Description: Enterprise Risk Management is often thought to be synonymous with managing an insurance company toward financial objectives with a focus on insurance-specific risks. Some might argue though that operational risks are the crux of all risks confronted by an insurance company and ultimately drive the company’s outcomes.Operational risk is the risk of impact on financial outcomes due to operational events, involving internal systems, personnel, procedures or controls, and also external events. Operational risk exists in all business activities, covering fraud, human error, accounting errors, legal actions and system failures. All of these activities could occur during the course of conducting day-to-day business operations. Additionally, insurance executives must consider the pace of change in the external environment and potential impacts on their business. This presentation is focused on operational risks, current and emerging, faced by health insurance companies.

Description: Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event. Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event.

Description: "The ACA RADV Program will begin to impact issuers’ risk transfers in the 2018 benefit year (BY) – potentially significantly. The program is expected to continue into the 2019 BY and beyond. Therefore, health actuaries working in the ACA market need to understand this program and its potential impact.The session includes panel experts who will provide attendees with high-level overview of the program, discuss the findings from a national study, and RADV’s ultimate impact to risk transfers, as well as downstream impacts to financial and pricing decisions. The nationwide study is based on 300+ issuers’ 2016 RADV results and contains emerging insights into the new ACA RADV program otherwise unavailable. The panel’s agenda will include:1. A succinct overview of the ACA RADV Program will be provided2. Summary of a national 2016 ACA RADV pilot study results and its findings. 3. Preliminary results from a national 2017 RADV study will be discussed (or CMS published results if available prior to session). 4. Walkthrough of how RADV results impact the overall risk adjustment transfers in the ACA market. 5. Finally, the panel will discuss RADV impact to issuer’s financial accruals and pricing strategy. 6. General Q&A, discussion"

Description: 1959 SOA Regional Meeting in Atlanta. This discussion covered the advantages and disadvantages of entering the pension field through Ordinary policies or Group Annuities. The panel also discussed considerations in entering the Accident and Sickness field.

Description: This chapter focuses on creating practical models that aid in the prediction of the risk of readmission to a specific hospital within 30 days of discharge for Medicare patients, to aid in the identification and stratification of at-risk patients for hospitals considering building an intervention program in a cost-effective manner. For readers who wish to develop their own predictive model, a dataset is provided on the Actexmadriver.com website, and R code is provided in the appendix to this chapter.