Enterprise risk management for health entities discussion forum
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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

Enterprise Risk Managementfor Health EntitiesDiscussion Forum


Definitions and framework
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?


Unique health entity characteristics
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???


Practice assessment of processes
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?


Practice assessment of planning
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?


Practice employer viewpoint
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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