Description: A priori, one would expect In Home Assessments (IHA) and Telehealth (TH) Encounters to identify some conditions that lead to actions that keep a member or two out of the Emergency Room. Similarly, one would expect Care Management and Disease Management engagement to ultimately influence some improvement in documentation that leads to more accurate Risk Adjustment. The business cases for these activities are often siloed to only the primary activity. The relationship between risk adjustment and care management is often more recognized as competing interests - one generally relying on utilization and the other trying to reduce it. Business cases can change dramatically when profiling has a more complete picture. This session will explore some techniques and share some observations - positive and negative - of the interactions between CoC and Risk Adjustment.

Description: The Smaller Insurance Company/Chief Actuary Forum presents a unique format for focusing on issues faced by actuaries in leadership positions or actuaries supporting the Chief Actuary. By discussing critical issues with your peers, you will leave with ideas to incorporate in your business environment. The Forum will feature presentations to introduce several of the discussion topics, followed by an opportunity to break into smaller discussion groups and rotate among topics.

Description: Dive into this review on Artificial Intelligence and Machine Learning (AIML) techniques for actuarial modeling for life & annuities. Presenters will showcase learnings from the recent SOA research paper "Predictive Analytics and Machine Learning – Practical Applications for Actuarial Modeling" (Nested Stochastic). The researchers will go over models and methodologies used to develop high-fidelity proxy models for various life & annuity applications.

Description: Watch as presenters highlight the SOA's work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and state principals to determine appropriate underwriting margin components within Medicaid managed care rates. In addition, explore a brief description of the motivation for an underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in states where they operate.

Description: Can you answer the question, 'What are the chances we will lose more than $1 million?' without saying, 'It depends'? If you miss a projection, can you estimate the chances that the miss was due to random variation versus an incorrect projection? Listen in as presenters demonstrate how to answer these questions and others using total risk analysis. Total risk analysis includes quantifying both the random variation risk and the projection risk associated with actuarial functions like pricing and reserving. After attending this session, you will be able to describe total risk analysis and to apply to many health actuarial functions.

Description: This session will discuss two important dimensions of why a holistic approach is recommended over a piecemeal, nonintegrated approach for an IFRS 17 modeling solution. Attendees will receive three perspectives from actuaries working as actuarial consultants or within an insurance company or as a software developer. The first dimension is model design. The session will demonstrate holistic model design advantages with regards to model inputs, model outputs, liability portfolio management, modeling efficiency, and transparency. The second dimension represents organizational impacts resulting from the model design.

Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: Building new models or migrating from one system to another is hard! During this session, you will hear from your colleagues who have gone through such projects. You will gain a better sense of what to expect, what to avoid, and what to prioritize for such projects. The discussion will be system agnostic. Learn about pitfalls and how to avoid them!

Description: Risk adjustment is widely used by public and private payers in value-based contracting and other risk-sharing arrangements aimed at addressing population health. Addressing social determinants of health (SDOH) and improving equitable outcomes is one of the aims of population health. Could SDOH be incorporated into risk adjustment? If so, how and how effectively? What implications might this have for market participants? In this session, Joan Barret, FSA, MAAA, from Axene Health Partners will begin by presenting background and findings from the 2022 SOA research report 'How Does Where you Live Impact Your Health?.' This is a question addressed through deep literature review and quantitative analysis, followed by an exploration of strategic approaches and barriers for payers and providers that wish to address SDOH inequities. Then, Rong Yi, FSA, MAAA, and Jeff Milton-Hall, FSA, MAAA, from Milliman will present their new SOA-sponsored analysis regarding integration of SDOH factors into Medicaid managed care risk adjustment. They will cover risk adjustment design considerations, policy and operational considerations for actuaries and states that wish to integrate SDOH into risk adjustment, simulated variation in financial outcomes for risk-bearing organizations when such integration occurs, and variation in the relationship of SDOH factors and morbidity to modeled risk across programs and populations. At the conclusion of the session, attendees will leave equipped to think critically and act effectively with respect to SDOH in their own work, from measurement and analysis design to actuarial interventions.

Description: This session will showcase how from an actuarial perspective IFRS17 has its roots in market consistent valuations. It will also show how International Financial Reporting Standard (IFRS) 17 is rooted in probability-weighted stochastic scenarios-same as fair valuation, and how initial recognition sets the stage, as in the pricing basis and report, for actual experience to emerge as in the subsequent recognition. A detailed model will be given for a simple annual premium non-par endowment and actual numbers given and explained. The stochastic model will explain in detail the key reserve items in IFRS 17 including: - Liability for remaining coverage (LRC) - Risk Adjustment (RA) - Contractual Service Margin (CSM) And it will explain their interactions with one another. A discussion will be held regarding universal life policies with simple interest guarantees. And how these guarantees merit a valuation similar to Lookback options because of their path-dependent nature.