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

Description: Panelists discuss opportunities to improve medical cost trends through underwriting, healthcare benefit designs, contracting, network management, claims operations, and medical management. From the Record of the Society of Actuaries, Vol. 31, No. 2, Session 40

Description: This is one of a series of SOA-sponsored papers on the subject of Evaluating the Results of Care Management Interventions. This paper addresses the theory of measurement design and provides a practical evaluation of the most common designs for the practitioner.

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: Panelists discuss recent developments that may impact health care costs over the next few years, such as: · Trends in research and treatment for various diseases · Advances in diagnoses, therapies, and medications · Various clinical trials From the Record of the Society of Actuaries, Volume 27, No. 1, Session 73

Description: This article examines the costs of mental health parity, presents the primary drivers of cost increases from legislation and shows evidence the initial cost projections were too high. From Health Section News, March 2005, Issue No. 49.

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

Description: Excel file containing extracts of utilization and costs for chiropractic and acupunture - visit and service date detail. From a research project examining the utility of standard eligibility and claims extracts for complementary and alternative medical therapies - CAM analysis.

Description: The momentum in value-based care has produced an opportunity for actuaries to become pioneers in health care