Description: This session explores the far-reaching changes to how clinical data will be sourced, processed and consumed in many payer use cases including risk adjustment, quality measurement, care management, claims adjudication, prior authorizations, and other payer functions. Robust, interoperable data exchange is a prerequisite for value-based care. Clinical data will be increasingly accessible to augment administrative (claims) data via standardized Fast Health Interoperability Resources (FHIR, pronounced 'fire'), at a fraction of the cost of a accessing a traditional medical record and in real-time. On May 1, 2020, HHS issued a final rule implementing interoperability and the patient access provisions of the 21st Century Cures Act of 2016, although enforcement has been delayed into 2021 because of the COVID-19 pandemic. The new regulations promote, “HHS’s vision and strategy for achieving a health information ecosystem within which all individuals, their personal representatives, their health care providers, and their payers are able to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable to support the health and wellness of individuals through informed, shared decision-making, as well as to support consumer choice of payers and providers.”Once enforcement begins, CMS and the Office of the National Coordinator for Health Information Technology (ONC), have the authority to mandate adoption of interoperability requirements, and also penalize payers and providers for non-compliance or the delay and withholding of data.This ‘digital transformation’ of the clinical data ecosystem has far-reaching implications for enabling technologies including Natural Language Processing (NLP) and entire segments of services and vendors. It will eliminate many departmental barriers, duplication and error sources for health plans and impact every department and the underlying economics of delivering and managing care.

Description: Slides from a session at a meeting of the Society of Actuaries held in San Diego, CA, June 22-23, 2000 Panelists build on the paper by Luke N. Girard, Market Value of Insurance Liabilities: Reconciling the Actuarial Appraisal and Option-Pricing Methods, that combines, in one framework, the traditional actuarial appraisal method and option-pricing method.

Description: This paper helps the audience understand the actuary’s role in estimating the financial impact of primary care programs. In addition, the paper can be used by actuaries to think about key issues when estimating the financial impact of their employers’ and clients’ own primary care programs.

Description: This paper develops a tool that may be useful in explaining the differences between earnings that are reported under GAAP and profits that are expressed as an internal rate of return.

Description: 2021 Life Meeting - Session 5C: Assumption Setting in an Uncertain World 8.31.21 Recording

Description: Insurers have been getting out of the individual medical expense market. This session will address the implications of such a decision: Nature of the problem Viability of individual medical products Challenge to the actuary Consequences of withdrawal Alternatives of withdrawal. Record of the Society of Actuaries Vol. 10, No. 2 at Salt Lake City

Description: Panelists consider the future environment of the valuation actuary in the U.S., the current environment in Canada and elsewhere, and the likely future methods of determining financial solvency in the U.S. From the 1988 Record of Society of Actuaries, Vol. 14, No. 4A.

Description: This session from the 1984 SOA Atlanta Meeting covers the issues in the individual medical insurance market - escalating costs, utilization rates and anti-select lapsation, the potential solutions and the challenges facing the actuary.

Description: Discusses the reasons for, and the economic impacts of, the backdating of life insurance policies, and what changes in the industry might evolve to address them.