Description: This session will explore the national landscape of state Medicaid risk adjustment program design & application and the key differences that drive effective managed care organization program management. Risk adjustment is a mechanism to adjust capitation rates between Managed Care Organizations to account for population morbidity differences. Although many states utilize this mechanism, the application of risk adjustment can vary significantly across states. The primary differences include populations, risk score models and data collection. These state application nuances affect the strategies and tactics utilized by MCOs for effective risk adjustment program management including provider financial alignment, encounter data submission and the capture of accurate diagnosis codes. The session is intended for Medicaid Managed Care Actuaries working to develop or support comprehensive risk adjustment program management functions.

Description: The National Association of Worksite Medical Clinics reported that one-third of U.S. employers with 5,000+ employees sponsored worksite (onsite) health care centers in 2017, and 24 percent of employers with 500-4,999 either have or plan to implement onsite health care by 2019. This session will explore why onsite health care programs are gaining traction: • Why do employers sponsor onsite healthcare? • What objectives do they hope to achieve? • How does the evidence compare with these objectives?

Description: The U.S. health care industry has gone through a dramatic change during the past several years. The business model has moved from a risk selection model to a risk management model. People can shop online for their health care coverage. Everyone is welcome! Annual and lifetime dollar limits, underwriting and the pre-existing conditions exclusion are all in the history book now. Facing the challenges of the post-reform era, many health insurance carriers began using big data analytics on all aspects of their decision-making processes. The goal is to be able to compete on analytics in this quickly changing environment. However, becoming an analytics competitor is not easy. It requires the belief from the leadership and a group of dedicated analytical professionals to solve emergent business problems that existing strategies cannot address in an evolving market. These problems include marketing for acquisition and retention, coding accuracy, revenue growth, health care disparity, payment integrity, quality of care, health care cost reduction and, ultimately, personalized care management. In this section, audience will learn a basic understanding of the role of predictive analytics in US Healthcare marketplace.

Description: Large claims have always been a major source of volatility in health care claims experience. In this session, the presenters will discuss techniques for analyzing large claims, predicting large claims and measuring the associated risk. The presenters will also discuss the early results of the SOA 5/50 research project which will examine the 5% of the population that accounts for 50% of the health care costs.

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: Why should actuaries care about non-quantitative considerations? We are the masters of accurate calculations, and our models should be based solely upon logic … right? Wrong! The touchy-feely holistic, irrational factors encountered so often in the real world, can wreak havoc upon a model that considers only rational logic. Our 2016 presidential election was a dramatic wake-up call to statisticians and actuaries that numbers alone are not always the determining factors in economic outcomes. Learn why this is true, and how you can adapt your models to better represent the real world, and gain competitive advantage.

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 seminar is designed to give life and annuity practitioners an in-depth view of the important topics and fundamentals of reinsurance, from the perspective of a U.S. life insurance company. Reinsurance industry experts will present on the various types of reinsurance, contract issues, financial implications and other considerations. Attendees will leave this seminar with a stronger understanding of life and annuity reinsurance, and current topics. Keep in mind this seminar is designed for participants with a moderate level of experience. Educational Objectives • Provide attendees with a stronger understanding of life and annuity reinsurance, and current topics • Give attendees an in-depth view of important topics and fundamentals of reinsurance

Description: We will determine the role of risk function in evaluating operational risks associated with the implementation of LDTI and any system conversions. Are all models validated by the risk function before they are productionalized and results used by management to make business decisions? Does the risk function play a part in to assist finance, actuarial and investor relations in communicating changes and volatility resulting from LDTI? If not, should it? We will articulate the role that risk functions play in being part of large transformation from the start as a stakeholder/input provider to subsequently being an independent reviewer (i.e., second Line of defense).

Description: The reinsurance market is experiencing unprecedented growth in both frequency and severity of catastrophic medical claims. Most experts identify specialty drugs, new gene therapies and high-intensity hospital in-patient stays as contributing factors. With Rx claims, high-cost drug protocols are creating chronic high-cost cases over multiple years. What can actuaries do to rapidly identify these cases? If identified, what techniques can be used to reduce or manage cost? Panel will include a nationally recognized consulting actuary, health plan executive and reinsurance executive.