Description: This report examines the demographic, medical, and pharmaceutical profiles of HIV-positive individuals in Medicare and how their needs differ from the general Medicare population.

Description: This study evaluates how integrating social determinants of health (SDOH) into Medicaid risk adjustment models impacts financial outcomes for ACOs/MCOs, offering foundational insights for policymakers and actuaries.

Description: On March 22, 2022, the Wall Street Journal hosted its annual Health Forum, a virtual all-day event which included several sessions. This session was attended by experts across the healthcare space and attendees included many from the healthcare technology companies. This report summarizes the event.

Description: This report outlines a framework for interpretable machine learning algorithms for detecting fraud in health insurance. It discusses the challenges of using black-box machine learning models in the insurance industry and proposes various interpretable methods to enhance transparency and understanding.

Description: Chronic Kidney Disease (CKD) affects many lives and has a large impact on health systems around the world. To better understand and predict costs for insurance plan members with CKD in the United States, we built a new model of their individual costs. Our model is the first to explicitly model both the CKD stage transition process and the distribution of costs given those stages.

Description: The devastation wrought by opioid related deaths is national news. This article looks at the details behind the statistics.

Description: The SOA is pleased to make available a research report providing insight and considerations for the actuarial profession in assessing the potential risk and opportunities of MACRA to both provider and payer organizations.

Description: The Health Care Cost Trends Strategic Research Committee is looking for research proposals to study the impact of Artificial Intelligence on any of the following elements of healthcare • Evaluate the impact on predictability of financial results • Evaluate the impact on the efficiency of care management techniques applied to members • Compare results to traditional risk adjustment and traditional methodologies of predictive analytics • Determine an overall financial impact of applying AI to identify these high cost claimants.

Description: This report illustrates employer group commercial health care costs and trends from 2013 – 2017.

Description: The SOA is pleased to make available a research report providing insight and considerations for the actuarial profession in assessing the potential risk and opportunities of MACRA to both provider and payer organizations.