Agenda Day 4 and Presentations

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Friday, June 17
7:00 a.m. – 11:30 a.m.
7:00 a.m. – 8:15 a.m.

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Moderator(s): Elaine T. Corrough, FSA, FCA, MAAA

Presenter(s): Elaine T. Corrough, FSA, FCA, MAAA; Paul I. Spitalnic, ASA, MAAA

Take advantage of this special opportunity to hear from Paul Spitalnic, chief actuary at CMS, as he addresses Health Section members at this breakfast event. You will also hear from Health Section leaders on initiatives related to the member community, education and research, as well as longer-term strategic planning. It's a great way to catch up on the year, and to start thinking about how you might want to get more involved. We'll be starting right on time and will have a lot to cover-so please arrive on time to get the most from this session.

Note:  There are no explicit assigned CE credits for this event. After you attend, you will need to assess personally whether this session has provided you with CE credits. 

This breakfast is open to all meeting attendees at no charge. Please be sure to register in order to receive a ticket. 

Session Coordinator(s) Elaine T. Corrough, FSA, FCA, MAAA

Facilitator(s)

8:30 a.m. – 10:00 a.m.

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Product Development Section

Competency: Strategic Insight and Integration

Moderator(s): Gregory L. Warren, FSA, FCA, MAAA

Presenter(s): Alejandro Miguel Cires, FSA, MAAA; Gregory L. Warren, FSA, FCA, MAAA; Denise Wolff

Experience Level: Intermediate

Presenters for this session will describe the pros and cons of various 'advanced' contracting strategies between pharmaceutical manufacturers and payers. This will include a discussion of the criteria that must be in place for a successful contract, as well as describe three to four types of contracts being used in the market today.

At the conclusion of the session, attendees will be able to: 

  • Define what an 'advanced' contract is between a pharmaceutical manufacturer and payer;
  • Explain pros and cons of various approaches; and
  • Describe financial mechanisms in place to determine the payments in an 'advanced' contract.

Country Relevance: Non-Nation-Specific

Session Coordinator(s) Jason Bradley Gomberg, FSA, MAA; Gregory L. Warren, FSA, FCA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Actuary of the Future, Education & Research and Entrepreneurial & Innovation Sections

Competency: External Forces & Industry Knowledge

Moderator(s): Lori Weyuker, ASA, MAAA

Presenter(s): Laura J. Bennett FSA; Lori Weyuker, ASA, MAAA

Experience Level: All levels

Actuaries are on the look-out for new areas in which to apply actuarial techniques! Pet health insurance is a new and exciting arena for actuaries. By participating in this session, attendees will learn:

  • What is pet health insurance?
  • What types of actuarial work is involved in pet health insurance?
  • What's driving current interest in pet health insurance?

At the conclusion of the session, attendees will be able to: 

  • Explain what a pet health insurance actuary does;
  • Describe how a pet health insurance actuary is an entrepreneur; and
  • Apply actuarial principles to pet health insurance.

Country Relevance : USA

Session Coordinator(s) Lori Weyuker, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Sabrina H. Gibson, FSA, MAAA

Presenter(s): Aaron Beaudoin, FSA, MAAA; Maria Catherine Dominiak, FSA, MAAA; Mathieu Doucet FSA,MAAA; Sabrina H. Gibson, FSA, MAAA

Experience Level: All levels

Since the passage of the American with Disabilities Act over 25 years ago, there has been an effort in the Medicaid program to transform its primary role as an institutional care-focused financing mechanism to a community-based long-term services and supports (LTSS) program. Many states are using Managed Medicaid Long-Term Care programs to support this transition while at the same time using this financing mechanism as a way to control trends and improve quality in Medicaid Long Term Services and Supports (MLTSS) costs. Managed Care Organizations (MCOs) receive capitation payments to provide services to the population, but the variations in costs across the spectrum of LTSS require a risk adjustment mechanism to support the appropriate distribution of funds across the MCOs. Simple risk methodologies of blending rates by service location have morphed into more complex risk adjustment mechanisms that account for the varying levels of member functionality in the more advanced models. This session will discuss these advanced models including:

  • Variables necessary in the models;
  • Data needed to support the models;
  • Complexities of building the models;
  • Case studies on two current models; and
  • The future of MLTSS risk adjustment models.

This is an intermediate to advanced session that assumes attendees have some experience with risk adjustment models and familiarity with MLTSS programs and Medicaid rate setting. Attendees should leave this session understanding the variables that impact cost differences between LTSS members, the type of data needed to develop MLTSS risk adjustment model, the challenges with building an MLTSS model, and what the next advances may be in MLTSS risk adjustment model development.

At the conclusion of the session, attendees will be able to discuss the special considerations needed to affect program design and pricing in Medicaid Long-Term Services and Supports.

Country Relevance : USA

Session Coordinator(s) Jennifer L. Gerstorff, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Predictive Analytics and Futurism Section

Competency: Strategic Insight and Integration

Moderator(s): Virgil Dickson, D.C. Bureau Chief, Modern Healthcare

Presenter(s): Brian Doty; Nicholas Marko, MD; Syed Muzayan Mehmud, ASA, FCA, MAAA

Experience Level: All Levels

Predictive analytics may be the single most disruptive improvement to the health care ecosystem in the 20th Century, but health systems, providers and payers remain a half-step behind the tech industry in their evolution from data collection (information) to predictive and prescriptive analytics (intelligence). Data science and predictive analytics offer limitless opportunities for efficiency in business operations, patient care, cost reduction, revenue management, epidemic preparedness and more. But where does the actuarial profession, with its rich experience in health care financial risk management, fit into this new equation? What are the applications of traditional actuarial sciences like statistical and economic modeling to today's broader health ecosystem? And what do tomorrow's actuaries need to know about predictive analytics to remain competitive in this burgeoning field? This session will convene data scientists, clinicians and predictive analysts from across the health care industry in a panel discussion about the evolution to predictive and prescriptive analytics and the role of actuaries in that progression while revealing some of big data's most unexpected applications in health care.

At the conclusion of the session, attendees will be able to identify opportunities for actuarial expertise in non-insurance health care organizations and develop new career opportunities/paths.

Country Relevance : Non-Nation-Specific

Session Coordinator(s) Stephanie Gray

Facilitator(s)

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Charles Phillip Herman, FSA, MAAA

Presenter(s): Margaret Cormier, FSA, MAAA

Experience Level: Intermediate

This session provides individual disability actuaries with an opportunity to participate in a round table discussion on topics of interest to them.

At the conclusion of the session, attendees will be able to describes topics of current interest and importance in the individual disability insurance market.

Country Relevance : Non-Nation-Specific

Session Coordinator(s) Daniel D. Skwire, FSA, MAAA

Facilitator(s)

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Moderator(s): Ashlee Mouton Borcan, FSA, MAAA

Presenter(s): Ashlee Mouton Borcan, FSA, MAAA; Anita Marie Recchio, FSA, MAAA; Heather K. Sligh, FSA, MAAA; Amanda B. Turcotte, FSA, MAAA

Experience Level: Intermediate

Over the last few years many carriers have developed and implemented a variety of supplemental health products. This session will discuss practical implementation issues that carriers have faced including marketing challenges, internal and external systems constraints, reserves and other items. This session will be interactive, so come prepared to share your favorite success (or sob) stories.

At the conclusion of the session, attendees will be able to understand the experiences that others have had when offering supplemental health products.

Country Relevance: USA

Session Coordinator(s) Ashlee Mouton Borcan, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Moderator(s): Howard J. Bolnick, FSA, MAAA, HONFIA

Presenter(s): Howard J. Bolnick, FSA, MAAA, HONFIA; Joseph Dieleman, Ph.D.; Andrew William Sykes, ASA, FFA

Experience Level: Intermediate

The session will present results from a comprehensive analysis of potential medical care cost savings associated with effective strategies to control modifiable health risk factors. The study is a collaborative effort between the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and actuaries from The Vitality Group, which is a commercial workplace wellness vendor. It uses analyses from the IHME Global Burden of Disease and U.S. Disease Expenditure Studies with a focus on the working age population.

At the conclusion of the session, attendees will be able to:

  • Evaluate the value of typical workplace wellness programs;
  • Interpret the value of a variety of approaches to measuring value; and
  • Design more effective workplace wellness programs.

Country Relevance : USA

Session Coordinator(s) Howard J. Bolnick, FSA, MAAA, HONFIA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Theresa Shouldis Bauer, FSA, MAAA

Presenter(s): Tricia Nguyen, MD; Joel Shalowitz, MD, MBA, FACP

Experience Level: All levels

What are providers' viewpoints on the ACA and how it has changed their practices? This session will let you hear from a provider about demographic, behavioral, and financial impacts to their practice. What kind of members do they see now-are they more or less healthy? Has their patient volume changed significantly? Are members more focused on preventive care than in the past? What is the average patient's "health care IQ" about their benefits and their own health and wellbeing? From a financial perspective-has the incidence of bad debt increased? What has been the cost of adopting health information technology and ICD10?  How prevalent are alternative payment models and ACO participation agreements?

At the conclusion of the session, attendees will be able to:

  • Identify how the ACA has impacted providers;
  • Compare members in 2016 against pre-ACA members, in terms of how they interact with their providers; and
  • Describe different risk characteristics and member behavior that exist under the ACA.

Country Relevance : USA

Session Coordinator(s) Theresa Shouldis Bauer, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Tracy Anne Margiott, FSA, MAAA

Presenter(s): Tracy Anne Margiott, FSA, MAAA; David M. Liner, FSA, MAAA, CERA

Experience Level: All levels

2015 was filled with high-profile merger and acquisition activity in the health insurance industry. In this session, the speakers will review recent headlines and provide commentary from a historical perspective. If approved, these deals could have a significant impact on the national health insurance landscape. We will review pre-merger and potential post-merger health insurance enrollment by market segment for affected companies and provide context on merger impact relative to the total U.S. population.

At the conclusion of the session, attendees will be able to understand the current health insurance market landscape, explain the potential enrollment impact of consolidation activity and evaluate the current health industry M&A environment from a historical perspective.

Country Relevance : USA

Session Coordinator(s) Tracy Anne Margiott, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Sara Corrough Teppema, FSA, MAAA

Presenter(s): Laura Seeff, MD; Jim Toole, FSA, CERA, MAAA

Experience Level: All levels

The Centers for Disease Control and Prevention (CDC) is working on an initiative called "6|18." The CDC is partnering with purchasers, payers and providers to accelerate the adoption of evidence-based prevention that will improve health and control costs. The overall goal is to align practices with value-based payment and delivery models to improve population health. Six high-burden health conditions are targeted: diabetes, tobacco use, high blood pressure, health care-associated infections, asthma and unintended pregnancies; with eighteen targeted interventions. This session will provide an overview of the CDC's initiative and explore what actuaries can learn from the vast world of public health research. It will also provide an overview of an SOA initiative to partner with public health entities around the country and provide actuarial coaching and support.

At the conclusion of the session, attendees will be able to connect recent work of the CDC with their everyday experience to enhance their analysis of population health.

Country Relevance: International

Session Coordinator(s) Sara Corrough Teppema, FSA, MAAA

Facilitator(s)

10:00 a.m. – 10:30 a.m.
10:30 a.m. – 12:00 p.m.

Credits: 1.80 CPD

Session Sponsor(s): Product Development Section

Competency: Strategic Insight and Integration

Moderator(s): Paul Douglas Erickson, FSA, MAAA

Presenter(s): Andrea Sheldon, FSA, MAAA

Experience Level: All levels

Medicare Advantage Part D has been around for ten years. The product landscape has been changing rapidly and there are many more strategies that have emerged. This is a chance to discuss what is happening in the industry. What does the future hold when 2020 arrives?

At the conclusion of the session, attendees will be aware of several expert views of many current and emerging Part D industry issues. The fun will be trying to figure out the impact 2020 bids holds as the ACA fills in the Part D gap fills-no one can be wrong, yet!

Country Relevance : USA

Session Coordinator(s) Paul Douglas Erickson, FSA, MAAA

Facilitator(s)

Credits: 1.80 CPD

Session Sponsor(s): Predictive Analytics and Futurism and Social Insurance & Public Finance sections

Competency: External Forces & Industry Knowledge

Moderator(s): Alejandro Miguel Cires, FSA, MAAA

Presenter(s): David Beshara, RPh, MBA; Alejandro Miguel Cires, FSA, MAAA

Experience Level: Intermediate

The pharmacy pipeline has traditionally been a big unknown when projecting future health costs. This session will attempt to review the largest anticipated product launches and quantify the impact these might have within Medicare. Specific focus will be provided on the oncology pipeline, where many new products might be classified as "Part B" or "Part D" drugs, where the classification impacts future costs.

At the conclusion of the session, attendees will be able to:

  • Describe how new drugs have different impacts within Medicare depending on if they are classified as Part D or Part B;
  • Identify largest anticipated specialty drug launches within Medicare; and
  • Define why a drug would be considered Part D or Part B within Medicare.

Country Relevance : USA

Session Coordinator(s) Jason Bradley Gomberg, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Investment Section

Competency: Results-Oriented Solutions

Moderator(s): Manchiu Chan, FSA, MAAA

Presenter(s): Andrew H. Dalton, FSA, MAAA; Mark Edward Zacherl, CFA

Experience Level: All levels

With positive cash flow in early years and negative cash flow in late years, long duration lines of business such as long-term care and disability insurance pose unique challenges during a Strategic Asset Allocation (SAA) analysis. The use of Efficient Frontier analysis is becoming more common when evaluating optimal investment strategies though there are many challenging issues that arise during this analysis. To get the most out of your company's models and systems, careful review and consideration must be given to certain topics. This presentation will review:

  • The characteristics of cash flows for disability and long-term care insurance and the implications for a company's investment strategy;
  • What information should be captured in an Efficient Frontier SAA analysis;
  • The selection of risk and reward metrics;
  • How to choose the single best investment strategy from the most optimal strategies;
  • Other techniques such as "what if" analysis that can be used to enhance the SAA results.

At the conclusion of the session, attendees will be able to:

  • Describe the characteristics of cash flows for disability and long-term care insurance and the implications for a company's investment strategy;
  • Identify  what information should be captured in an Efficient Frontier SAA analysis;
  • Understand the selection of risk and reward metrics;
  • Decide how to choose the single best investment strategy from the most optimal strategies; and
  • Define other techniques such as "what if" analysis that can be used to enhance the SAA results.

Country Relevance : Non-Nation-Specific

Session Coordinator(s) Manchiu Chan, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Robert T. Eaton, FSA, MAAA

Presenter(s): Robert T. Eaton, FSA, MAAA; Brian D. Rankin, FSA, MAAA; Pieter M. Williams, JD

Experience Level: Beginner

This session will discuss health regulatory updates including a summary of all non-health benefit plans, such as LTC, cancer, hospital/limited benefit plans, and stop loss. This would include views from regulators and companies.

At the conclusion of the session, attendees will be able to identify important health regulatory updates for non-health benefit plans.

Country Relevance : USA

Session Coordinator(s) Josh Anton Hammerquist, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Modeling and Predictive Analytics and Futurism sections

Competency: Strategic Insight and Integration

Moderator(s): Stephen P. Melek, FSA, MAAA

Presenter(s): Stephen P. Melek, FSA, MAAA

Experience Level: Intermediate

The Colorado State Innovation Model touches nearly every aspect of our health care system, setting the stage for a sweeping transformation that will help us accelerate our progress toward the "Triple Aim" of lower costs, better care and improved population health. It will also allow us to reach our goal of becoming the healthiest state. Our vision is bold. Central to transforming the Colorado health care system is the integration of behavioral health and primary care, a necessary step in our accelerated achievement of the "Triple Aim." Our integration efforts will be supported by an improved public health infrastructure. In turn, behavioral health integration will improve population health by addressing behavioral factors that often impede the management of chronic health problems, especially obesity, smoking and diabetes. Improving access to behavioral health services and programs for most Coloradans is the cornerstone of the Colorado transformation effort. Under our plan, we will offer truly integrated physical and behavioral health care. A broad range of public health programs will extend health care, including disease prevention, on a population-wide scale. Payment systems will evolve to ensure that our new model of care is sustainable for the long haul. Data will be used effectively and securely to support innovation. And Coloradans will be at the center, with the power and opportunity to make the best choices possible for their own health.

At the conclusion of the session, attendees will be able to:

  • Demonstrate the value of integrated medical-behavioral health care.
  • Identify the payment model reforms that are needed away from fee-for-service.
  • Identify the key factors for success of integrated practices.

Country Relevance: USA

Session Coordinator(s) Stephen P. Melek, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health, Modeling and Predictive Analytics and Futurism sections

Competency: Strategic Insight and Integration

Moderator(s): Kevin E. Dotson, FSA, MAAA

Presenter(s): Jordan Paulus, FSA, MAAA; Karen Salfity

Experience Level: Intermediate

Providers are taking on more risk through value based contracts, and to be successful these organizations need to deploy new and improved predictive analytics for population stratification to support population health management activities. Attendees will learn about the more progressive predictive models in the market and gain knowledge of how organizations are applying these new tools to realize additional value. This topic will provide new insights for actuaries who are focused on value based care representing either payers or providers.

At the conclusion of the session, attendees will be able to demonstrate knowledge of the more progressive predictive modeling being used by provider organizations for population health management activities.

Country Relevance: Non-Nation-Specific

Session Coordinator(s) James Patrick Hazelrigs, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Moderator(s): David M. Liner, FSA, CERA, MAAA

Presenter(s): Patrick Dooling, CPA; David M. Liner, FSA, CERA, MAAA; Daniel J. Perlman, ASA, MAAA

Experience Level: Intermediate

The Affordable Care Act (ACA) includes risk mitigation mechanisms, collectively known as the 3R's, for individual and small group health insurance markets. While the 3R's intended to provide market stability, health plans faced many challenges when developing risk adjustment, risk corridor, and reinsurance estimates for 2014 and 2015 financial statements. This session will review industry actual-to-expected results for 3R financial statement values and discuss best practices for developing 3R financial statement estimates.

At the conclusion of the session, attendees will be able to apply an actual-to-expected analysis of financial statement estimates to improve the estimate of future ACA risk mitigation program financial statement items.

Country Relevance: USA

Session Coordinator(s) Nancy J. Hubler, ASA, MAAA; David M. Liner, FSA, CERA, MAAA

Facilitator(s)

Credits: 1.80 CPD

Session Sponsor(s): Society of Actuaries

Competency: External Forces & Industry Knowledge

Moderator(s): Rebecca Owen, FSA, MAAA

Presenter(s): Rebecca Owen, FSA, MAAA; Team Innovation, University of Waterloo; Adam Ryan Singleton, FSA, MAAA

Experience Level: All levels

The session will lay out the research pipeline for health related research at the SOA. There will be at least two papers presented; one will be on high performing networks.

At the conclusion of the session, attendees will be able to identify the areas of research currently being pursued. They will have an increased understanding of high performing networks.

Country Relevance : USA

Session Coordinator(s) Rebecca Owen, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Professional Values

Moderator(s): Joe Wurzburger, FSA, MAAA

Presenter(s): Pedro Luis Alcocer, FSA, MAAA; Joe Wurzburger, FSA, MAAA

Experience Level: All levels

Never has professionalism been more important for health actuaries than during this period of high visibility and nearly constant change. Join a panel of experts in reviewing professionalism standards and expectations to make sure that you are up to the challenge.

At the conclusion of the session, attendees will be able to:

  • Identify Actuarial Standards of Practice that are relevant to them;
  • Describe the following: ASOPs, practice notes, the Code of Professional Conduct; and
  • Demonstrate understanding of professionalism concepts through the consideration of realistic scenarios.

Country Relevance: Non-Nation-Specific

Session Coordinator(s) Joe Wurzburger, FSA, MAAA

Facilitator(s)