Description: This session explores the far-reaching changes to how clinical data will be sourced, processed and consumed in many payer use cases including risk adjustment, quality measurement, care management, claims adjudication, prior authorizations, and other payer functions. Robust, interoperable data exchange is a prerequisite for value-based care. Clinical data will be increasingly accessible to augment administrative (claims) data via standardized Fast Health Interoperability Resources (FHIR, pronounced 'fire'), at a fraction of the cost of a accessing a traditional medical record and in real-time. On May 1, 2020, HHS issued a final rule implementing interoperability and the patient access provisions of the 21st Century Cures Act of 2016, although enforcement has been delayed into 2021 because of the COVID-19 pandemic. The new regulations promote, “HHS’s vision and strategy for achieving a health information ecosystem within which all individuals, their personal representatives, their health care providers, and their payers are able to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable to support the health and wellness of individuals through informed, shared decision-making, as well as to support consumer choice of payers and providers.”Once enforcement begins, CMS and the Office of the National Coordinator for Health Information Technology (ONC), have the authority to mandate adoption of interoperability requirements, and also penalize payers and providers for non-compliance or the delay and withholding of data.This ‘digital transformation’ of the clinical data ecosystem has far-reaching implications for enabling technologies including Natural Language Processing (NLP) and entire segments of services and vendors. It will eliminate many departmental barriers, duplication and error sources for health plans and impact every department and the underlying economics of delivering and managing care.

Description: A look at the near future and far future of various elements of Actuarial Models as defined through ASOP 51. What is driving the complexity for inputs, calculations, and outputs. Howe will actuaries handle these challenge?

Description: Profile of an actuary in a non-traditional actuarial role: focusing on medical cost and analysis, both retrospective and prospective.

Description: Technology has streamlined countless processes in our daily lives, and insurance is no stranger to this transformation. Technology can make insurance simpler and more personal for consumers, and can enable actuaries to better analyze unstructured data, make good decisions, create new products, and find channels to enhance profitability, provided they can tame the flood of information pouring in from across the digital ecosystem.

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.

Description: Presented at May 1985 Spring Meeting. This session discussed: What measures should be used in setting objectives and evaluating performance for companies and product lines, What variations are appropriate for stock and mutual companies and for United States and Canadian companies.

Description: As the insurance industry continues to evolve due to a pandemic and rapidly changing economic and regulatory conditions, the role of data scientists and actuaries has become increasingly important. In an interview with the Atidot data science and actuarial team, we discuss what it is like to work at an InsurTech, how data scientists and actuaries can collaborate, and look at some concrete technical examples of where the innovation is having an impact. This article explores what collaboration can look like and how the role of data science and actuary may evolve in the InsurTech industry in the future.

Description: "Visual storytelling is frequently used to effectively convey complex actuarial concepts to our clients and other audiences. When talking about data visualization, we often focus on the explanatory aspect. But data visualization is also a crucial tool in developing insights from large and complex data sets at every stage of data analytics spectrum: • descriptive (what happened?), • diagnostic (why it happened?), • predictive (what will happen?), • and prescriptive (how do I influence what will happen?). In exploratory and modeling stages of data analytics’ project, we let the data tell the story or explore our intuition and hypothesis through data pictures. We demonstrate the power of visual display in healthcare data analytics through vivid examples from the healthcare case studies. These illustrations of data visualization exploratory power range from assessing the quality of data or examining outliers, to exploring variables’ relationships and trends, to hypothesis testing, to guiding in feature selection and models’ comparison and evaluation, to model validation. Throughout these illustrations, we will discuss principles of graphical effectiveness, excellence and integrity."

Description: Principal component analysis is an unsupervised linear transformation mainly used for dimension reduction. Determine key numerical variables with maximum variances in a dataset, identify the correlation and removal of redundant variables are the key aspects of this exploratory data analysis.

Description: Presents a theoretical basis for a computerized methodology for estimating biological age - a measure of time to death.