Description: Explore the value and cost of prescription drugs, how they should be defined and measured and the effects various stakeholders in the pharmacy ecosystem can have on these factors in the latest webcast. You'll investigate the impact of coverage, formulary and rebate negotiations and related benefit design. Find out how actuaries can answer questions related to the prescription drug industry, in addition to improving the access, quality and affordability of prescription drugs in the United States. Join us for this webcast and come learn about value-based contract design, negotiations, implementation and administration for prescription drugs.

Description: Heatmaps are an effective tool for visualizing changes in cancer incidences over time in large datasets. They can show the impact of screening measures, particularly when targeting specific age groups, and reveal characteristics of individual cohorts.

Description: The Supplemental Health, DI & LTC Conference provides a unique opportunity to consider a cross-functional view of supplemental health products, individual disability insurance, and long-term care standalone and combination products.

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: 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: LIMRA, Reinsurance Group of America (RGA), the Society of Actuaries (SOA) Research Institute, and TAI have collaborated on an ongoing effort to analyze the impact of COVID-19 on the individual life insurance industry’s mortality experience and share the emerging results with the insurance industry and the public. This report documents a high-level analysis of the claims that have been reported.

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: 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 discusses the causes of the 1918 influenza pandemic, the reasons it occurred and the likelihood that it could happen again. In addition, the author discussed ways, in general, to model and manage risks that occur infrequently, yet have a significant impact.