Description: A study of whether tobacco, area and industry rating in one state may be reflecting unintended factors such as race, ethnicity or socioeconomic status. This study does not consider whether the rating factors accurately reflect underlying claims costs.

Description: Risk adjustment has been utilized for many years in different settings, primarily as a tool to help properly compensate insurers for the risks they take when enrolling members in their insurance plans.

Description: CPT, NCCI, ICD, CCI, DRG, APC, PTP – understanding healthcare claims involve a dizzying array of code sets and payment methodologies, and yet the claim form is the intersection of health plan affordability, provider payment, and data analysis. This webcast will cover: • The code sets used in medical coding • Types of correct coding policies implemented by CMS and commercial payers • Payment integrity strategies to drive health plan affordability • Data analytics approaches leveraging medical coding knowledge

Description: 2021 Life Meeting - Session 5F: Premium Leakage - How Outdated Claims Systems are Losing You Money 8.31.21 Recording

Description: Learn the roles and responsibilities of a valuation actuary to help health actuaries learn best practices, technical considerations, and professionalism issues surrounding the calculation and reporting of health liabilities and reserves. Focus on key actuarial liability and reserve provisions, including Claims Unpaid and Premium Deficiency Reserves. Explore new ideas about calculation methods and the importance of the underlying assumptions. Examples will be provided to present best practices and practical applications concerning reserve calculation. A discussion of best practices regarding the preparation of an actuarial memorandum supporting a Health Annual Statement will be included to focus on key considerations from the American Academy of Actuaries’ Practice Note about documenting and supporting the actuarial calculations. The discussion will feature views and considerations from both the insurer’s and the regulator’s perspectives. By attending this session, you will be able to: • Understand the roles and responsibilities of the appointed actuary. • Identify what’s in scope for the actuarial opinion. • Understand actuarial qualification requirements. • Learn the statutory rules for establishing key actuarial liability provisions. • Understand the general purpose of financial reporting. • Understand best practices with reserve calculations and resources available, including relevant practice notes and Actuarial Standards of Practice. • Understand the sufficient documentation needed to support valuation work. • Understand the critical elements sought by regulators, auditors and other users of an actuarial memorandum.

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: This session series is sponsored by Hannover Re Session 1 - COVID-19: Past, Present and Future and Its Impact on Health Products COVID-19 has had an unprecedented impact on the health industry, forcing insurance companies and other risk-sharing entities to re-assess how to write and manage its business going forward. This first of two sessions in the special COVID-19 series will review the impact the pandemic has had on the development, pricing and risk management of health products. The speakers will review COVID-19 mortality and morbidity trends, share possible outlooks for the future of the virus, and analyze how COVID-19 has impacted the pricing strategies and risk management of health business across various markets (e.g., the ACA marketplace, Group Commercial and Medicare). By attending this session, you will be able to explain the latest COVID-19 trends in the US and globally and the resulting impact on mortality and morbidity experience. Attendees will develop a clearer understanding of how the pandemic has impacted the pricing and risk management of health products.

Description: The past couple years during the pandemic have had a tremendous and costly impact on society’s collective mental health. What’s next? Examine patterns of MH/SA needs identified from living with COVID-19 for two years and discuss what MH/SA needs to expect in the future. Across society, mental health has been one of the most impacted areas of total health and wellness and has been highly publicized. What’s here to stay, and how does that impact how we think about mental health going forward? With increased publicity and campaigns to normalize MH/SA needs, what are the supply-side and demand-side limits? By attending this session, you will be able to: • Identify drivers of MH/SA services in the pandemic. • Understand future expectations of MH/SA needs, with population specific considerations (ex. gender, business type, etc.). • Analyze impact of increased awareness of MH/SA needs and reduced stigma.

Description: Telehealth continues to be a story of unrealized potential than realized success. Find out what's pushing telehealth forward as a means of remote healthcare and the challenges its facing. Discuss questions, including: - Telehealth's role in expanding access to mental healthcare is clear, but what about other conditions? - Was access expanded for all patients or do modern delivery methods leave some patients behind - How do telehealth costs compare to in-person costs? - What happens to the value proposition if unit cost savings is off the table?

Description: Follow up to the study 2014 GLTD Termination Table study. Reporting on recent experience and relative to the parameters underlying that table examined.