Description: Welcome to the future of insurance, for actuaries and non-actuaries! Discover how cutting-edge AI models are revolutionizing underwriting, risk assessment, and customer experience for the insurance industry. Experts in management consulting and actuarial consulting firms will provide valuable insights into the consideration and challenges surrounding the adoption of Generative AI.

Description: How do we take a Minimum Viable Products (MVP) approach to launch new insurance products? Join this moderated discussion and focus on three key development aspects: Distribution, Systems, and the design and pricing of the Insurance product itself. Come discuss reasons to choose an MVP approach and how it solves many of the product launch challenges.

Description: The presenters give a history lesson on the origin of CMS Medicare star ratings, including why this demonstration was originally created and how the program has worked over the years. The discussion will cover both the evolution of the underlying measures and the financial impact to Medicare Advantage stakeholders. By attending the session, you will have a stronger understanding of how member experience and outcome-based measures can be factored into the funding within a health care system to better align incentives among various stakeholders.

Description: Hear about some applications using quantile regression-derived individual and group claim distributions and how they may be used in various traditional health care modeling situations. The session will not focus on the technical use of quantile regression to obtain estimates of claim distributions, but more so is intended to focus on the uses of the distributions in actuarial modeling and the additive framework in assessing claims distributions. Presenters will show how actuaries can better assess risks by focusing on the individual- and group-specific claims distributions as opposed to traditional point-estimate-centric models.

Description: 2021 Life Meeting - Session 5F: Premium Leakage - How Outdated Claims Systems are Losing You Money 8.31.21 Recording

Description: CPT, NCCI, ICD, CCI, DRG, APC, PTP – understanding healthcare claims involve a dizzying array of code sets and payment methodologies, and yet the claim form is the intersection of health plan affordability, provider payment, and data analysis. This webcast will cover: • The code sets used in medical coding • Types of correct coding policies implemented by CMS and commercial payers • Payment integrity strategies to drive health plan affordability • Data analytics approaches leveraging medical coding knowledge

Description: This session explores the far-reaching changes to how clinical data will be sourced, processed and consumed in many payer use cases including risk adjustment, quality measurement, care management, claims adjudication, prior authorizations, and other payer functions. Robust, interoperable data exchange is a prerequisite for value-based care. Clinical data will be increasingly accessible to augment administrative (claims) data via standardized Fast Health Interoperability Resources (FHIR, pronounced 'fire'), at a fraction of the cost of a accessing a traditional medical record and in real-time. On May 1, 2020, HHS issued a final rule implementing interoperability and the patient access provisions of the 21st Century Cures Act of 2016, although enforcement has been delayed into 2021 because of the COVID-19 pandemic. The new regulations promote, “HHS’s vision and strategy for achieving a health information ecosystem within which all individuals, their personal representatives, their health care providers, and their payers are able to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable to support the health and wellness of individuals through informed, shared decision-making, as well as to support consumer choice of payers and providers.”Once enforcement begins, CMS and the Office of the National Coordinator for Health Information Technology (ONC), have the authority to mandate adoption of interoperability requirements, and also penalize payers and providers for non-compliance or the delay and withholding of data.This ‘digital transformation’ of the clinical data ecosystem has far-reaching implications for enabling technologies including Natural Language Processing (NLP) and entire segments of services and vendors. It will eliminate many departmental barriers, duplication and error sources for health plans and impact every department and the underlying economics of delivering and managing care.

Description: Back in the day, when data was scarce and computers were slow, actuaries were forced to use simple methods to account for risk. By far, the most common method was to add a margin, usually 5% to a “best estimate” calculation. Remarkedly, this method still works quite well in the aggregate. The problem is that, in many cases, decisions today require a more in-depth analysis. For example, how big a risk is a health plan really taking if it lowers its premiums by 10% to attract more members? This session will discuss techniques for measuring risk in today’s environment. Speakers will also share the results from the 5/50 research project, which forms the foundation for the techniques.

Description: Like it or not, variable annuity (VA) liabilities are inextricably linked with the equity markets. Generally, up markets reduce the excess benefit liability and increase fee income, while down markets increase the excess benefit liability and reduce fee income. Given the volatility, most VA writers will hedge to meet their needs. In this session, the presenters will discuss the need for hedging, regulatory requirements and how companies ultimately determine their hedging strategies.

Description: Explore how certain actuarial roles should be reserved under defined benefit plans for more than 50 years during the Reserved Roles for Actuaries in Defined Contribution Plans webcast. This online event will be focused on actuaries and defined contribution (DC) plan actuaries and how they have been spotlighted by the pension industry due to their roles. Join us to discover which roles under DC plans could be reserved for actuaries by plan sponsors or through legislation.