Description: Review a recently completed research project for a multi-stakeholder data consortium on social determinants of health (SDOH). In this project, claims, external SDOH data, geospatial analysis, and machine learning models were used to examine several questions: How to identify SDOH vulnerabilities? How sensitive are the findings with respect to provider coding pattern variations? How much variability in cost can be explained by SDOH vs. morbidity? What are the key risk drivers revealed by machine learning models? The session will review the methodology and main findings from this project.

Description: "Spread pricing is a pricing methodology where pharmacy benefit managers (PBMs) bill a payer one price but reimburses the dispensing pharmacy a lower price for the same prescription drug. PBMs have historically relied on spread pricing as a revenue source. However, a growing number of states are introducing and passing legislation prohibiting spread pricing for Medicaid and commercial clients. In addition, new entrants to the PBM and mail-order pharmacy space are disrupting the market by offering services that promote increased transparency and member satisfaction. Expect updates on recent legislative trends and market disruptions targeted towards increasing PBM drug pricing transparency. By attending this session, you will have a better understanding of how changing legislation and market disruptions may impact current pricing methodologies."

Description: Join us as we explore how recent innovations & future changes in the American worksite will impact the future of the Critical Illness product

Description: The past couple years during the pandemic have had a tremendous and costly impact on society’s collective mental health. What’s next? Examine patterns of MH/SA needs identified from living with COVID-19 for two years and discuss what MH/SA needs to expect in the future. Across society, mental health has been one of the most impacted areas of total health and wellness and has been highly publicized. What’s here to stay, and how does that impact how we think about mental health going forward? With increased publicity and campaigns to normalize MH/SA needs, what are the supply-side and demand-side limits? By attending this session, you will be able to: • Identify drivers of MH/SA services in the pandemic. • Understand future expectations of MH/SA needs, with population specific considerations (ex. gender, business type, etc.). • Analyze impact of increased awareness of MH/SA needs and reduced stigma.

Description: Hot topics for Medicare, including enrollment trends, enticing benefits, risk score projections, market strategy trends, formulary considerations, STAR rating changes, and COVID implications including vaccine/testing requirements Proposed/enacted changes to Part D from the Build Back Better (BBB) Act-CMS’s commitment to advancing equity in health and health care for all individuals Discussion of removing barriers to equal opportunity, health disparities, and closing health equity gaps, including collecting more and improved data on beneficiaries’ race, ethnicity and social determinants of health By attending this session, you will be further prepared for current and future changes in the Medicare Advantage program. Gather additional insight into future trends in policy changes and cost spending and to be more equipped to adapt to changes in the marketplace.

Description: The health care sector in general, and physicians in particular, are a large and important part of the market for group and individual insurance products. Explore a variety of subjects related to physicians and disability insurance, including experience trends, purchasing trends, external factors affecting physicians, and the impact of the COVID-19 pandemic.

Description: Explore the role of inflation across health products, including medical plans, disability, and long-term care. Explore various drivers of cost trends, wage increase, and cost of care. Understand their role in the pricing and valuation of a product and how to manage the risk.

Description: "Examine the exciting possibilities for artificial intelligence (AI) in health care and its potential to transform the patient journey. You will learn about the various touchpoints where AI is being applied along the patient/care journey, including provider search tools, claims analysis, and fraud detection. By attending the session, you will be able to: Have a comprehensive understanding of the opportunities and challenges presented by AI in health care Evaluate the potential impact of AI on their own organizations Be equipped with strategies for effectively implementing AI solutions and maximizing their benefits for patients, providers, and payers"

Description: The rules governing the framework of Affordable Care Act (ACA) marketplaces continue to be refined at the state and federal level. The catalyst for such changes has been a desire to improve markets, which has been primarily informed by data and experience in the ACA's first decade. This session will feature a panel of consulting actuaries, a state policy advisor who has influenced ACA legislation, and an attorney deeply involved in ACA risk adjustment litigation. Discussion will include new federal proposals, efforts to strengthen enforcement of rating compliance, new actuarial insights from public data, and the anticipated future implications for ACA markets. By attending this session, you will be able to: • Understand what precipitated risk adjustment lawsuits and how proposed federal rules address these concerns. • Identify how state regulators are addressing premium misalignment between metal levels and shaping local policies. • Develop new insights on publicly available data. • Understand the implications these policy changes will have on the future of pricing health insurance benefits, consumer value and enrollment distributions in ACA marketplaces. • Understand the primary factors leading to ACA market success.

Description: The presenters in this session will highlight the SOA’s work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and State principals to determine appropriate underwriting margins components within Medicaid managed care rates. Understand a brief description of the motivation for and underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in where they operate. By attending this session you will be able to: • Understand the role that Medicaid underwriting margin plays in Medicaid rate setting. • Understand the key components of Medicaid underwriting margin. • Understand the factors that necessitate underwriting margins. • Understand how to incorporate appropriate Medicaid underwriting margin levels in Medicaid rate setting.