Description: Renal disease is a very heterogenous medical condition whose end state is dialysis, a recurring cost intensive medical condition. Dialysis cost is one of the major medical cost drivers in USA. Insufficient and improper care management in the early stages of CKD (chronic kidney disease) leads to early incidence of end stage renal disease (ESRD) among CKD patients which not only leads to high medical costs, but also reflects poor health quality.

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: With the mandated health plan transparency files, health plans and providers are now able to substantially enhance their provider contracting efforts. Although the files are large and cumbersome they are market disruptors and provide new insights for provider contracting efforts. Explore a demonstration on the type of information now available and how it can be used to enhance this from both a health plan and health care provider perspective.

Description: CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.

Description: Open source programming languages have become a common part of the actuarial toolkit over the years. Using tools like R and Python, highly technical actuaries can automate onerous processes, easily work with massive amounts of data, create models and generate reports. Although these tools excel at turbo-charging analysts, it can be difficult for benefits to inure to the rest of the organization given the learning curve (“Can’t you just put this in Excel?”), control risks (“So your entire process could break overnight if some random person in Nebraska changes something?”), and internal IT environments. Listen in on a panel discussion where presenters share their personal stories of working with open source in a production setting. Hear about real world business problems, how open source tools were used, what risks were present, how they were overcome and the final business result.