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: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.

Description: The COVID-19 pandemic helped accelerate many changes in the Health Care system that were already taking place. The major disruptions to the way providers operated was quite evident with shifting of focus away from elective services to create capacity for treating COVID-19. However, even before the pandemic, providers were adapting to changes in their environments.

Description: Under the new long term care model regulation, initial filing requirements include a statement regarding underwriting practices, which makes an actuary's awareness of underwriting techniques even more important. This session discusses underwriting tools and strategies. From the Record of the Society of Actuaries, Volume 27, No. 1, Session 112OF

Description: The SOA analyzed Health Care Cost Institute (HCCI) claims data from 2009 – 2015 to better understand cost and utilization trends in the commercial health insurance market.

Description: This article describes Medicare Supplement and short-term care products in more detail, and we compare their risk profiles. We explore the concept that these two products—when offered together—may provide a complementary hedge of certain policyholder behavior risks.

Description: The summary and introduction of an SOA research paper that explores valuable insights and recommendations for insurance companies considering entering the market of commercial long-term care insurance (LTCI) in the Asia-Pacific, based on individual health status.

Description: The speech was mainly introduced the current government long-term care insurance in China, analyzed the potential opportunities and challenges of commercial homecare insurance driven by the aging of the society and the pressure of social insurance. Briefly introduced some innovated explorations conducted by our company Fulfill Homecare in these couple of years, with some insurance companies, to bring some thoughts to the innovative insurance product design of commercial care insurance.

Description: As the topic of affordable long-term care (LTC) insurance comes into focus in political conversations, we often find ourselves thinking, “What is going to happen to the private LTC insurance industry going forward?” The need for LTC in the United States is not going away, especially as the population continues to age. With this in mind, this article explores three possible future paths for LTC insurance funding and the associated implications for the private LTC industry.

Description: Family members who care for people with dementia need a wide range of support services to help them do the important work of care giving at home.