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: Learn about the latest developments in hospital and payer price transparency data. Hear experiences working with the data and attempts to gain meaningful insights for actuarial and other purposes. Discover challenges and workarounds associated with this data, including file size, comparability of prices, duplication of prices, aggregating provider NPIs into meaningful groupings, and missing payer information.

Description: This webcast will walk through several statistical methods for imputing race and ethnicity from U.S. datasets, highlighting strengths and weaknesses and evaluating accuracy.

Description: One common barrier to employing GLM modeling is the lack of sufficient data. This limitation often comes from the combination of the considerations in ASOP No. 25 “Credibility Procedures” and the fact that GLMs assign full credibility to the data. Explore the possibilities of credibility-based regression by expanding the intended purpose of modeling analysis from producing a single model as output to producing data insights, credible differences, and a range of reasonable models.

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: This article delves into the transformative realm of Business Intelligence (BI) tools. We explore the fundamental functionality and structure of these tools, and through case studies illustrate how they offer valuable insights into carrier experience and underwriting dynamics. From real-time data visualization to in-depth data analysis, discover the essential features that empower businesses to make better informed decisions.