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: This article discusses what actuaries see as ideal components of a health care reform package with an emphasis on cost control, efficiency, elimination of fraud and reduction of errors.

Description: This article is the first in a four-part series about what actuaries see as ideal components of a health care reform package. This part covers health care reform ideas explored at the Conference of Consulting Actuaries’ CCA 2009 Annual Meeting in Tucson, Ariz.

Description: This model arose from a project to evaluate the cost of a health care access' program to provide comprehensive medical care to uninsureds in Minnesota, for the Minnesota Health Care Access Commission. The project was to provide estimates of the impact on per-person and aggregate costs for various participation percentages in the access program. In order to evaluate those costs, the antiselection model described in this was developed. Of note, this was the ACTUARIAL EDUCATION AND RESEARCH FUND 1991 PRACTITIONERS AWARD WINNER. From Actuarial Research Clearing House 1991, VOL. 2.

Description: Successful healthcare reform: First, it must help that must keep healthy people healthy. Second, it must help people mitigate or eliminate the health-risks associated with unhealthy lifestyle behavior choices, and Third, it must ensure the provision of evidence-based care to those who are ill.

Description: 2001 SOA Annual Meeting, New Orleans. Health care cost trends have substantially increased in the past two years. Panelists discussed the factors contributing to these increased trends, the prospect for further increases in the future, and national health care issues.

Description: Update on the potential impact of national health law legislation, and discussion of the influence of inflation on both the relation between actual and expected claims, and the design of new benefits and administrative procedures. This presentation was made at the 1975 SOA Los Angeles Spring Meeting.

Description: Panelists discuss key public policy issues relating to access, coverage, and financing of health care, as well as current health care reform proposals. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 47

Description: This article discusses the potential characteristics of health care reform and the associated impact on small insurance companies.

Description: This 1993 paper examined the premium rate changes that could have resulted from the passage of The Health Insurance Reform and Cost Control Act of 1991. From Actuarial Research Clearing House 1993, VOL. 3.