Description: ACA risk adjustment has now been in play for years. The original intent of risk adjustment was to help stabilize the market through measuring risk levels of each issuer. However, the risk adjustment program may have introduced additional uncertainty due to annual market shifts and model changes, making risk adjustment estimation is a difficult task. This article analyzes the results over time, including impacts from market changes and model changes.

Description: This chapter introduces a few probability distributions that play an important role in understanding and analyzing healthcare data. While theoretical in nature, these distributions model real life if appropriately chosen. Probability distributions are mathematical representations of how statistical data behave.

Description: Regulatory change and increased focus on internal risk management are driving a renewed interest in model efficiency. In this session, we will review several new and existing tools, that show significant promise for advanced modeling of equity linked products. These include: • Clustering • Use of unique--and potentially a different number of--scenarios for each policy • Semi Monte Carlo (SMC) – this is a proprietary technique that is similar to a combination of Monte Carlo and numeric integration • Using a neural network approach to optimize some of the more complex and manual aspects of clustering and improve the fit of the clustered model • Combining SMC with the use of unique scenarios per policy

Description: Retirees will face the societal issue of inadequate savings with likely insufficient time to rectify the situation. They need immediate growth, but also the disciplines of risk management. They typically do not know how to engage with these two aspects in a harmonious manner on their own. Insurance companies are in the business of providing the solution but regulators have been clamping down in favor of simpler and more transparent products. In addition, the market reality over the last decade has been that insurers have stock betas at a multiple to the general markets with PE ratios well below. A panel of senior professionals from writers of retirement product business will present their vision of how the insurance industry can address the above dilemma, including the risks underlying the writing of the business, impact of financial markets, and regulations in the development of the business.

Description: In the evolving realm of healthcare actuarial practice, value-based contracts are reshaping the landscape. This article explores the pivotal role of AI-enhanced Electronic Medical Records (EMRs) in empowering actuaries to navigate this dynamic sector. Despite challenges in data standardization, AI-enhanced EMRs offer a solution by extracting and standardizing diverse medical records. The article delineates how AI-EMR integration benefits actuaries and provider organizations, enabling more accurate forecasting, earlier shared savings prepayments, and real-time quality metric aggregation. Moreover, it discusses how this fusion addresses historical data limitations, can help project catastrophic claims, and can help identify risk score capture opportunities. Ultimately, it indicates the transformative potential of AI-EMR synergy, positioning actuaries at the forefront of healthcare analytics with unprecedented precision and insight.

Description: This report explores AI bias in insurance and health data, highlighting the ethical role of actuaries and offering cross-disciplinary guidance for fairer decision-making systems.

Description: 2014 marked a new beginning for small group(SG) health insurance market ushered in with adjusted community rated products priced from a single risk pool. It was anticipated that the mandated pooling of the risk would result in higher rates, especially for healthier groups. It is the aim of this article to show whether that view bears out in the actual market rates and if it is higher, then by how much. The article provides a point in time(1st quarter 2025) comparison of premium rates under two segments of the small group market, namely Qualified Health Plans(QHP) available under the small group ACA market versus self-insured Multiple Employer Welfare Arrangements(MEWA) plans.

Description: The Society of Actuaries (SOA) Research Institute released a report summarizing the InsurTech Insights Americas conference held May 24-26, 2022. InsurTech, a concept created 10-15 years ago, is maturing and currently western financial markets are recording a downward trend while inflation is rising. While this downward pressure on financing makes investors more cautious, stakeholders are working towards partnerships to improve the overall effectiveness and purpose of the insurance industry.

Description: It's your first full day of productive learning! Start it off right with a delicious breakfast and warm welcome.

Description: This report is presented in the form of a Tableau dashboard and is the sixth public release from this report series and contains the results of an excess mortality analysis for the fourth quarter of 2021. Data from 30 companies representing approximately 69% of the industry’s face amount inforce were included in the analyses in this report. A total of 3.2 million death claims from individual life policies from 2015 through December 31, 2021 make up the basis of the analyses. The report also compares the experience under COVID-19 of the insured population versus the general population.