GOING DEEPER
CH. 1

IMPORTANCE
The relationship between income and life expectancy is well established but remains poorly understood.

OBJECTIVES
To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation.

DESIGN AND SETTING
Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy.

EXPOSURE
Pretax household earnings as a measure of income.

MAIN OUTCOMES AND MEASURES
Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas.

RESULTS
The sample consisted of 1,408,287,218 person year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61,175
per year). There were 4,114,380 deaths among men (mortality rate, 596.3 per 100,000) and 2,694,808 deaths among women (mortality rate, 375.1 per 100 000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI,14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = −0.69,P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and government expenditures (r = 0.57, P < .001). CONCLUSIONS AND RELEVANCE In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics. Continued

Ample research demonstrates the mind’s capacity to influence a person’s health, both positively and negatively. If left unchecked, depression and despair can inhibit recovery from illness and lead to hopelessness and premature death.

Researcher Ken Wells, in the landmark Rand study at the University of California, Los Angeles, found that 50 percent of all depressed people are over 65. Wells studied depressed versus nondepressed people and found that depressed elderly patients used four times the amount of health care dollars than nondepressed seniors, and had a 58 percent greater mortality rate within the first year of admittance to a skilled nursing facility than their nondepressed counterparts.

For example, depressed people tend to lack motivation to get up and move about. This inactivity makes them susceptible to urinary tract infections and pneumonia, which if left untreated can lead to kidney failure and death.

Stimulating the mind and body

For a community’s enrichment and activity program to be effective, it must be sensitive to the emotional forces that motivate people in this age group. The program must be designed to redirect their focus away from their limitations and toward productive, educational and social activities with a positive emphasis that will enhance the quality of life.

Today’s senior apartments are full of activity. Residents are attending college courses, cooking classes, traveling, and remaining active in service organizations in the community. Variety and respect for individual preference are key elements in a successful recreational activities program. Leisure interests are lifelong habits that each person develops. These interests continue into later life, even after one has entered a senior living community.

A sense of purpose

Many innovative programs utilizing different services and modalities have been developed. Where communities provide supportive living and socialization, along with medical care, resident functioning is enhanced and deteriorations of old age are significantly delayed.

More and more research shows that if seniors want to feel younger and stay healthier, they need to get involved with life. The very act of volunteering and interacting with others brings a sense of purpose and contribution to one’s self and community in a way that can actually build longevity while strengthening the body, mind and spirit.

Improving brain function

According to recent studies, there is a strong and direct link between physical activity and how the brain works. Different types, amounts and intensities of physical activities improve brain function. Michelle Carlson of Johns Hopkins University is working with a novel new program called Experience Corps. This program embeds physical and mental activity into weekly volunteering for older adults to mentor children in local elementary schools.

“We need to address socioeconomic barriers to motivate older adults to regularly engage in healthful behaviors,” Carlson says. “And many people don’t appreciate the power of physical activity for our brains.”

Multiple studies from this and other similar programs have found that regular physical and mental activity has resulted in improved memory and other cognitive functions.

Theme-based activities

Intergenerational programs are part of the routine at Renew Roaring Fork. “We have a weekly music expressions group which brings seniors at the community together with toddlers to share a regular musical journey and explore the feel, sound and vibrations from various musical instruments,” according to Jennetta Howell, Renew enrichment director who leads the group.

As a musician and former singer/performer, she has both experienced and personally witnessed how the children and residents interact through the common string of music.

“The residents, children and moms all look forward to these weekly sessions which leave everyone invigorated and engaged,” she said.

She has found that targeting low-intensity activity that is theme-based, in this case music, is an important and scalable intervention that leaves everyone challenged and satisfied.

Meaningful impacts

Many older adults have a desire to participate in meaningful, productive activities that have been proven to be highly beneficial. In one recent study published in Aging magazine, epidemiological data suggests that for older adults, volunteering and intergenerational activities have been associated with lower mortality, improved well-being, life satisfaction and may decrease functional decline.

We all age differently mentally physically and emotionally. Whether you are you are simply experiencing “senior moments” or have been diagnosed with dementia, research shows that the condition is never bigger than the person and that there is something everyone can do to make an impact.

Whether it is helping children with reading skills or making art to donate to an underprivileged children’s program, seniors are not done yet and they still have something to contribute — and seniors are strengthened from that contribution, according to research in major universities like Johns Hopkins.

“We use activities and programming to promote a sense of well-being and purpose,” explained Lee Tuchfarber, CEO of Renew Management. “This provides a sense of accomplishment and contribution that is ‘instrumental’ to combatting the unhealthy effects of boredom and depression.“

Active aging

Research shows that creativity and imagination are untapped reserves in all elderly people and even in those with dementia. Given that, it’s possible that true retirement can actually become obsolete for active adults.

“We believe there are no age limits and that age is just another limit to shatter,” according to Mr. Tuchfarber. “Participating in a volunteer program drives health benefits through increased physical activity, a sense of contribution, and social connectedness. … Keeping busy by volunteering is a form of active aging and if you don’t use it you lose it, but if you do use it, you become stronger,” he concluded.

Originally posted Sept. 11, 2019 on www.postindependent.com

Commissions are an important part of the life insurance and annuity business model, but if the process does not go smoothly, it can impede effective partnerships, increase costs and waste valuable time.

InsurTech Express is rethinking the way life and annuity providers handle the complex challenge of commissions—leveraging technology to solve historic issues and enabling participants to focus on growth and serving customers well.

InsurTech Express published a White Paper, available for free download at InsurTechExpress.com, explaining how in today's marketplace, the current life and annuity commission model is archaic and cumbersome, resulting in wasted time for all parties—time they would prefer to spend on growth and serving their clients' needs.

"The Commission Blockchain plan that InsurTech Express is launching can streamline the entire commission and contracting process for participating carriers and distributors alike," said Dan LaBert, CEO of the National Association of Independent Life Brokerage Agencies (NAILBA). "Ken and the team have designed an innovative approach to leverage the latest blockchain technology to solve recurring challenges our members see in their businesses. I look forward to NAILBA members further engaging in this exciting new technology that could resolve commission accounting concerns."

"The InsurTech Express Blockchain for Life and Annuity Commissions solves many pain points that distribution and carriers have experienced for years," said Ken Liebow, InsurTech Express Founder and Chief Executive Officer. "This innovative approach to paying commissions will reinforce trust between all parties. By setting up commission schedules and hierarchies, the new process eliminates manual entry into Agency Management Systems. All parties will have easy and secure access to their unique respective commission statement details for all parties in one place with clean, accurate information. We are delighted with the early favorable feedback on this revolutionary model. This commission Blockchain model delivers secure and reliable capability and truly is a gamechanger!"

"Blockchain technology has the potential to simplify and improve the overall speed and accuracy of the commission accounting process," said Sherri Isaacson, Director of Agency Management at Ebix, a leading international supplier of On-Demand software and E-commerce services for the insurance industry. "The establishment of commission schedules and payment transactions at a single source then shared with the distribution chain will remove one of the biggest pain points of a BGA Commission team – duplicated data entry."

About InsurTech Express

InsurTech Express is a leading technology and process improvement central resource for the life insurance and annuity industry, including carriers, distributors, and solution providers. With a core leadership team totaling more than 100 years combined experience, InsurTech Express focuses on technology, process and education.

Originally posted August 22, 2019 - prnewswire.com

Both U.S. life settlement trade groups are up in arms over what they see as carrier interference in the market, with one of the groups lambasting it as "encroachment."

The life insurance and life settlement industries long have been at odds, but the situation has heated up lately with efforts apparently by insurance companies to interfere with the life settlement market by making competing offers on policies and demanding purchase prices under a yet-to-be-finalized Internal Revenue Service rule.

An attorney representing the largest trade group, the Life Insurance Settlement Association, wrote to insurance regulators last fall complaining about what he saw as illegal conduct by Lincoln Financial Group in offering more than 5,000 policyholders the option to take enhanced cash benefits to retire their policies.

If any of the offers were accepted, it meant those policies would never hit the life settlement market and the insurer would never have to pay death claims for them.

Now, LISA said that Sun Life Assurance Co. of Canada has begun taking a more aggressive approach this spring - competing one-on-one with life settlement providers when it learned policies were for sale after change of ownership, change of beneficiary or verification of coverage requests were made.

In return for surrendering the policy, the insured would receive the cash surrender value plus an additional payment. Sun Life has entered into bidding wars with providers, raising offers in response to higher life settlement offers, LISA said in its Thursday, June 20, Public Policy Council teleconference packet obtained by The Life Settlements Report.

In addition, other carriers, including John Hancock Life Insurance Co. and Protective Life Insurance Co., are apparently sending letters to policy purchasers saying they must tell them policy sales prices due to a new IRS reporting rule under IRC 6050Y, which were added by the Tax Cuts and Jobs Act.

The Life Settlements Report has seen a copy of a John Hancock letter demanding a purchase price with the recipient's name blacked out. A source said that Protective Life has written a similar letter, although a copy of it was not available to be verified.

There's one problem with this: the rule hasn't been finalized and the law implementing the rule said carriers are not entitled to pricing information.

The request so alarmed Jack Kelly, who heads the other trade group, the Institutional Longevity Markets Association, that he said he reported the demand to the IRS general counsel's office about a month ago.

"ILMA has been actively involved in this issue since it was first brought to my members' attention in mid-April," Kelly, managing member of ILMA, said.

"We've advised our members that such requests for information are premature and unwarranted until such time as the final rule has been promulgated," he added.

He said he didn't know if not responding to a request for pricing information has held up any transactions, saying he's aware of three cases in which such requests were made. He declined to name the carriers which made the requests.

Ruth Ray, compliance director with Montage Financial Group Inc. of San Juan Capistrano, Calif., said her provider received a notice from a carrier asking for the price for a purchase about eight weeks ago when the provider made a verification of coverage request.

She didn't remember which carrier sought the information, but said the transaction wasn't held up after her company told the carrier that reporting information isn't required yet.

Ray gave the carrier's representative the benefit of a doubt about why it was making such a request.

She said the representative "might have had good intentions" and may have been "just a little uninformed."

LISA's leadership is so perturbed that it put the IRS reporting and "encroachment" issues on the agenda for its teleconference meeting for its new Public Policy Council last week to discuss the situation.

"The issue of carrier encroachment is LISA's top priority because if a party interceded or transacted a life settlement without proper licensure and disclosures required by various states that would be highly disruptive of the regulated life settlement market," Chris Conway, board chairman of LISA, said.

Life settlement companies in most states must be licensed, he said. Many of them require brokers and providers to get forms approved. In addition, many of the states require consumer disclosures such as the right to rescind a sale, he noted.

"These regulatory protections are not afforded to them (consumers) if transactions are happening outside the regulations," Conway said.

"Right now, we've become aggressively proactive to inform the regulators and their staff where we have clear documentary evidence of encroachment to address this issue," he added.

He said LISA still is in the evidence-gathering stage and is asking its members to send him or the group's CEO, Bryan Nicholson, or staffer Nisha Thakker any information on what they're seeing. They're with Association Management Strategies Inc. of Washington, D.C., the outside management firm that has been running LISA since April.

Once the final IRS regulations are completed, he said LISA will hold a series of educational sessions for its members on how to comply with the new tax reporting requirements.

"We do expect there will be parties who will not be familiar with the specific requirements for each of the different kind of reports," Conway added.

He said LISA knows anecdotally that some carriers have asserted their right to pricing information.

"There is a fair amount of confusion among market players with respect to the specific regulations and how they apply to the vast array of transactions. It's not beyond the realm that carriers might be confused at the operational level," he said.

Conway said his group has no verification yet on whether requests for prices and any refusals to provide them are delaying transactions because the group is in the midst of collecting information from its members.

But wrongly asking for such IRS information could have consequences.

"No carrier should be able to require, as a condition of approving and recording change forms, that the new owner report to the carrier the amount paid by the new owner to the seller," said an email by Tom Sherman, an attorney with the Locke Lord LLP law firm in Atlanta, who has sent comment letters on behalf of LISA about the proposed rule to the IRS.

"A strong argument could be asserted that any such requirement by a carrier would be a violation of both federal and state laws (and possibly an unfair trade practice as well). The proposed regulations and forms are clear that the acquirer is not required to report to the carrier the amount paid to the seller."

Sherman gave a slide presentation at the LISA call last week.

His presentation advises LISA members to "provide to each payee only that portion of the IRS report that pertains to that payee."

It added: "And for Acquirer reports to the carriers - only report as to the seller and, most importantly, exclude the amount paid to the seller."

One of his slides said market members will see a four-part form: one part for the IRS, one for each payment recipient, one for the carrier and one to be retained by the acquirer.

He wrote in all caps: "THE IRS HAS MADE IT CLEAR ON THE COPY TO BE PROVIDED TO THE CARRIER THE AMOUNT PAID BY THE ACQUIRER TO THE SELLER IS OPTIONAL."

Nat Shapo, an attorney with the Katten Muchin Rosenman LLP law firm in Chicago, who is representing the association, contacted five state insurance departments about what the trade group saw with Lincoln last fall and now apparently will repeat the process with Sun Life.

Shapo, who declined to comment for this story, wrote a letter in October to the Florida insurance commissioner alleging that Lincoln was acting as an unlicensed life settlement provider by offering enhanced cash surrender payments.

He complained that the insurer offered this option to about 5,300 policyholders nationwide who own Lincoln LifeGuarantee SUL 2009 policies.

His seven-page letter said Lincoln National Life Insurance Co's conduct violated "a slew of consumer protection laws," including Florida laws on acting as a life settlement provider without a license, changing approved policy forms without filing amendments or riders for review and likely engaging in discriminatory behavior.

At that time, he said a review of several of the policies showed that Lincoln was offering policyholders between 59% to 81% above the basic cash surrender value.

Initially, Shapo's work on behalf of LISA was paid for by Coventry First LLC through May, according to a LISA Public Policy Council document for the conference call. Although it said he had contacted five state insurance departments, it did not say what, if anything, resulted from his efforts.

Despite repeated requests over the ensuing months by The Life Settlements Report, Karen Kees, a spokeswoman for the Florida Office of Insurance Regulation, has refused to say how the agency has responded, although she acknowledged on Oct. 23 that it received LISA's letter.

As recently as Jan. 30, she replied that the department had no additional information to provide at that time. She said the same thing in a Nov. 14 email. She has not responded to an additional email on Monday, June 24.

Not everyone in the market was critical of Lincoln's offer.

Larry Rybka, CEO of ValMark Securities Inc., an Akron, Ohio-based life insurance brokerage that also runs a life settlement broker, said he saw nothing wrong with Lincoln's offer.

Lincoln said "we're going to give twice as much cash value. What's wrong with that?" he asked.

"I think it's evidence of good behavior by Lincoln. I can't see how any regulator would have a problem with that" especially contrasting that with carriers who have been raising cost-of-insurance rates, he added.

Media representatives for Sun Life, Protective and Lincoln either did not comment or did not respond to a request for comment.

Originally posted June 27, 2019 on www.thedeal.com

DealFlow Events today revealed the program for The Life Settlements Conference 2019 coming up September 10 in New York City. This event is packed with valuable information essential to the success of anyone involved in the life settlements market.

Attendees will get answers to questions from more than two dozen speakers, all experts in their fields. Life settlements professionals will talk about what they’re doing to boost business, increase efficiency and fatten the bottom line using high-tech tools for insurance underwriting and forecasting.

Bleeding-edge topics include discussion of the latest reporting and taxation proposals announced this year by the IRS. Cost of insurance is another industry concern. This conference offers in-depth panel discussions on these hot-button topics, as well as the state of the market, how new technology is improving underwriting accuracy, straight-to-consumer marketing strategies and much more.

The Life Settlements Conference program puts attendees in the same room with highly respected professionals sharing years of experience. These pros are vetted for their knowledge, background and ability to engage an audience with high-value information. DealFlow Events are also renowned for their unparalleled networking opportunities.

Attendees at DealFlow Events’ last Life Settlements Conference gave rave reviews. The Life Settlements Conference 2019 is a can’t-miss event for people looking to stay up-to-date in this market.

Corporate sponsors of The Life Settlements Conference 2019 include Holwell Shuster & Goldberg, RRBB Accountants + Advisors, and Arent Fox.

Discover more about The Life Settlements Conference and register today.

About DealFlow Events
When it comes to the business of finance, the tag line “A DealFlow Event” is known as a symbol of the finest quality. We’ve produced more than 200 conferences, seminars, and webcasts on a variety of financial topics over the last 17 years. These events are the signature programs in their respective markets, offering the highest-quality content and unequaled professional networking opportunities.

For more information visit www.DealFlowEvents.com and www.LifeSettlementsConference.com.

Originally posted July 5, 2019 via globenewswire.com

To get a glimpse of where the life-insurance industry is heading, try answering this: What is a fruit that vegans avoid eating?

That query is part of an online quiz created by tech startup Health IQ Insurance Services Inc. to assess whether self-identified dieters, athletes, cyclists and weightlifters are worthy of discounts on life-insurance policies. Get a passing grade, and you could ultimately save thousands of dollars in premiums over the life of your policy, the company says.

Health IQ belongs to a select group of new companies that believe the future of the industry isn’t one of startups replacing insurers, or one of big carriers completely untouched by the benefits of innovative algorithms and data-driven analysis. What’s happening instead is that startups in these areas are joining forces with old-line carriers to complement the way they’re doing business. Health IQ, for example, is in partnership with two big insurers. It offers the quiz to prospective customers, then sells them coverage on behalf of the insurers.

It wasn’t supposed to play out this way.

If smartphones and digital apps could shake up the way people hail rides and rent hotel rooms, they would seemingly have a field day with stodgy life insurers. Most policies continue to be sold as they have been for decades, through agents, face to face, and are still based on mathematical tables of mortality risk. The application process, meanwhile, generally remains tedious, typically requiring blood, urine and other medical analysis. It can take weeks.

Sitting ducks?
All of this made life insurers seem like sitting ducks to Silicon Valley whiz kids and their algorithms.

But as insuretech ventures, as they are collectively known, have raked in growing sums of investment over the past couple of years, a nondisruptive business model has emerged as a path to success in life insurance. Newcomers have their sights on big dollars, including $3 billion in new annualized premiums for term-life policies, according to industry-funded research firm Limra. Term life is a popular option that pays a specified amount if death occurs in a specified number of years.

“We’re not here to disrupt anybody, which is very un-Silicon Valley,” says Health IQ Chief Executive Munjal Shah. “We found that collaboration was the easier answer in this, and that was a bit antithetical to what a lot of other people were trying to do.”

The typical Silicon Valley approach to a stodgy business model is to make it as easy as possible for consumers to buy the newcomer’s product. But that is problematic with life insurers, as less-healthy Individuals could swarm to an insurer with the least-restrictive screening process, tanking profits.

To speed up the application process, data scientists have experimented with replacements for taking blood and urine samples. But insurers generally have found that higher premiums must be charged in the absence of such tests. Also, while most startups get instant feedback from app-store ratings, it could take years for alternatives to prove themselves.

“The challenge with life insurance that we found is, to prove out a hypothesis, it could take a decade of data,” says Max Chee, a technology investor at Aquiline Capital Partners, which invested in Health IQ in May.

Remora fish
Kweilin Ellingrud, head of the life-insurance practice at McKinsey & Co., likens the partnerships that have arisen between insuretech companies and life carriers to the symbiotic relationship between sharks and remora fish that eat harmful parasites on the sharks’ skin. “They help each other,” she says.

The industry seemed poised for a radical overhaul “given decades without much change in products or distribution and the pain of legacy IT systems,” she says. But venture investors and entrepreneurs who have looked at the life-insurance industry find that the capital requirements mandated by state regulators translate into lower returns on equity compared with the “hit-it-out-of-the-ballpark” expectations for other tech investments. Life insurers typically post modest 8% to 10% returns on equity.

That is where companies like Health IQ come in.

Health IQ has all the trappings of a prototypical tech startup, including venture funding from the likes of Andreessen Horowitz and an office in Mountain View, Calif., near Google’s headquarters.

Mr. Shah co-founded Health IQ in 2013 as a way to quantify a person’s health-consciousness. The founders raised money from investors without having a clue how an online quiz would generate revenue.

The startup developed about 3,000 questions that it believed correlated to a person’s health literacy. Rather than ask self-proclaimed yoga practitioners how often they practice, Health IQ asks if a person doing Bikram yoga was supposed to drink water during the start of a class.

Timed responses
To guard against potential cheating, it times applicants’ responses and detects whether they switch tabs on their browsers to search for an answer.

The answer to the yoga question: no. And the fruit vegans avoid: figs.

SAMPLE QUIZ QUESTIONS

Health IQ uses questions like these to score applicants. The more informed a consumer is about healthy lifestyles, the more likely they’ll qualify for discounted life insurance.

A: How many different poses are there in Bikram yoga?

B: Which of the shoulder muscles is hardest to train for size?

C: Endurance runners often need more of this nutrient because of foot pounding, sweat, and gastrointestinal losses.

D: A cup of what can provide the same amount of calcium as milk?

E: What ingredient common in nutrition bars is a form of hidden sugar?

F: Soaking and sprouting breaks down the phytic acid found in outer hull of seeds. Less phytic acid means ____.

ANSWERS: A: 26; B: Rear delt; C: Iron; D: Cooked collard greens; E: Barley malt; F: More iron absorption

Eventually, after cross-checking the death rate of high scorers on the quiz using publicly available data like the Social Security Administration’s Death Master File with the death rate of the overall population, Mr. Shah realized he had accidentally created a one-of-a-kind mortality table: Those with high Health IQ scores correlated with lower risk of dying prematurely, he says.

Mr. Shah presented the correlations to big reinsurer Swiss Re, which certified the results and agreed to take on the risk of backstopping life-insurance policies underwritten by Health IQ.

“In a way, he got lucky,” says Aquiline Capital’s Mr. Chee. “He was able to take that data and find a really good use case for that in the underwriting and pricing for life insurance.”

Applicants have to verify their healthy lifestyle by doing things like giving Health IQ one-time access to their fitness-tracker results. They also need to submit to a physical and let a doctor draw bodily fluids to unlock the most savings.

“Many of them don’t mind doing the blood test because they view that it’s going to affirm where they are from a healthy-living perspective,” says Jim Morgan, CEO of Savings Bank Mutual Life Insurance Co. of Massachusetts, one of the carriers that Health IQ works with.

Another insuretech startup taking the partnership route is Policygenius Inc., whose co-founder and CEO, Jennifer Fitzgerald, says her team concluded early on that dislodging carriers wasn’t the way to go. Instead, the team saw there was room for a website like Policygenius.com for consumers to learn about products, brands and prices to comparison-shop, she says. “The way to shop for life insurance was outdated,” Ms. Fitzgerald says.

When consumers buy policies on Policygenius.com, they move onto the books of traditional insurers such as American International Group Inc., Lincoln Financial Group, Pacific Life Insurance Co. and Principal Financial Group Inc.

Change is rippling across much of the industry. At 114-year-old Lincoln, for instance, new automated procedures speed up issuance of policies for as much as $1 million in face value for people up to 60 years old, says Heather Milligan, senior vice president of underwriting and new business.

In-house startups
Some old-line insurers, meanwhile, are looking to create startups using in-house resources. Haven Life, a digital insurance agency owned by 168-year-old Massachusetts Mutual Life Insurance Co., uses algorithms that draw on old MassMutual data to assess the health risks of potential policyholders as they apply online. It also uses answers provided by the applicants, data pulled from prescription-drug databases, motor-vehicle records and other sources.

Yaron Ben-Zvi, Haven Life’s founder and CEO, says a benefit of linking with a well-established carrier is that there are huge amounts of data to be mined to develop algorithms for online issuance of policies. MassMutual developed the underwriting model used by Haven Life based on nearly 20 years of historical data and more than one million old applications, Mr. Ben-Zvi says.

“Disruption in the life-insurance industry is probably not the right word,” Mr. Ben-Zvi says of the rise of new companies and adapting of new technologies. “Maybe increased pace of change.”

Originally appeared on wsj.com June 10, 2019

The public forum is dominated by discussions surrounding access to medical care. In part, calls for expanded “health care” abound with the term often a misnomer. There is no doubt that modern medical advances extend life and cure or make chronic diseases that once held little hope possible. This progress restores individuals to their baseline if not better. Methods for prevention are also amplified and monitored. But, a new study in the Annals of Family Medicine suggests the lion’s share of curtailing or curbing premature death in a population may not rest with sick care (or “health care”) alone, but instead with behavioral factors.

The researchers found their data “produced estimates ranging from 0% to 17% of premature mortality attributable to deficiencies in health care access or delivery. Estimates of the effect of behavioral factors ranged from 16% to 65%.”

In an effort to clarify an age-old argument over where investments should be deployed to make the most positive contribution to population health and life expectancy, researchers decided to “review 4 different estimates of the contributions of health care to premature mortality and other health outcomes.” Resources are often considered best directed to medical services. But, that is only one piece of the story, as much evidence shows how influential social determinants of health are to outcomes and promoting longevity.

To understand what actually is incorporated into this concept of premature mortality, consider, for example, a fatal motor vehicle accident where excessive alcohol intake was the cause. Or, death from lung cancer due to cigarette smoking. These eventualities would be categorized more by behavioral factors. There is much work done on trying to link variations in health care use with morbidity and mortality, and debate surrounding how to direct resources tends to focus on medical services when any number of avenues warrant attention. The investigators here sought to determine how much the prior data collected on this topic actually does or does not tell us about the weighted contribution of health behaviors (eg tobacco use, poor diet, sedentary lifestyle, substance abuse), medical care albeit access to it or level of its quality, environmental exposures (eg toxins, air quality), or socioeconomic influences (eg income, support structures, safety of community, education) when it comes to health outcomes.

There are many more estimates that have made their way to the literature over the years. So, more exists than was examined in this work. It is a monstrous challenge to assess the effect of medical treatment in this manner and the limitations to doing so abound. For instance, stratifying by disease state will be more beneficial to understanding the genuine impact of a therapy than one number for an entire population’s life expectancy. As poignantly evidenced by the authors,

“For example, successful treatment of women with cervical cancer could add 21 years to the life expectancy of a particular patient. The condition affects about 13,000 women annually, therefore the estimated gain in total US population life expectancy for treatment of cervical cancer is only 1 week. Similarly, successful treatment of colorectal cancer could add 12 years of life to as many as 155,000 adults. But on a population-wide basis, it contributes only about 1 week to average life expectancy. Likewise, treatments for appendicitis, pneumonia, and influenza, although successful for many individuals, on average have a negligible effect on population life expectancy.”
So, understanding that even life expectancy as a term has refined meaning when put into context is critical to its actual interpretation. This is why comparing countries by infant mortality rates is also an incredibly flawed endeavor. For example, some countries define it differently and include first breath, while others do not. Some track till the first year, others do not. The notion it is a uniform, standard value is a false premise.

Here’s the rub. When it comes to longevity, in general, and metrics like life expectancy, they are often flawed and idealized. What benefits a population or the aggregate, may not be in the best interest of the individual as there is tremendous variability in genetics, disease, clinical status and beyond. Practicing medicine offers unique insights into how people manage risk. Intellectually, for most, knowing that 90% do well following a particular path is calming until you fall into the 10% group. Then, that potential for poor outcome becomes 100% to you. And, the meaning shifts dramatically. This is why making sweeping generalizations rarely moves the needle in improving health care delivery. Understanding the nuances of geography, populations, medical histories, behavior, biopsychosocial spheres etc is essential to compelling genuine change for the better - and for the most people.

One thing is clear, to say a population’s life expectancy rates are exclusively correlated with the availability and quality of healthcare services is overly simplistic and does not begin to address the complexity of factors involved. As inconvenient as it is, the multifaceted nature of what contributes to overall longevity is unique to individuals within a population and can have much variability by region, genetic influences, occupation, lifestyle, clinical status, education and so on.

This report’s analysis conveys “social and behavioral factors account for a much higher percentage of the variation in premature mortality than health care does.” Now, that doesn’t mean that investing in health care isn’t worthwhile. Don’t forget, these metrics don’t emphasize or address new treatments and modalities that are extending life and converting once ominous disease to more chronic conditions. There is great value in funding research and optimizing health care delivery. This piece simply reminds us that there is also value to consider that extends beyond the hospital bed and exam room. Also investing in communities and social determinants of health will improve quality of life in a multi-prong fashion, and this, too, can yield great dividends to a population - in daily life and in terms of longevity.

The take home message of this study is to diversify. Recognizing access to and the quality of medical services is one crucial component to enhancing longevity is important - especially for the individual. Factoring in the others adds value too.

On Trend

This publication reinforces (and rides the current wave on) the importance of social determinants of health already underway.

For instance, in the not-so-new realm of nontraditional health coverage, the Centers for Medicare and Medicaid Services (CMS) is expanding their Medicare Advantage plan to include benefits that meet patients “unique health needs” and improve “their quality of life.” Behavioral economics is currently in full swing and now being put to the test by this recent roll out set to take effect this year. Based on the premise that social determinants can drive poor health outcomes and increase costs, equalizing these factors through non-emergent medical transportation (NEMT, read here) as a means to reduce barriers thereby improving care access, providing air conditioners for high risk populations and specific foods for those with diabetes could impact healthcare spending with a hope of yielding overall savings. Read more here and also learn about spending by other countries on social services compared to the United States.

Source:

Robert M. Kaplan, PhD and Arnold Milstein, MD, MPH. Contributions of Health Care to Longevity: A Review of 4 Estimation Methods. Ann Fam Med May/June 2019 vol. 17 no. 3 267-272. doi: 10.1370/afm.2362, see here.

Note:

The authors are from Stanford University School of Medicine's Clinical Excellence Research Center (CERC). I recently attended a conference (unrelated to this journal article) in Chicago organized by Stanford's CERC on "Reducing the Cost of Great Care: Pathways to Value."

Originally posted May 22, 2019 on www.acsh.org

The Social Security Administration plans to release an additional 694,959 historical death records contained in the Death Master File.
The release of the records to subscribers of the database, including members of the life settlement market who track deaths of insureds on policies, is set for April 27, according to the National Technical Information Service of the U.S. Department of Commerce.

The new records will be in addition to the normal weekly death-record update, a Thursday, April 25, announcement from John Hounsell, program manager with the Office of Program Management with the NTIS in Alexandria, Va., said. "SSA continues to be actively engaged in an initiative to improve our death data. As a part of this initiative, in fiscal year 2019, SSA will add nearly 3 million death records to the full and publicly available Death Master File (DMF) over the course of several months," the announcement stated. "These records are deaths currently maintained in our records that we determined should be included in the DMF."

The Social Security Administration also said the effort to update the Death Master File may result in an increase in the volume of death records received by subscribers.
It said these historical records might include more zeroes in the date of death field, which generally occurs on older records because the agency previously didn't require a valid date of death. It said the zeroes could indicate that information was missing in the death report or, in the case of paper records, was illegible when the information was put in the database.

"Sharing these deaths will increase the accuracy, integrity, and completeness of our records as well as the DFM," the announcement also said.
Servicers in the life settlement market use the Death Master File as one of its resources to track deaths of insureds on policies so they may know when to seek death benefits from insurance companies. Life expectancy providers also use the information to measure the accuracy of their forecasts on deaths.
The Death Master File contains 91 million names of deceased people that have been collected since 1938.

Originally posted 4/25/19 TheDeal.com