Description: In the evolving realm of healthcare actuarial practice, value-based contracts are reshaping the landscape. This article explores the pivotal role of AI-enhanced Electronic Medical Records (EMRs) in empowering actuaries to navigate this dynamic sector. Despite challenges in data standardization, AI-enhanced EMRs offer a solution by extracting and standardizing diverse medical records. The article delineates how AI-EMR integration benefits actuaries and provider organizations, enabling more accurate forecasting, earlier shared savings prepayments, and real-time quality metric aggregation. Moreover, it discusses how this fusion addresses historical data limitations, can help project catastrophic claims, and can help identify risk score capture opportunities. Ultimately, it indicates the transformative potential of AI-EMR synergy, positioning actuaries at the forefront of healthcare analytics with unprecedented precision and insight.

Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.

Description: The article describes the insurance industry's preparation for pandemic events and the public finance response.

Description: The last three decades have witnessed an important rise in number of people with diabetes in Asia, especially Type 2 Diabetes. Like no other common condition, numerous innovations are currently entering the healthcare system that will soon have a significant impact on management of the condition. This presentation explores the role played by sensors/wearables, artificial intelligence, new drugs and diabetes apps. We assess the realistic potential of such advancements and give an outlook on medium-term pricing and product development.

Description: Read the October 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Read the February 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: The Effect of Medical Technology on Health Care Cost, the Effect of Health Care on Longevity and Vice Versa.

Description: Read the June 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: The SOA provides information about the actuarial career path in health care and predictive analytics. Throughout 2016, we will share more about actuaries who are tackling some of the industry's biggest challenges and hear from top employers in healthcare analytics.

Description: Health Watch, Issue 79, December 2015, Health Watch

Description: Review of 2015 from perspective of the Health Section

Description: Essential Health Benefits and Actuarial Value

Description: This is the English version of the research report, “Funding Public Health Insurance Plans Canada and Globally”. This report briefly looks at the actual health care funding models and metrics in seven countries (Canada, Sweden, France, Germany, Switzerland, the United Kingdom, and the United States) along with health care metrics for another 13 countries (20 OECD countries in total). This report also suggests a number of possible areas where actuaries could provide expertise to assist in the management of public health care plans.

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

Description: May 2013 issue of the Health Watch newsletter

Description: October 2012 issue of Health Watch newsletter

Description: Actuaries should understand the economic considerations involved in the formulary drug decision-making process, and the presence of actuarial input in the process could improve it, especially by tying it to overall decision making for the health plan. From Prescription Drugs Monograph, M-HB04-1.

Description: An essay discussing universal access to high quality, low cost health care.

Description: Essay discussing cost, quality and access of healthcare and then describes the need for rationing.

Description: Essay offers a vision of health care where everyone is covered, everyone is eligible, receives fair pricing, receives vital information and is taxed the same.

Description: A call for essays issued by the SOA Health and Long Term Care Sections on the visions for the future of the U.S. health care system.

Description: Article discussing the use of enterprise risk management in the health care industry.

Description: This article examines the dynamic environment of the health care system in the United States and the challenges facing the health actuary.

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: This session presents information sources used in tracking health technologies, the value of health technology assessments and clinical data typically available. From the Record of the Society of Actuaries, Vol. 31, No. 2, Session 4

Description: This article looks at pharmacy benefit management and the use of data, reviews standard pharmacoeconomic analysis methods, and discusses points for formulary decision making and what is known about the process. From Health Section News, March 2005, Issue No. 49.

Description: This session covers current topics of interest to self-funded health benefit programs. Topics include carve-out of pharmacy, participation in employer coalitions for pooling of risk and negotiating favorable terms with providers and administrators, stop loss insurance market developments and transparency. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 51

Description: This study was sponsored by the Society of Actuaries Health Section. This paper explores the relative significance of aging as a determinant of financial cost of health care beyond age 50, with particular attention to the effect for ages 65 and older. The paper presents concepts of aging factors and aging curves, which define relative values between ages for utilization or cost of health care services. General conclusions are drawn from Medicare data that utilization and cost differ by age, but that aging factors vary across services and may be less significant at very old ages. The author then turns to the question of measuring the significance of an aging curve assumption and what accuracy is lost in the simpler alternative of a single value across an age range.

Description: Incorporating Pended Claims in Medical IBNR Estimates. Issue No. 45.

Description: There is a wide range of literature on aging and health care. We sample this literature and find it fits into the subcategories of theoretical aging, medical significance of aging, treatment of the elderly, and resource allocation to the elderly. Themes are that financial arrangements can cause inefficient and ineffective care and that care guidelines need to developed specifically for the elderly rather than extrapolating guidelines for younger patients.

Description: Paper on the number and growth of the uninsured and underinsured in health insurance. Reviews literature on the following items trends in the number of uninsured, state policy activities, disparities in access, health care access and the health care safety net.

Description: Financial Reporting for Healthcare Plans objectives, defining market segments, preparing & recasting segment monitoring reports, quantification of liabilities, reconciliation of claim payments, medical management reports, expense control, company plans & projections & budgets, financial indicators & measurements. Issue No. 41.

Description: This analysis provides an overview of the functional components of the managed care system. It discusses the market forces underlying the United States’ system for health care financing and delivery and suggests how market forces impact the health care industry. The analysis focuses on societal goals for health care delivery and on managed care’s effectiveness in enabling achievement of those goals. The analysis develops and uses an innovative model developed to summarize the complex interplay among the many stakeholders, or participants, in the health care system. The model provides a framework for analysis of the many relationships among stakeholders. The analysis also highlights current issues in managed care, particularly the barriers that impede collaboration among stakeholders.

Description: Presented at May 2000 Spring Meeting. Discusses trends affecting costs for prescriptions, factors behind these trends, and cost management strategies for both the commercial and Medicare markets.

Description: Panelists discuss the methods HMOs employ to measure their providers' quality of care, outcomes, compliance with best practice guidelines, and cost control. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: Panelist discuss issues relating to new medical technologies and how these are going to affect the practice of medicine, the delivery of care, the costs of care, the insuring of care, claims handling, utilization, and cost management. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: Panelists discuss the role of the valuation actuary in health insurance. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This 1991 panel discussion is about health care trend including current experience, measurement techniques and problems, uses of trend projections, and other considerations such as the impact of selection and the impact of initial and renewal underwriting practices. From the Record of the Society of Actuaries Vol. 17, No. 3A.

Description: This session discussion is an overview of issues and recent developments: alternative delivery systems, managed care, utilization review, traditional group insurance, actuarial issues of AIDS, Medicare and retiree medical benefits, COBRA, the uninsured etc., HMO solvency, and long-term care. From Record of the Society of Actuaries 1988 Vol. 14, No. 1.

Description: This session discussion is about development of medical cost estimates, differences between indemnity and HMO techniques, relationship of premiums and capitations, HMO organizational structures, experience rating, community rating and community rating by class. From Record of the Society of Actuaries 1987 Vol. 13, No. 1.