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: Excel file containing extracts of utilization and costs for chiropractic and acupunture - all members combined. From a research project examining the utility of standard eligibility and claims extracts for complementary and alternative medical therapies - CAM analysis.

Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: This project shows how to use agent-based models to simulate the behaviors of agents in complex health systems.

Description: Pilot study made determining a satisfactory form for future experience studies under major medical expense insurance.

Description: Health Watch Newsletter, May 2006, Issue No. 52. This article presents information from a recently completed client-sponsored survey of hospital contracting best practices. Individual health plans were evaluated using a structured survey document. The primary objective of the survey was to identify best practices that the client sponsor could implement to improve its already better-than-average hospital contracting practices