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: In this article, we talk to Lei Rao-Knight, FSA, Vice President and Actuary at Prudential Financial. Lei discusses her model development experience in the Modeling Center of Excellence.

Description: An overview of the basic tooling and packages available for the Julia programming language, with a focus on why this is of interest to the actuarial profession. It covers some of the built-in language features as well parts of the Julia package ecosystem that make Julia ideal for modeling and data analysis. This is the second installment in a series of article aimed at actuaries. The first installment, Julia for Actuaries, was published in the October 2020 edition of Actuarial Technology Today, and covered the base language itself, its high-level, math-friendly syntax, and why the actuary of the future should consider its adoption.

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are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context.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: The actuarial profession is at a tipping point and a combination of disruptive technologies and external pressures are creating a unique opportunity to move from results producer to insightful adviser. For a prudent but forward-looking professional, this is exciting and scary in equal measure. The ability to process large masses of business data to make more accurate calculations has become one of the most sought-after skills for leaders across all industries, including insurance.<br><br>The presenters will introduce current data technologies used to manage, process and visualize data. They will cover solutions like Microsoft BI, Tableau, Amazon Redshift, Hadoop, Alteryx, Python, etc. and their applications in data, process improvement, automation, reporting and predictive analytics. In particular, they will explore management reporting and how it leverages data analytics to help business leaders with strategic decisions making, how to evaluate the effectiveness of management reporting structures, drivers of change and ways to improve them, and proposed steps toward entrenching this dynamic and insightful approach to management reporting in which insurance leaders can have confidence.

Description: View the Avoiding Unfair Bias in Insurance Applications of AI Models

Description: 1993 SOA Meeting, Quebec. This session is about implementing new technology, choosing between competing technology, problems to watch out for, unexpected benefits, migrating from mainframe to client/server, automating the field force and large-scale networks.

Description: As the insurance industry continues to evolve due to a pandemic and rapidly changing economic and regulatory conditions, the role of data scientists and actuaries has become increasingly important. In an interview with the Atidot data science and actuarial team, we discuss what it is like to work at an InsurTech, how data scientists and actuaries can collaborate, and look at some concrete technical examples of where the innovation is having an impact. This article explores what collaboration can look like and how the role of data science and actuary may evolve in the InsurTech industry in the future.

Description: This article describes one of the keys to successful marketing in the current environment - build a relational database that will help the agent communicate with a client in an organized way, so that we can educate, inform, present choices and help these clients navigate their financial future. This article provides the elements of such a database.

Description: This article summarizes five key lessons we have learned in implementing LDTI and shares our insights on practical ways to address them. This is not an exhaustive list of implementation challenges, but companies that can successfully tackle the issues we describe should have a smoother data and systems implementation transition.