Description: Risk adjustment in government regulated health plans has been around for over two decades. Yet the strategies for promoting risk score accuracy haven't varied much during that time. Most health plans, physician groups, and vendors promote chart reviews and/or in-home assessments as the primary vehicle for collecting data not perceived to be present in the routine claims submission and adjudication stream. We know that most organizations trying to coalesce encounter data from multiple sources often fail to ensure that all relevant data is ultimately submitted to CMS or a state Medicaid agency. Crucial data, often with significant financial value, frequently gets lost in the data pipeline, somewhere between the provider's billing system and the health plan and/or its vendors. Because 837-formatted data is difficult to read, it complicates payers and vendor’s abilities to track encounter data so that every service delivered to patients is credited to the applicable risk adjustment formula. It is incumbent upon successful risk-adjusted entities to be able to track encounter data, identify processes and/or vendors which may be mangling or losing data, in order to ensure that risk scores are sufficiently accurate to be compliant with plan sponsor requirements and to ensure appropriate revenue to the health plan or provider group.

Description: Maintaining solid financial performance is a KPI for senior management. With the advancement of technology, the management can leverage new techniques to improve their decision making and focus on higher value activities in a timely manner. This presentation sets out the use of 1. correlation analysis to draw relationship between financial metrics and 2. smart analytics techniques, including text mining and analytics, to identify trends and drivers that impact the valuation of a company. We will also assess how the results of a comprehensive financial analysis could influence risk management considerations, including business steering and risk strategy.

Description: This article offers ways to make use of Excel more efficient, by applying software development and design principles

Description: CMS provides ACOs with monthly claims data for members, including their medical visits and ACO program eligibility. This data can be divided into Membership and Claims tables through the ETL process. However, when calculating PMPY at specific levels of detail using these tables, issues arise due to unrelated dimensions, leading to inaccurate and understated results. This article presents a solution to this problem by utilizing Tableau's data blending capabilities.

Description: This article delves into the transformative realm of Business Intelligence (BI) tools. We explore the fundamental functionality and structure of these tools, and through case studies illustrate how they offer valuable insights into carrier experience and underwriting dynamics. From real-time data visualization to in-depth data analysis, discover the essential features that empower businesses to make better informed decisions.

Description: As the insurance industry continues to evolve due to a pandemic and rapidly changing economic and regulatory conditions, the role of data scientists and actuaries has become increasingly important. In an interview with the Atidot data science and actuarial team, we discuss what it is like to work at an InsurTech, how data scientists and actuaries can collaborate, and look at some concrete technical examples of where the innovation is having an impact. This article explores what collaboration can look like and how the role of data science and actuary may evolve in the InsurTech industry in the future.

Description: In year’s past, we presented the Practical Predictive Analytics Seminar (PPAS) as an add-on to the Life and Annuity Symposium or attached to the Predictive Analytics Seminar, this year it will take place as a stand-alone virtual Seminar.

Description: This article summarizes IT trends that impact life, health and P&C insurance providers as revealed by Gartner's research.

Description: Natural Language Process (NLP) techniques can be used to find insights in large unstructured data sets and Word Embeddings are pervasive on a wide spectrum of NLP applications. These word representations improve downstream tasks such as Sentiment Analysis, Recommender System, and Topic Modeling. Learn how NLP transforms the Insurance Industry; and how word embeddings and pre-trained models improve the effectiveness and performance of NLP applications. NLP is increasing in importance for insurance companies. Additional application examples are available in session 36.

Description: Mindful data visualizations show the end users the end way in how to analyze and interpret your data. More importantly, they can then use this data they see to drive decisions and modeling going forward.