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: The advent of machine learning algorithms has taken predictive analytics and risk scoring to a new level. From gradient boosting machines to k-nearest neighbors regression, the use of these techniques has gained significant traction in healthcare - including health systems like the Cleveland Clinic. This session will discuss the use of predictive analytics to go beyond just assessing the risk of a patient, and instead focus on prescribing a specific intervention of care. In practice, the recommendation of a care plan goes beyond just attributing a score to a patient. It provides physicians and care coordinators the most probabilistic options - e.g. referral to social worker, depression screening, weight-loss program - for positively impacting a patient's future healthcare outcome.

Description: This article is illustrates the implications of the managed care organization MCO risk based capital RBC formula adopted by NAIC and compares it to the health organization risk based capital HORBC formula. From The Actuary, Nov 1997, Vol. 31, Issue 9

Description: Presented at the Living to 100 Symposium, January 2011. This paper examines the relationship between the earliest stages of dementia—mild cognitive impairment—and mortality. Using data from long-term care insurance applicants, and linking this to the Social Security Master Death File, the authors focus on the classification results of two cognitive screens used at various times in the underwriting process. Applying the Cox Proportional Hazards Model as well as relative mortality ratio analysis, the authors show that the proportion of individuals classified as cognitively impaired have significantly higher relative mortality compared to those classified as cognitively intact.

Description: Presented at Living to 100 Symposium, January 2011. This article estimates the impact of obesity and diabetes on disability and mortality for those older than 65 using the 2004 National Long Term Care Survey with disability based on the Health Insurance Accountability and Portability Act's Activities of Daily Living and Cognitive Impairment triggers.

Description: Successful healthcare reform: First, it must help that must keep healthy people healthy. Second, it must help people mitigate or eliminate the health-risks associated with unhealthy lifestyle behavior choices, and Third, it must ensure the provision of evidence-based care to those who are ill.

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Presented at Living to 100 Symposium, January 2011. This paper first explores the current state and contributing causes of obesity. It then explores the mortality and health care costs of obesity. It ends with a discussion of its management.

Description: This session will cover the definition of a risk-taking health entity, the kinds of risk and ways to measure it. Included is an update from the Risk-based Capital Task Force. From Record of Society of Actuaries Vol. 20, No. 3B.

Description: This document provides an explanation of the Health Company Pandemic Modeling tool excel workbook and gives step by step instructions for companies to enter specific scenarios and assumptions.