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: Session 176: The Future of Medical Records in Underwriting

Description: Prior to the global pandemic, investment in new health technologies had already reached an all-time high. As the world begins to emerge from COVID-19, what new technologies will next take root in the health care system and how will those affect medical costs? This session will review recent research from the SOA Health Section on how new technologies are spread and adopted. Particular focus will be given to emerging modes of consumer engagement and highly-focused gene and cell therapies that are breaking new ground in combating rare diseases. (We plan on focusing on 2 technologies like Consumerism or Telehealth & Gene & Cell Therapy depending on availability of speakers or if there are other sessions in this virtual meeting covering the same topic)

Description: Data science, predictive analytics and AI are certainly the buzzwords these days. They are heavily used and developed in underwriting and marketing but for most actuaries, they might/may as well be science fiction. The presenters will demonstrate how a normal actuary can utilize data science techniques in their daily job function without forming an official data science team within a company. It can be done in a gradual fashion so that normal business is not disrupted and improvements are made over time. The usage of data science techniques will include demonstrations of the following areas: - Regression analysis - Economic scenario generator - Experience study - Data quality checks - Inforce compression for explicit hedging

Description: 2021 Life Meeting - Session 3F: LDTI - Disclosure Production Deep Dive 8.30.21 Recording

Description: The supplemental health market is changing. Carriers are looking to simplify claims processes, proactively identify missed claim opportunities, and reduce barriers to claim payment. As a result, more and more companies are looking at ways to use data from medical diagnostic and treatment codes. Take an introductory look at the most used medical codes—ICD (9 and 10), CPT, and HCPCS. Discuss the history and purpose of each code system and decipher the structure. Dive into how medical codes can be used in the supplemental health market (automatic claims adjudication, fraud identification, pricing), as well as common pitfalls encountered when using medical coding. By attending this session, you will have a basic understanding of the different types of medical codes, their actuarial applications, and common pitfalls.

Description: Speakers discuss how to develop alternative or improved processing methodologies to reduce errors, correct error tracking tools, and metrics. Participants discuss balancing reasonable testing given time constraints. From the Record of the Society of Actuaries, Volume 27, No. 2, Session 47IF of the Toronto Spring Meeting

Description: 2021 ImpACT Conference - Session 6B: A Courtroom Case: Data Democratization to Drive Analytics? 10.27.21 Recording

Description: 2021 ImpACT Conference - Session 2D Value-Based Models for Home-Based Care and Digital Health 10.25.21 Recording

Description: This article discusses the publication of the “Encyclopedia of Quantitative Risk Assessment”