Description: Reference Based Pricing (RBP) efforts have increased in popularity as tools to reduce the cost of care. Now with the ability to use CMS health plan transparency information, organizations can estimate the impact of savings from the use of RBP. This session will share the results of an analysis of this in the form of a case study.

Description: Gather with members and non-members in the China actuarial community to discuss recent topics and related issues in areas such as macroeconomic sharing, pension, investment, product strategy, and more.

Description: En el seminario hablaremos sobre los nuevos flujos de tarificación, y nos enfocaremos en la inclusión del análisis geográfico en el proceso de modelado para optimizar la extracción del riesgo en modelos de Machine Learning.

Description: Health claims are not normally distributed. Claims Forecasting can be improved by understanding the entire distribution of plausible values of future claims, for example knowing there is an 80% chance future claims are between $340 and $375 PMPM. Confidence intervals around our estimates allow us to understand for each range around the best estimate (for example +/- 1%) what is the probability that future claims will fall in that range. Quantile Regression is a mathematical technique where you can estimate any percentile of the claims distribution you are looking for as a function of demographics, diagnosis indicators, prior cost variables, or other significant predictors. You can see which coefficients are important at different parts of the distribution. Individual and group distributions can be constructed. There are numerous applications in pricing and underwriting, stop loss, provider profiling, ACO target setting, allocation of group risk charges based on volatility, discounting strategy, and experience analysis.

Description: This report explores AI bias in insurance and health data, highlighting the ethical role of actuaries and offering cross-disciplinary guidance for fairer decision-making systems.

Description: Read the Society of Actuaries' latest update about how health care executives view the future of predictive analytics in the health care industry.

Description: This report covers the latest emerging trends in U.S. population mortality. The SOA relied upon data furnished by the Centers for Disease Control and Prevention (CDC). Observations are based on the CDC’s recent release of 2021 mortality experience, along with prior mortality experience data from 1999 through 2020.

Description: Get up to date on the current and potential use of artificial intelligence (AI) in the health care space. In this interactive session, you will learn how AI is being used today and discover its potential to reshape and revolutionize health care. Take advantage of the opportunity to find out how AI can influence patient experience in every phase of health care delivery, and join the conversation about the challenges and limitations that arise with the use of this technology.

Description: Virtual - Session 4A: Data Science-Driven MA Product Design Strategies

Description: "Risk adjustment is an important aspect of establishing appropriate capitation rates. When a set of services is carved out for specific management under a sub-capitation, establishing appropriate adjustments for varying levels of underlying risk is more complicated. Dive into analytical and operational challenges and resolutions as presenters share more about developing a risk adjustment model specific to the carve-out of behavioral health services through a real-life case study. You will further explore a definition of the use case, availability of historical data sets, selection of the modeling approach, learnings from the iterative modeling process, and the potential application of the results. After attending this session, you will be able to: Understand why a behavioral health specific-risk adjustment model has business value Understand the unique challenges related to developing risk adjustment on member and cost subsegments Understand the impact of trade-offs between model complexity and interpretability in the context of implementation Increase awareness of data nuances and requirements unique to this type of project Describe analytic techniques that can be investigated for use in projects of similar business objectives"