Description: Medical/Technological Advances

Description: This session will describe best practices for the preparation of the actuarial memorandum that supports the statement of actuarial opinion that is part of a health annual statement and review highlights of the new (2019) practice note on this topic. Presenters will represent different perspectives to discuss the components of an actuarial memorandum and use examples to present best practices and practical application of the information presented in the practice note.

Description: A panel of practicing actuaries and policy analysts will discuss the 'big issues' that could affect the actuarial profession in the future, and suggest ideas on how the actuarial profession could adapt to these challenges. This will be an interactive session where attendees can expect to have an opportunity to weigh in through polling questions and discussion. Topics touched will include: socialized medicine, artificial intelligence, the competition from data scientists, data commoditization, disruption from new entrants into the healthcare insurance space, and more.

Description: Learn about key actuarial and analytic tools and methodologies used by commercial health insurance to identify and quantify drivers of healthcare cost and utilization (including wasteful and low-value ones) and risks. Use case scenarios in which these tools and methodologies apply, such as underwriting, reinsurance, medical management for population health and chronic diseases, managed care contracting, insurance market reform, provider payment reform, etc., will also be covered. Experience from the U.S., China and other parts of the world will be shared.

Description: The prospects for China's health insurance has increased significantly in 2018, incentivized by a series of favorable government policies to support the development of commercial health insurance. However, the market still lacks relatively mature products and services. Overall there is a common understanding in the industry that good coverage plus service is the foundation for health insurance future development, and product innovation plus care management is key for an insurance company to maintain sustainable development in the competition. In this presentation, Dr. Yang will discuss the market trend both at home and abroad with respect to health management as well as its impact on product design, pricing and cost control. With the development of internet and big data, today’s health actuary has a special role in taking advantage of the digital transformation and achieving a high-quality and efficient health care service model.

Description: 1. Overview of challenges with Managed Medicaid (MLTSS/Dual Medicaid) 2. Mechanisms to identify the business problem. 3. Predictive Model approach a. Understand / Define the business problem b. Determine the appropriate solution c. Model build (data manipulations/transformations) d. Model scoring & monitoring results 4. Case Study - Disenrollment predictive model a. Describe the problem b. Recommended model to solve the problem c. Results d. Monitor results e. Fine-tune / calibrate model

Description: The proposed session will introduce Outcome Based Risk Sharing Arrangements (“OBRSA”) between health insurance payers (“payers”, including insurance companies, health plans, sponsored employers, and government programs) and pharmaceutical manufacturers (“pharma”), and it’s intended to meet the needs of actuaries who focus on pharmacy benefits and risk sharing arrangements. The covered content will include (1) the background of OBRSAs, definitions, stakeholders, and OBRSA’s role in shifting the system from volume-based toward value-based; (2) conflicting perspectives about OBRSAs between payers and pharma (cultural and methodological); (3) identification of incentive gaps between payers and pharma, and incentive alignment between them; (4) barriers to implement OBRSAs; (5) limitations and considerations of OBRSA implementation; and (5) hypothetic OBRSA examples.

Description: Predictive Analytics and Epigenetics are two of the most impactful driving forces for the future of healthcare, precision medicine, and insurance. Learn why this is true, how if will change the way our industry operates, and how you can stay viable and contribute to the betterment of humanity while also protecting the actuarial profession from obsolescence. Learn how personalized medicine keying off genetic testing is saving life insurers big dollars. The only limit seems to be testing access for their insureds.

Description: Offering supplemental benefits likes accident, hospital indemnity and critical illness to traditional worksite employees has become routine, but how do you handle gig workers? Traditionally these workers would be considered uninsurable, but can you afford to ignore them? The panel will discuss the unique factors of the gig economies and key thoughts for providing insurance in this space.

Description: As baby boomers continue aging into Medicare, prescription drug plans (PDPs) will continue to be an option to meet prescription drug needs. Several new PDPs introduced in 2019 address these needs, and we will share our experiences with implementing, pricing and operationalizing a new PDP, including how this product integrates across the enterprise. While we will discuss topics specific to launching a PDP, several of the concepts can be generalized to starting other insurance product lines within an organization.