Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: Regression to the mean is a phenomenon that arises when comparing sequential data points. It states that when an initial observation is extreme or an outlier, future observations will be closer to the average. Health care actuaries need to understand and be able to mitigate the effects of regression to the mean to avoid misapplying predictive models or misstating measurements of historical effects.

Description: This article provides an overview of activities that should be considered by an actuary when validating a predictive model. It describes several components to consider when validating a predictive model and provides an examination of various methodologies that can be implemented in the validation process.

Description: An introduction to the methods and parameters for Bayesian Hyperparameter Optimization in a Life Insurance context.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: Uncertainty of a predictive model is a fact of life that many insurers could be overlooking at their peril without a framework for assessing it. The article provides a framework to understand the prediction uncertainty, which can be critical for the insurance operations using predictive models. Coin toss example explains model uncertainty and randomness inherent in making predictions to the number of heads expected. A mortality analysis case study illustrates how the Bayesian methodology can be used to develop the prediction uncertainty. In particular, the article shows that the Bayesian framework is a way to combine historical data and actuarial judgment, and directly address the model uncertainty through its posterior distribution.