Description: Actuaries historically modeled new launches in pharmaceuticals by anticipating the expected change to the market basket. This became more complicated with the recent launches of gene and cell therapies as they address rare diseases. Rare conditions have low total member volume to study and some do not currently have a diagnosis code to identify them within claims data. Addressing this modeling challenge has been growing more important in the recent years with the number of therapies launching. What has the health care industry, and more specifically health care, done to enhance modeling and how should this be altered for the future? Additionally, historic modeling has sometimes incorporated a level of direct medical treatment cost offsets where studies have shown lower treatment costs are achievable. Can gene and cell financial modeling include cost offsets as well? And if so, what are suggested precautions or limitations to this effort?

Description: One of the most effective ways to convey quantitative results is via data visualization. However, many times actuaries have been ineffective in doing this. In this session, you will see a demonstration of certain dataviz choices that make communicating results more effective in terms of graph type choice, graph element styles, colors and more. All examples will be in Excel-and doesn't require Visual Basic for Applications (VBA)! Nothing too fancy! I want to distribute working files to attendees before the session so they can follow along with how to build the graphs, make changes, etc. Graph choices will include line graph, tile grid map and jitter graph.

Description: Similar to how states had made adjustments to their capitation rates to reflect acuity adjustments caused by the onset of the pandemic, states will need to modify the rates to reflect the unwinding since utilization patterns and average acuity per enrolled member will change. When the continuous coverage requirements set forth by the COVID-19 Public Health Emergency (PHE) ended, Medicaid-managed care programs across the country adopted various approaches to phasing out maintenance of effort (MOE) as a result of changes to the PHE-era continuous eligibility requirements. Phasing out the MOE requirement will ultimately result in members who no longer meet eligibility requirements losing their Medicaid coverage. Further, states are facing a wide variety of circumstances and are implementing diverse approaches to the MOE phase-out. This topic will be of significant interest to all actuaries and stakeholders of the capitation rate development process for Medicaid-managed care programs. Join us as we discuss the operationalization of the PHE unwind while referencing the SOA's research project which models the effects of the unwinding on Medicaid eligibility and population costs. You will learn about the various approaches that different states have adopted to manage the unwinding process, which will be instrumental for accurately pricing managed care rates.

Description: Cover a variety of topics centered around the unsupervised learning technique called 'clustering'. The presenters will take you through a wide array of topics that range from 'What is Clustering?' to 'How can I use this technique to solve problems I didn't even know existed?' In the health care industry, everyone is looking for an edge in reducing total spend-cluster analysis finds the unambiguous in an ambiguous framework of results.

Description: Sarah Rockhill, MPH, Geospatial Epidemiologist at CDC will discuss the latest in the Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity.

Description: At the conclusion of this session, attendees will be equipped to apply relative risk curves in their actuarial work, including the ability to examine dose-response relationships, apply population attributable fractions (PAFs), and develop customized risk models for cause-specific mortality and morbidity outcomes based on individual-level exposures to selected risk factors. These skills are becoming increasingly important as actuaries adopt novel applications of big data and dynamic health information to refine risk assessments and keep pace with global health trends.

Description: Both LDTI and IFRS 17 have introduced numerous new metrics with most companies having only crossed the finish line, just complying with what's needed for reporting due the complexity and large amounts of data required to simply comply. How do you leverage all the work you did to get proper business insights across the organization that tie back to these reporting metrics?

Description: Modern actuarial work, being quite data intensive, provides many opportunities for actuaries to use the statistical skills that are part of their basic training. Furthermore, modern computing allows us to analyze vast quantities of data intensively, and each package will provide statistical 'answers' to any questions the actuary might ask of it.

Description: How well can we predict ACA HHS Risk Adjustment Data Validation (HRADV) results? Put another way, how susceptible is the current HRADV process to small sample volatility? What potential remedies are there to the current model's shortcomings? Every plan, regardless of how many members they have above the 1000 minimum, count equally if they qualify for an HRADV with how the result is interpreted, and the subsequent HRADV risk transfer ($330M in 2023).

Description: With the unprecedented proliferation in the size and complexity of data over the past decade, actuaries have invested considerable time and energy in the development of new skills and expertise in order to be able to understand and use “big data” to its fullest potential in the development of actuarial work product.