Description: Large claims have always been a major source of volatility in health care claims experience. In this session, the presenters will discuss techniques for analyzing large claims, predicting large claims and measuring the associated risk. The presenters will also discuss the early results of the SOA 5/50 research project which will examine the 5% of the population that accounts for 50% of the health care costs.

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: Chapter 3 describes the methods and data being used in the evaluation predictive accuracy. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.

Description: Underwriting is one of several areas in the insurance industry being impacted by insurtech. In this session, we will hear from experienced experts in underwriting transformation. Digitization, machine learning and other approaches are among topics to be discussed.

Description: This SOA-funded study examines the relative performance of different risk assessment methods and risk adjustment systems. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.

Description: A summary of pathology, risk factors, treatments, public health issues, and economic costs of Alzheimer's Disease.

Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: Chapter 5 simulates the risk adjustment process within a hypothetical purchasing alliances using four different risk assessment methods. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.

Description: Three appendices: Selected Readings, Summary of Data Preparation and Data Issues, and Detailed Results on Predictive Accuracy. From A Comparative Analysis of Methods of Health Risk Assessment, M-HB96-1.

Description: Summary of research from the Initiative 18/11 - Pharmacy team about the drug development process for traditional pharmaceuticals: Who does the research and discovery? What does the research and discovery process entail? How are targets identified and validated for research and discovery? What are clinical trials and how are they conducted? How is the drug development process regulated? How is the drug development process funded?