Description: Electronic Health Records, or EHRs, are a major worldwide initiative to eliminate paper recordings – including Attending Physician Statements (APSs) – of an individual’s medical history and current treatment.

Description: This section presents book reviews and summaries of recent publications on a variety of topics.

Description: Panelists at this session of the SOA 1997 Palm Desert Spring Meeting discuss Internet resources that may be useful to health actuaries and hints on how to best access data.

Description: This article focuses on the recent surge of digital medicine data being seen in the healthcare industry. While an increase in data can generally be perceived as good, it is important to remember that current privacy practices need to be maintained, if not strengthened, to continually protect healthcare members. The COVID-19 pandemic helped fuel digital medicine data, but it also created new avenues for privacy to potentially be compromised (i.e. healthcare employees using personal devices while working from home). Digital medicine data is a very powerful asset, but it is also a massive responsibility. If mishandled, this data can cause more harm than good.

Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: Is your development team or IT staff growing tired of last-minute requests to include additional functionality? Have you strained to explain challenging actuarial topics to non-actuarial staff for implementation? Do your teams find themselves revisiting deadlines & timelines when building solutions? During this interactive panel discussion, three technologists (two software engineering managers and one data scientist) along with three actuaries will discuss real world problems and approaches using experience from previous projects. Although the challenge of running efficient software teams is not unique to actuarial science, this webcast will discuss best practices on how to organize teams to reduce friction and context switching. Presenters will also explore unique actuarial challenges and concepts including how to address standards on data quality when building software, how to build intuitive software that meets actuarial standards and how test-driven development makes it easier to meet actuarial standards of practice.

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: This session series is sponsored by Zelis Claim analytics produces valuable insights about provider cost, quality, and referral patterns. Provider networks can be created around high-value providers to improve clinical outcomes while lowering the cost of care. Programs to improve provider performance and/or incentivize members to choose high-value providers exist, but how do you bring all of this together to achieve desired outcomes? Join us to learn how to leverage provider level analytics to build and optimize a network with high-value providers at the center. Analyze the network for competitiveness and adequacy and demonstrate progress toward network cost saving goals to key stakeholders by modeling claim data for a member population. Finally, ensure the success of your network through an incentive program that shifts utilization to those high performing providers. By attending this session, you will be able to: - Build a realistic provider network with high-value providers at the center. - Evaluate the overall financial impact of network build and optimization efforts. - Learn about an innovative member incentive program.

Description: Read this report to learn more about interpretable machine learning techniques for health insurance fraud detection.

Description: This session discussion is about the trends and proliferation, the impact, the horizon, genetic research, considerations for containing utilization of various procedures and technology. From Record of Society of Actuaries Vol. 17, No. 3.