Description: Mental health spending has reached $147 billion in the United States with demand only increasing greatly impacting society as nearly 1 in 5 experience these issues. There are even more indirect costs associated with mental health causing a national crisis surpassing 1 percent of the GDP. These costs coupled with the severe lack of licensed clinicians calls for an innovative solution. Through years of development and completion of a randomized controlled trial, Prevail has built and validated a low-cost, scalable solution. Prevail's clinically proven digital mental health treatment provides increased access to care while reducing overall health costs. Private and public payors should being reimbursing this model and offering it to their members.

Description: This is the Health Section News, August 2005, Issue 50 and discusses accessing and using public data: A primer for the health actuary. Health data no longer is an afterthought but it is an essential component of health care delivery, payment and decisions.

Description: Recent health care reform activity has highlighted the importance of Clinical Integration in improving the quality, safety, efficiency and reimbursement infrastructure of the health care system. This article discusses relevance and implication of regulatory measures, implementation and data issues, and provides an end-to-end example.

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: Medicare Advantage Organizations must consider influences both internal and external to the adjudication process as they review and use data for bid preparation

Description: This article describes and, more importantly, identifies information systems which are either in existence or planned on the national, state, and local levels. It describes the data available on the national level from the National Center for Health Statistics, the 05ce of Research and Statistics of the Social Security Administration, the AMA, the AHA, etc. It also describes a number of state and local information systems and addresses itself to information systems for inpatient care, ambulatory care, and the needs and likely sources of data for PSRO’s.

Description: A Regulatory Perspective on Rate Review Before and After the Affordable Care Act

Description: Essential Health Benefits and Actuarial Value

Description: Medicare Advantage and ACA

Description: Summary of SOA initiative on preparing and positioning actuaries to move into new roles which are becoming available as the health care industry changes.