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: The SOA Research Institute has executed research for over twenty years on some repeating themes and topics. The reports build on each other and add content. This article summarizes and discusses a summary report on long-term care, caregiving and housing linked to long-term care and caregiving.

Description: The summary and introduction of an SOA research paper that explores valuable insights and recommendations for insurance companies considering entering the market of commercial long-term care insurance (LTCI) in the Asia-Pacific, based on individual health status.

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: Health care continues to move from a fee-for-service model to a value-based care model. Hear from our expert panel how actuaries can play key roles in designing and contracting value-based agreements, monitoring experience, and driving results, as well as measuring value. The discussion will cover different structures currently in use, types of services covered (total cost of care, claim service lines, specialties, condition based, pharmacy products, etc.) and nuances by market (Medicare FFS, Medicare Advantage, Commercial, Medicaid). Listen to presenters discuss latest innovations in the value-based care space, as well as how current events have impacted these contracts. In this interactive session you will also be able to ask our diverse panelists questions.

Description: This article highlights the findings of a recent SOA survey on accelerated underwriting (AU) practices, including the amount of AU business ceded, the results of three opinion questions, and an estimate of mortality slippage among AU programs.

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: This session is designed to inform you about the current state of mental health and mental health care in the United States, as well as future trajectories. By exploring topics such as plan design, provider network, provider reimbursement, and other relevant channels, this session aims to enlighten everyone on existing challenges and the strategies being employed to tackle them. Notably, this will include and highlight proposed changes to the mental health parity. Additionally, attendees will hear from a mental health provider/academic on these topics to gain a non-actuarial perspective.

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: The Society of Actuaries (SOA) Board of Directors (Board) gathered in Chicago March 16–17 for its first meeting of the year. Among key topics on the agenda were the FSA pathway evolution update, Board elections, strategic planning and the use of AI in the workforce.