Description: CMS provides ACOs with monthly claims data for members, including their medical visits and ACO program eligibility. This data can be divided into Membership and Claims tables through the ETL process. However, when calculating PMPY at specific levels of detail using these tables, issues arise due to unrelated dimensions, leading to inaccurate and understated results. This article presents a solution to this problem by utilizing Tableau's data blending capabilities.

Description: Some research implies that micro SDOH-related risk factors can influence a significant proportion of an individual's overall health outcome. Contained in SDOH are items such as mental health, ongoing social connection and interactions, transportation, financial confidence, and other items.

Description: "Weighted compositional data analysis for modeling and forecasting life-table death counts – Han Lin Shang, Ph.D., Professor of Business Analytics and Director of Research at the Department of Actuarial Studies and Business Analytics at Macquarie Business School, Macquarie University, Sydney, Australia, Steven Haberman, PhD, Bayes Business School, City University of London, UK Compensation Effect of Mortality as a Challenge to Life Extension – Natalia S. Gavrilova, Ph.D., Leonid A. Gavrilov, Ph.D. Academic Research Centers, NORC at the University of Chicago"

Description: This article delves into the transformative realm of Business Intelligence (BI) tools. We explore the fundamental functionality and structure of these tools, and through case studies illustrate how they offer valuable insights into carrier experience and underwriting dynamics. From real-time data visualization to in-depth data analysis, discover the essential features that empower businesses to make better informed decisions.

Description: The SOA Research Institute and LIMRA have completed the most up-to-date study of variable annuity contract owner behavior. Learn more about this vital resource for actuaries working with annuities.

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: "Issues surrounding end-of-life and palliative care are not well understood and there is little research in the actuarial literature. From an actuarial perspective, however, end-of-life is important because of the significant cost to the healthcare system. Ian Duncan will discuss some of his research on the financial implications of end-of-life care, as well as the outcomes of a palliative care program. Dr. Matzo is an engaging personality with decades of experience in gerontology and palliative nursing, including training and teaching professionals in the field. Dr. Matzo focuses on educating the public on the importance and benefits of palliative care and hospice (care given in the final six months of life). In this session on “Palliative Care Public Education,” Dr. Matzo will give us an overview of the benefits of palliative care and how this knowledge empowers the individual to make important decisions about their healthcare options. Attendees will have the opportunity to discuss the role that the actuarial profession may play in this area."

Description: Applying Predictive Analytics for Insurance Assumptions Setting: high level principles.

Description: The SOA Research Institute and LIMRA have completed the most up-to-date study of variable annuity contract owner behavior. Learn more about this vital resource for actuaries working with annuities.