Description: Health care has changed rapidly over the past couple of years. The pandemic has shifted consumer behavior in how and where they receive health care as well as consumer attitudes toward health care. Payers continue to design innovative solutions in responses to their patient’s needs and expectations. These changes in consumer behaviors and the responses by payers are expected to impact both health care cost and utilization. Discuss changes in health care that have emerged due to the pandemic and how they are expected to influence actuarial assumptions. Explore epidemiological models commonly used in the industry, the considerations when using these models, as well as the challenges with regards to gathering and interpreting relevant experience data. By attending this session, you will be able to: Identify shifts in consumer behavior that have emerged from the pandemic and describe how payers are responding to new patient expectations. Discuss how these post-pandemic changes by consumers and payers influence medical spending. Determine which actuarial assumptions are impacted and how and if the impact is expected to be temporary or permanent. Discuss considerations taken by actuaries and challenges faced when modelling actuarial assumptions post pandemic.

Description: Actuaries historically modeled new launches in pharmaceuticals by anticipating the expected change to the market basket. This became more complicated with the recent launches of gene and cell therapies as they address rare diseases. Rare conditions have low total member volume to study and some do not currently have a diagnosis code to identify them within claims data. Addressing this modeling challenge has been growing more important in the recent years with the number of therapies launching. What has the health care industry, and more specifically health care, done to enhance modeling and how should this be altered for the future? Additionally, historic modeling has sometimes incorporated a level of direct medical treatment cost offsets where studies have shown lower treatment costs are achievable. Can gene and cell financial modeling include cost offsets as well? And if so, what are suggested precautions or limitations to this effort?

Description: Innovation in technology has disrupted nearly every industry, creating mounting internal and external pressures on organizations to accelerate the adoption of their digital agendas. The COVID-19 pandemic further brought to light the need for tools and technology to be adaptable, powerful, and scalable. As the insurance industry leaps into the future, actuaries must not only proactively refine their roles and responsibilities within insurance organizations but also seek opportunities for improvements and optimization in their day-to-day work. Discuss a variety of opportunities to streamline, accelerate, and optimize actuarial processes by using modern technology. Cover a wide spectrum of actuarial solutions from automation of actuarial data transformation to actuarial reserve calculations and calibration of economic scenarios. By attending the session, you will: Be able to articulate how modern low-code/no-code technology can help actuaries automate, streamline and optimize processes in yourday to day work tohelp focus on higher value tasks.

Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: Modeling Approaches and Challenges focuses on approaches to real world simulation and the challenges and considerations in real world simulation. Topics include: A frequency domain approach to build realistic multi-horizon scenarios. (Ortec approach) Cascade models structure linking models for major asset classes and economic variables. (Moody’s approach) Overview of models, calibrations & approaches within the context of different use cases. Deterministic & stochastic approaches. Importance of model re-calibration flexibility. We will also discuss specific insights into considerations and challenges in real world simulation, which include topics like: Setting capital market assumptions and/or calibration targets. Assumptions about correlation and causality. Calibrating the model to capital markets assumptions. Validating the model against capital market assumptions. Role of history, market data and stylized facts. Importance of back testing. Calibrating the model to multiple investment horizons. Inclusion of alterative asset classes such as private equity, infrastructure, and direct real estate. Associated issues of limited data, illiquidity and greater uncertainty about calibration targets.

Description: Actuarial transformation is a growing trend with clear impacts on data, software, analytics and reporting. So how does modeling fit in? The presenters will explore how the actuarial modeling function fits into a transformed business, starting with the questions below in a case study discussion to allow attendees to learn from peers.

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: 2021 Life Meeting - Session 5E: Importance of Strategic Asset Allocation in a Rapidly Changing Macro Environment 8.31.21 Recording

Description: Risk adjustment in government regulated health plans has been around for over two decades. Yet the strategies for promoting risk score accuracy haven't varied much during that time. Most health plans, physician groups, and vendors promote chart reviews and/or in-home assessments as the primary vehicle for collecting data not perceived to be present in the routine claims submission and adjudication stream. We know that most organizations trying to coalesce encounter data from multiple sources often fail to ensure that all relevant data is ultimately submitted to CMS or a state Medicaid agency. Crucial data, often with significant financial value, frequently gets lost in the data pipeline, somewhere between the provider's billing system and the health plan and/or its vendors. Because 837-formatted data is difficult to read, it complicates payers and vendor’s abilities to track encounter data so that every service delivered to patients is credited to the applicable risk adjustment formula. It is incumbent upon successful risk-adjusted entities to be able to track encounter data, identify processes and/or vendors which may be mangling or losing data, in order to ensure that risk scores are sufficiently accurate to be compliant with plan sponsor requirements and to ensure appropriate revenue to the health plan or provider group.

Description: Model design is an important part of being an actuary, and the SOA highlights the importance of the actuarial control cycle of model design, evaluation and monitoring. What tools are at our disposal for these steps? When should we be concerned or excited about model performance? Can we, and should we, use machine learning tools to assist with model improvement or development?