Description: "Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations."

Description: Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations.

Description: You’ve written the position papers, updated the models, and designed the required disclosures, but you may be wondering how to explain the results during interim financial reporting periods to company management as well as other stakeholders. This session will explore ways to adapt existing management reporting and offer ideas for new metrics. We will explore various methods for analyzing DAC amortization patterns, market risk benefit reserve patterns, and Liability for Future Benefits (LFPB) movements. In addition, this session will explore ways to integrate changes in LDTI with business planning and other broader business issues such as product pricing considerations and reinsurance strategy.

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: Focus on Accelerated Underwriting (AUW) in the life insurance industry, which is an expedited underwriting process that utilizes predictive models. Expect to address the challenges in designing the process, from modelling to performance monitoring. Additionally, you'll address risk management, particularly in mortality and proxy discrimination andhighlight the role an actuary can play in the AUW process, as well aswhat they should know to contribute effectively.

Description: "Examine the exciting possibilities for artificial intelligence (AI) in health care and its potential to transform the patient journey. You will learn about the various touchpoints where AI is being applied along the patient/care journey, including provider search tools, claims analysis, and fraud detection. By attending the session, you will be able to: Have a comprehensive understanding of the opportunities and challenges presented by AI in health care Evaluate the potential impact of AI on their own organizations Be equipped with strategies for effectively implementing AI solutions and maximizing their benefits for patients, providers, and payers"

Description: Regression to the mean (RTTM) is inflating your health care intervention evaluations if you are not carefully managing it's omnipresent and significant impact RTTM is the statistical phenomenon which arises when comparing sequential data points when an initial observation is extreme or an outlier, and states that with no other intervention, future observations will be closer to the average. Members who had high costs last year will, on average, have lower costs this year, even in the absence of any intervention or clinical program, simply by 'regressing' to the mean. This means that if your clinical programs are simply targeting members who had adverse medical experience last year, you’re targeting the wrong people. And if your savings methodologies are simply last year’s costs minus this year’s costs, the savings are inflated. By attending this session, you will be able to identify situations where RTTM will be a significant factor, how to eliminate it's impact when performing retrospective evaluations, how to identify prospects for clinical intervention with RTTM in mind, and more.

Description: "As digitization and automation rapidly progress in today’s life and health industry, issues with misrepresentation during the insurance application process are also becoming a growing concern for insurers around the globe. A recent survey finds that misrepresentation in application forms costs the average insurance customer an estimated 5% to 10% in higher premiums. In order to reduce this risk, insurers must find and correct areas of misrepresentation, consult post-issue sampling, review the automated underwriting processes, and monitor the quality of financial advisory firms. Learn how predictive disclosure modeling detects and reduces misrepresentation by harnessing readily available underwriting data to analyze issues, helping insurers understand various drivers for disclosure rates and areas of misrepresentation.Advantages of this modeling to various stakeholders in the life insurance journey include improved risk selection, claims experience, and reinsurance terms for insurers. For customers, it leads to increased certainty of coverage, payout of the claim, and ultimately lower premiums on average. By the end of the session, attendees will understand: The disclosure modeling process at a high level The technical details of a standard approach to disclosure modeling: data cleaning, standardization, visualization, and predictive modeling Success stories about how predictive disclosure modeling has impacted insurers"

Description: Almost half of recent FDA approvals have been for orphan drugs. This trend is expected to continue in 2023. Orphan drugs are priced more than 30 times higher than non-orphan drugs, therefore their cost burden in aggregate has the potential to overwhelm the budgets of payers, especially that of smaller health plans. Hear how the cost impact analysis for smaller health plans require different considerations than for a larger health plan when modeling the impact of rare diseases.

Description: Explore wellness programs and their effectiveness within the LTC industry by attending the Considerations for LTC Wellness Programs webcast. You will experience discussions about design tactics and evaluation processes for programs, as well as discovering ways to assist policyholders achieve a sustainable and equitable life. There will also be a conversation about the current regulatory environment as it relates to LTC wellness programs. This webinar will focus on subsets of insured populations that are high risk of claim in order to properly manage care decisions and ensure unfair bias is avoided. Learn how to test for unfair bias and determine best possibilities on how to guard against this when testing is unavailable.