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: The ACA’s Medical Loss Ratio Provisions

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: Feature article with helpful hints on video conferencing and more!

Description: An approach to quantify medical intervention savings when medical claims data is not available by leveraging overlapping measurement techniques.

Description: A compilation of feedback from actuaries in the Health Section of the affects of the ACA.

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.

Description: Affordable Care Act and Payment Reform

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

Description: This paper provides an outline of three potential initiatives that may be undertaken by the government and the private sector. The first initiative aims at reducing the cost of health care at the provider level. The second initiative provides a means to improve the quality of health care. The third initiative creates a constructive basis for identifying medical best practices to enhance quality.