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: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: Methods and assumptions used in the valuation of savings by external care vendors

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements

Description: As health care changes, actuaries need to be able to understand developments and work with users of health plan information. Actuaries also must be a credible source of data. This article describes the efforts of the Society of Actuaries Task Force on Alternative Care to determine the effectiveness of alternative or integrative medicine, including nontraditional techniques such as chiropractic, acupuncture, massage therapy, and nutritional counseling.