Interpreted Clinical Data Reveals Nicotine Users in Three Key Categories.
“ Giving up smoking is the easiest thing in the world. I know because I’ve done it thousands of times .”— Mark Twain While many health benefits of quitting begin to accrue almost immediately, cancer risks remain elevated, and the damage to some organs is persistent. It takes 10 to 15 years for the additional risk of lung cancer to drop by 50%; an ex-smoker has to stay quit for 15 years before the risk of heart disease drops to match that of someone who never smoked. 9 Those high rates of relapse and long-lasting adverse health impacts are reason enough to question the common practice of treating insurance applicants with no evidence of smoking in the previous 1, 2 or 3 years as if their mortality was the same as that of people who have never smoked. If anything, our re - search has convinced us that any evidence of nicotine use, even years prior to an application, should flag increased mortality risk. Thus, it’s not a surprise that unidentified smokers are a significant cause of mortality slippage in accelerated underwriting programs. What are carriers to do in an era when consumers are accustomed to seamless, one-click purchase experiences? EHRs or APSs are likely to note a history of nicotine use where present, but those tools add substantial time and cost to the underwriting process. Relying on applicant self-disclosure obviously leaves insurers open to misrepresentation. Applicants’ an - swers can be confirmed with a lab test for cotinine—a nicotine metabolite that may be found in a smoker’s blood, urine or saliva—but consumers may consider fluid tests invasive. Even if they’re tolerated by ap - plicants, tests add cost and negate efforts to accelerate underwriting. Cotinine tests are also fallible; some smokers can stay off nicotine long enough for their co - tinine levels to drop below testing thresholds; others can easily find advice on YouTube or Google that will help them avoid being caught by saliva or urine tests. SaaS Tools Can Use Medical Billing and Diagnostic Code Data To Instantly and Affordably Identify Nicotine Dependence Insurtech software as a service (SaaS) tools sup - ported by appropriate data networks can instantly identify nicotine use in over 16% of applicants by automatically retrieving, reviewing and interpreting up to 7 years of medical billing and diagnostic codes. The time period is limited by Fair Credit Reporting Act (FCRA) rules. A history of nicotine use may also show up in prescription fills for cessation products
such as Chantix, Zyban or various nicotine patches, gum or lozenges. Nicotine use is only one of hundreds of medical con - ditions flagged by tools such as Irix Medical Data. However, given the prevalence of smoking and the severity of a “miss,” whether by applicant nondisclo - sure or for other reasons, the identification of nicotine use is certainly one of the most important ways that such tools deliver value. The share of smoker appli- cants varies from 5% to 40% depending on the state, carrier and type of policy. In most programs, smoker nondisclosure is a real issue; as previously noted, we’ve found that about 80% of the time, a history of nicotine use flagged in Medical Data was not found any other way. Ensuring Guidelines Are Met and, Possibly, Calling Guidelines Into Question Life insurers have had lots of practice sizing up nico - tine-using applicants. Over that time, the percentage of Americans who smoke has fallen, but the number of applicants using nicotine is still large. The magni- tude of nicotine’s impact on mortality, its compound effect on comorbidities, the herculean challenge of quitting, and the stubborn persistence of elevated mortality—long after a successful cessation—all mean Three categories of billing and diagnostic codes flag tobacco use: Active use codes are entered by a physician to indicate that a patient is currently a tobacco user; cessation treatment codes are entered when physicians counsel patients about quitting; and finally, there are diagnostic codes entered when patients tell a physician of a history of tobacco use.
ON THE RISK vol.40 n.3 (2024)
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