Description: As health insurance self-funding becomes more popular among smaller group sizes, risk is evolving for the MGUs, stop loss writers, and reinsurers that cover them. Assessing more small groups at lower attachment points means rethinking traditional stop loss underwriting techniques.

Description: In this presentation, actuaries and data scientists from Cleveland Clinic and Milliman discuss the development of a sepsis prediction model using machine learning. Presented with a unique challenge of handling massive amounts of data for near real-time risk scoring, the team took their model development to the cloud and delivered a product in less than a week through a unique virtual engagement.

Description: "Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations."

Description: This report provides actuaries and other professionals working with risk, data and analytics or program evaluation in the health care space with considerations and frameworks related to the use of determinants of health (DOH) in data and actuarial work streams. Such frameworks can leverage new data sources to enrich health care data analysis to move beyond traditional data elements, such as age, gender, zip code or health diagnosis.

Description: Much of the work performed by disability insurance actuaries depends on the availability of accurate and detailed data, which is not always as simple as it sounds. Explore a variety of data challenges faced by disability actuaries, along with potential solutions. Potential topics include finding relevant data, the impact of poor data on valuation work, the impact of new privacy rules, and the potential bias in the data used to develop predictive models.