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: Learn how insurers provide new opportunities for efficiency and value creation from product design and underwriting through customer engagement and claims. Glimpse some industry use cases for Gen AI and its outcomes as observed by the first movers.

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: This session series is sponsored by Zelis Claim analytics produces valuable insights about provider cost, quality, and referral patterns. Provider networks can be created around high-value providers to improve clinical outcomes while lowering the cost of care. Programs to improve provider performance and/or incentivize members to choose high-value providers exist, but how do you bring all of this together to achieve desired outcomes? Join us to learn how to leverage provider level analytics to build and optimize a network with high-value providers at the center. Analyze the network for competitiveness and adequacy and demonstrate progress toward network cost saving goals to key stakeholders by modeling claim data for a member population. Finally, ensure the success of your network through an incentive program that shifts utilization to those high performing providers. By attending this session, you will be able to: - Build a realistic provider network with high-value providers at the center. - Evaluate the overall financial impact of network build and optimization efforts. - Learn about an innovative member incentive program.

Description: This document is a Request for Proposal (RFP) issued by the SOA Research Institute, seeking researchers to assess the impact of artificial intelligence on the insurance and healthcare industries in Asia, with specific research objectives, proposal requirements, selection process, submission guidelines, and appendix providing cost estimates.

Description: This session will include examples of healthcare claims and market data to be used for educational purposes to highlight trends in the insurance industry. It will also highlight opportunities to enforce existing laws around fraud and abuse, and areas for regulators and legislators to focus to address this growing problem. Finally, it will discuss recent law changes and highlight areas requiring additional regulatory intervention. Expect discussions of recent claim issues and laws in the healthcare market as well as emerging issues in healthcare. The presentation will be beneficial to healthcare professionals working for health insurers, healthcare providers, auditors, regulators and healthcare providers and will also cover professionalism related topics for actuaries.

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 session series is sponsored by Zelis Shifting utilization of health services to efficient and high-value providers presents an opportunity to reduce harmful cascades of wasteful spending, ultimately freeing up funds for additional high-value services that will improve quality and member satisfaction. Identifying the right providers to put at the center of networks is challenging for any health care organization. How can you objectively determine which providers are delivering the greatest value when compared to their peers? And once those providers are identified, what’s next? Join Zelis and their partner HealthCorum to review a case study on a shared services organization where they leveraged statewide multi-payer claims data to produce provider level analytics, allowing for transparency into provider practice patterns at a granular level. By attending this session, you will be able to: - Create a fair methodology to benchmark providers. - Develop metrics and scores to identify high-value providers. - Produce actionable data to be used for network optimization strategies.

Description: Come explore an in-depth overview of telehealth to set context and navigate the continuing expansion of telehealth and its integration into the healthcare delivery system. You will examine the forces that shape telehealth offerings and expect a view of the possible futures of this evolving modality.

Description: This session will examine bias from a social science perspective. It will discuss the three types of systemic biases using the National Institute of Standards and Technology (NIST) model. The NIST model details the three types as historical bias, societal bias, and institutionalbias. The session will also provide several examples of each type to provide a framework for identifying the social structure of bias.