Description: Hear about some applications using quantile regression-derived individual and group claim distributions and how they may be used in various traditional health care modeling situations. The session will not focus on the technical use of quantile regression to obtain estimates of claim distributions, but more so is intended to focus on the uses of the distributions in actuarial modeling and the additive framework in assessing claims distributions. Presenters will show how actuaries can better assess risks by focusing on the individual- and group-specific claims distributions as opposed to traditional point-estimate-centric models.

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: Almost half of recent FDA approvals have been for orphan drugs. This trend is expected to continue in 2023. Orphan drugs are priced more than 30 times higher than non-orphan drugs, therefore their cost burden in aggregate has the potential to overwhelm the budgets of payers, especially that of smaller health plans. Hear how the cost impact analysis for smaller health plans require different considerations than for a larger health plan when modeling the impact of rare diseases.

Description: The COVID-19 pandemic has had an impact on all aspects of daily life and its impact extends to how disability incidence may play out in the future. Product profitability will be shaped by how morbidity patterns, interest rate levels and other key drivers will play out into the future. In this session, our panel will discuss COVID’s impact on IDI morbidity experience as observed over the past 18 months, offer comparisons and insights in light of other insurance lines of business, and share emerging information on the on-going effects of Long COVID. Highlights will also include how regional differences and implications for insurers as the industry moves further into the COVID vaccine era.

Description: Chapter 1 presents the background to the current study, followed by the methodology used, and a summary of the findings of the study. From Group Medical Insurance Large Claims Database Collection and Analysis, M-HB97-1.

Description: The attached report presents the results of a survey conducted by the Society of Actuaries Mortality and Underwriting Survey Committee in July of 2008 under the following categories: 1. Modeling Mortality Risk. 2. Use of Reinsurance to Manage Mortality. 3. Retention / Large Case Management. 4. Catastrophe Reinsurance. 5. Mortality Concentration of Risk. 6. Catastrophic Bonds.

Description: Universal Life with Secondary Guarantees (ULSG) was first introduced in the late 1990's as low-cost, long-term death benefit protection. As this business ages, writers are experiencing pressured earnings from emerging experience, secondary markets for insurance products and low interest rates. In response, writers are sharpening their pencils on experience analysis and risk management with an eye for opportunities to increase the performance of their blocks.

Description: Regression to the mean (RTTM) is inflating your health care intervention evaluations if you are not carefully managing it's omnipresent and significant impact RTTM is the statistical phenomenon which arises when comparing sequential data points when an initial observation is extreme or an outlier, and states that with no other intervention, future observations will be closer to the average. Members who had high costs last year will, on average, have lower costs this year, even in the absence of any intervention or clinical program, simply by 'regressing' to the mean. This means that if your clinical programs are simply targeting members who had adverse medical experience last year, you’re targeting the wrong people. And if your savings methodologies are simply last year’s costs minus this year’s costs, the savings are inflated. By attending this session, you will be able to identify situations where RTTM will be a significant factor, how to eliminate it's impact when performing retrospective evaluations, how to identify prospects for clinical intervention with RTTM in mind, and more.

Description: Data science, predictive analytics and AI are certainly the buzzwords these days. They are heavily used and developed in underwriting and marketing but for most actuaries, they might/may as well be science fiction. The presenters will demonstrate how a normal actuary can utilize data science techniques in their daily job function without forming an official data science team within a company. It can be done in a gradual fashion so that normal business is not disrupted and improvements are made over time. The usage of data science techniques will include demonstrations of the following areas: - Regression analysis - Economic scenario generator - Experience study - Data quality checks - Inforce compression for explicit hedging

Description: Data is at the core of the actuaries' role within companies, but how can actuaries translate data insights into informed and actionable decision making? The key is communicating data insights into a language that transcends analysis and enables real-time decisions that can provide an advantage to your management team. Learn an approach to choosing a tool or medium for your data insights, questions to ask yourself to better understand the communication necessary, and perspectives on how actuaries can take a larger role in actionable decisions within the industry. Understand availability, quality, and practical application of data sources health actuaries can access easily, how that data looks, approaches to transforming data into decisions, how it enriches administrative and claims data, and applications to pricing and reserving. Finally, discuss implications of ASOP 23, ASOP 41, and ASOP 56 as it relates to this topic. By attending this session, you will be able to: - Create an action plan on how to transform data into messaging for your leaders. - Use real experiences to formulate a strategy to expand the actuaries' role in informing decisions within the industry, including examples, to illustrate how data can benefit financials of health coverages. - Understand the application of ASOP 23 (Data), ASOP 41 (Communication), and ASOP 56 (Modeling) as it relates to turning data into decisions. - Be knowledgeable about new sources of morbidity for medical care and LTC and how to acquire and apply this information in actuarial models.