Description: The article explores how integrating AI into insurer apps can address critical challenges in healthcare, such as patient no-shows, medication adherence, and cost management. These non-disruptive approaches aim to increase the effectiveness of patient interventions and improve medication adherence.

Description: This is an Excel workbook that can be used as a tool for health insurance companies to model their potential risk exposure from an influenza pandemic. It is based on a model developed for a Society of Actuaries study examining the potential implications of a pandemic on the U.S. health insurance industry. The spreadsheet is saved with many of the same assumptions used in this research and reproduces the results of the exhibits contained in the June 2010 report, 'Potential Impact of Pandemic Influenza on the U.S. Health Insurance Industry.'

Description: ReMark's Global Consumer Study delivers 10 key insights to empower customers. Insurers can design products that meet customers' needs and enhance client experiences and add significant value to their business. At the same time with new products being launched seemingly continuously, it is important to take a step back and assess risk throughout the product management cycle.

Description: Challenges of Provider Reimbursement

Description: "The script is for a Medicare session by the Society of Actuaries, led by Danica Turner, which introduces how revenue works on Part D. It covers the various cash flows and subsidies that Part D plans receive, including direct subsidies, federal reinsurance, and low-income subsidies. The session also explains the different phases of coverage and the upcoming changes due to the Inflation Reduction Act in 2025. The goal is to provide a high-level understanding of the revenue and payment calculations for Part D plans.

Description: This report outlines a framework for interpretable machine learning algorithms for detecting fraud in health insurance. It discusses the challenges of using black-box machine learning models in the insurance industry and proposes various interpretable methods to enhance transparency and understanding.

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.

Description: On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 stars on average. This 0.70 disparity in quality ratings creates significant hardship on new contracts when this lower star rating decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage Star Ratings between contracts receiving their first star ratings (“New” contracts) and existing contracts, including: 1. Understanding what happens to Medicare Advantage Payments when contracts receive lower star ratings? – What is the Star Rating cliff and why does it matter to new contracts? 2. Explaining when a contract receives their first star rating and how much enrollment this requires – When does the Star Rating cliff occur? 3. Noting which specific star measures “New” contracts struggle with, including those contracts under large parent organizations, contracts with rapid growth, and all other new contracts. – How can my contract avoid the Star Rating cliff?

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.