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: Discussion of how to mature value-based contracts between health insurers and provider organizations to improve population health and financial sustainability. Centers around contract parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ACO actuaries and leaders. Authors are writing from the provider perspective in value-based contracts.

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements

Description: What you need to know about risk scores to be competitive in the Medicare Advantage market.

Description: Review of reimbursement methodologies APGs, APCs, Medicare ASC, discount on charges, commercial hybrid, methods and trends in contracting, impact on trent, benchmarking. Issue No. 44.

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: An edited written interview with two actuaries and a public health professional on issues related to the intersection between the two fields.

Description: This interview article summarizes the work being done by a Health Section Strategic Initiative Committee.

Description: Read the June 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.