Description: "Most patients enter the health care system through their primary care provider or through the Emergency Room or an Urgent Care Center. How an emergency room is structured, managed, and provides care is one of the major forces impacting the total cost of care. Yet it is often an after-thought and ignored by both health plans and health systems. In reality, the structured introduction of efficient practices can substantially reduce the quantity and cost of health care services. Further explore useful information to better understand and see how there are still substantial opportunities for improvement."

Description: Highlights from the 8th Intercompany Long-Term Care Insurance Conference held in March 2008, consisting of 56 sessions covering a range of long-term care insurance LTCI topics each with a track-specific focus.

Description: Shared savings deals are all the rage these days. Significant numbers of payers and provider groups in many markets around the U.S. want to engage in shared savings contracts covering commercial, Medicare and Medicaid patients. The fundamental question underlying a value-based contract is, for whom is the value accruing? Ostensibly, value is accruing to the sponsor—whether employer or public payer—but should be accruing to the provider as well. Often design flaws in value-based arrangements and contracts and/or the inability to execute in a value-based paradigm diminish the savings that could have accrued, create inequities in value or drive unintended consequences. This presentation will provide attendees with insights into how to design a workable value-based payment initiative, how to educate both payer and provider participants, and how to oversee the initiative’s operations. Specific topics will include: • Attribution logic: prospective, retrospective and the details in between • Risk adjustment: why one model doesn’t fit all arrangements, and even if it does, how do you implement? • Data and reporting: matching business needs to the payer’s willingness to be transparent and provider capabilities • Quality improvement as a component of payment: actionable and tied to the attributed population or just “out there?”

Description: Come discuss how reinsurers can work side by side with insurer to better develop products, and lift in the areas that reinsurers have more experience, help matching products with distributions (or vice versa) and provide advanced technologies associated with tools and software. The speakers will also present Direct to Consumer plan from various points of view, i.e., distributors, carriers, and reinsurers. Some case studies will also be presented where traditional reinsurers and asset-intensive reinsurers helped insurers bring products to life.

Description: "Hear AM Best rating analysts discuss the rating process and the best capital adequacy ratio (BCAR), a quantitative foundation for AM Best’s assessment of carriers’ financial strength. The benchmarking of BCAR scores for various company types (national MCOs, BCBS plans, smaller regional plans) will be discussed. Look at how changes in investment and underwriting environment impacted the results over the past several years. Further, AM Best’s view of the quality of capital and various factors impacting the overall assessment of the balance sheet strength will be discussed. By attending this session, you will: Gain an understanding of AM Best’s building block approach to ratings and how the BCAR results fit into the process. Learn the differences between RBC and BCAR models. Learn how various factors—e.g. liquidity, financial flexibility, financial leverage, the org structure—impact the final AM Best assessment of health companies' capital."

Description: Baseline and "what if"/stressed projections of cash flows, financial statements and capital requirements are critical inputs for a range of business purposes: forecasts, risk management, liquidity management, strategic decision making, etc. Forward-looking projections have historically been inefficient and were performed in silos, making it difficult to scale the process as CFOs and CROs ask for more. The presenters discuss challenges of the forecast process and opportunities to meet desired future capabilities. They will also discuss "what if" analysis and ways to support production of forward-looking projections for "what if" analysis in an efficient way.

Description: The article provides an introduction to the Stock Value Approach to enterprise risk management (ERM). A clear path toward implementation of comprehensive and pragmatic ERM is shown. The framework is underpinned by a company's goals as they relate to growth of the value of the company stock price.

Description: This paper evaluates the current practice of operational risk management in the insurance sector. Operational risk is nothing new in insurance, but, because of regulatory requirements, companies have initiated computation of risk capital for their operational losses. The current effort to manage operational risk is not a naturally evolving phenomenon, and operational risk, in the Basel Committee on Banking Supervision’s Basel II definition, is unlikely to be a significant cause of insurers’ failure. In addition, the current Basel II definition of operational risk is not suitable for the insurance sector. Consequently, the invention of models and tools based on the definition is incomplete and illusionary. My findings are based on the analysis of dozens of interviews with insurance industry professionals. I demonstrate the way operational risk is quantified in practice, show that the result obtained from this computation is of littl e use in managerial decision making and propose a set of policy recommendations illustrating the characteristics of operational risk in insurance. This study can be used as a platform for launching dialogues to initiate fresh thinking about operational risk in insurance beyond the current artificial and narrow boundaries.

Description: Regulatory change and increased focus on internal risk management are driving a renewed interest in model efficiency. In this session, we will review several new and existing tools, that show significant promise for advanced modeling of equity linked products. These include: • Clustering • Use of unique--and potentially a different number of--scenarios for each policy • Semi Monte Carlo (SMC) – this is a proprietary technique that is similar to a combination of Monte Carlo and numeric integration • Using a neural network approach to optimize some of the more complex and manual aspects of clustering and improve the fit of the clustered model • Combining SMC with the use of unique scenarios per policy

Description: This article is part of a 2 part series on real options analysis (ROA). Before you can understand the limitations of ROA, you must first understand the difference between risk and uncertainty. This article goes into detail explaining the vast differences between the two phenomena.