Session: Revenue Optimization through Risk Adjustment
Speakers: Monisha Machado-Pereira and Jim Oatman, FSA, MAAA

Risk adjustment profoundly changes the economics of the Small group, Individual, and Medicare Advantage businesses. Our proprietary modeling has shown that this is not just a flattening of the margin curve by risk, age, and gender but a fundamental inversion of the drivers of profitability. Furthermore we have seen that granular and predictive analytics have the power to identify meaningful pockets of opportunity and to inform pragmatic actions that can optimize a payer’s book of business. We have seen a number of plans incorporate such insights into product and pricing decisions in the first quarter and into retention, acquisition and distribution tactics as they prepare for open enrollment. We have also seen considerable efforts to learn from MA experience. This session will provide insights on how risk adjustment will drive margin and lessons from actions to date.

Monisha Machado-Pereira is a Partner in the Healthcare Systems and Services (HSS) practice of McKinsey & Company. Since joining the Firm, Monisha has focused on serving clients in the healthcare space – large health plans, hospital systems, retail pharmacies, pharmaceutical, and medical products companies. Monisha leads the Medicare and Risk Adjustment Service Lines for the Firm. Her topics of expertise include: Product and network design for health plans, local market planning to guide health plan growth strategies, Medicare Stars diagnostic approach and predictive modelling, risk adjustment performance improvement, and collaboration strategies to drive value for the Retail consumer.

Jim Oatman is a Solution Partner and Leader of the McKinsey Actuarial team, which is a dedicated team of actuaries that help payers identify pragmatic actions to drive profitable growth. Jim has over 20 years of executive and actuarial leadership in individual health insurance. He was General Manager of the individual business unit at Anthem and the former Chief Actuary at Assurant. He is a Fellow of the Society of Actuaries (FSA). He has served as Chairperson of Individual Committee at the Americas Health Insurance Plans, and has served as the Co-Chairman Individual Medical Rate Filing Task Force of the American Academy of Actuaries.

Sessions: Medicare Advantage—an Overview and Personal Perspective
Speaker: Kristina B. Norton, ASA, MAAA

PLEASE FIND PRESENTATION HERE: MedicareOverviewandPuertoRico_Norton_20160323

Since the Social Security Act was amended in 1965 to establish Medicare, Medicare has been the primary funding vehicle and benefit program providing health care coverage for Americans over age 65. This session provides an overview of the program’s history as well as the general terms of a health plan’s participation in today’s Medicare Advantage program. The latter half of the session will focus on the presenter’s unique experience of working in Medicare Advantage in a US territory since 2006, soon after Medicare Part D was established.

Kristina B. Norton has over twenty years of actuarial experience. In the early years of her career she served single employer and multi-employer retirement plan clients as part of a team within distinguished consulting firms. More recently she has concentrated on supporting the Medicare Advantage business for her health plan employers. She has served as the Chief Actuary and Appointed Actuary for 2014 for a Blue Cross Blue Shield Medicare Advantage organization. She currently leads a team of actuaries in support of the Medicare Advantage business for a Blue Cross Blue Shield insurer in the Chicago area.

Session: Were the New ACA Enrollees Different?
Speaker: Rebecca Owen, FSA, MAAA

This session will be an examination of pharmaceutical utilization in one state’s exchange population.
It will summarize findings from an analysis of pharmaceutical utilization patterns in an ACA population and compare it to other recently published reports on comparative use and health status of the ACA expansion populations.

Rebecca Owen is the Health Research Actuary at the Society of Actuaries, specializing in health topics. She is involved in coordinating research as well as working on research projects sponsored by the society. She has been on the staff for one and a half years. Prior to coming to the Society, she worked in industry with a focus on actuarial analytics for both medical and pharmaceutical products. She has worked with commercial, individual, Medicare and Medicaid populations, but is particularly interested in the structure, payment methods and population management of optimal delivery systems for Medicaid members.

Session: The Actuary’s Role in Payment Reform
Speaker: Juliet Spector, FSA, MAAA

With the goal of more affordable medical spending, there has been continued attention to increasing the value of healthcare through arrangements in which healthcare providers and payers work together through sharing financial risk (i.e., payment reform) to better align incentives to provide quality care at more affordable prices. Although the idea of integrated delivery systems and providers taking on risk is not new, there has been a renewed focus on these value-based arrangements. It is important for stakeholders to understand the elements of these arrangements as well as some of the practical issues and impediments that have determined their past success or failure. The actuary, an expert on risk, can help the provider understand the various risks the provider is taking when selecting a payment model.

Juliet Spector is an actuary in the Chicago-Milwaukee Health Practice at Milliman. She lends actuarial expertise to enable providers to understand a patient-centered quality care delivery system. She develops customized actuarial cost models to allow her provider clients to maximize revenue when implementing changes to reimbursement strategies or capitation rates. She develops customized utilization and cost benchmarks to enable a focus on quality of care and best practices. She has experience analyzing and pricing bundled payments and doing longitudinal analysis of specific disease states.

Session: PBR Implementation
Speakers: Tim Cardinal, FSA, MAAA, CERA and He Jiang

The Valuation Manual operative date is on track for 1/1/2017 for statutory reporting requirements. This session will present

-What’s new on Valuation Manual issues;
-Implications of implementing VM-20 including advice from the PBA Implementation Guide and Sequel; and
-Selected lesson excerpts from the online PBA Training Course

The session then opens the floor to questions and a discussion of issues important to you.

Tim Cardinal is a Principal at Actuarial Compass providing actuarial and reinsurance consulting services as well as educational and training services. Actuarial Compass published two SOA-commissioned white papers – Life Reinsurance Treaty Construction and the PBA Implementation Guide. Tim was a 2014 SOA Volunteer of the Year recipient. He is a Council member of the SmallCo and Modeling Sections, co-editor of the Modeling Platform, Project Oversight Group Chair of the LIMRA and SOA VAGLB Utilization Study, and is past chair of the advanced Corporate Finance and ERM Exam and a current curriculum committee member.

He Jiang is a master student majoring in actuarial science at the University of Illinois at Urbana-Champaign. Prior to beginning the graduate program, she received her Bachelor’s degree in statistics from Nanjing Normal University, China and worked as a data analyst for People’s Insurance Company of China. Her undergraduate thesis focused on risk measurement and management in securities market. Her current work focuses on occupation time in a renewal risk model. She is also assisting in part of the VM-20 research under the supervision of Tim Cardinal.

Session: International Actuarial Association’s Risk Book
Speaker: Tom Herget, FSA, MAAA, CERA

This book has been prepared by a team of international actuaries to assist the IAIS in its determination of the best techniques to assess capital adequacy in its quest to develop International Capital Standards.
The attendee will learn the contents of the book and how it might evolve to become a reliable source for education.

PLEASE FIND THE PRESENTATION HERE: Risk Book CAA March2016 Workshops

Tom Herget is a retired life company actuary currently doing volunteer work for the SOA, AAA and IAA in the financial reporting area of practice.

Session: PBR: What It Means for Smaller Companies
Speakers: Alexandre Lemieux, FSA, MAAA

This presentation will focus on the new PBR guidance and how small companies can manage the change (or avoid the change all together).

PLEASE FIND PRESENTATION HERE: Small Company PBR

Alexandre Lemieux has over 10 years of insurance industry experience with particular emphasis on financial reporting, risk management, capital, and hedging strategies. He joined PwC from Great-West Financial, where he led the FP&A, capital, and financial risk functions. Prior to that Alex was valuation and modelling actuary for John Hancock’s annuity function.

Session: NAIC/LATF and PBR Update
Speakers: Marianne Clifford, FSA, MAAA, CERA, and Bill Kelley

VIEW PRESENTATION HERE: CAA NAIC_LATF_PBR

This presentation will review highlights from the most recent NAIC meeting in November, 2015 as well as regulatory updates from recent LATF conference calls. Additionally, an overview of the most current Principles Based Reserves methodology will be presented.

Marianne Clifford is Manager, Actuarial Services, with PolySystems in the production area providing client support. Prior to joining PolySystems, she worked at two stock life companies and a consulting firm. She graduated from the University of Texas at Austin with a BS degree in Mathematics and began working in the insurance industry in 1995.

Bill Kelley is an Actuarial Analyst at PolySystems working closely with VM-20 compliance. Prior to joining PolySystems, Bill was a high school physics teacher. He graduated from Illinois State University with a BS degree in Physics and a Minor in Mathematics.

Session: Predictive Analytics in Life Insurance
Speakers: Allen Klein, FSA, MAAA, and Zubair Shams

Predictive analytics has been used by P&C actuaries for some time. It is just now beginning to be used by life actuaries. This session will start with a brief definition of Big Data and predictive analytics and a description of the predictive analytics process. This will be followed by presentations on two case studies using predictive analytics – one on distribution and sales behavior and the other on underwriting. By the end of the session, attendees will see how predictive analytics can be used and applied to some of the issues faced in their work environment today and in the future.

Allen Klein is a principal and consulting actuary with Milliman’s Buffalo Grove / Chicago office. He joined the firm in 2009. Al’s primary responsibilities include industry experience studies and helping clients with mortality, longevity, and underwriting related issues. This may involve product development, assumption setting, and mergers and acquisitions. Al’s expertise on mortality and underwriting includes traditional products, simplified issue, final expense, older age, and preferred. Al received a BS in Actuarial Science and Finance at the University of Illinois, Urbana. Prior to joining Milliman, Al worked for a large stock life insurance company where he was responsible for experience studies across all lines of business. He has also worked for other life insurance companies, a reinsurer and consultant, where he has been responsible for strategic planning, product development and traditional reinsurance. Al is a frequent speaker and currently involved with a number of industry activities, including: Society of Actuaries (SOA) representative and Co-Vice Chair for the Mortality Working Group (MWG) of the International Actuarial Association; MWG Chair of the following projects: Underwriting practices around the world, Future drivers of mortality, and Older age mortality; SOA Longevity Advisory Group; SOA Longevity Illustrator Development Team; Chair of the SOA Underwriting Issues and Innovation Seminar Planning Committee; SOA Life Insurance Mortality and Underwriting Survey Committee; Joint American Academy of Actuaries (AAA) /SOA Preferred Mortality Oversight Group; Joint AAA / SOA Underwriting Criteria Team; 2015 SOA Valuation Basic Table Development Team; SOA Longevity Illustrator Development Team; Longer Life Foundation Advisory Board

Zubair Shams is a director in KPMG’s Actuarial and Insurance Risk practice. For more than 15 years, Zubair has helped various organization implement end-to-end business solutions that are rooted in predictive modeling. He joined KPMG in 2015. Prior to joining the firm, he led the claims analytics initiative for a global insurance carrier and served as a project leader at another Big Four consulting firm.

Session: Tornadoes—How Social Media Tracks Them and the Ensuing Health Risk from Them
Speaker: Steven Siegel, ASA, MAAA and Rebecca Owen, FSA, MAAA

This session highlights information and analyses that were presented at the last two annual National Tornado Summits. The National Tornado Summits serve as an important, interdisciplinary forum for insurance professionals and regulators to improve emergency management. Part One of the session will focus on how the rise of social media has interacted with the goal of more rapid communication of the onset of a tornado. With the growing popularity of social media, the potential for better reporting may lead to a reduction of insurance and other costs. Part Two of the session will focus on health costs that occur as a direct result of the impact of a tornado. Using an applicable health care claim database, a profile of relevant health care costs and related analyses will be presented.

Steven Siegel is a Research Actuary at the Society of Actuaries. In his role at the Society, he manages research projects and related efforts for a number of actuarial practice areas. He is also the staff liaison for research committees responsible for funding and initiating research efforts sponsored by the Society of Actuaries. He has written numerous articles for actuarial and other industry publications. He has been on the staff of the Society of Actuaries for close to 15 years. Prior to coming to the Society of Actuaries, Steven was an Actuarial Director of Pricing and Product Development for health care products with CNA Insurance Companies.