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: The aim of this project is to present proposals for Variable Uninsured Life Annuities—or “Value annuities.” The report and the accompanying models illustrate how Value annuities work.

Description: Technology has streamlined countless processes in our daily lives, and insurance is no stranger to this transformation. Technology can make insurance simpler and more personal for consumers, and can enable actuaries to better analyze unstructured data, make good decisions, create new products, and find channels to enhance profitability, provided they can tame the flood of information pouring in from across the digital ecosystem.

Description: Many life and health insurers are beginning to use Predictive Analytics (PA) for a variety of purposes. This article addresses the unique challenges and potential disruption PA brings to the risk manager, as well as the opportunities.

Description: Editorial for the May 2019 issue of Predictive Analytics & Futurism newsletter.

Description: This addresses the changing role for property-casualty actuaries as companies are looking toward actuaries to play a bigger role in moving the business forward.

Description: History of Big Data, and approaches to cope with it. The author suggests that actuaries have been using similar methods for a long time; but need to get up to speed on the newer terms and variations.

Description: David Moore has seen life insurance industry disrupted by new technology. David’s company seeks innovative approaches to engage with customers using analytics.

Description: Carol McCall led three teams – predictive analytics, health economics and outcomes research, and personalized medicine. The “river running through them” was that they all leveraged data. Her predictive analytics team eventually built a broad portfolio of models with some of them having a significant impact on Humana’s top and bottom lines.

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"