Description: This article discusses what actuaries see as ideal components of a health care reform package with an emphasis on cost control, efficiency, elimination of fraud and reduction of errors.

Description: NewsDirect article that discusses the benefits of automating the underwriting process. Underwriting speed, the east of case submission and sales support stand out as the most important factors.

Description: Essay reforming healthcare where participants have a vested interest in reaching the best answer.

Description: We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective screening and follow-up care.

Description: Essay reforming management in health care, structure of reimbursement, program management, health information, measurement systems, etc.

Description: A discussion of fraud and abuse in the Medicare payment system, and steps to address these problems.

Description: The presenters discuss the results from the CIA/SOA-sponsored survey on analytics practices of the Canadian life and health insurance industry. This is an opportunity to understand what other companies are doing and benchmark your practices with those of your peers and gain deeper insights about potential applications and their perceived value and effort. Attendees do not need specialized knowledge in predictive analytics to benefit from the information presented. Examples are provided from a Canadian context, but potential applications are relevant across a wide spectrum of geographies.

Description: Overview of evolving industry trends and examples of how life insurers in Canada are innovating.

Description: In the evolving realm of healthcare actuarial practice, value-based contracts are reshaping the landscape. This article explores the pivotal role of AI-enhanced Electronic Medical Records (EMRs) in empowering actuaries to navigate this dynamic sector. Despite challenges in data standardization, AI-enhanced EMRs offer a solution by extracting and standardizing diverse medical records. The article delineates how AI-EMR integration benefits actuaries and provider organizations, enabling more accurate forecasting, earlier shared savings prepayments, and real-time quality metric aggregation. Moreover, it discusses how this fusion addresses historical data limitations, can help project catastrophic claims, and can help identify risk score capture opportunities. Ultimately, it indicates the transformative potential of AI-EMR synergy, positioning actuaries at the forefront of healthcare analytics with unprecedented precision and insight.

Description: Recent health care reform activity has highlighted the importance of Clinical Integration in improving the quality, safety, efficiency and reimbursement infrastructure of the health care system. This article discusses relevance and implication of regulatory measures, implementation and data issues, and provides an end-to-end example.