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: Presenter discusses issues related to alternative care, as well as SOA activity in regard to alternative care. From the Record of the Society of Actuaries, Vol. 24, No. 1.

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

Description: Panelists discuss major reforms of health care financing and delivery systems around the world. From the Record of the Society of Actuaries, Vol. 24, No. 2.

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: Essays show a new system that will encompass minor changes to the current health insurance system, it will allow consumers to sign up for Federal Employees Health Benefit Plan and be administered like Medicare but with more benefits and emphasis on preventive care.

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

Description: Essential Health Benefits and Actuarial Value

Description: Affordable Care Act and Payment Reform

Description: A Regulatory Perspective on Rate Review Before and After the Affordable Care Act