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Enterprise Risk Management for Health Entities Discussion Forum

Enterprise Risk Management for Health Entities Discussion Forum. Definitions and Framework. How does ERM differ from “business management” in the sense we have previously used it ? How does ERM differ from “strategic planning” ? How does the role of the health actuary fit into ERM ?

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Enterprise Risk Management for Health Entities Discussion Forum

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  1. Enterprise Risk Managementfor Health EntitiesDiscussion Forum

  2. Definitions and Framework • How does ERM differ from “business management” in the sense we have previously used it ? • How does ERM differ from “strategic planning” ? • How does the role of the health actuary fit into ERM ? • Who are the other professionals in a firm that are part of an ERM process? • Can the ERM process be tailored to fit health insurance needs and functionality? • How many firms have a CRO or Risk Management Team? • What are the barriers to implementing an ERM process? • Do you feel qualified to be a CRO? Why or why not? • How does ERM “look” for a health care provider vs. a payor?

  3. Unique Health Entity Characteristics • Time Horizon • Unique Risk Factors • Trend Uncertainty • Provider Contracting and Access • Rate Increases / Morbidity / Lapsation • Risk Concentrations • Government Intervention • Enrollment Growth and Decline • Impact of Investments • ALM Impact – Matching Risk? • Liquidity Risk • Cash Flow Testing (NAIC filing – Section 7 & 8) • Unique Capital Expenditures • Systems - mandated or strategic • Network, Operational, and product development • Others???

  4. Practice – Assessment of Processes • Any use of Stochastic or Dynamic Modeling? • What is planning/forecast process ? • Is there a point of “diminishing returns” for modeling ? • Involvement of Actuaries in risk assessment? • Environmental • Financial • Operational • Pricing • Market or Reputational • Strategic • Others? • How do risks get identified or categorized? • What risks go unmodeled and why?

  5. Practice – Assessment of Planning • Categorize the Budget Process • How are Tactical and Strategic budgeting/planning linked? • What risks are included in the budget/planning process? • How is Capital Budget integrated into Budget and Planning? • How are Actual/Expected and Recast outcomes handled? • How are companies’ risk tolerance measured? • Profit outcomes? • New Ventures? • Quantification • How does provision for adverse deviation fit the into planning process? • What are surplus targets and how are they established?

  6. Practice – Employer Viewpoint • Has the modeling of behavioral characteristics been researched? • Data mining of information from various employer files related to health care, worker’s comp, short-term disability, etc. • How are employers managing their risk of increasing health care costs?

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