Description: This research report, sponsored by the Society of Actuaries' Health Section, measures the annual frequency of medical errors in the United States and the total measurable cost to the United States economy of these errors.

Description: This report provides an exploration of the potential impact of Artificial Intelligence (AI) on medical malpractice claims, with a focus on one specialty (radiology) and one state (New York). The discussions in this report are targeted to actuaries who are interested in developing a method to quantify the potential impact of AI to their own medical malpractice portfolio or to their own work.

Description: This report summarizes a study that estimates the total economic burden of the opioid crisis in the United States from 2015 through 2018 and projects future costs of the opioid epidemic for 2019.

Description: Describes a process to develop a good forecast. Also provides an example.

Description: The level-funding approach to medical stop-loss insurance is growing in popularity, yet is highly specialized. This session will give the actuarial community an overview of level-funding, including the basic mechanics, the benefits of offering level-funding to clients, and the five keys to success, including the ability to underwrite this specialized coverage.

Description: This paper helps the audience understand the actuary’s role in estimating the financial impact of primary care programs. In addition, the paper can be used by actuaries to think about key issues when estimating the financial impact of their employers’ and clients’ own primary care programs.

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 is a brief report that summarizes recent changes in the prevalent medical loss ratio methodologies and also looks at some of the more recent experience of health insurers that filed medical loss ratio reports.

Description: 2021 Life Meeting - Session 5C: Assumption Setting in an Uncertain World 8.31.21 Recording

Description: 2021 Life Meeting - Session 8A: Use of Electronic Health Records in the Assessment of Life and Health Risks 9.1.21 Recording