think the state level especially offers a lot of opportunity for those that maybe want to kind of dip their toes in it, get an experience with it, and hopefully see the powerful tool that it is before going more broadly, because it's definitely got a ton of value there in the industry.

Carolyn McAvinn:
And I love Clinton's 80% of cases. I'm already going to use that. Like in the next five minutes I'm going to be using that. So that's a great stat.

Greg Dewey:  
What is leading with EHRs? What are the benefits, Clinton?

Clinton Innes: 
We've alluded to this a little bit already – leading with EHRs is exactly what it sounds like. It means simply ordering an EHR as the first piece of medical evidence and using it as your primary evidence source. This lets carriers reflex to additional evidence – like labs, billing codes – only when necessary, which strengthens both the economic and protective value of underwriting.

So the benefits of this are substantial. Carriers can, based on our studies, cut lab expenses by up to 15%, all while maintaining mortality protection. Because EHRs contain fully underwritten evidence like clinical data, you're able to not only cut these expenses, make better decisions, but you're also able to improve cycle time.

Since fully underwritten underwriting typically can add 20+ days to overall underwriting times, the reduction from leading with EHRs can be really significant from the applicant's experience – up to 25% improvement in underwriting time is what we've seen for typical industry-level programs.

Carolyn McAvinn:
That's great. Like Clinton said, we covered a little bit of EHR first in prior questions. The other benefit that I see is it really does enable a more personalized approach to underwriting and tailor each applicant's own particular health history. Do we really have to always get a lab, maybe an insurance lab, on a customer when clinical labs are in the record and speak to that client's particular history?

I like the idea of allowing underwriters to use that critical thinking muscle. Either use it or start building it more to determine: What is enough? Do I have enough here – combining information from what the clients disclosed with other third-party data? We have to go from a must-have mindset to a nice-to-have – or wait, reverse that – the nice-to-have to the must-have, because sometimes it is just not additive. It is just duplicating what we already have and what we already know by going for an APS, just because you think some of the EHR data might be a little bit light or not feel and look like an APS.

That's something I think we can get to in one of the benefits with leading with EHR – it’s the only piece of data, or electronic data, that has the ability to give you so much information, more so than the single types of electronic data does, such as prescription or just claims data, or just billing data. So, why not start with that and then just see where you need to go?

Greg Dewey: 
That's a great point. Kind of shifting gears, we talked about the benefits. What are the challenges of leading with EHRs? 

Carolyn McAvinn:
EHRs are a patient-centric search, if you will. We go and we hit the database for anything on Carolyn McAvinn. People are still hungry for a provider-centric search – minimize the noise, I don't want what I don't want. I want the cardiac records from Doctor Smith for Carolyn McAvinn.

That’s something that we're really focused on at MIB – figuring that piece of it out. I will tell you that we will figure it out in a way that makes sense, that isn't gimmicky. We don't like the idea of coming out with something that works for some of the data, but not all of it. We really prefer to have something that works with all of our EHR vendors and suppliers.

We're actively looking at that because we think that's really what the industry is demanding right now. That is a challenge, though we could still flip that around and say there are still benefits; you find out with a patient-centric search what’s not disclosed. There's going to be a little bit of give and take. What I think is going to happen is we're going to solve for it, and that people are going to be, “I want to go back to the patient-centric search.” We’re not going to be able to please everybody, but that's a perceived challenge out there. 

A second one is that, for decades, underwriters were using APS that looked and felt the same. EHRs don't always look the same. It's raw data that gets converted into a style sheet. They're not all the same. We hear a lot about that. At MIB, we choose to offer tools to enhance the usability, whether it be a summary service that we offer, or a data consolidation – cleaning up, duping the data. We have answered those complaints with solutions. But there are still challenges that we hear of and that we deal with day to day.

Clinton Innes:
That's a great point about the impairment versus patient-centered view, since, for leading with EHRs, I feel like the patient-centric view is where it will go eventually. But for sure it's better.

Carolyn McAvinn:
It's better. But we give the market what they want.

Clinton Innes: 
We talked a little bit about why it's challenging to put together that impairment-centric view – it’s that EHRs are long, they're unstructured, they're time-consuming to review. 

How do we enable the use of EHRs more broadly, while also being mindful of the impact of underwriters, because underwriters are the most important? Fortunately, new tools like Munich Re’s alitheia are making automated and light-touch EHR decisions possible. In fact, our recent AUW survey found that roughly 30% of carriers expect to make instant decisions from EHRs within the next 1 to 2 years.

Moving EHRs to this accelerated underwriting use case is very much top of mind for the industry. I will say, even without all these enhancements to EHRs as well as the adoption of instant decisions, there's still an opportunity to leverage leading with EHRs for programs that already have very manual review processes. For example, high net worth product line – these are already fully underwritten. Adding an EHR here has a great opportunity to really improve cycle times, as well as improve the customer journey even today with more manual review of EHRs.

Greg Dewey: 
I think that's what's really impressive about a tool or an approach like this is it really allows us to get the best value. We're not just throwing a fishing net out as much as it’s, “Here is where we want to be very focused and getting that information.” Looking ahead, what future trends do we expect to see in EHR underwriting? Let's start with Clinton.

Clinton Innes:
The future of EHR underwriting is strong. With ongoing improvements in data quality, automation, and carrier adoption, the value of EHRs and underwriting will keep expanding, making this an increasingly compelling strategy going forward.

Carolyn McAvinn:
From my perspective, I touched on the provider-centric search functionality already. That will become a must-have for some of our users. But I think the next real big thing is going to be a focus on accessing a specific type of content, versus a record. So, if you're looking for labs for Caroline McAvinn, tell us what you want, tell us what you're looking for, and trust that your data aggregator is going to source that for you. It shouldn't really matter to you where it's coming from. It shouldn't matter if it's an EHR. It shouldn't matter if it's a clinical lab that we have access to. Just tell us what you want, and we'll get that for you.

I think that there will be less emphasis, too, on how many data suppliers that you are connected to. For a long time, when customers are coming in and trying to figure out who they want to partner with as a data access provider it’s, “How many data sources do you have?” What difference does it make? What if I have 100 and 50 of them return nothing or poor quality data? It really is going to go back to, “What do you want?” Trust us to source it for you. That's going to be what's coming in the next few years as the next big change. That, and the provider-centric search, for us anyway, are the two things we're paying a lot of attention to at MIB.

Another thing looking forward about the future of EHR underwriting is access. Historically, the records that MIB retrieves for customers are all based on the HIPAA consent process. What you'll see come in 2026 through MIB is an individual access services approach, which doesn't rely on the HIPAA consent process. It is using the patient's direction to send the records to MIB to access information on their behalf. More to come on that in likely Q2 of 2026.

Greg Dewey: 
That's really great insight. Thank you, Caroline, and thank you, Clinton.

Carolyn McAvinn:
Thanks for having me, Greg.

Clinton Innes:
Thanks, Greg. 

Greg Dewey: 
I've really appreciated the conversation today. I also want to thank our listeners for joining us. Stay tuned for our next podcast, which will dive deeper into underwriting with EHRs. Thank you.