Description: This session will explore the national landscape of state Medicaid risk adjustment program design & application and the key differences that drive effective managed care organization program management. Risk adjustment is a mechanism to adjust capitation rates between Managed Care Organizations to account for population morbidity differences. Although many states utilize this mechanism, the application of risk adjustment can vary significantly across states. The primary differences include populations, risk score models and data collection. These state application nuances affect the strategies and tactics utilized by MCOs for effective risk adjustment program management including provider financial alignment, encounter data submission and the capture of accurate diagnosis codes. The session is intended for Medicaid Managed Care Actuaries working to develop or support comprehensive risk adjustment program management functions.

Description: 1993 SOA Spring Meeting, San Diego. This session is about point-of-service plans, overview of current enrollment statistics/ tends, in-network and out network utilization patterns, trends in benefit design, employer/benefit consulting demands and employee/employer satisfaction.

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: 2004 SOA Spring Meeting, Anaheim, CA. In this session panelists presented an overview of underwriting processes for a variety of product lines. They also discuss related topics such as identifying keys to underwriting decisions, the cost of underwriting and protective value, and ensuring consistency with pricing assumptions. Some of the underwriting tools discussed were use of RX history, credit checks, DMV history, and fraud data bases.

Description: Learn industry best practices including challenges faced by retirees, such as needing exposure to growth, most exposed to sequencing risk, and the need for smooth returns to avoid poor investor behavior caused by risk aversion. Other topics will include how to set investment objectives which consider the members’ real-world needs and how to build portfolios and implement risk management strategies to meet those objectives. The speaker will provide real-life examples/case studies.

Description: 1994 SOA Spring Meeting, Orlando. In this teaching session, techniques were presented to get the optimal result with the least effort. Techniques discussed: 1. Look at the whole process, working backwards from the result. 2. Look at all of the pieces of the job and redesign. 3. Bring technological tools into the process.

Description: Mr. Zhao stressed that the CBRC adhered to the national principles of risk-oriented, problem-oriented, and openness-oriented, and remained fully mobilized and united to the benefit of the insurance industry. The CBRC overcame the difficulties of the epidemic and pushed forward the C-ROSS Phase II project.