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: 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: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.

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: 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: 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: This webcast will focus on recently published health research which examines the impacts of social determinants of health on oral health outcomes as well as on chronic kidney disease progression. Participants will gain insights on how different aspects of social determinants of health can impact how healthcare is delivered as well as the impact on health care costs.

Description: Investigate the importance of collaboration with accounting, underwriting, sales, marketing and other professions as an actuary when you attend this webcast. Cross-functional positions can cause unique challenges to arise, like various experts attempting to balance growth and profitability. Discover an opportunity to learn about relevant ASOPs and dive deeper into contemporary examples that highlight specific professionalism issues that can develop.