Description: "Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations."

Description: Data is everywhere. Health care generates as much as 30% of the world’s data, and new technologies are changing how life insurers analyze consumer information. Actuaries are business-savvy problem solvers. They understand how to leverage the latest technologies and techniques to turn data into actionable insights and solutions for businesses and can communicate those findings to multiple audiences. SOA-credentialed actuaries use predictive analytics to inform organizational and business strategies, with efforts such as identifying chronic conditions in their early stage or determining stress levels through sweat patterns.

Description: Explore wellness programs and their effectiveness within the LTC industry by attending the Considerations for LTC Wellness Programs webcast. You will experience discussions about design tactics and evaluation processes for programs, as well as discovering ways to assist policyholders achieve a sustainable and equitable life. There will also be a conversation about the current regulatory environment as it relates to LTC wellness programs. This webinar will focus on subsets of insured populations that are high risk of claim in order to properly manage care decisions and ensure unfair bias is avoided. Learn how to test for unfair bias and determine best possibilities on how to guard against this when testing is unavailable.

Description: After a decade of traditional actuarial work in health care, David Sotelo was seeking a new kind of opportunity to make an impact. He found it at Collective Health, where he works with a team of actuaries and data scientists that use analytics to streamline health insurance.

Description: This report provides actuaries and other professionals working with risk, data and analytics or program evaluation in the health care space with considerations and frameworks related to the use of determinants of health (DOH) in data and actuarial work streams. Such frameworks can leverage new data sources to enrich health care data analysis to move beyond traditional data elements, such as age, gender, zip code or health diagnosis.

Description: Attend if you are an organization interested in utilizing various kinds of client data to improve the whole insurance sales process, and to develop new applications. Interested parties may include distribution sales force, underwriting, claims, actuarial and finance departments within a typical insurance company, online distribution partners, health care providers and other consulting service providers. The research looks into various use cases, which are typically main issues in modeling in the insurance industry. The research also helps benchmark performance using different languages that may serve as a good reference when best to use a certain language to enhance the development cycle.

Description: "Discuss research conducted at the Cleveland Clinic to understand levels of anxiety and depression across Northeast Ohio. Specifically, learn how advanced analytical techniques were utilized with social media data from Twitter and Google to estimate the need for psychological support by geography and overtime. The panel will go further to demonstrate how natural language processing (NLP) and machine learning could be used to make operational decisions at a leading health care provider."

Description: Early in his career, Ehren Nagel, FSA, MAAA, scoured through podcasts and articles about predictive analytics, long suspecting this was a field with potential for him.

Description: Abstracts of recent articles of interest to health actuaries

Description: Creating a predictive model is one thing, but then taking that model and getting full stakeholder buy-in is another. Learn from presenters' experiences and insights on proving model effectiveness in the long-term care (LTC), life and annuity spaces. Explore various topics such as feasibility, model transparency, fairness and equity, ROI measurement, data assets and compliance, infrastructure and more. By the end of the session, you will gain an understanding of how to navigate the challenges of proving the effectiveness of predictive modeling and obtaining management buy-in.