Description: Health care is a complex market with a wide variety of stakeholders. These stakeholders have diverse business needs, requiring complicated data-driven decisions. The analytics and research supporting these decisions are often dependent on the availability of real-world data (RWD), which includes a wide variety of data capture technology and data reflecting treatment, clinical outcomes, and costs of health care in real treatment settings (e.g.,, outside of controlled clinical trials). The goal of this panel discussion is to explore how existing and emerging sources of RWD can enhance benefit design, improve risk assessment, influence treatment decisions, and advance the measurement of clinical, humanistic, and financial outcomes. The diverse speaker panel includes actuarial and non-actuarial perspectives, representing the pharmaceutical industry, a health-care services business, and academia. The panel will describe the decision-making that drives their individual needs to use RWD, identify current and developing RWD sources, provide examples of analyses using RWD, and discuss how emerging RWD may influence actuarial analytics and potentiate the development of new interdisciplinary methods and value drivers.

Description: This session describes the process payers and employers can use to evaluate emerging medical device technologies, recent or pending FDA submissions for prescription drugs and experimental treatments that impact patient care, resource utilization and health care expenditures. We will walk through the process of identifying and selecting impactful treatments (Horizon Scanning) and quantifying the financial cost of new technologies before they arrive in the market. These workflows can be leveraged by actuaries, healthcare economists, clinicians and pharmacists from a payer (Commercial and Medicare) and employer perspective for self-funded plans. We will also walk through some sample models that illustrate how costs for emerging technologies and treatments can be modeled.

Description: While medical and pharmacy claims data is a well-established source for healthcare analytics, significant data can be found elsewhere in electronic medical records (EMRs) and in hospital admit, discharge, and transfer (ADT) messages. Increasing availability of bulk EMR data to analyze coupled with more powerful and specialized tools for analyzing it presents an opportunity for actuaries to incorporate these sources in their work. This session will take a look at some of the data available beyond claims in EMRs and HL7 ADT messages, and will discuss case studies, with consideration around structure, ease of use, cleanliness, and tools available for analyzing these data types including natural language processing.

Description: Predictive modeling is a powerful toolset for assumption setting (mortality, lapse, etc.). The multivariate approach has its advantages in handling high-dimensional data, address correlations, and statistical significance. However, building insurance assumptions is far more than a simple modeling practice. One must take care to address how the model is applied and its business implications. This session will share the learnings from multiple projects.

Description: Why should actuaries care about non-quantitative considerations? We are the masters of accurate calculations, and our models should be based solely upon logic … right? Wrong! The touchy-feely holistic, irrational factors encountered so often in the real world, can wreak havoc upon a model that considers only rational logic. Our 2016 presidential election was a dramatic wake-up call to statisticians and actuaries that numbers alone are not always the determining factors in economic outcomes. Learn why this is true, and how you can adapt your models to better represent the real world, and gain competitive advantage.

Description: Medical/Technological Advances

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: 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: 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.