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: Panelists address topics such as techniques for testing data quality, the actuary’s responsibility for verifying the reasonableness of data, and considerations in modifying data sources for specific situations. Included is a discussion of ASOP No. 23. From the Record of the Society of Actuaries, Volume 27, No. 1, Session 96

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.

Description: This is a transcript of a 1982 meeting of the Health Section. Includes presentation and discussion of three papers: a. Cumulative Anti-selection Theory by William F. Bluhm b. Regulatory Monitoring of Individual Health Insurance Policy Experience by John B. Cummings c. Medical Care and Services in Canada by Frank G. Reynolds From Record Vol. 8, No. 4