Description: Renal disease is a very heterogenous medical condition whose end state is dialysis, a recurring cost intensive medical condition. Dialysis cost is one of the major medical cost drivers in USA. Insufficient and improper care management in the early stages of CKD (chronic kidney disease) leads to early incidence of end stage renal disease (ESRD) among CKD patients which not only leads to high medical costs, but also reflects poor health quality.

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: Actuaries are leveraging predictive modeling and machine learning more and more as they strive to provide greater value to their stakeholders. Actuarial standards of practice provide guidance around modeling and data. The world has changed significantly over the last few years, so it is important these models be tested for fairness as well as any statistical biases. This article addresses some of the key issues actuaries need to be aware of as Corporations and society work through the responsible us of this technology and underlying data.

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: "Explore a general introduction to the opportunity of applying a relatively newer area in machine learning called uplift modeling, which has been successfully used in retail (Wayfair etc). The concepts are parallel to the intervention programs in health care, where we are interested in measuring the treatment effects and ultimately directing the right members to the most effective programs, driving the highest value for the programs both from a financial and health outcomes perspective. Uplift modeling can also be viewed in context of causal modeling where we are interested in assigning cause to a treatment relative to a member not receiving the treatment. Check out an introduction on the concept, seehow it relates and builds on existing work, and use a demo to showcase the potential of integrating this ML approach to current work."

Description: Explore wellness programs and their effectiveness within the LTC industry by attending the Considerations for LTC Wellness Programs webcast. You will experience discussions about design tactics and evaluation processes for programs, as well as discovering ways to assist policyholders achieve a sustainable and equitable life. There will also be a conversation about the current regulatory environment as it relates to LTC wellness programs. This webinar will focus on subsets of insured populations that are high risk of claim in order to properly manage care decisions and ensure unfair bias is avoided. Learn how to test for unfair bias and determine best possibilities on how to guard against this when testing is unavailable.

Description: This report provides actuaries and other professionals working with risk, data and analytics or program evaluation in the health care space with considerations and frameworks related to the use of determinants of health (DOH) in data and actuarial work streams. Such frameworks can leverage new data sources to enrich health care data analysis to move beyond traditional data elements, such as age, gender, zip code or health diagnosis.

Description: "Risk adjustment is an important aspect of establishing appropriate capitation rates. When a set of services is carved out for specific management under a sub-capitation, establishing appropriate adjustments for varying levels of underlying risk is more complicated. Dive into analytical and operational challenges and resolutions as presenters share more about developing a risk adjustment model specific to the carve-out of behavioral health services through a real-life case study. You will further explore a definition of the use case, availability of historical data sets, selection of the modeling approach, learnings from the iterative modeling process, and the potential application of the results. After attending this session, you will be able to: Understand why a behavioral health specific-risk adjustment model has business value Understand the unique challenges related to developing risk adjustment on member and cost subsegments Understand the impact of trade-offs between model complexity and interpretability in the context of implementation Increase awareness of data nuances and requirements unique to this type of project Describe analytic techniques that can be investigated for use in projects of similar business objectives"

Description: This session is a primer on how to apply Gestalt psychology to display quantitative information to improve neural receptiveness. While much of brain functioning is still a mystery to psychologists and neuroscientists, we do understand a great deal about which parts of the brain engage or disengage given visual cues. Actuaries are often tasked with presenting very technical information and are prone to focus more on the substance of numerical data rather than a pictorial presentation based on neural preferences. This presentation will discuss how to display quantitative information more effectively tailored to these preferences.

Description: The objective of this paper is to provide a practical guide with concrete case studies to help actuaries implement artificial intelligence and machine learning (AIML) to help accelerate the speed of analysis for life and annuity actuarial modeling. We do so by researching the existing literature regarding AIML and its applicability to stochastic modeling and exploring case studies.