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: The article explores how integrating AI into insurer apps can address critical challenges in healthcare, such as patient no-shows, medication adherence, and cost management. These non-disruptive approaches aim to increase the effectiveness of patient interventions and improve medication adherence.

Description: Read this report to learn more about interpretable machine learning techniques for health insurance fraud detection.

Description: This article provides an overview of critical illness insurance: history, product description, and the three primary ways to offer critical illness coverage in the United States. This article also contains an illustration of an issue age premium rate calculation, as well as product features and rating applications specific to the various types of critical illness coverage.

Description: The purpose of this document is to inform the user of the 2022 Health Care Cost Model about the sources of data, other reports, and assumptions which were used to populate this report and drive some of the key considerations.

Description: Summary in Simplified Chinese

Description: Report Summary in Simplified Chinese.

Description: There are early indications of a six year cycle in ACA markets reminiscent of the traditional underwriting cycle.

Description: Read the October 2020 issue of Health Watch published by the Health Section. Newsletters provided practical information for the working actuary, articles on trends that impact sections and news about section activities.

Description: The always popular Medicaid Hot Topics session is back with discussions from an expert panel on the most riveting Medicaid topics of the year. These could include the following: • Medicaid Fiscal Accountability Proposed Regulations• Tennessee's Block Grant Proposal• ACA court battles: What are the potential impacts on Medicaid? • Pass-through payments are converting to directed payments: What is changing?• And more current topics of interest to Medicaid actuariesMedicaid is dynamic and it is difficult to stay current on all of the changes. This session provides insightful discussion into the major changes that impact actuaries and their companies or state clients.

Description: Many new and innovative companies are leveraging technology to improve the effectiveness of the care provided to patients. They are employing better tools to identify patients who can benefit from specific programs that best meet the patient's need. They are also dramatically increasing the use of these programs by guiding plan members through the maze of offerings to match them with the programs that will be most beneficial to them. Employers are making these third party programs available to their members and Medicare Plans are using these new tools to identify emerging health risks for early intervention and more accurate risk scoring. This session will explore some examples of these programs, how they are being effectively integrated into the operations of health plans and how the results of these programs are being measured.The speakers will be:Raj Behal, MD, MPH,Chief Quality Officer, One Medical. Raj leads the quality and safety, value and innovation, and data science teams at One Medical. One Medical is changing the way primary care is delivered with a concierge approach with technology seamlessly woven into their offering. This includes booking appointments on line, virtual face to face care, accessible medical records and health reminders.Mylea Charval,Ph.D., CEO and Founder, Savonix. Savonix is a next generation cognitive assessment platform that brings clinical, evidence-based, and all mobile digital assessment of cognitive and emotional function. These capabilities are critical for early identification of the onset of dementia and for the proper risk assessment of seniors enrolled in Medicare Advantage Plans.Ed Cymerys, FSA, Advisor. Ed will serve as moderator. Over the last six years Ed has served as an advisor to a number of early stage technology companies looking to improve the way health benefits are being delivered.Dave Sotelo, FSA, MAAA, Actuarial Manager, Collective Health, Inc. Collective Health is an integrated solution that allows self-funded employers to administer their health plans, control costs, and take care of their people -- all in one place. They have effectively integrated more than 70 distinct third party solutions for self-funded employers and are rigorously assessing the impact of these programs

Description: Since the outbreak began in January, numerous research groups throughout the world have developed models to forecast the number of deaths that could result from COVID-19. Updated April 24, 2020.

Description: Since the outbreak began in January, numerous research groups throughout the world have developed models to forecast the number of deaths that could result from COVID-19.

Description: While intended to assist health plan actuaries responsible for stress testing and ORSA filings, this session will also be informative for actuaries interested in communicating the impact of potential catastrophic events for health plans to their management and board. It will begin with a discussion of event thresholds for stress tests and their impact on capital and financial statements. Presenters will take a detailed look at several catastrophic event case studies (historical and hypothetical) in the following areas: healthcare specific (e.g. pandemic, specialty Rx), financial institution/credit market, operational/business, strategic and multi-event scenarios.</

Description: Lower costs doesn't necessarily help ACA markets. It often makes things worse.

Description: Electronic Health Records, or EHRs, are a major worldwide initiative to eliminate paper recordings – including Attending Physician Statements (APSs) – of an individual’s medical history and current treatment.

Description: This is the Introductory Study Note for the Society of Actuaries Group and Health-Company/Sponsor Perspective examination for Spring 2012 that will be given on Friday, April 27th, from 8:30 a.m. – 11:45 a.m. and 1:30 p.m. – 4:45 p.m.

Description: Update on Health Section research projects and topics, including health care reform, complexity science, and strategic planning.

Description: This is an article about debt protection and credit insurance as products. From Small Talk Newsletter, November 2005, Issue No. 25.

Description: This presentation from Session 15 of the SOA 2005 Health/Pension Spring Meeting discusses current developments affecting health plan contracting with institutional, professional and ancillary providers. Specific questions addressed are: 1. What are the trends in financial arrangements sought by providers?, 2. Has consolidation changed negotiating strategies?, 3. Has technology affected the types of financial arrangements available?, and 4.How can actuaries assist in the analytical/negotiating process?

Description: A panel of actuaries and clinical consultants at this session of the SOA 2003 Vancouver Spring Meeting provides an assessment of current and future applications of predictive modeling techniques in the health arena. A practical example of risk adjustment, discussion of the clinical use of this technique, and applications in underwriting are discussed.

Description: Adding value in the development, production and marketing process of medical devises regulatory environment, designer/manufacturer perspective, product failure and litigation risk. Issue No. 44.

Description: This teaching session provides a summary of publicly available data and information sources for health actuaries. Several of the more useful resources are reviewed in detail. From the Record of the Society of Actuaries, Volume 28, No. 2, Session 15

Description: Presented at October 2000 Annual Meeting. Discusses the marketing of voluntary benefits to employee groups and addresses key success factors for distribution, product, and technology associated with the work-site marketing distribution channel.

Description: In session 120 PD of the Las Vegas Spring Meeting panelists discuss new developments and strategies related to provider contracting. What changes in the risk-sharing arrangements are occurring? What contracting methodologies have been successful and what ones have not? From Record of Society of Actuaries, Volume 26, No. 1.

Description: This article is about our dependence on prescription drugs, their cost and the desire for insurance coverage of drugs.

Description: This is a series of 4 articles designed to address fundamental concepts such as GAAP rules and their application to some of the major accident and health lines of business offered by insurers. The first article begins with a review of the structure/hierarchy of generally accepted accounting principles GAAP. From Society of Actuaries Financial Reporting Monograph, M-AS99-1.

Description: 1997 Valuation Actuary Symposium, Session 5 explores health cash-flow testing.

Description: Panelists at this session of the SOA 1997 Palm Desert Spring Meeting discuss Internet resources that may be useful to health actuaries and hints on how to best access data.

Description: The panel will present a discussion by several experts on reform activity at the state level, including a review of some initial results. From the Record of the Society of Actuaries, Vol. 21, No. 4a.

Description: Society of Actuaries SOA research and activity on health databases will be presented. From the Record of the Society of Actuaries, Vol. 21, No. 3b.

Description: This is the abstract for the paper entitled &#39;Pricing Long Term Insurance Contracts.&#39; This paper considers several models describing the changes in the needs of the insured for care over time. From Actuarial Research Clearing House 1994, VOL. 1.

Description: This session discussion is about medical technology: trends and proliferation of medical technology, its impact, future, employer strategies to limit exposure, considerations of containing utilization of various procedures and technology. From Record of Society of Actuaries Vol. 18, No. 1A.

Description: This paper examines four and-a-half years of prescription records for an elderly population who have relatively comprehensive out-of-hospital drug coverage under the Pharmaceutical Assistance Contract for the Elderly program in Pennsylvania. The result is a discussion of the determination of non-parametric estimations of the distributions. From Actuarial Research Clearing House 1991, Vol 1.

Description: This session at the SOA 1990 Annual Meeting looks at the outlook over the next 10 years of employee benefits. The effect on the role of the actuary is discussed.

Description: This 1990 Valuation Actuary Symposium session is an open forum on short-term and intermediate risks in health insurance today. This forum will also discuss HMOs and the valuation actuary.

Description: This session from the 1984 SOA Salt Lake City Meeting discusses the small and mini-group market including trends in plan design, underwriting strategies, approaches to marketing compensation and claim cost containment strategies. Record of the Society of Actuaries Vol. 10, No. 2

Description: This session discussed A successful HMO An emerging PPO A dynamic employer coalition An industry-sponsored wellness at the worksite program. Record of the Society of Actuaries Vol. 10, No. 2 at Salt Lake City

Description: This session from the 1984 SOA Atlanta Meeting covers the small group and mini-group market, specifically the trends in plan design, underwriting strategies, approaches to marketing compensation and claim cost containment strategies.

Description: This session is about the successful HMO, A dynamic employer coalition, An emerging dental PPO and An industry-sponsored wellness at the worksite program.

Description: This article contains a listing of the publications of the National Center for Health Statistics. Copies of any of the listed publications can be obtained from the National Center for Health Statistics, Rockville, Maryland. In ordering, the series number and the number within the series should be given.

Description: Digests of following discussions: 1. Mutual life insurance companies - their objectives and operating philosophy 2. State, provincial, and municipal employee pension plans - financing and other problems 3. Mortality and underwriting of individual policies for large amounts 4. Investing during the 1970&#39;s 5. Long-range viability and regulation of corporate pension plans 6. Forecasting the environment for business 7. Liabilities and surplus in the 1970&#39;s 8. Changing modes of family life - work and income over the life cycle 9. The role of the actuary in collective bargaining 10. Health insurance in the United States 11. Adjusted earnings

Description: This paper deals with credibility as applied to group insurance, where the problem is to estimate the future claim rate of a group as a function of both its own past claim rate and the average claim rate observed for similar groups.

Description: This note compares hospital utilization and average daily hospital costs for persons aged 65 and over as indicated by 1968 data under Medicare&#39;s Hospital Insurance Program and from the American Hospital Association.