Critical Point

In Europe, flooding was the most prevalent—and most expensive—climate peril last year, making 2024 the “Year of the Flood.” On this episode of Critical Point, five authors of Milliman's annual Extreme Weather in Europe report assess the toll of flooding in their country and the response from insurers, governing bodies, and communities. They discuss what Italy is doing to protect the insurance industry, how construction in the UK and France may be contributing to flood risk, and why new regulations in Romania and the Benelux region may not do enough to keep pace with climate change. Don't miss the full Extreme Weather in Europe report, as well as the related paper, Flood risk modelling in Europe, both available at Milliman.com.  

AI has taken the world by storm—but not all insurance companies, or countries, are approaching the technology the same way. On this special episode of Critical Point, experts from Munich Re and Milliman who work across five continents come together for a global conversation exploring how insurers and regulators are approaching AI around the world. Plus, don't miss Part 1 and Part 2 of this series on AI and insurance. You can read the episode transcript on our website.

Cell and gene therapies have been grabbing news headlines, both for their potential to cure rare diseases and for their million-dollar price tags. Milliman pharmacists and healthcare experts explain why state Medicaid agencies are particularly affected and the strategies many are using for predicting uptake and covering these high costs. You can read the episode transcript on our website. 

Healthcare costs are a hot topic as we approach open enrollment and the presidential election. In this episode of Critical Point, host Deana Bell sits down with Dave Liner and Jason Clarkson, principals at Milliman and co-authors of the Milliman Medical Index (MMI), to discuss the key drivers of 2024's healthcare costs. They dive into the effects of government programs like Medicaid and the Inflation Reduction Act, the rising use of weight loss medications, and how these factors are shaping healthcare costs for Americans on employer-sponsored insurance. Learn how policy changes and market trends could impact your healthcare expenses and decisions in the coming year.You can read the episode transcript on our website.

Cyber risk, climate change, new pharmaceutical therapies—as companies look for ways to manage increasing costs and unforeseen exposures, captives are a popular mechanism to insure against the unexpected. Around since the 1950s, today there are more than 7,000 captive insurers worldwide, with many headquartered in Vermont, Bermuda, and the Cayman Islands. As these insurance vehicles grow in popularity, Milliman experts answer the top 10 questions everyone's asking about captives.You can read the episode transcript on our website.

Drugmakers are taking steps to make sure clinical trials include participants from a variety of backgrounds—and they are steadily making progress, as evidenced by new studies of multiple sclerosis and sickle cell disease. Milliman health researchers Ellyn Russo and Chris Page unpack a history of distrust in medical research, the implications of failing to attract diverse study participants, and how simple strategies like rideshare vouchers, childcare, and check-in apps can help expand a study's reach, so more patients have access to the latest treatments and medical research moves forward.You can read the episode transcript on our website.

Life insurers have historically invested their portfolios in the relative safety of mortgages and bonds, but economic volatility, sticky inflation, and other headwinds have spurred many insurance companies to diversify into alternatives, a trend explored in a recent Milliman paper. On this episode of Critical Point, three of the paper's authors discuss two alternative asset classes that are particularly attractive to insurers in today's market: private equity and real estate. They talk about unexpected assets like student housing and storage facilities, the synergy of private equity firms investing in insurers and vice versa, and why many insurance companies continue to hold commercial real estate despite post-pandemic office vacancies.You can read the episode transcript on our website.

For decades, companies with traditional pensions have been freezing those plans and replacing them with defined contribution options to help their employees save for retirement. But IBM made headlines when it restored its defined benefit program in early 2024. Three Milliman pension actuaries discuss this choice, new hybrid DB plan designs, and how plan sponsors can avoid the mistakes that led them to close their pension plans in the first place.You can read the episode transcript on our website.

Actuaries are vital to the insurance industry and national economies, but the profession is still emerging in many developing countries. That's why Milliman and the United Nations Development Programme have launched a program to increase actuarial capacity around the world. In this episode, five Milliman volunteers reflect on the initiative's first year and their work in 10 countries, from Nigeria to Nepal.You can read the episode transcript on our website.

In our second Critical Point episode about AI applications in insurance, we drill down into the topic of machine learning and particularly its evolving uses in healthcare. Milliman Principal and Consulting Actuary Robert Eaton leads a conversation with fellow data science leaders about the models they use, the challenges of data accessibility and quality, and working with regulators to ensure fairness. They also pick sides in the great debate of Team Stochastic Parrot versus Team Sparks AGI. You can read the episode transcript on our website.

Artificial intelligence has been the buzz term of 2023, evolving at a pace unimaginable when Milliman launched this podcast five years ago. For this 50th episode of Critical Point, we gathered a group of our AI experts to discuss how the technology is poised to reshape the insurance value chain, from hiring practices and actuarial modeling to customer service and communication.You can read the episode transcript on our website.

Insurers are feeling the heat as another record-breaking summer finally cools off. In this episode of Critical Point, Milliman leaders Rich Moyer, Garrett Bradford, and Andi Shah—who have studied the impact of extreme heat from the Middle East to Europe to North Carolina—discussed the ramifications on property, workers' compensation, health, and other types of insurance. They also talk about data, including available sources for measuring heat risk now, and the data they would like to see to help measure the future effects of a warming planet. You can read the episode transcript on our website.

After 2022's rollercoaster of soaring interest rates and plunging investment returns, sponsors of single-employer defined benefit plans face a key choice as they calculate the 2023 variable rate premium they'll pay to the Pension Benefit Guaranty Corporation (PBGC). Milliman pension actuaries Casey Baldwin and Ryan Cook spoke with Nina Lantz about using the full yield curve, not being afraid of the five-year lock-in, and how switching from the alternative calculation method to the standard method can mean the difference between a $100,000 premium and a premium of $1.7 million.You can read the episode transcript on our website.

As companies embrace diversity, equity, and inclusion (DE&I) efforts, many are realizing their benefit policies and communications can help address health inequities and be more inclusive. From modernizing the language in plan documents, to simplifying fertility care for same-sex couples, to not showing a skinny marathoner in the ads for your fitness challenge, Milliman's Chief DE&I Officer joined health benefits experts to discuss how plan sponsors can help make sure all beneficiaries get the care they need.You can read the episode transcript on our website. 

In this companion episode to our look at SECURE 2.0 and defined contribution (DC) plans, Milliman employee benefits expert Nina Lantz explores how the new retirement law affects single-employer pensions. She talks with Milliman Consulting Actuary William Strange about what it means for retirement that life expectancy is rising more slowly, how companies can incentivize long-term employees, and why a reduction in insurance premiums could make corporate pension plan sponsorship appealing again. You can read the episode transcript on our website . 

When the SECURE 2.0 Act passed in late 2022, it introduced 92 provisions affecting retirement plans—and created a long to-do list for plan professionals. In this episode of Critical Point, Milliman employee benefits expert Nina Lantz talks with Brandy Cross, our director of defined contribution (DC) plan compliance, about how DC plans are coping. Learn which provisions plan sponsors are addressing first, and why it's OK to wait before making plan changes. Plus, don't miss Nina's companion episode on SECURE 2.0's impact on defined benefit plans.You can read the episode transcript on our website .

More than three years after the coronavirus shut down the world, the Biden administration announced in early 2023 the end of the U.S. National Emergency and the Public Health Emergency, two declarations that had mandated health insurance coverage of COVID-19 tests and vaccines, among other requirements. As these regulations are now rolled back, what does that mean for employer-sponsored health plans? In this episode of Critical Point, Milliman health experts discuss the implications, from whether to continue paying for at-home COVID-19 tests and when to phase out standalone telehealth benefits, to how to communicate any changes with plan members at this significant moment in the pandemic. You can read the episode transcript on our website.

As climate change causes more storms and floods, residents of coastal areas are being forced to move inland—driving up rents and displacing current residents of those regions. Milliman recently studied this issue in a paper called “Climate Displacement in New York City: Making Space for Our Neighbors,” published with Rebuild by Design, a nonprofit that helps communities build resilience. On this episode of Critical Point, two of the study authors discuss the groups most at risk, designing Manhattan to be more like Hong Kong, and how 40% of New Yorkers may be displaced without proactive city planning. You can read the episode transcript on our website.

Hear from Milliman's first female principal, Peggy Pearson, about her path from homemaker (and home economics major) to actuarial leader, all while breaking through the cultural barriers of the time. In honor of Milliman's 75th anniversary, Peggy sits down with current Milliman principals Angela Bolduc and Kim Guerriero to discuss how she “got into actuarial work on a dare,” her experience as a female leader in a primarily male-dominated field, and what has changed – and still needs to change – for women in the workplace.

Church retirement plan sponsors face unique considerations. While helping to position their clergy and other plan members for a secure future, they also must stay competitive across the wider benefits landscape to recruit and retain lay employees. For a look at how one diocese manages these pressures, Milliman actuaries Jake Pringle and Delbert Zamora sat down with Gary Patton, HR director for the Diocese of Fort Worth, Texas.

Insurtech never stops evolving. In this episode of Critical Point, Milliman actuaries Sheri Scott and Robert Eaton discuss recent trends they've seen and opportunities on the horizon--everything from new motion data and technology for improving the customer experience, to coverage for emerging risks including autonomous trucks, cryptocurrency, and even space travel.

The VM-20 requirement is no longer hypothetical—it's here, and it's had a big impact on principle-based reserving for the life insurance industry. In this episode of Critical Point, we hear how experts are coping. Michael McCarty from Legal & General America shares the direct carrier's side, while Laiping Wong-Stewart from RGA brings the reinsurer's perspective. They are joined by Milliman actuaries Uri Sobel and Paul Fedchak in a conversation about the challenges and successes surrounding assumption setting, governance processes, and other changes created with the new regulation.

Learn how SECURE 2.0 could derail or reduce participant contributions, and what plan sponsors and HR professionals need to know about this potential regulation. In this episode of Critical Point, Milliman's Jason Brantley sits down with Charles Clark and Karina Guerrero to talk about surprises in SECURE 2.0 and some of the details below the headlines. They'll discuss the impact to required minimum distributions (RMDs), catchup contributions, and what this means for companies with non-full-time employees.

Hear real-life experiences and get an “inside the company” look at the regulatory examination of principles-based reserve valuations for life insurers. PBR is a new method of determining U.S. statutory reserves in life insurance that better quantifies product risks. Milliman's Karen Rudolph sits down with Catherine Murphy from John Hancock and Sarah Theis from WoodmenLife, qualified actuaries who will share firsthand experiences around the regulatory review of PBR valuations within their respective companies. 

In this one-on-one conversation with Vicky Nevin, Microsoft's head of international compensation and benefits, learn how a leading multinational organization is approaching its compensation and benefits strategy and overcoming global challenges. Vicky speaks with Milliman / MBWL global EB leader John-Paul Augeri to share perspectives and priorities for benefits leaders during this time of global change.

Learn about five trends and creative approaches heading into 2022 for supplemental health benefits. Strategy consultant Christin Kuretich fuses Milliman market intel with a broader lens on society and the shifting nature of the workplace, to make some educated predictions on what we will see change and evolve in the voluntary benefits market. From mental health benefits to pet insurance and product design disruption, Christin gives a high-level overview on emerging approaches to supplemental products. Stay tuned for future episodes in this series, which will take a deeper dive into product design. 

For corporate financial officers who are considering a pension annuity buyout, there's an opportunity cost to 100% risk transfer, as Milliman's Zorast Wadia and Bret Linton discuss on this episode of Critical Point. With the passage of the COVID-19 stimulus, many CFOs and plan sponsors likely see the second half of 2021 as an opportune time to de-risk their company's pension liabilities; but pension risk transfer via an annuity buyout creates the potential to leave money on the table. This episode dives into the differences between pension risk mitigation and transfer, and some of the benefits of plan hibernation over annuity buyouts.

In fall 2020, due to the Covid-19 pandemic and the looming flu season, public health experts feared the possibility of a “twindemic”—a one-two punch of Coronavirus plus influenza. But that year, flu cases hit historic lows. The so-called twindemic never happened. Milliman health care expert Ellyn Russo discusses why the volume of flu cases decreased, and what health care systems can learn from this phenomenon. 

In late July, the IRS provided additional guidance on changes to single-employer defined benefit pension plan cash contribution rules under the American Rescue Plan. In this episode of Critical Point, Milliman pension consultants Charlie Clark and Casey Baldwin break down the guidance and what it means for pension plans and their plan sponsors. Baldwin and Clark discuss the implications for interest rate relief, amortization rates, prefunding balances, and written elections, among other things. They also share pitfalls to be aware of under this guidance.

When it comes to long-term care, what are some of the benefits and challenges of aging-in-place services, and how can these work hand-in-hand with long term care insurance? In this episode of Critical Point, Milliman's Robert Eaton and Missy Gordon are joined by Char Hu, founder and CEO of The Helper Bees, a healthcare insurtech company that offers care concierge services for LTCI carriers and health plans. The three experts discuss trends in the LTCI market, the rise of virtual care, and how aging-in-place services can improve experience for both policyholders and insurers. They also dive into how predictive analytics plays an important role in understanding aging-in-place needs and long-term care insurance. 

Milliman pension experts Charlie Clark, Vanessa Vaag, and Grant Camp discuss how the American Rescue Plan Act may impact single and multiemployer pension plans, and why pension funding has been integrated into the bill. The conversation ranges from the $86 billion special financial assistance for multiemployer plans, good faith compliance, and what plan sponsors should to consider when taking potential action as a result of ARPA.

Flooding stands out among other natural catastrophes because of the risk it poses to the financial health of the average U.S. homeowner. In this episode, Milliman flood risk experts Dave Evans and Cody Webb are joined by Andrew Netter from Milliman’s mortgage group and Brand Katz from KatRisk to discuss the relationship between flood insurance and mortgage risk, and how that risk can impact financial instruments designed to cover mortgage default exposure. 

The COVID-19 pandemic has spurred—and aggravated—a range of mental health and substance use issues in the United States. In this episode, Milliman’s Stoddard Davenport talks with host Lesley Pink about how different populations are faring on the mental health front, how the rising demand for mental health services is being met, and how recent statistics reveal the depth of the problem in this country.

COVID-19 has dramatically increased the use of telehealth services across the U.S. In this episode, Milliman’s Susan Philip sits down with Mei Kwong, executive director of the Center for Connected Health Policy, to discuss some of the biggest changes to telehealth in 2020, including regulatory changes around reimbursement and access, provider usage, and ways in which the service has been an integral part of healthcare during the global pandemic.

COVID-19 has had far-reaching economic implications, but what does the pandemic mean for the U.S. mortgage market? On this episode of Critical Point, Milliman’s Mike Schmitz from the firm’s mortgage practice, and Chris Harner from Milliman’s Cyber Risk Solutions group, discuss the impact of the pandemic on mortgage defaults and the credit risk market. While unemployment spiked and remains high, Schmitz notes that mortgage risk is much more sensitive to home prices than unemployment rates, and currently all signs point to market trends that will not be as severe as during the global financial crisis.

Artificial intelligence (AI) along with low-dose CT scans hold promise for the early detection of lung cancer, but there are challenges that come with scaling up this new technology. In this episode of Critical Point, Milliman’s Bruce Pyenson is joined by Jim Mulshine, a thoracic medical oncologist who spent 25 years at the National Cancer Institute and is now with Rush Medical Center. He outlines the promise AI holds in sifting through the reams of digital information from a CT scan to efficiently evaluate results and detect a myriad of diseases. But challenges in data quality and standardization must be addressed if the tool is to be used on a national or global level.

The CARES Act – which stands for the Coronavirus Aid, Relief, and Economic Security Act – has sweeping implications for both defined benefit (DB) and defined contribution (DC) retirement plans in the U.S. From distribution and loan relief for qualified individuals on the DC side, to deferral and election options for single-employer plans on the DB side, the CARES Act is intended to provide fast and direct economic assistance for workers and plan sponsors across the country. On this episode of Critical Point, Charles Clark, Milliman’s Employee Benefits Research Director, and Ginny Boggs, Senior Regulatory Compliance Consultant at Milliman, discuss the ins and outs of the CARES Act and what it means for retirement plans.

Black lung disease presents a significant, long-term liability exposure for coal companies, risk pools, and governments – a liability complicated by climate change and its effects on the industry. After the number of reported cases declined in the late 1990s, a recent CDC report indicates that trend has reversed and that cases of black lung in miners are the highest they've been since recordkeeping began in the early 1970s. In this episode of Critical Point, Milliman consultants Christine Fleming and Travis Grulkowski discuss what this means for companies and insurers looking to manage this risk for their employees.

At the heart of effective risk management is the ability to manage tail events, and the COVID-19 pandemic is raising some quite profound questions for risk practitioners in the life insurance industry. On this episode of Critical Point, Milliman consultants Anthony Dardis, Ariel Weiss, and Chloe Lau discuss enterprise risk management and emerging issues that life insurers may need to confront in the face of the global pandemic, including stress testing and operational risk.

The COVID-19 pandemic will have far-reaching implications for both short- and long-term healthcare costs in the U.S., as Milliman consultants Pamela Pelizzari, Stoddard Davenport, Doug Norris, and Matt Kramer discuss on this episode of Critical Point. For the past month, Milliman consultants have been building actuarial models to better understand what costs could look like for consumers, hospitals, and to the healthcare system overall. While there are more questions than answers at this early stage, our subject matter experts discuss the possibility that costs may in fact decrease in the short-term, as people avoid non-essential healthcare services.

Managing cyber risk in emerging markets such as South Africa comes with its own unique challenges and opportunities, as Milliman’s David Kirk and Chris Harner discuss in this episode of Critical Point. Insurers and companies are confronting varying levels of preparedness, with outstanding questions around how to best understand, measure, and quantify the cost of cyber risk and then communicate these metrics to their boards. Harner and Kirk discuss top-of-mind issues such as hardware and software challenges, the latest regulations, security concerns, and what actions insurers can consider when moving forward with managing this risk.

Every country has its own, unique healthcare system, but within these disparate systems there are shared approaches that cross borders and languages. This next episode of Critical Point, which is based on a series of papers by Milliman experts around the world, explores some of those commonalities and shared approaches that we see in healthcare systems globally, and tackles topics such as population health management, risk equalization, and wellness programs in different countries.

New trends in dental care and insurance coverage are aimed at improving the patient experience, as Milliman’s Joanne Fontana discusses on this episode of Critical Point. According to the American Dental Association, one-third of adults in the U.S. lack dental insurance, but emerging technologies such as ‘smart’ toothbrushes, teledentistry, and dental therapists are introducing new methods of care, and dental insurtech is rising to meet this changing landscape.

What if, in the future, homeowners had a flood risk score, like a credit score? In this episode of Critical Point, Milliman consulting actuaries Nancy Watkins and John Rollins discuss flood risk, and what flood insurance could look like in the future. They address some of the public misconceptions about flood insurance coverage, the rise of the private market, and what this market could look like decades from now.

The American pension plan is in flux, but not for the first time in U.S. history. In this episode of Critical Point, Milliman consulting actuaries Kelly Coffing and Becky Sielman discuss why it’s a turbulent time for retirement security in America, and what the next generation of pension plans could – and should – look like given emerging technology and the changing nature of the U.S. workforce.

Insurance companies that issue long-duration contracts (LDTI) can expect volatility, increased data and disclosure requirements, and the potential for a new market for reinsurers thanks to recent accounting changes, according to Milliman’s William Hines and Francois Dauphin. In the latest episode of Critical Point, Milliman’s life insurance actuaries discuss key takeaways from the Financial Accounting Standards Board (FASB) Targeted Improvements to the Accounting for Long-Duration Contracts (LDTI), which will require significant risk management and has a go-live date of January 2021.

Global events like climate change, immigration, and the opioid epidemic have the potential to affect mortality rates, that is, the rate at which people die. Mortality rates drive many factors that affect our everyday living, like pensions, healthcare, and taxes, as Milliman principal and consulting actuary Dale Hagstrom discusses in the latest episode of our Critical Point podcast.

What constitutes effective HR communication for Millennials, Gen-Xers, and Boomers today? In this episode of Critical Point, Heidi tenBroek, a Milliman employee communication consultant, and Jill Godschall discuss how generational differences, behavioral economics, and technology are driving change in the HR communications space.

A cyberattack has the potential to disrupt the global economy, but using traditional underwriting and risk management approaches may leave insurers and businesses vulnerable to large financial losses. In this episode, Milliman’s Chris Harner and Chris Beck discuss how a cyberattack could create a scenario similar to 2008’s financial crisis, and the need for a new risk management paradigm that not only takes into account the interconnectedness of the risk, but provides a way for businesses to measure their exposure and prepare for it.

Blockchain has the potential to influence - or disrupt – the insurance industry, but implementing any new technology comes with both benefits and drawbacks. In this episode of Critical Point – the third in our series on blockchain – Milliman consultants Shea Parkes and Anders Larson begin to look at real-world blockchain applications in the health insurance space and some of the compromises that have to be made to implement it.

What is a critical point and why would we name Milliman’s podcast after this mathematical concept? In this episode, host Jeremy Engdahl-Johnson speaks with Milliman consultants Hans Leida and Doug Norris, who are both healthcare actuaries and math PhDs, about the concept of a critical point and how it relates to Milliman’s work.