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: 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: 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: Over the last 10 years, Artificial Intelligence (AI) healthcare foundation models have made tremendous strides when it comes to delivering highly accurate predictive results when compared to traditional models. This is especially true for models developed and trained on the ‘language’ of healthcare. When trained on healthcare data sequences (claims, EHR, CPT, ICD, pharmacy, lab, etc.), these models deliver far more accurate results as to WHAT beneficiary-level health events will occur and even WHEN they will occur.

Description: How do social determinants of health (SDOH) affect health outcomes in the United States, how might SDOH factors be incorporated into financing and risk adjustment of Medicaid, and what implications might this have for market participants?

Description: Come learn from a panel of LTC industry professionals as they discuss setting goals for LTC wellness, measuring success of the programs, and integrating them with other LTC process (e.g. assumption setting) in an effort to create sustainable programs.

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: Amid the growing adoption of AI/ML models for underwriting and pricing, Life and Annuity carriers are facing increasing regulation in North America on Model Risk Management (MRM) and the use of AI. Colorado has set a precedent in the US by requiring reporting in June 2024, with other states looking to follow suit. To ensure compliance, Chief Risk Officers and Heads of MRM, working with their business partners, will need to evolve their MRM and AI risk frameworks, enhance model validation capabilities, and strengthen governance. This session will present: - Key trends and challenges faced by carriers amid increasing model landscape complexity and regulatory expectations - Regulatory outlook and implications for carriers' MRM and AI risk programs - An approach to enhance MRM and AI risk frameworks, including specific model validation program updates to address the unique risks of AI/ML models - Opportunities to enhance both MRM validation effectiveness and efficiency through the adoption of more risk-based approaches, smart sourcing, and automation - Case studies of how leading carriers are evolving their MRM and AI risk programs Upon attending the session, the attendees will develop a good understanding of increasing regulatory expectations, the required MRM and AI risk framework enhancements, and approaches to design and execute an effective MRM validation program in a cost-efficient manner.

Description: The upcoming VM-22 standard promises significant changes for the non-VA life insurance industry, impacting regulatory compliance, risk management, and financial reporting. This presentation equips insurance companies to navigate this crucial transition. We'll delve into key considerations from capital, modeling, and hedging perspectives, providing actionable insights for optimizing your VM-22 implementation strategy.

Description: At the end of this session attendees will understand how their company's existing cash flow models can be leveraged to meet the new requirements for principle-based reserves under VM-22.