Description: Renal disease is a very heterogenous medical condition whose end state is dialysis, a recurring cost intensive medical condition. Dialysis cost is one of the major medical cost drivers in USA. Insufficient and improper care management in the early stages of CKD (chronic kidney disease) leads to early incidence of end stage renal disease (ESRD) among CKD patients which not only leads to high medical costs, but also reflects poor health quality.

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: 2021 Life Meeting - Session 8A: Use of Electronic Health Records in the Assessment of Life and Health Risks 9.1.21 Recording

Description: Read the Society of Actuaries' latest update about how health care executives view the future of predictive analytics in the health care industry.

Description: Actuaries are leveraging predictive modeling and machine learning more and more as they strive to provide greater value to their stakeholders. Actuarial standards of practice provide guidance around modeling and data. The world has changed significantly over the last few years, so it is important these models be tested for fairness as well as any statistical biases. This article addresses some of the key issues actuaries need to be aware of as Corporations and society work through the responsible us of this technology and underlying data.

Description: "Examine the exciting possibilities for artificial intelligence (AI) in health care and its potential to transform the patient journey. You will learn about the various touchpoints where AI is being applied along the patient/care journey, including provider search tools, claims analysis, and fraud detection. By attending the session, you will be able to: Have a comprehensive understanding of the opportunities and challenges presented by AI in health care Evaluate the potential impact of AI on their own organizations Be equipped with strategies for effectively implementing AI solutions and maximizing their benefits for patients, providers, and payers"

Description: This is a case study session where the speakers will describe a project where a major health system converted its provider distinct reimbursement (i.e., separate physician IPA and hospital capitation) to an integrated reimbursement involving global capitation. The session will discuss the strategic issues considered by the parties and how they evaluated them in their decision process. This session will provide attendees an example of how to approach this type of decision.

Description: LTC insurers can proactively identify policyholders more likely to go on claim in the near future, and methods to potentially delay or prevent claims, benefiting company and customer.