Description: Essay reforming management in health care, structure of reimbursement, program management, health information, measurement systems, etc.

Description: Yi-Ling Lin, FSA, MAAA, FCA, started the SOA’s Predictive Analytics Certificate Program to keep pace with the impact big data and predictive modeling is having on the health care industry

Description: This article discusses the pros and cons of high speed electronic transfer of medical data, and the implications this technology may have on health actuaries.

Description: This article discusses what actuaries see as ideal components of a health care reform package with an emphasis on cost control, efficiency, elimination of fraud and reduction of errors.

Description: While medical and pharmacy claims data is a well-established source for healthcare analytics, significant data can be found elsewhere in electronic medical records (EMRs) and in hospital admit, discharge, and transfer (ADT) messages. Increasing availability of bulk EMR data to analyze coupled with more powerful and specialized tools for analyzing it presents an opportunity for actuaries to incorporate these sources in their work. This session will take a look at some of the data available beyond claims in EMRs and HL7 ADT messages, and will discuss case studies, with consideration around structure, ease of use, cleanliness, and tools available for analyzing these data types including natural language processing.

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: NewsDirect article that discusses the benefits of automating the underwriting process. Underwriting speed, the east of case submission and sales support stand out as the most important factors.

Description: We highlight a new approach leveraging predictive analytics to identify high risk and rising risk opioid users for more effective screening and follow-up care.

Description: A discussion of insurance claims processing and payment systems, and how to achieve the minimum possible number of errors.

Description: Essay stating Americans need to invent, implement, and evaluate sustainable health care policies, divert cash-flow streams away from projects which feed the beast and focus on projects and policies which enhance value. It will require a combination of thoughtful, coordinated policies and a change in our cultural expectations of infinite resources and unlimited choice.