Insurance Medicine and the Medical Profession A discussion of competing factors and opportunities Dr Antony Vriens Chief Medical Director Manulife Financial Asia Ltd

Agenda  Insurance and Clinical Medicine  Differences in approach  Potential areas of conflict  Getting the best from the Dr…  Your CMO  Your Medical Examiner  Medical Information 2

Insurance Medicine: The science that supports Insurance Medicine is based in observational studies of disease, their prognosis, life expectancy, risk of associated illness or risk of recurrence, based on many thousands of patients and local and worldwide populations studies. This morbidity (sickness) and mortality data underpins the pricing and risk assessment of insurance policies The role of Insurance Medicine encompasses:  The selection of applicants for insurance according to the expected morbidity and mortality of those individuals  Providing input in to product design and wordings  Assisting in the administration of death, disability, and health claims of insured individuals  Analysing insurance morbidity and mortality experience 3

Clinical Medicine (your own Dr)  A medical encounter between Dr and Patient, with a focus on current symptoms, diagnosis and treatment, coupled with a proactive view for future risk, and time to assess those risks  Developing a relationship with the patient  Gather data (Medical history, physical examination, investigations  Analyse that data, and then:  Develop a treatment plan  Treat the patient accordingly  Assess the progress of treatment and alter the plan as necessary 4

Insurance Medicine (your CMO/medical adviser)  The Physician-Patient relationship does not exist in the traditional sense, and the lens through which medical history and investigation is viewed less about treatment and planning, but more about what are the future consequences of current illness  Will it recur?  Does the presence now indicate a risk for future development of illness?  Do we know the exact diagnosis around an abnormal test or group of symptoms, and how does that translate in to future risk?  Does this pose a greater risk to claim than the average person 5

Areas of Conflict exist  There are many examples where the medical management of an illness and the client communication is very different to that of the insurance medicine approach  What is the meaning of: ‘nothing really wrong with you’ ?  What is the meaning of: ‘you have a good prognosis’ ?  Future prognosis based on medical management vs. underwriting  Luxury of time to watch and monitor (Cholesterol)  Luxury of time to treat when necessary (Valve disease)  Ability to continuously influence  Assume compliance,  Best treatment available,  Lifestyle change with be sustained, 6

Areas of conflict that affect quality of data…be aware…  The primary relationship between the Doctor and Patient is based on trust, and above all, the Doctor is an advocate for the client. This may translate to filtering of data for insurance purposes…  The Doctor DOES NOT have a duty of disclosure to the Insurance company  Clinical summaries potentially trivialise illness at underwriting time…  Clinical summaries potentially inflate disability at claims time  More conflict exists in a business sense, particularly in health care spend..  Treatment differs in private and public hospitals  Insurance companies deemed to have deep pockets  Financial gain behaviour exists in any profession… 7

Getting the best from your CMO…  Always have an opinion, and justify that opinion…  In you referrals for underwriting:  Describe the benefits being underwritten and product structure  Attach all relevant reports  Reference the guidelines (Which are not a cookbook or a bible…)  In your referrals for claims  Understand the policy wordings and make sure the information addresses those wordings  Understand that the client may have just experienced the worst event in their lives, and your communication should reflect that even if claim is a decline 8

Getting the best from your medical examiner  Be very clear about what you need and want. It is not just a form to be filled out…Why are you asking for the information?  Ask for insight  Make sure the examiner understands the right customer attitude for your client (there are good ones and bad ones).  Develop a good working and business relationship 9

Getting the best medical information…  2 approaches…  Get all the information (unfiltered)  Ask for specific data and insight  Not all data is equal…  Where is the data from?  Surgical vs Medical summaries  Medical vs Traditional  Does it tell you all you need to know? 10

Thank you