Description: Keynote Speaker: J.D. Kleinke, Author and Medical Economist J.D. Kleinke has been instrumental in the creation of four health care information organizations; has served on the Boards of several health care companies; and spent many years advising both sides of the political aisle on non-partisan, practical approaches to health policy and legislation.

Description: This article focuses on the recent surge of digital medicine data being seen in the healthcare industry. While an increase in data can generally be perceived as good, it is important to remember that current privacy practices need to be maintained, if not strengthened, to continually protect healthcare members. The COVID-19 pandemic helped fuel digital medicine data, but it also created new avenues for privacy to potentially be compromised (i.e. healthcare employees using personal devices while working from home). Digital medicine data is a very powerful asset, but it is also a massive responsibility. If mishandled, this data can cause more harm than good.

Description: Healthcare risk adjustment methodologies have become increasingly complex, largely due to the belief that complexity enhances accuracy. However, a disconnect exists between how healthcare risk is assessed and how payments are adjusted. This article explores the stark difference between measuring the accuracy of a risk assessment model at a member level, and that of a risk adjustment mechanism at the health plan level. I show that a highly simplified approach that does not use diagnosis codes can have similar accuracy on risk adjusted payments to models that do. These findings suggest that accuracy is not a barrier to developing simpler risk adjustment methodologies, which can improve payment accuracy and reduce the financial incentive for coding diagnoses.

Description: This article is an update on the No Surprises Act, which is a U.S. Act aimed to reduce the risk that a person unexpectedly receives out of network charges for their health care visits. This is Part 2; Part 1 was featured in Health Watch's Sept 2024 issue.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

Description: Is your development team or IT staff growing tired of last-minute requests to include additional functionality? Have you strained to explain challenging actuarial topics to non-actuarial staff for implementation? Do your teams find themselves revisiting deadlines & timelines when building solutions? During this interactive panel discussion, three technologists (two software engineering managers and one data scientist) along with three actuaries will discuss real world problems and approaches using experience from previous projects. Although the challenge of running efficient software teams is not unique to actuarial science, this webcast will discuss best practices on how to organize teams to reduce friction and context switching. Presenters will also explore unique actuarial challenges and concepts including how to address standards on data quality when building software, how to build intuitive software that meets actuarial standards and how test-driven development makes it easier to meet actuarial standards of practice.

Description: Planning for retirement is at the top of many minds. How do I save? When is the right time? What are my plans? But what are the impacts of your health on retirement? Learn more about the effects of a healthy lifestyle on retirement in order to maximize life span. Review more in-depth findings from a recent report sponsored by the SOA Research Institute’s Aging and Retirement Strategic Research Program and conducted by the Vitality Group, as well as other expert insights.

Description: Estimating premium deficiency reserves (PDR) for medical insurance and other short-duration health products is an area that not only requires application of actuarial judgment, but also alignment between actuaries, accountants, and regulators. Significant diversity of practice exists across the industry on a number of key issues, among them: how to group products for PDR measurement purposes; which future premium & claim cash flows to include (time horizon); forecasting future membership change; which administrative expenses to include; and how to think about investment income. In many cases, practices that are common in the actuarial community may be met with skepticism by auditors and/or regulators, and vice versa. This session will showcase the existing diversity of practice observed in both U.S. GAAP and U.S. Statutory PDR estimation, articulating multiple points of view on the issues noted above with a focus on finding common ground between actuaries and accountants.

Description: This webcast will walk through several statistical methods for imputing race and ethnicity from U.S. datasets, highlighting their strengths and weaknesses, talking about how to use them and evaluating their accuracy, and telling you where you can get code packages as well as a free dataset to try the methods out.

Description: Actuarial Standards of Practice (ASOPs) are critical to an actuary's work, but staying abreast of changes to ASOPs could be challenging. Several ASOPs have been created or updated in the last few years while ValAct was on hiatus. Are you up to date? This session will focus on ASOPs 7, 11, 28, 41 and 57. Come ready to play, as we challenge your knowledge of these ASOPs in a fun game show format. By the end of this session, attendees will learn the major provisions included in ASOPs that have been recently updated or created and understand how their work may be impacted by these recent changes.