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: Health care predictive analytics varies between payers and providers as well as being a powerful tool in business decision modeling.

Description: Collaborative filtering models drive recommendations provided by Netflix and Amazon. This article uses the same models to explore patients’ medical conditions.

Description: Highlights of two 2018 health events organized by the Colombian Association of Actuaries and sponsored by the Colombian Government. Seminar on Risk Adjustment and Predictive Modeling in Health. Seminar on Risk Management for the Health Insurers