Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: While medical and pharmacy claims data is a well-established source for healthcare analytics, significant data can be found elsewhere in electronic medical records (EMRs) and in hospital admit, discharge, and transfer (ADT) messages. Increasing availability of bulk EMR data to analyze coupled with more powerful and specialized tools for analyzing it presents an opportunity for actuaries to incorporate these sources in their work. This session will take a look at some of the data available beyond claims in EMRs and HL7 ADT messages, and will discuss case studies, with consideration around structure, ease of use, cleanliness, and tools available for analyzing these data types including natural language processing.

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

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: This article discusses the pros and cons of high speed electronic transfer of medical data, and the implications this technology may have on health actuaries.

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

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: 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.