Description: The Health Care Cost Trends Strategic Research Committee is looking for research proposals to study the impact of Artificial Intelligence on any of the following elements of healthcare • Evaluate the impact on predictability of financial results • Evaluate the impact on the efficiency of care management techniques applied to members • Compare results to traditional risk adjustment and traditional methodologies of predictive analytics • Determine an overall financial impact of applying AI to identify these high cost claimants.

Description: Take your professional development to the next level, all in one place. Join SOA Board President Dave Dillon and fellow leaders for an inside look at Professional Development Edge+ (PD Edge+), the Society of Actuaries’ comprehensive subscription for continuing education, created by actuaries, for actuaries. Now, in its second year, PD Edge+ is trusted by 88 corporate subscribers to meet their continuing education needs. This webcast is designed for both current subscribers and those exploring what PD Edge+ has to offer. During the session, you’ll see how PD Edge+ simplifies earning CE credits and staying current on industry trends. Don’t miss this opportunity to discover how PD Edge+ can make your learning more engaging, convenient, and impactful.

Description: The Actuarial Research Clearing House (ARCH) is an informal communication providing current actuarial research to friends and members of the actuarial community. View the second issue for 2024.

Description: One of the Health Section's key focuses in 2019 is Initiative 18/11. Last year the SOA joined forces with the Kaiser Family Foundation (KFF) and the Healthcare Financial Management Association (HFMA) to answer the nagging question: “What can we do about the cost of healthcare?” A steering group has been formed to lead a research project as to what managed care companies can do to reduce costs without sacrificing quality. The project [called Managed Care 3.0 in the 18/11 paper] will examine historical models that have worked as well as investigate the impact that new technologies and care models may have on cost and quality, with the goal of better understanding the current environment and identify­ing potential risks and opportunities.

Description: This is the second half of a two-part session regarding FASB Targeted Improvement (LDTI) to U.S. GAAP for long durational insurance contracts. Presenters of the session will discuss operational (e.g., data, systems, models and process, etc.) and financial issues concerning the implementation of the accounting changes. We will also discuss interpretation of the new standards specific to accident and health insurance. Throughout the session, we would like to encourage the audience to share their experiences.

Description: Many new and innovative companies are leveraging technology to improve the effectiveness of the care provided to patients. They are employing better tools to identify patients who can benefit from specific programs that best meet the patient's need. They are also dramatically increasing the use of these programs by guiding plan members through the maze of offerings to match them with the programs that will be most beneficial to them. Employers are making these third party programs available to their members and Medicare Plans are using these new tools to identify emerging health risks for early intervention and more accurate risk scoring. This session will explore some examples of these programs, how they are being effectively integrated into the operations of health plans and how the results of these programs are being measured.The speakers will be:Raj Behal, MD, MPH,Chief Quality Officer, One Medical. Raj leads the quality and safety, value and innovation, and data science teams at One Medical. One Medical is changing the way primary care is delivered with a concierge approach with technology seamlessly woven into their offering. This includes booking appointments on line, virtual face to face care, accessible medical records and health reminders.Mylea Charval,Ph.D., CEO and Founder, Savonix. Savonix is a next generation cognitive assessment platform that brings clinical, evidence-based, and all mobile digital assessment of cognitive and emotional function. These capabilities are critical for early identification of the onset of dementia and for the proper risk assessment of seniors enrolled in Medicare Advantage Plans.Ed Cymerys, FSA, Advisor. Ed will serve as moderator. Over the last six years Ed has served as an advisor to a number of early stage technology companies looking to improve the way health benefits are being delivered.Dave Sotelo, FSA, MAAA, Actuarial Manager, Collective Health, Inc. Collective Health is an integrated solution that allows self-funded employers to administer their health plans, control costs, and take care of their people -- all in one place. They have effectively integrated more than 70 distinct third party solutions for self-funded employers and are rigorously assessing the impact of these programs

Description: This report illustrates employer group commercial health care costs and trends from 2013 – 2017.

Description: The SOA is pleased to make available a research report providing insight and considerations for the actuarial profession in assessing the potential risk and opportunities of MACRA to both provider and payer organizations.

Description: Development of annuities markets is a critical element of any private system. In Mexico, when the new pension regimen came into existence in 1997, the Mexican Institute of Social Security [IMSS] was supposed to buy a single premium annuity for all the people who become eligible under the new regime. Disability pensions represent 37% of total pensions sold up to date. Mortality of disables show substantial differences against the mortality table use to compute the annuity. Most of the differences can be explained by looking at the disability causes. Using information for social security for 2001 and 2002, regarding mortality and disability, this is the abstract of a paper that presents the main causes of disability among disables and the main causes of mortality of those disables who died in their first and second year of disability. The analysis of those cases apart from explaining the important differences between the expected mortality and the observed mortality during the first two years of disability, also explains some of the latter changes in the operational rules of IMSS.

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?