Description: This session series is sponsored by Zelis Shifting utilization of health services to efficient and high-value providers presents an opportunity to reduce harmful cascades of wasteful spending, ultimately freeing up funds for additional high-value services that will improve quality and member satisfaction. Identifying the right providers to put at the center of networks is challenging for any health care organization. How can you objectively determine which providers are delivering the greatest value when compared to their peers? And once those providers are identified, what’s next? Join Zelis and their partner HealthCorum to review a case study on a shared services organization where they leveraged statewide multi-payer claims data to produce provider level analytics, allowing for transparency into provider practice patterns at a granular level. By attending this session, you will be able to: - Create a fair methodology to benchmark providers. - Develop metrics and scores to identify high-value providers. - Produce actionable data to be used for network optimization strategies.

Description: You will be reminded how to spot and avoid statistical biases and fallacies that are common to health care actuarial data and problems. We plan to explain various statistical biases and fallacies and for each show one or two examples of how they might pop up in healthcare data and what strategies can be used to avoid/account for them. Likely topics include simpson's paradox, regression to the mean, base rate fallacy, sampling bias, survivor bias, Berkson's fallacy, and others.

Description: "Are you a health actuary affected by recent developments in business practices and accounting standards that have created situations in which you may be involved in estimating balances under accounting rules that differ from those typically used by insurers? In this session you will learn about situations where non-insurance accounting regimes may intersect actuarial practice, with an intended focus on two particular topics. One topic is general accepted accounting principles (GAAP) for insurance brokers under ASC 606 (Revenue Recognition) for commissions on Medicare Advantage and Medicare Supplement contracts, where the broker may get to recognize the expected value of all future commissions on a contract as revenue when the contract is placed. The other topic is GAAP under ASC 460 (Guarantees) in situations where a non-provider entity is bearing risk related to health care services, which can occur under the CMS Direct Contracting/ACO REACH model or under private sector care coordination contracts."

Description: Investigate the importance of collaboration with accounting, underwriting, sales, marketing and other professions as an actuary when you attend this webcast. Cross-functional positions can cause unique challenges to arise, like various experts attempting to balance growth and profitability. Discover an opportunity to learn about relevant ASOPs and dive deeper into contemporary examples that highlight specific professionalism issues that can develop.

Description: High performance providers and in turn networks are often a prerequisite for a highly competitive product. If performance is lacking, the ability to offer a competitive product on the street can be significantly hampered. Learn from a case study how an actuary might measure performance and compare and/or rank network providers on multiple concrete factors. Discussed comparators will include efficiency, care management effectiveness, market attractiveness (enrollment changes), inclusion in other health plan networks, etc. By attending this session, you will be able to use principles discussed in this session to more effectively evaluate provider networks for their employer.

Description: Is your development team or IT staff growing tired of last-minute requests to include additional functionality? Have you strained to explain challenging actuarial topics to non-actuarial staff for implementation? Do your teams find themselves revisiting deadlines & timelines when building solutions? During this interactive panel discussion, three technologists (two software engineering managers and one data scientist) along with three actuaries will discuss real world problems and approaches using experience from previous projects. Although the challenge of running efficient software teams is not unique to actuarial science, this webcast will discuss best practices on how to organize teams to reduce friction and context switching. Presenters will also explore unique actuarial challenges and concepts including how to address standards on data quality when building software, how to build intuitive software that meets actuarial standards and how test-driven development makes it easier to meet actuarial standards of practice.

Description: The SOA’s Individual Disability Experience Committee (IDEC) has reviewed industry experience for both claims incidence and terminations. Based on this review, the committee has published two reports with experience modifiers that when applied to the 2013 IDIVT table best fit experience from 2005 to 2015. During this session, the factors and their development will be reviewed as well as their impact on active and disabled life reserves.

Description: Explore professionalism topics of specific interest to disability actuaries. It will include discussions of items such as business challenges, actuarial standards of practice, and methods to address problems in a proactive manner.

Description: "Can you answer the question 'what are the chances we will lose more than $1 million next year?' without saying 'it depends'? If you miss a projection, can you quantify the chances that the miss was due to random variation vs. an incorrect projection? ten in as presenters demonstrate how to answer these questions and others using total risk analysis. Total risk analysis includes quantifying both the random variation risk and the projection risk associated with actuarial functions like pricing and reserving. After attending this session, you will be able to describe total risk analysis, apply total risk analysis to many actuarial functions."

Description: A panel of leading reinsurance executivesprovide perspective on topics to include market capacity, cell and gene therapy, COVID-19's impact on results, syndication arrangements, mergers and acquisitions, and how reinsurers view a variety of risk transfer opportunities.