Description: From a session at the Health/Pension Spring Meeting held in New Orleans, Louisiana June 15-17, 2005 Panelists discussed some of the research behind understanding decision-making and how this type of research can be used to enhance the modeling of consumer choice. Discussion of the field of behavioral economics and its potential application in improving assumptions for modeling health care purchasing.

Description: This session is targeted for new ASAs/FSAs or actuaries who are new to reserving. The session will be delivered in two parts. The first part is intended to deliver a basic understanding of IBNR reserving and different reserving methods and assumptions. We will go through examples of constructing claims triangles and developing completion factors, while exploring concepts such as seasonality, trend and outlier claims. During the second part of the session, we will apply the material from the first part to look at various example from different products such as inpatient, outpatient, RX, Medicare Supplement, dental, critical illness, etc.

Description: On December 21, 2018, the Centers of Medicare & Medicaid Services (CMS) released the final rule for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. 'Pathways to Success' makes sweeping changes and will push ACOs to assume financial risk more quickly. This session will discuss the key changes in the final rule, reasons why providers would remain in the program while being forced to downside risk, and how actuaries can add value to providers who will be taking on millions of dollars of risk in the coming years.

Description: This is a presentation From 38th Annual Actuarial Research Conference 8/9/2003, University of Michigan, Ann Arbor, Michigan. Pricing health insurance presents numerous statistical problems. This paper develops a non-parametric method for handling these problems. This method involves kernel density estimation of the charge level distribution and also kernel smoothing between the reimbursement function derivatives. It derives some properties of the estimates so obtained. It illustrates the method with some dental data and compares the results to some other simpler estimation techniques.

Description: Health care is a complex market with a wide variety of stakeholders. These stakeholders have diverse business needs, requiring complicated data-driven decisions. The analytics and research supporting these decisions are often dependent on the availability of real-world data (RWD), which includes a wide variety of data capture technology and data reflecting treatment, clinical outcomes, and costs of health care in real treatment settings (e.g.,, outside of controlled clinical trials). The goal of this panel discussion is to explore how existing and emerging sources of RWD can enhance benefit design, improve risk assessment, influence treatment decisions, and advance the measurement of clinical, humanistic, and financial outcomes. The diverse speaker panel includes actuarial and non-actuarial perspectives, representing the pharmaceutical industry, a health-care services business, and academia. The panel will describe the decision-making that drives their individual needs to use RWD, identify current and developing RWD sources, provide examples of analyses using RWD, and discuss how emerging RWD may influence actuarial analytics and potentiate the development of new interdisciplinary methods and value drivers.

Description: There has been a proliferation of proposals to expand access to public health insurance plans, either to strengthen insurance markets under the Affordable Care Act (ACA) or to replace the ACA marketplaces or other health insurance programs altogether. These proposals range from creating a public plan that would operate alongside private plans in the ACA marketplaces, to allowing individuals to buy into Medicare or Medicaid, to expanding Medicare to all. The terms used to describe these various options are often used interchangeably but they would be structured differently and have different impacts depending on the implementation details. Panelists at this session will discuss the general approaches for expanding access to public plans and their potential implications.

Description: Numerous behavioral finance theories have emerged in recent years, many of which apply to insurance. The presenters look at key theories and their use in explaining, predicting and inducing behavior from the perspective of the health insurance customer journey.

Description: Insurance commissioners and/or deputy commissioners will discuss a variety of current topics including health care reform, risks in the major medical markets, voluntary products and other topics. At the conclusion of the session, attendees will be able to identify issues that are on the mind of the regulatory agencies and the different approaches used across the country.

Description: Enterprise Risk Management is often thought to be synonymous with managing an insurance company toward financial objectives with a focus on insurance-specific risks. Some might argue though that operational risks are the crux of all risks confronted by an insurance company and ultimately drive the company’s outcomes.Operational risk is the risk of impact on financial outcomes due to operational events, involving internal systems, personnel, procedures or controls, and also external events. Operational risk exists in all business activities, covering fraud, human error, accounting errors, legal actions and system failures. All of these activities could occur during the course of conducting day-to-day business operations. Additionally, insurance executives must consider the pace of change in the external environment and potential impacts on their business. This presentation is focused on operational risks, current and emerging, faced by health insurance companies.