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: Innovation in technology has disrupted nearly every industry, creating mounting internal and external pressures on organizations to accelerate the adoption of their digital agendas. The COVID-19 pandemic further brought to light the need for tools and technology to be adaptable, powerful, and scalable. As the insurance industry leaps into the future, actuaries must not only proactively refine their roles and responsibilities within insurance organizations but also seek opportunities for improvements and optimization in their day-to-day work. Discuss a variety of opportunities to streamline, accelerate, and optimize actuarial processes by using modern technology. Cover a wide spectrum of actuarial solutions from automation of actuarial data transformation to actuarial reserve calculations and calibration of economic scenarios. By attending the session, you will: Be able to articulate how modern low-code/no-code technology can help actuaries automate, streamline and optimize processes in yourday to day work tohelp focus on higher value tasks.

Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: Asset liability management is an important task for any insurer, where tools like Excel play an important role from an analytics perspective. Dashboard tools like Power Bi and Tableau can supercharge an organization’s ability to perform ALM with real-time precision and monitoring of risk/imbalances. The dashboard can provide insights into potential risks posed by asset allocation and concentration, allowing for informed decision-making to mitigate those risks. The presenters will walk the audience through an example of ALM use case, including how to build key performance indicators such as cash flow, asset allocation, and risk exposure. Additionally, we will demonstrate how these types of dashboards can be customized to fit the specific needs of your organization.

Description: Actuarial models and modeling processes continue to grow in complexity, accelerated by the changes in U.S. Statutory, U.S. GAAP and IFRS reporting requirements in the past few years. Modeling and valuation teams are expanding their toolkits beyond the traditional vendor-maintained actuarial software and the MS Office suite of tools. Companies have started to use a variety of tools to improve model dev and valuation processes, including: - Data management - Automation and workflow - Reporting and analytics

Description: Data science, predictive analytics and AI are certainly the buzzwords these days. They are heavily used and developed in underwriting and marketing but for most actuaries, they might/may as well be science fiction. The presenters will demonstrate how a normal actuary can utilize data science techniques in their daily job function without forming an official data science team within a company. It can be done in a gradual fashion so that normal business is not disrupted and improvements are made over time. The usage of data science techniques will include demonstrations of the following areas: - Regression analysis - Economic scenario generator - Experience study - Data quality checks - Inforce compression for explicit hedging

Description: Stochastic modeling requirements are resulting in more 'run time' and less 'analysis time'. An expensive solution is leveraging cloud infrastructures and robust computing grids. The presenters will explore the use of cluster modeling and present case studies showcasing this automatable and robust technique, which could allow actuaries to recover the time lost to 'run time'. Developing automatable and clustered models requires robust governance practices to ensure credibility of results.

Description: CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.

Description: Discuss various analytics and use cases using payer published reimbursement contract data under federal mandate of Transparency in Coverage. These contract rates are publicly available in machine readable format (MRF) starting July 1, 2022, and refreshed monthly. By attending the session, you will have a better understanding of the state-of-art development and analytics using MRF data, including the technologies used to extract and analyze huge MRF files, validation and limitations of published rates, and their use cases.

Description: Come discuss modeling costs and its governance, as well as introduce some platforms for more granular asset modeling.