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

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: This article is a brief overview of what digital health is, how it is regulated, and who some of the big unicorns are.

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: Panelists discuss pricing issues, patent issues, safeguards, successes, failures, and other observations about the future of automated underwriting. From the 2002 Record of Society of Actuaries, Volume 28, No. 3. Session 134PD of the Boston Annual Meeting.

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: Natural Language Process (NLP) techniques can be used to find insights in large unstructured data sets and Word Embeddings are pervasive on a wide spectrum of NLP applications. These word representations improve downstream tasks such as Sentiment Analysis, Recommender System, and Topic Modeling. Learn how NLP transforms the Insurance Industry; and how word embeddings and pre-trained models improve the effectiveness and performance of NLP applications. NLP is increasing in importance for insurance companies. Additional application examples are available in session 36.

Description: Big data, predictive analytics, machine learning and AI will likely transform the insurance market and the actuarial profession. The actuarial profession is seeing changes many markets, including health and property and casualty. This article describes these trends and provides an introduction into what companies and the Society of Actuaries (SOA) are doing to adapt and capitalize on these trends.

Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.