Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

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: Health Watch, Issue 79, December 2015, Health Watch

Description: A new health insurance pricing model takes external market prices into account, as well as regulatory rate restrictions and other traditional pricing factors. Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral & loss ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has a healthier than average mix of risks.

Description: Medical management programs have traditionally addressed more acute and short-term issues with chronic disease. As LTC becomes an important product in the insurance industry, including disease management is likely to be valuable for reducing costs and prolonging the healthy, premium-paying portion of a claimant's life.

Description: A discussion of permissible use and collection of genetic information for Health Risk Assessments and wellness programs under the Genetic Information Nondiscrimination Act of 2008.

Description: The proposed session will introduce Outcome Based Risk Sharing Arrangements (“OBRSA”) between health insurance payers (“payers”, including insurance companies, health plans, sponsored employers, and government programs) and pharmaceutical manufacturers (“pharma”), and it’s intended to meet the needs of actuaries who focus on pharmacy benefits and risk sharing arrangements. The covered content will include (1) the background of OBRSAs, definitions, stakeholders, and OBRSA’s role in shifting the system from volume-based toward value-based; (2) conflicting perspectives about OBRSAs between payers and pharma (cultural and methodological); (3) identification of incentive gaps between payers and pharma, and incentive alignment between them; (4) barriers to implement OBRSAs; (5) limitations and considerations of OBRSA implementation; and (5) hypothetic OBRSA examples.