Description: The key tasks of credit risk capital project under CROSS II mainly focus onL(1 )Adjustment of measurement framework; (2) Calibration of risk factors, including both credit spread risk and credit default risk;3)Introduction of concentration risk measurement; (4) Higher requirement on look-through rule.

Description: CMS provides ACOs with monthly claims data for members, including their medical visits and ACO program eligibility. This data can be divided into Membership and Claims tables through the ETL process. However, when calculating PMPY at specific levels of detail using these tables, issues arise due to unrelated dimensions, leading to inaccurate and understated results. This article presents a solution to this problem by utilizing Tableau's data blending capabilities.

Description: The global doubling of information content has been estimated to occur at a rate of every 12 hours, and conceivably faster. This ‘infowhelm’ is a double-edged sword for insurers. While maximization of the global knowledge base can fuel innovation, it can occur only in the context of reasonable cost for a higher benefit. The insurance industry – underwriters and actuaries in particular – are challenged to constantly examine new innovations that promise to raise confidence and protective value for insurability, within legal limits. This report aims to be the first of several to alert the SOA of promising innovations for the profession.

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: Electronic health records (EHRs) are one of the fastest-growing digital health data categories, with over 90% of carriers using or evaluating EHRs for underwriting, according to a recent Munich Re survey. This session brings you up to speed on the current (and future) state of EHRs.

Description: In September 2017, the China Insurance Regulatory Commission (CIRC) issued the “C-ROSS Phase II project construction plan”, planned to be used across three years’ time, by perfecting the regulations, improving the operational mechanism and strengthening the regulatory cooperation.

Description: CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.

Description: This article delves into the transformative realm of Business Intelligence (BI) tools. We explore the fundamental functionality and structure of these tools, and through case studies illustrate how they offer valuable insights into carrier experience and underwriting dynamics. From real-time data visualization to in-depth data analysis, discover the essential features that empower businesses to make better informed decisions.