Description: The introduction of new gene and cell treatments is not without scrutiny. Although these treatments are often curative, they come with a significant price tag. Health plan actuaries find themselves wondering if the intended outcome supports the cost and whether the potential medical cost savings will offset the high drug cost. The Institute for Clinical and Economic Review (ICER) reviews results from clinical trials to produce a report evaluating the cost-effectiveness of new therapies. Depending on the results, the ICER report can be used by pharmaceutical companies to justify the high cost or by the health plan to do the opposite. Go beyond the ICER report and discuss an alternative method for valuing new drugs using nonmedical revenue streams, such as disability and nutrition benefits, and return-on-investment modeling. By attending this session, you will have a better understanding of the nonmedical revenue streams, such as disability and nutrition assistance benefits, that may offset the cost of a drug and how those revenue streams can be incorporated into return-on-investment modeling.

Description: An overview of bias and fairness in machine learning models, as they apply to use cases in life insurance.

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 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.

Description: A preview of the details and content of the new Certificate in Climate Risk to be offered by the SOA beginning in early 2023.

Description: This is the first of a two-part article introducing and elaborating an “Adaptor” strategy for ERM. Such a strategy is intended to fulfil two purposes: first, switching among four styles of risk-coping strategies in order to track qualitative changes in a business’s risk environment; and, second, to support the business in navigating with resilience through all the seasons of a business-economic cycle, i.e., of boom, bust, moderate, uncertain. This latter requires careful study of the nature of resilience, the familiar idea of bounce back, and the less familiar idea of bounce forward. Part I of our article is underpinned therefore by a supplementary document (available from https://riskviews.wordpress.com/adaptor-exceptionalism/), which addresses the issue of structural change in a business or economy. It draws heavily on ideas taken from the discipline of control engineering, as well as some from ecology, social anthropology, and economics. The entire two-part article is thus an exercise in cross-disciplinary Systems Thinking.

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: Discount rate curve construction has been a topic of renewed interest following recent changes in financial reporting standards. Interpolation is a key component of curve construction and can be conducted via an assortment of methods. This article explores six popular interpolation techniques and assesses how they perform with regards to desirable features of such methods: continuity of forwards, stability and locality, simplicity, and market consistency.

Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: In the United States, there has been much industry discussion of the challenges associated with a sustained low interest rate environment, which impacts both the asset and liability sides of the balance sheet in unfavorable ways. The intent of this article is not to focus on these strategic issues. Rather, we attempt to shine a spotlight on some of the modeling challenges that practicing actuaries may experience when incorporating negative interest rates into their models.