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It’s an immensely complex – and rewarding – role. One moment a medical director may be called on to untangle a highly complex medical claim; the next, he or she may be required to present insurance medicine advances at an industry conference or even perform a sophisticated data analysis.  

RGA made the rounds with Dr. David Rengachary, DBIM, FALU, FLMI, Senior Vice President and Chief Medical Director, U.S. Mortality Markets, to demystify what medical directors do and learn why investing in medical review matters. To learn more about RGA’s medical expertise and support services, contact us at CMSTeam@rgare.com.

It wasn’t so long ago that the role of the Medical Director entailed a fairly predictable series of responsibilities – cosigns, manual updates, interpreting EKGs. Yet we see signs the position is evolving. How do you spend your time during an average day?

There is no such thing as an average day anymore. Consults used to come in the form of application referrals, and that of course remains RGA’s core strength. But now we are asked to provide input on prescription scoring, underwriting rules for automated engines, and scoring of digital health data, to name just a few tasks. We’re even evaluating startups with medical concentrations for potential partnerships or investments. There has been enormous change.

The industry seems to be awash in data. They say underwriting is both an art and a science, but it sounds like the shift is towards science.

Well, I won’t deny that data science is of greater importance. But medical science is also advancing rapidly. We are hearing from clients that training for underwriters must adapt to new modes of risk assessment and selection. That means reinsurer training resources need to adapt, too, and RGA works hard to keep our training current and relevant.

So, if we are seeing a move away from paper, to more automated or straight-through processing of simple cases, without human intervention, what does that mean for the profession? What is the benefit of having a medical director?

Due to increased acceleration, what’s left behind in the fully underwritten space is inherently more complex. Medical directors offer experience and specializations necessary to help insurers assess these cases. My background is in neurology, and I work with colleagues around the world with expertise in everything from cardiology to geriatrics. The point here is that this variety of skillsets, taken together, can contribute invaluable input on different markets’ approaches to medical impairments, regulatory constraints, unique lines of business, and product development. Medical directors also play a key role in basic underwriter education and manual development.

And yet we are seeing that more and more small to mid-sized insurers lack a medical director. Could this be having a corrosive effect on the industry? We are all familiar with warnings of the “staffing cliff” or talent gap, but in a 2018 RGA survey of chief underwriting officers, lack of training for the existing workforce was considered the larger threat.

Not all shops are able to staff multiple physicians to provide medical support and training, yet all insurers want to make decisions based on the most current evidence-based treatments available. As insurance medical directors, and particularly at a reinsurer, we are uniquely able to draw on data to view healthcare trends on a large scale. RGA recently launched SUP MD (Strategic Underwriting Program – Medical Directors) to help make this expertise more available to clients. SUP is essentially a staffing augmentation program, featuring both underwriters and MDs. We are familiar with the unique underwriting philosophies of our various clients and are prepared to step in and evaluate  impairments from the specific direct carrier point of view and in many cases from their prescribed guidelines.

In your opinion, what does the future look like for the role of medical directors across the insurance industry?

It sounds cheesy, but the future is what we make of it. Medical directors have often had a relatively restricted role within a company, so frankly we have to push our way into some of the opportunities arising in multiple areas. In order to present a compelling case that we belong, we have to develop new skill sets and vocabularies. We’ve made this an ongoing priority at RGA and are eager to share our learnings with clients.