Merck pharmaceutical has just released initial clinical trial study results for a new drug that is being touted as having the potential to stop progressive cardiovascular plaque in it's tracks. Associated with a new class of drugs-Anacetrapib is making some waves in the clinical science community. Unlike statin drug therapies, which increase HDL (good cholesterol) levels-assisting in slowing the progression of coronary plaque development, this new drug significantly reduces LDL (plaque causing cholesterol)-essentially removing the risk of plaque development.
The initial trial studied 1,623 heart patients (with known coronary heart disease) for a period of 18 months. The results noted a significant impact on lowering LDL (by 40%) as well as increasing HDL levels (by 138%!).
This all sounds very exciting, and lends to initial thoughts that this may be the "Silver Bullet" in cardiovascular disease that will bump this off the list as the number one (or even top 5) killers in the U.S. However, a number of cautionary notes should be made:
1) This is an extremely small study group over a short period of time. It will take at least another (5) years of study and thousands of trial participants (Merck indicates a pending study of 30,000 global participants) to support initial theory and determine overall efficacy.
2) During this small trial, 8 participants taking the drug required further cardiovascular intervention (bypass and/or angioplasty)
3) LDL levels dropped to extremely low and dangerous levels in 18% of the participants-so they were removed from the study prior to completion.
4) There were a reported 11 deaths for which it is unclear if it was related to abnormally low LDL levels.
5) This is in the same class of drugs which was previously studied- and withdrawn- by Pfizer due to high incidents of heart attacks and deaths.
Lastly, as this underwriter has seen with statin therapies (the wonder drugs of the Millennium) in elderly patients, due to the number of side effects experienced there is always a large percentage of the population that cannot tolerate these drugs. Just think of the most recent pharmaceutical ad you watched on t.v. which always wraps up with the list of potential side effects and it becomes very clear that anything too good to be true, often times comes at a price!
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Tuesday, November 23, 2010
Thursday, October 14, 2010
Major Press Release from Life Expectancy Providers
October 14, 2010- Major Life Expectancy Providers (LEPr) have formed a focus group to provide best practices standards and transparency to the life settlement and longevity markets. Members of the newly formed LEPr focus group were participants in the "Best Practices" committee of the Life Insurance Settlement Association (LISA) and recognized the need to further expand the sope and definition of "best practices" by continuing this effort as an independent group. All major life expectancy providers were invited, and encouraged, to join in this important endeavor. The goal of the LEPr focus group is to provide a comprehensive and consistent set of best practices and performance standards to all longevity markets that may benefit from life expectancy and mortality information. It is also the intent that all major life expectancy providers participate and adhere to our best practices and professional standards.
Life Expectancy underwriting "Best Practices" are based on the principal of full disclosure and transparency in the information and performance results of LE underwriters, while protecting the integrity of their proprietary methodology and practices. Issues that the LEPr focus group are addressing include privacy, fraud, and confidentiality policies as well as comprehensive performance reporting and definitions common to life expectancy providers.
The founding members of the LEPr focus group are Advanced Underwriting Solutions, AVS Underwriting, Examination Management Services Inc., ISC Services, and 21st Services. Once a "Best Practices" document is completed by the LEPr focus group, the document will be presented to the Life Insurance Settlement Association (LISA), Institutional Life Markets Association (ILMA), European Life Insurance Settlement Associations (ELSA), and Bundesverband Vermogensanlagen im Zweitmarkt Lebensversicherungen (BVZL) for acceptatnce and adoption by those organizations. The LEPr focus group will continue to review and refine its best practices as well as provide education opportunities to the longevity and life settlement markets.
The LEPr focus group will initially host an "investors only" educational seminar on December 7, 2010 in New York. The day-long event is intended to open direct channels of dialog with investors to discuss the results of the LEPr's ongoing work. Seminars for providers, brokers and other interested parties will be scheduled in the near future. For further information regarding the Life Expectancy Provider group you are encouraged to contact any of the LE providers participating in this focus group.
Life Expectancy underwriting "Best Practices" are based on the principal of full disclosure and transparency in the information and performance results of LE underwriters, while protecting the integrity of their proprietary methodology and practices. Issues that the LEPr focus group are addressing include privacy, fraud, and confidentiality policies as well as comprehensive performance reporting and definitions common to life expectancy providers.
The founding members of the LEPr focus group are Advanced Underwriting Solutions, AVS Underwriting, Examination Management Services Inc., ISC Services, and 21st Services. Once a "Best Practices" document is completed by the LEPr focus group, the document will be presented to the Life Insurance Settlement Association (LISA), Institutional Life Markets Association (ILMA), European Life Insurance Settlement Associations (ELSA), and Bundesverband Vermogensanlagen im Zweitmarkt Lebensversicherungen (BVZL) for acceptatnce and adoption by those organizations. The LEPr focus group will continue to review and refine its best practices as well as provide education opportunities to the longevity and life settlement markets.
The LEPr focus group will initially host an "investors only" educational seminar on December 7, 2010 in New York. The day-long event is intended to open direct channels of dialog with investors to discuss the results of the LEPr's ongoing work. Seminars for providers, brokers and other interested parties will be scheduled in the near future. For further information regarding the Life Expectancy Provider group you are encouraged to contact any of the LE providers participating in this focus group.
Friday, October 1, 2010
Life Settlement Consumer Disclosure-NCOIL Holds the Line
In recent years, life settlement business transactions and ethics have been under intense scrutiny. Some of which has been well deserved, but largely LS was caught up in the failing economy and questionable wall street practices. Unfortunately, the value and intrinsic benefits of LS to seniors was lost in the turmoil. NCOIL may be the start of providing seniors with the ability to take control, once again, of their life insurance assets.
No matter which side of the argument you sit on, at the end of the day each individual should be provided full disclosure of their options so that they can make an informed financial decision. By withholding this information someone will lose, and it will most likely be the consumer.
In an climate that now requires full disclosure on all financial products and transactions, why should life insurance be the one product that is excluded from that? We will all be watching the status of the Consumer Disclosure Model Act in the coming weeks and months to see if NCOIL will ultimately side with consumers in their ability to have all options fully disclosed to them.
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No matter which side of the argument you sit on, at the end of the day each individual should be provided full disclosure of their options so that they can make an informed financial decision. By withholding this information someone will lose, and it will most likely be the consumer.
In an climate that now requires full disclosure on all financial products and transactions, why should life insurance be the one product that is excluded from that? We will all be watching the status of the Consumer Disclosure Model Act in the coming weeks and months to see if NCOIL will ultimately side with consumers in their ability to have all options fully disclosed to them.
"If knowledge can create problems, it is not through ignorance that we can solve them"
Isaac Asimov, 1920-1992
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Monday, September 20, 2010
Mild Cognitive Impairment-Different than Dementia?
Mild cognitive impairment (MCI) has been on the rise as a "diagnosis" in the medical records being reviewed on senior market insurance applications and settlements. On the life side, this is causing increased challenges in getting policies approved by underwriting, and hence increased frustrations at the broker level. Brokers by and large are under the impression that these are merely typical, age related changes and underwriters have the belief that this is early stage dementia-They are both correct! On the settlement side, this is often the cause of unwarranted aggressive life expectancy estimations, a problem for the investor. Here are some insights to help both sides successfully navigate through this impairment.
According to the AGS (American Geriatrics Society); MCI is the intermediate stage between cognitive changes of normal aging and dementia. Although MCI typically shows up years prior to a formal diagnosis of dementia, and there is some increased risk of MCI progressing to dementia, it is not a definitive measure for development of dementia. Approximately 12% of those over the age of 70 that have MCI are3-4 times more likely to develop AD (Alzheimer's Disease).
Mayo clinic developed a general criteria utilized for the identification of MCI: 1) Self reported memory complaints, 2) Objective memory impairment, 3) Preserved general cognitive function, 4) Intact activities of daily living (ADL), 5) Not meeting criteria for dementia.
In the thousands of senior medical records reviews I have completed over the years, it is important to really evaluate the symptoms and patient presentation when the AP (attending physician) has indicated MCI. I have found a number of instances when all criteria have not been met yet the AP indicates this as a diagnosis-always troublesome for the underwriter to make the appropriate assessment yet retain case documentation that will not haunt them on future underwriting audits!
It is clear, based upon the research to date, that MCI is a risk factor for dementia, much the same as hyperlipidemia is a risk factor for coronary artery disease. As such, it would be reasonable to expect a mild rating, but declinations of insurance based upon this single factor would be unwarranted.
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Contact our Expert/Blogger:
Traci Davis, President/Chief Underwriter
tdavis@advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
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Senior assessments require experienced medical underwriters that understand the differences in impairment mortality on applicants and insureds over the age of 65. AUS has that underwriting expertise-contact us today to find our more about our suite of underwriting services!
www.advanceduwsolutions.com
newbus@advanceduwsolutions.com
According to the AGS (American Geriatrics Society); MCI is the intermediate stage between cognitive changes of normal aging and dementia. Although MCI typically shows up years prior to a formal diagnosis of dementia, and there is some increased risk of MCI progressing to dementia, it is not a definitive measure for development of dementia. Approximately 12% of those over the age of 70 that have MCI are3-4 times more likely to develop AD (Alzheimer's Disease).
Mayo clinic developed a general criteria utilized for the identification of MCI: 1) Self reported memory complaints, 2) Objective memory impairment, 3) Preserved general cognitive function, 4) Intact activities of daily living (ADL), 5) Not meeting criteria for dementia.
In the thousands of senior medical records reviews I have completed over the years, it is important to really evaluate the symptoms and patient presentation when the AP (attending physician) has indicated MCI. I have found a number of instances when all criteria have not been met yet the AP indicates this as a diagnosis-always troublesome for the underwriter to make the appropriate assessment yet retain case documentation that will not haunt them on future underwriting audits!
It is clear, based upon the research to date, that MCI is a risk factor for dementia, much the same as hyperlipidemia is a risk factor for coronary artery disease. As such, it would be reasonable to expect a mild rating, but declinations of insurance based upon this single factor would be unwarranted.
--------------------------
Contact our Expert/Blogger:
Traci Davis, President/Chief Underwriter
tdavis@advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
--------------------------
Senior assessments require experienced medical underwriters that understand the differences in impairment mortality on applicants and insureds over the age of 65. AUS has that underwriting expertise-contact us today to find our more about our suite of underwriting services!
www.advanceduwsolutions.com
newbus@advanceduwsolutions.com
Sunday, August 29, 2010
Life Insurance vs. Settlement Indices-July 2010
Medical Information Bureau (MIB) released results of July 2010 activity reflecting life insurance applications entering the market. For a second month in a row, there was a notable decline in applications of -3.9%. It is important to note that although this is following declines in June, these declines are consistent with the cycle of business that is "historically" typical during the summer months.
Applications on Senior ages continues an upward tick. Ages 60+ noted a +7% increase , year-over-year.
Life settlement trends, provided by Amrita Financial noted a stable level compared to June 2010. The index posted 460 points for July.
As there continues to be a trend towards senior market applications and settlements, it's becoming even more critical that the underwriters utilized to evaluate the risks associated with seniors are specialized and experienced. AUS, Inc. -Founded and managed by Senior Market Underwriting Consultants
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tdavis@advanceduwsolutions.com
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Applications on Senior ages continues an upward tick. Ages 60+ noted a +7% increase , year-over-year.
Life settlement trends, provided by Amrita Financial noted a stable level compared to June 2010. The index posted 460 points for July.
As there continues to be a trend towards senior market applications and settlements, it's becoming even more critical that the underwriters utilized to evaluate the risks associated with seniors are specialized and experienced. AUS, Inc. -Founded and managed by Senior Market Underwriting Consultants
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www.advanceduwsolutions.com
newbus@advanceduwsolutions.com
Contact Traci Davis-Underwriting Expert!
tdavis@advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
Thursday, July 15, 2010
Diabetic Miracle Drug and Acute Heart Attacks!
A common drug utilized for control of Type II diabetics, Avandia, was recently brought before an FDA panel of experts to evaluate the potential risk of increased cardiac incidents and death. The concerns with the drug date back to 2005 when the FDA requested that the product manufacturer (Glaxo) conduct a meta-analysis of the drug effects due to mounting concerns related to increased cardiac risk. The analysis presented to the FDA did indicate increased risk of acute coronary events. The FDA then completed it's own analysis which concurred with the Glaxo results and a boxed warning was applied.
The issue was again brought before the FDA this past week by a Dr. Steven Nissen-cardiologist at the Cleveland Clinic. Dr. Nissen completed his own study, based upon more than 35,000 patients and a combined 56 studies, Dr. Nissen's findings indicated troubling incidences of increased cardiac risk and death associated with the use of this drug. His findings indicated a 28-39 % increased risk of cardiac incidences in otherwise healthy patients. Younger patients were found to have excessive myocardial infarction events and older patients had increased cardiac death.
Amazingly, the FDA expert panel decided against pulling the drug from the market -even in light of the compelling study details outlined by Dr. Nissen. The final voting tally noted the following; (13) votes for pulling the drug from the market ; (17) votes for increased label warnings and possible usage restrictions; (3) voted against any changes.
I would suspect that this will not be the last time we hear about issues with this drug. Glaxo has apparently paid out a number of settlement fees to individuals and families that have been impacted by the drug effects-however, this is the most financially lucrative medication for that company so it is doubtful that they allow removal of this drug from the market without a tremendous fight. After all, drug companies are in the market to make money, not save lives....Right?
The issue was again brought before the FDA this past week by a Dr. Steven Nissen-cardiologist at the Cleveland Clinic. Dr. Nissen completed his own study, based upon more than 35,000 patients and a combined 56 studies, Dr. Nissen's findings indicated troubling incidences of increased cardiac risk and death associated with the use of this drug. His findings indicated a 28-39 % increased risk of cardiac incidences in otherwise healthy patients. Younger patients were found to have excessive myocardial infarction events and older patients had increased cardiac death.
Amazingly, the FDA expert panel decided against pulling the drug from the market -even in light of the compelling study details outlined by Dr. Nissen. The final voting tally noted the following; (13) votes for pulling the drug from the market ; (17) votes for increased label warnings and possible usage restrictions; (3) voted against any changes.
I would suspect that this will not be the last time we hear about issues with this drug. Glaxo has apparently paid out a number of settlement fees to individuals and families that have been impacted by the drug effects-however, this is the most financially lucrative medication for that company so it is doubtful that they allow removal of this drug from the market without a tremendous fight. After all, drug companies are in the market to make money, not save lives....Right?
"Perhaps better we not obscure the idea that happiness and misery, kindness and greed, and good works and bad deeds are in the capacities of us all, not merely a select few"
David P. Mikkelson, snopes.com, September 8, 2003
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Thursday, July 8, 2010
Reflections on June Indices
June indices were released for both the life insurance and life settlement industries. Both reflecting a downward trend. Are these merely a reflection of "summertime cycles" or a reflection of the continued uncertainty in the economy?
Medical Information Bureau (MIB) is a firm that gathers data on the submission of all life insurance policies by participating carriers. Their index indicated a overall reduction of 3.9%on life insurance applications. Applications received from proposed insureds (PI's) aged 0-44 were down -7.2%, PI's aged 45-59 were down -3.1%, and for the first time this year PI's in the 60+ age group reduced to single digit growth vs. a consistent trend in past months of double digit growth. Compared to 2009 trends, these numbers are atypically low for the summer months.
Amrita LS index reflected a reduction in policy transactions as well. A decline of 14.3% over the prior month. Following on the heels of two prior months reflecting sharp gains-so what happened? The potential reasons given were inconsistent buying power - access to capital and reflection of an unbalanced recovery between funding sources and providers.
It appears that the struggling economic recovery continues to haunt all industries, including ours, and we will most likely continue to see a year of inconsistent numbers. A challenging reality!
Medical Information Bureau (MIB) is a firm that gathers data on the submission of all life insurance policies by participating carriers. Their index indicated a overall reduction of 3.9%on life insurance applications. Applications received from proposed insureds (PI's) aged 0-44 were down -7.2%, PI's aged 45-59 were down -3.1%, and for the first time this year PI's in the 60+ age group reduced to single digit growth vs. a consistent trend in past months of double digit growth. Compared to 2009 trends, these numbers are atypically low for the summer months.
Amrita LS index reflected a reduction in policy transactions as well. A decline of 14.3% over the prior month. Following on the heels of two prior months reflecting sharp gains-so what happened? The potential reasons given were inconsistent buying power - access to capital and reflection of an unbalanced recovery between funding sources and providers.
It appears that the struggling economic recovery continues to haunt all industries, including ours, and we will most likely continue to see a year of inconsistent numbers. A challenging reality!
"Our imagination is the only limit to what we can hope to have in the future"
-Charles F. Kettering
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Monday, July 5, 2010
The Centenarian Code-Genes and Longevity
The associated press released a story this past week on how close genetic researchers are getting to establishing specific genes shared by those robust elderly that are living past the age of 100, with the ability to specifically cull out factors of lifestyle.
Researchers have found that there are common gene variations shared by individuals living past the age of 100. A very early step in determining which genes reflect potential vulnerability for diseases with mortality impact. The study did note the importance of lifestyle factors.
The research team, studying specific genetic markers, were able to predict mortality with 77% accuracy. For those of us with a specific focus on predicting longevity this may become a critical factor, and possible tool, as the research evolves.
Stay tuned as AUS leads the field of underwriting in utilizing genetic markers in longevity estimations!
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www.advanceduwsolutions.com
newbus@advanceduwsolutions.com
Connect with Traci Davis (President/Chief Underwriter/Blogger):
www.linkedin.com/in/tddavisaus
tdavis@advanceduwsolutions.com
303-367-1129
Researchers have found that there are common gene variations shared by individuals living past the age of 100. A very early step in determining which genes reflect potential vulnerability for diseases with mortality impact. The study did note the importance of lifestyle factors.
The research team, studying specific genetic markers, were able to predict mortality with 77% accuracy. For those of us with a specific focus on predicting longevity this may become a critical factor, and possible tool, as the research evolves.
Stay tuned as AUS leads the field of underwriting in utilizing genetic markers in longevity estimations!
Contact Us!
www.advanceduwsolutions.com
newbus@advanceduwsolutions.com
Connect with Traci Davis (President/Chief Underwriter/Blogger):
www.linkedin.com/in/tddavisaus
tdavis@advanceduwsolutions.com
303-367-1129
Tuesday, June 8, 2010
Emerging Malignant Melanoma Treatment
Bristol-Meyers released information on a new drug therapy which has promise for significant impact on Malignant Melanoma (MM) survival.
A clinical trial of 676 patients - who had previously undergone treatment (some with advanced stages (3/4) tumors) indicated a near doubling of life expectancy. 12-month survival increased from 25% to 46% and 24-month survival increased from 14% to 24%.
The new drug (Ipilimumab) acts as a targeted T4 cell suppressant (immunosuppressive affect) for patients that carry a specific HLA gene. Data on the percentage of MM treated patients with this gene was not covered in the releases.
Although the drug has not achieved FDA approval, it is available at (75) cancer centers in the U.S. on a "compassionate-use trial" basis.
In addition to treatment of MM, there is indication that it may be a powerful therapy for other advanced cancers of the breast, prostate, and lung.
This blogger wonders if we are on the edge of "silver bullet" cancer therapy-what a hopeful thought!
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Email Us: newbiz@advanceduwsolutions.com
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A clinical trial of 676 patients - who had previously undergone treatment (some with advanced stages (3/4) tumors) indicated a near doubling of life expectancy. 12-month survival increased from 25% to 46% and 24-month survival increased from 14% to 24%.
The new drug (Ipilimumab) acts as a targeted T4 cell suppressant (immunosuppressive affect) for patients that carry a specific HLA gene. Data on the percentage of MM treated patients with this gene was not covered in the releases.
Although the drug has not achieved FDA approval, it is available at (75) cancer centers in the U.S. on a "compassionate-use trial" basis.
In addition to treatment of MM, there is indication that it may be a powerful therapy for other advanced cancers of the breast, prostate, and lung.
This blogger wonders if we are on the edge of "silver bullet" cancer therapy-what a hopeful thought!
Contact us for all of your underwriting needs!
Website: www.advanceduwsolutions.com
Email Us: newbiz@advanceduwsolutions.com
Connect with the Prez;
www.linkedin.com/in/tddavisaus
http://twitter.com/TraciDavisAUS
Wednesday, May 19, 2010
April Indices-Oh the Ups and Downs!
April was positive for Life Settlements however Life Insurers continue to struggle. Let's see what the experts had to say;
Amrita LS index noted that in April 2010 there was an unexpected, and quite positive, jump in life settlement transactions over the prior month. The reported numbers climbed an astonishing 92.8 points over March. Amrita indicates that the jump was largely attributed to an increase in market activities and "renewed bullish expectations".
On the flip, Medical Information Bureau (MIB) indicated that individually underwritten life insurance was off -1.4% in April over March. Comparitively, the index has been fluctuating between mild growth and losses since January 2010. Senior life insurance applications continue to reflect growth - with a continued upward trend of +10.5% on applicants aged 60+. MIB indicates that the April numbers are consistent with "seasonal norms".
Have you considered conducting your underwriting and LE business from a different perspective? AUS has been busy incorporating new services from Red Flag Underwriting (exceptional tool for portfolio tracking) to obtaining medical records and pharmaceutical profiles.
Our prices are reasonable and our customer focus is second to none! Give us a call for a full list of our services!
www.advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
http://twitter.com/TraciDavisAUS
Amrita LS index noted that in April 2010 there was an unexpected, and quite positive, jump in life settlement transactions over the prior month. The reported numbers climbed an astonishing 92.8 points over March. Amrita indicates that the jump was largely attributed to an increase in market activities and "renewed bullish expectations".
On the flip, Medical Information Bureau (MIB) indicated that individually underwritten life insurance was off -1.4% in April over March. Comparitively, the index has been fluctuating between mild growth and losses since January 2010. Senior life insurance applications continue to reflect growth - with a continued upward trend of +10.5% on applicants aged 60+. MIB indicates that the April numbers are consistent with "seasonal norms".
Have you considered conducting your underwriting and LE business from a different perspective? AUS has been busy incorporating new services from Red Flag Underwriting (exceptional tool for portfolio tracking) to obtaining medical records and pharmaceutical profiles.
Our prices are reasonable and our customer focus is second to none! Give us a call for a full list of our services!
www.advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
http://twitter.com/TraciDavisAUS
Tuesday, May 11, 2010
A Finger on the Pulse of Mortality
A recent study I happened across indicated a direct correlation of resting pulse rates in cardiac patients with all-cause mortality.
The study indicated that in cardiac patients with resting pulse rates of greater than 70 had a mortality increase of 40% after adjusting for all factors.
Additionally, it was noted that these individuals were also at risk for increase hospitalizations related to acute episodes of congestive heart failure (CHF)-a leading cause of death in the seniors we underwrite every day!
The study indicated that in cardiac patients with resting pulse rates of greater than 70 had a mortality increase of 40% after adjusting for all factors.
Additionally, it was noted that these individuals were also at risk for increase hospitalizations related to acute episodes of congestive heart failure (CHF)-a leading cause of death in the seniors we underwrite every day!
"Among nearly all mammals, life expectancy is close to 1 billion heartbeats"
Michael S. Lauer, MD
National Health, Lung and Blood Institute
Cleveland Clinic Journal of Medicine
76 (2009): S18
"Hanks Hot Notes", Vol. 9 Num. 5, May 2010
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Friday, April 9, 2010
Life Insurance Applications-March Madness!!
MIB (Medical Information Bureau) just released the March index which reflects life insurance application trends (insurance industry in-total) and it had some surprisingly good news. There was an increase in life insurance applications (+2.4%) "year over year" ages combined. Interestingly, compared to prior years, year-over-year growth in March is atypical and has not been seen in over six years.
Applications based upon age reflected lack of growth in ages 0-44, however ages 45-59 were up +4.6% over prior years and there is a continued rise in senior applicants over the age of 60 with an astounding +15.5% year-over-year. This trend in growth in the 60+ market has been seen since April of 2007.
For those of us that focus on senior markets, it is further verification that our focus is not misplaced!
Applications based upon age reflected lack of growth in ages 0-44, however ages 45-59 were up +4.6% over prior years and there is a continued rise in senior applicants over the age of 60 with an astounding +15.5% year-over-year. This trend in growth in the 60+ market has been seen since April of 2007.
For those of us that focus on senior markets, it is further verification that our focus is not misplaced!
Quote of the Day:
Aging is not 'lost youth' but a new stage of opportunity and strength
Betty Friedan (1921-2006)
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Monday, April 5, 2010
What Interviews and RX Profiles Tell You-That Doctors Don't!
Underwriters utilize a number of "tools" during the assessment process of a life insured. These provide a wide array of additional data points and insight that just cannot be gleaned from doctors reports. A number of these tools are unavailable to the Life Settlement (LS) underwriter - however, two of the most valuable tools ARE available however investors often don't know about these tools and they are not readily available by the life expectancy providers in the industry.
Two critical underwriting tools are the telephone interview and the RX profile. Telephone interviews, completed by the experienced underwriter, can provide a tremendous amount of insight into the individuals medical history, compliance with therapy, details on doctor consultations, and most importantly-lifestyle (activities of daily living-ADL) factors. A recent study of 658 seniors noted a direct correlation of lower mortality and morbidity rates associated with a senior engaging in a "hobby". Researchers found that with a simple "hobby" a senior was more likely to have increased ADL scores, lower depression scores, and closer ties to family and friends. Simple, but critical, insight gleaned from a simple conversation with a senior that will rarely be reflected in medical records but can have a tremendous impact in the individuals longevity.
The RX profile is a simple pharmaceutical database check that provides an underwriter with critical data on the individuals medications, the refill history (denoting compliance, or non-compliance, of prescribed therapy), insight into changes in medical history (outlining introduction of new medications or changes in prescribed amounts) and detail on prescribing physicians. A simple check that provides a tremendous amount of information, that reviewed by a trained underwriting professional, can be a powerful tool in assessing ones mortality.
These tools are the "tip of the iceberg" in the benefits that can be gleaned from these sources. The lingering question may be "Why don't all underwriting firms offer these benefits to their customers?". It's this underwriting professionals "humble" underwriting opinion that because some groups do not appreciate the value an underwriter brings to the assessment of an individuals mortality-they disregard all traditional underwriting tools and methodologies-stating that they have no basis in understanding an individuals mortality. Additionally they don't have ready access to obtain these value added products.
AUS, founded and managed by underwriters offers our clients the full value of all underwriting tools available-from medical history interviews by an experienced underwriter to RX profiles to our clients. Traditional life insurance and life settlement clients have full access to our suite of services-including our blog!
Come visit us!
www.advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
http://twitter.com/TraciDavisAUS
Two critical underwriting tools are the telephone interview and the RX profile. Telephone interviews, completed by the experienced underwriter, can provide a tremendous amount of insight into the individuals medical history, compliance with therapy, details on doctor consultations, and most importantly-lifestyle (activities of daily living-ADL) factors. A recent study of 658 seniors noted a direct correlation of lower mortality and morbidity rates associated with a senior engaging in a "hobby". Researchers found that with a simple "hobby" a senior was more likely to have increased ADL scores, lower depression scores, and closer ties to family and friends. Simple, but critical, insight gleaned from a simple conversation with a senior that will rarely be reflected in medical records but can have a tremendous impact in the individuals longevity.
The RX profile is a simple pharmaceutical database check that provides an underwriter with critical data on the individuals medications, the refill history (denoting compliance, or non-compliance, of prescribed therapy), insight into changes in medical history (outlining introduction of new medications or changes in prescribed amounts) and detail on prescribing physicians. A simple check that provides a tremendous amount of information, that reviewed by a trained underwriting professional, can be a powerful tool in assessing ones mortality.
These tools are the "tip of the iceberg" in the benefits that can be gleaned from these sources. The lingering question may be "Why don't all underwriting firms offer these benefits to their customers?". It's this underwriting professionals "humble" underwriting opinion that because some groups do not appreciate the value an underwriter brings to the assessment of an individuals mortality-they disregard all traditional underwriting tools and methodologies-stating that they have no basis in understanding an individuals mortality. Additionally they don't have ready access to obtain these value added products.
AUS, founded and managed by underwriters offers our clients the full value of all underwriting tools available-from medical history interviews by an experienced underwriter to RX profiles to our clients. Traditional life insurance and life settlement clients have full access to our suite of services-including our blog!
Come visit us!
www.advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
http://twitter.com/TraciDavisAUS
Tuesday, March 30, 2010
Fatty Liver Disease-Chewing thru the Fat!
As an underwriter, it is common to review medical records indicating a history of "benign fatty liver disease" - especially in those patients with history of high BMI's that carry the majority of their weight through the mid section. Often times, there will be correlation to mildly elevated liver enzymes in a serum blood draw. In a number of underwriting assessments this finding, absent of any alcohol or hepatitis concerns, is typically treated as a non-debitable situation.
A recent research study has focused on the usefulness of utilizing specific laboratory panels to better identify non-alcoholic fatty liver disease (NAFLD) vs. advanced stage non-alcoholic steatohepatitis (NASH). The latter carrying a much higher rate of mortality impact from increased liver disease complications.
The study conducted on 541 patients in the NIH-funded NASH clinical research network found that there was correlation between specific lab/body habitus and biopsy proven advanced stage NASH. Specific areas of importance included; BMI, AST/ALT ratio, AST/platelet ratio, BARD score (BMI, AST/ALT ratio, diabetes), and cirrhosis discriminant score. Unfortunately, lab tests still are unable to clearly identify advanced NASH cases-but these tests are a step in the right direction for identifying situations that require further evaluation.
This will continue to be a problematic issue for underwriting professionals, especially in light of the increasing obesity issues that will affect increased diagnosis of NAFLD making it difficult to weed out those that are higher risk NASH cases.
A recent research study has focused on the usefulness of utilizing specific laboratory panels to better identify non-alcoholic fatty liver disease (NAFLD) vs. advanced stage non-alcoholic steatohepatitis (NASH). The latter carrying a much higher rate of mortality impact from increased liver disease complications.
The study conducted on 541 patients in the NIH-funded NASH clinical research network found that there was correlation between specific lab/body habitus and biopsy proven advanced stage NASH. Specific areas of importance included; BMI, AST/ALT ratio, AST/platelet ratio, BARD score (BMI, AST/ALT ratio, diabetes), and cirrhosis discriminant score. Unfortunately, lab tests still are unable to clearly identify advanced NASH cases-but these tests are a step in the right direction for identifying situations that require further evaluation.
This will continue to be a problematic issue for underwriting professionals, especially in light of the increasing obesity issues that will affect increased diagnosis of NAFLD making it difficult to weed out those that are higher risk NASH cases.
Wednesday, March 10, 2010
Market Trends-Still struggling to find growth!
Two updated indices that track activity in life insurance and life settlement provided no encouragement for improvement in insurance related markets.
MIB (Medical Information Bureau) released February activity numbers yesterday, and the positive trend we saw in January was no where to be seen in the "flat" numbers reflected last month. The month was noted to be "off" -0.2% - all ages combined. One area that still shows promise for future growth is insurance applications on those over the age of 60-an age group that has historically reflected double digit growth over the past 13 months. February is a lower month of production historically so there is hope that moving into 2nd Q we could see moderate increases.
Amrita's Life Settlement Index also released February numbers reflecting a 73 point decline in transactions over January. The indication is that it is related to the policies in the market outpacing the funding to purchase and tightened provider buying perameters. As an LE provider in the space, the trend of lower production in life insurance seems to mirror life settlement as we have historically noted reduced case flow numbers in the first and early 2nd Q.
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MIB (Medical Information Bureau) released February activity numbers yesterday, and the positive trend we saw in January was no where to be seen in the "flat" numbers reflected last month. The month was noted to be "off" -0.2% - all ages combined. One area that still shows promise for future growth is insurance applications on those over the age of 60-an age group that has historically reflected double digit growth over the past 13 months. February is a lower month of production historically so there is hope that moving into 2nd Q we could see moderate increases.
Amrita's Life Settlement Index also released February numbers reflecting a 73 point decline in transactions over January. The indication is that it is related to the policies in the market outpacing the funding to purchase and tightened provider buying perameters. As an LE provider in the space, the trend of lower production in life insurance seems to mirror life settlement as we have historically noted reduced case flow numbers in the first and early 2nd Q.
Come Visit Us!
www.advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
http://twitter.com/TraciDavisAUS
Tuesday, March 9, 2010
Smoking & Benefits of Reduction?
I recently came across an Israeli study that studied the effects of smoking cessation AND reduction in survivors of acute MI (myocardial infarction-acute heart attack). The focus was on long-term mortality in 1581 patients. Both genders were studied, the mean age of the patients was 54, 19% of those studied were women.
Participants in the study had their first cardiac event between 1992 and 1993 and were followed for more than 10 years. At baseline, 123 participants had never smoked, 70 were former smokers, and 234 were current smokers.
Results of the study indicated that of those that were persistent smokers, but noted to reduce at least 5 cigarettes daily status post MI, there was an associated 18% decline in mortality risk.
Although this was considered a "young" cohort of first time MI patients, it did reinforce a significant benefit smoking cessation, but more surprisingly, the benefit of moderate reduction in smoking.
For many smokers plagued with the challenges of quitting, these benefits of smoking reduction are at least a positive step toward encouraging smokers to make initial "first steps".
Participants in the study had their first cardiac event between 1992 and 1993 and were followed for more than 10 years. At baseline, 123 participants had never smoked, 70 were former smokers, and 234 were current smokers.
Results of the study indicated that of those that were persistent smokers, but noted to reduce at least 5 cigarettes daily status post MI, there was an associated 18% decline in mortality risk.
Although this was considered a "young" cohort of first time MI patients, it did reinforce a significant benefit smoking cessation, but more surprisingly, the benefit of moderate reduction in smoking.
For many smokers plagued with the challenges of quitting, these benefits of smoking reduction are at least a positive step toward encouraging smokers to make initial "first steps".
"It has been my experience that folks who have no vices have very few virtues" Abraham Lincoln (1809-1865)
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Friday, February 19, 2010
Trends in Cardiovascular Disease
I recently happened across two studies which focused on hospital mortality rates associated with patients presenting with acute coronary ischemia. One study performed by the National Health and Nutrition Examination Survey (NHANES) noted a .6% decline in death in men (ages 35-44) and 1.3% decline in men (ages 45-54).
The other study from the National Registry of Myocardial Infarction (examining hospital mortality for men and women presenting with acute coronary ischemia) between the years of 1994-2006 noted decreases in associated mortality as well. Specifically, among the oldest men and women (over the age of 85) hospital mortality decreased 8.7%! The bad news for women is that in the later cohort-hospital mortality remained higher among women-especially those under the age of 60.
Although the reduction in hospital related mortality has dropped, the modest improvement in survival of the patients overall suggests that it is extremely important to continue focusing on modifying factors that lead to cardiovascular risk and progression. The risk factors, for young and old, continue to include; control of blood pressure, lipids, and weight and a lifestyle with consistent physical activity, along with controlled co-morbid factors such as diabetes.
The other study from the National Registry of Myocardial Infarction (examining hospital mortality for men and women presenting with acute coronary ischemia) between the years of 1994-2006 noted decreases in associated mortality as well. Specifically, among the oldest men and women (over the age of 85) hospital mortality decreased 8.7%! The bad news for women is that in the later cohort-hospital mortality remained higher among women-especially those under the age of 60.
Although the reduction in hospital related mortality has dropped, the modest improvement in survival of the patients overall suggests that it is extremely important to continue focusing on modifying factors that lead to cardiovascular risk and progression. The risk factors, for young and old, continue to include; control of blood pressure, lipids, and weight and a lifestyle with consistent physical activity, along with controlled co-morbid factors such as diabetes.
"Walking is the best possible exercise. Habituate yourself to walk very far"
Thomas Jefferson (1743-1826)
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Monday, February 15, 2010
Barretts Esophagitis-Increased Risk of Colon Cancer
Recently, researchers in the Netherlands released results of the largest cohort study of the relative risk of Barretts Esophagitis (BE) patients developing future Colorectal Cancer (CRC).
This large based population study involved over 42,000 BE patients. Over the course of the 5 year study, 713 participants (1.7%) were diagnosed with CRC.
All CRC diagnosis were made over the age of 40, the majority of those developed the cancer in their 50's (96%). Most excess risk was identified during colonoscopy following the recent BE diagnosis, as such, no change in baseline colonoscopy testing was felt to be warranted.
What this blogger takes away from this study is the importance of thorough screening in individuals newly diagnosed with BE. As an underwriter I have had the benefit of Insurance MD's in the past that theorized the increased associated risk; planting the seed that these cases must be underwritten with care!
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This large based population study involved over 42,000 BE patients. Over the course of the 5 year study, 713 participants (1.7%) were diagnosed with CRC.
All CRC diagnosis were made over the age of 40, the majority of those developed the cancer in their 50's (96%). Most excess risk was identified during colonoscopy following the recent BE diagnosis, as such, no change in baseline colonoscopy testing was felt to be warranted.
What this blogger takes away from this study is the importance of thorough screening in individuals newly diagnosed with BE. As an underwriter I have had the benefit of Insurance MD's in the past that theorized the increased associated risk; planting the seed that these cases must be underwritten with care!
Quote of the Day:
"Happiness is nothing more than good health and a bad memory"
Albert Schweitzer (1875-1965)
Come visit us!
www.advanceduwsolutions.com
TD on LinkedIn: www.linkedin.com/in/tddavisaus
TD Twitter: http://twitter.com/TraciDavisAUS
Wednesday, February 3, 2010
Trends in Life Insurance and Life Settlement
Two recent indices (one tracking life insurance sales, the other life settlement transactions) have both reflected a positive trend in the markets.
Medical Information Bureau (MIB) noted a continued trend towards growth in life insurance policy applications-especially on older applicants (60+ year olds) which reflected an outstanding YTD increase of 13% over 2008 sales.
Amrita Life Settlement Index just posted it's inaugural index (the first of its kind in the LS market) reflecting an increase in LS transactions (as reported by provider firms in the market) from its benchmarked 500 points to 528. A modest growth but a positive trend nontheless. This blogger is looking for future indices from this group that are more specific and refined-and have no doubt they are committed to providing a quality and reliable reporting for years to come.
Any growth is positive, and after the year we all experienced (whether from a life insurance or life settlement view point) it is quite welcome as we move into a new year!
Quote of the Day:
Medical Information Bureau (MIB) noted a continued trend towards growth in life insurance policy applications-especially on older applicants (60+ year olds) which reflected an outstanding YTD increase of 13% over 2008 sales.
Amrita Life Settlement Index just posted it's inaugural index (the first of its kind in the LS market) reflecting an increase in LS transactions (as reported by provider firms in the market) from its benchmarked 500 points to 528. A modest growth but a positive trend nontheless. This blogger is looking for future indices from this group that are more specific and refined-and have no doubt they are committed to providing a quality and reliable reporting for years to come.
Any growth is positive, and after the year we all experienced (whether from a life insurance or life settlement view point) it is quite welcome as we move into a new year!
Quote of the Day:
"Small opportunities are often the start of great enterprises "
Demosthenes (384 BC-322 BC)
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Wednesday, January 6, 2010
Who Knew? Salt over the Shoulder is Healthier than Salt Consumed
A recent article in Journal Watch brought to light a large scale research study that focused on determining if daily salt intake could prevent cardiac and stroke events. Upon review of 13 studies from 1968 through 2008, which incorporated over 177,000. participants, the researches were able to determine that those participants in the "high consumption" range had significantly increased cardiac (relative risk 1.14)and stroke (relative risk 1.23) events. The difference in salt intake between high risk and average was a mere 5g (1 tsp.) of daily salt intake.
Breaking the information gleaned from this study down, into relative terms that we can all identify with, by decreasing your daily intake of salt by 1 tsp. (86 mmol of sodium) you could reduce your risk of cardiac events by 17% and stroke by an astounding 23%!
Leave the vascular devils at bay by throwing your excess salt over your shoulder instead of sprinkling it on your meal!
Quote of the Day:
I have always regarded myself as the pillar of my life.
Meryl Streep (1949 - )
Contact us:
www.advanceduwsolutions.com
TD on LinkedIn:
www.linkedin.com/in/tddavisaus
TD on Twitter:
http://twitter.com/TraciDavisAUS
Breaking the information gleaned from this study down, into relative terms that we can all identify with, by decreasing your daily intake of salt by 1 tsp. (86 mmol of sodium) you could reduce your risk of cardiac events by 17% and stroke by an astounding 23%!
Leave the vascular devils at bay by throwing your excess salt over your shoulder instead of sprinkling it on your meal!
Quote of the Day:
I have always regarded myself as the pillar of my life.
Meryl Streep (1949 - )
Contact us:
www.advanceduwsolutions.com
TD on LinkedIn:
www.linkedin.com/in/tddavisaus
TD on Twitter:
http://twitter.com/TraciDavisAUS
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