Description: Risk adjustment in government regulated health plans has been around for over two decades. Yet the strategies for promoting risk score accuracy haven't varied much during that time. Most health plans, physician groups, and vendors promote chart reviews and/or in-home assessments as the primary vehicle for collecting data not perceived to be present in the routine claims submission and adjudication stream. We know that most organizations trying to coalesce encounter data from multiple sources often fail to ensure that all relevant data is ultimately submitted to CMS or a state Medicaid agency. Crucial data, often with significant financial value, frequently gets lost in the data pipeline, somewhere between the provider's billing system and the health plan and/or its vendors. Because 837-formatted data is difficult to read, it complicates payers and vendor’s abilities to track encounter data so that every service delivered to patients is credited to the applicable risk adjustment formula. It is incumbent upon successful risk-adjusted entities to be able to track encounter data, identify processes and/or vendors which may be mangling or losing data, in order to ensure that risk scores are sufficiently accurate to be compliant with plan sponsor requirements and to ensure appropriate revenue to the health plan or provider group.

Description: Actuarial models and modeling processes continue to grow in complexity, accelerated by the changes in U.S. Statutory, U.S. GAAP and IFRS reporting requirements in the past few years. Modeling and valuation teams are expanding their toolkits beyond the traditional vendor-maintained actuarial software and the MS Office suite of tools. Companies have started to use a variety of tools to improve model dev and valuation processes, including: - Data management - Automation and workflow - Reporting and analytics

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: Stochastic modeling requirements are resulting in more 'run time' and less 'analysis time'. An expensive solution is leveraging cloud infrastructures and robust computing grids. The presenters will explore the use of cluster modeling and present case studies showcasing this automatable and robust technique, which could allow actuaries to recover the time lost to 'run time'. Developing automatable and clustered models requires robust governance practices to ensure credibility of results.