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

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 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: 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 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: 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: 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: As part of an upcoming Society of Actuaries (SOA) research release to model health care costs in 2020 and 2021, a set of “Return Stages” were created in order to define the various level of activities being observed, as well as to contemplate the ways these stages may progress as various cities, counties and states release their own phasing processes for returning their jurisdictions to normal.

Description: The Society of Actuaries (SOA) published its first COVID-19 research brief on March 10, 2020, followed by regular updates and expansions through June 12, 2020. The comprehensive report included a section of statistics that highlight the pandemic’s impact on economies in the U.S. and Canada. This report shows updates through July 29, 2020, to selected graphs from the Economic and Asset Impact section of the comprehensive report.