Agenda Day 2

 

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Day 1 | Day 2 | Day 3 | Day 4

Monday, June 12
6:00 a.m. – 4:00 p.m.
6:15 a.m. – 7:15 a.m.

Presentation(s): View Presentation

Session Sponsor(s): Canadian Track

Presentation by Canadian leadership.  Networking opportunity for Canadian members.

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) Ben Marshall, FSA, FCIA, CERA, MAAA, J.D.

Facilitator(s)

Session Sponsor(s): Health Section, Disability Special Interest Group

Presenter(s): Vincent A. DeMarco, FSA, MAAA

This session provides an update on activities of the SOA's Disability Special Interest Group, along with brief presentations of interest to disability insurance actuaries.

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) Daniel D. Skwire, FSA, MAAA

Facilitator(s)

6:30 a.m. – 7:30 a.m.
7:30 a.m. – 9:00 a.m.

Nick Buettner

Keynote Speaker:

Nick Buettner, Blue Zones Project

Nick Buettner has first-hand knowledge of the Blue Zones, or places that have the greatest life expectancy and where more people reach age 100 than anywhere else in the world. Using National Geographic photography and a dynamic, storytelling delivery, Buettner will take you to these longest-lived cultures, sharing his observations from the field, and will provide you with ideas to increase healthy longevity and well-being.

Session Coordinator(s)

Facilitator(s)

9:30 a.m. – 11:00 a.m.

Presentation(s): View Presentation

Session Sponsor(s): Health Section and Technology Section

Competency: External Forces & Industry Knowledge

Moderator(s): John Sardelis, ASA, MAAA

Presenter(s): Mark J. Jamilkowski, FSA, MAAA; Joseph Schulman, Executive Director, Northwell Care Solutions; Lawrence R. Smart, FSA,MAAA

Experience Level: Intermediate

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
"Population Health" can be defined as the process by which the health information of a population within a service area is captured and analyzed. This may become additive information for the delivery of care to patients within that population as well as outreach programs and educational support to insured members that do not incur claims. Population Health involves the identification and capture of a wide range of data that is intended to promote health and wellness within the health population, augmenting and improving care management and case management within the care delivery process. This has implications for product design and pricing; risk management; provider contracting; analytic support to care management and disease management programs; patient engagement (e.g. higher clinical compliance, better outcomes, and greater satisfaction, resulting in higher retention) from an actuarial perspective.

Learning Outcomes:
At the conclusion of this session, attendees will be able to understand emerging market trends and business needs skill sets in demand and professional opportunity

Session Coordinator(s) Mark J. Jamilkowski, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Gabriela Dieguez, FSA, MAAA

Presenter(s): Anna L. Bunger, ASA, MAAA; Naomi Reitz; Gregory L. Warren FSA, FCA, MAAA

Experience Level: All

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:

This session will explore recent developments in value-based contracting with pharmaceutical and device manufacturers. It will present a framework for analyzing feasibility, identifying obstacles, and building a strong proposition around value-based contracts. As healthcare capital moves from volume to value, value-based contracts are an attractive alternative to traditional drug and device contracting for payers and risk-bearing providers. However, these contracts require a significant amount of data analytics. Presenters of this session will describe the pros and cons of various 'advanced' contracting strategies between payers and pharmaceutical manufacturers and/or pharmacies. This will include a discussion of the criteria that must be in place for a successful contract, as well as descriptions of types of contracts emerging in the market today. This session is intended to meet the needs of actuaries who are or will be focusing on implementing value-based contracts for drugs and devices.

Learning Outcomes:

At the conclusion of this session, attendees will be able to describe the incentives for value-based contracting of drugs and devices, compare different types of value-based contracting, identify current obstacles to implementing value-based contracting, andidentify the key elements of a robust value-based contract offering.

Session Coordinator(s) Gabriela Dieguez, FSA, MAAA; Jennifer Sciascia Carioto, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Will Stabler

Presenter(s): Sushma Jamboor, AHIMA, RHIT, MA, Commercial and RADV Specialist; Marc David Lucas, ASA; Eponine Lupo, Tessellate Principle Analyst

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
A profile of historical risk adjustment data validation (RADV) subjects selected by CMS. Distributions of size, Star, average risk adjustment factor over prior years, compliance scores, and other observations. Built around a model to essentially create a RADV insurance product to cover the likelihood and possible outcomes of being the subject of a CMS RADV audit.

Learning Outcomes:
At the conclusion of this session, attendees will have a basic understanding of historical RADV CMS communications, future RADV profiles and distributions of historical RADVs.

Session Coordinator(s) Marc David Lucas, ASA

Facilitator(s)

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): William S. Bade, FSA, MAAA

Presenter(s): William S. Bade, FSA, MAAA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
The hospital indemnity market is active with a large number of carriers offering wide varieties of products. In this session, we will discuss observations of key trends and anticipated future developments. The presenters will address any current concerns regarding the impact on hospital indemnity insurance from changes in D.C. or tri-agency activity.

Learning Outcomes:
At the conclusion of this session attendees will understand the current market for hospital indemnity and the future potential for change.

Session Coordinator(s) William S. Bade, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section and Financial Reporting Section

Competency: Strategic Insight and Integration

Moderator(s): Lisa Marie Parker, ASA, MAAA

Presenter(s): David M. Dillon, FSA, MAAA; Lisa Marie Parker, ASA, MAAA; Steven Williams, CFE, CPA

Experience Level: Intermediate

CPD: 1.80

Country Relevance: USA

Description:
Risk focused examinations of insurance companies involve accountants, actuaries, and state examiners working together to assess the risk of a company. This session will provide a summary of what the regulators look for and what they focus on. This will involve the opinions of the different types of examiners and their sometimes different viewpoints.

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

  • understand what state regulators look for while assessing the risks of insurance companies
  • compare and contrast the different roles of the various regulators involved in an examination

 

Session Coordinator(s) David M. Dillon, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Canadian Track

Competency: Strategic Insight and Integration

Presenter(s): Ken C. Beckman, ASA, ACAS, MAAA; Dr. Caldwell Esselstyn, Jr.

Experience Level: Beginner

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
This session presents a dietary solution to help significantly reduce health care costs. It is based on the studies and research of Dr. Caldwell Esselstyn, Jr., who is a physician, former Olympic rowing champion, and author of the 2007 book Prevent and Reverse Heart Disease . He and actuary Ken Beckman will review studies indicating not only preventive but also remedial benefits of dietary changes including greater plant-based content. Content is intended to broaden the perspective of actuaries practicing in the health and wellness areas, to include a greater emphasis on prevention and remediation through alternatives related to lifestyle and how the insurance industry can play a role.

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

  • examine studies of chronic health issues
  • understand drivers
  • determine alternative practices

 

Session Coordinator(s) Ben Marshall, FSA, FCIA, CERA, MAAA, J.D.

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Long Term Care Insurance Section

Competency: Strategic Insight and Integration

Presenter(s): Vincent L. Bodnar, ASA, MAAA; John O’Leary; Maria Ferrante-Schepis

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
The SOA's LTC Think Tank has taken an active role in promoting innovation in the world of LTC financing. Through the support of the SOA's Research Expanding Boundaries (REX) Funding Pool, rigorous research has been conducted to address two needs: development of a model for determining the general insurance company pricing of savings-oriented, universal long-term care products; and development of in-depth qualitative and quantitative consumer testing of this product idea and interest. This session will share the results of this research and explore what it means for the future of LTC financing.

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

  • Describe the two research projects;
  • Explain the research results as outlined in this session; and
  • Interpret these results and what they mean for the future of LTC financing.

 

Session Coordinator(s) Juliet Michelle Spector, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Leadership & Development Section

Competency: Leadership

Moderator(s): Joanne Ryan, FSA, MAAA

Presenter(s): Jennifer Barley, PCC; Karen Sullivan, MA, PCC

Experience Level: All

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
Using the Coach Approach to Leadership to clarify goals and objectives creates outcomes, yet most conversations just scratch the surface. They don't address the real issues, and then we shake our heads, wondering why we don't get the results or changes we wanted. Coaching as a leadership skill is the new, almost super powered skill that will transform the way you appear as a leader. Instead of the command and control approach, the coaching skills of listening, reflecting, and powerful questioning, will change the response from your decisions. . These coaching skills alone are the key to leadership. They will allow your leadership abilities to really shine. By quickly identifying a new approach to empowerment, leaders will be able to create impact within the organization and yield better results. With these tools you'll build focus, expand possibilities and create a culture of accountability, all to help drive engagement and increase employee impact. This interactive workshop will have you using the 'see it, do it, live it' approach to everything you learn.

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

  • Discover how to change your conversations to change your results.
  • Create a 4 questions buy-in.
  • Develop skills that will immediately and proactively influence the workplace.
  • Embrace being a forward-thinking leader by utilizing the "questions are the answers" approach.
  • Determine the core issues which obstruct your progress and discover how to shift from focusing on problems to focusing on solutions for sustainable changes.
  • Create strategies that inspire action which create results.

 

Session Coordinator(s) Joanne Ryan, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Tasha S. Khan, FSA, MAAA

Presenter(s): Roger Loomis, FSA, MAAA; Kenneth Warren Pagington, FSA, CERA, MAAA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
The new individual disability valuation table presents insurers with much more than a simple valuation basis update. It includes a new occupation class, new variables, and very different underlying rates. This session explores how companies can and should take this opportunity to explore their valuation systems and methods to identify potential improvements.

Learning Outcomes:
At the conclusion of the session, attendees will:

  • Learn about the new individual disability valuation table.
  • Identify the challenges and opportunities it offers.
  • Explore potential improvements in their valuation methods.

 

Session Coordinator(s) Robert W. Beal, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Hans K. Leida, FSA, MAAA

Presenter(s): Gary Gau, ASA, MAAA; Joe Long; Michael Cletus Niemerg, FSA, MAAA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
Predictive modeling and machine learning are rapidly finding applications across many actuarial areas of practice, replacing or complementing traditional tools and approaches. For new practitioners, getting your bearings among the many algorithms and software tools can be daunting. This session will give an overview of some of the trending algorithms and approaches that successful modelers are using, as well as a survey of some of the software platforms that can be used to implement them.

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

  • Describe the current algorithmic approaches used by successful predictive modelers at a high level.
  • Have a basic understanding of the choices available to them as far as software platforms for implementing machine learning models.

 

Session Coordinator(s) Hans K. Leida, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): David Dobberfuhl, FSA, MAAA; Lindsy Marie Kotecki, FSA, MAAA; Chris Pallot

Experience Level: Beginner

CPD: 1.80

Country Relevance: International

Description:
This session will provide an overview of the US and UK healthcare delivery and financing systems, specifically focusing on how each system is working to improve quality and reduce the cost of care. Examples from the UK will include, how clinical guidelines developed on a national basis, have driven quality improvement and reduced cost, while addressing how payers have consolidated the provision of highly specialized therapies to deliver the same outcomes. In the US, accountable care organizations (ACOs) and other shared savings arrangements have payers and providers working together to manage care and reduce costs. There is a push for greater transparency in the delivery and cost of care, as well as the use of health information technology used to support evidence based practice and quality measurements.

You will hear from a US-based actuary, a Director from Northampton General Hospital in the UK (who has also spoken at previous SOA Meetings), and a US healthcare provider. These panelists will present their unique perspectives on how these approaches are being observed in each health system.

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

  • Develop a basic understanding of the US and UK healthcare delivery and financing systems.
  • Identify specific US and UK programs aimed towards improving the quality of care and reducing costs.
  • Understanding how quality improvement can be demonstrated in terms of improved clinical outcomes whilst reducing overall cost to Payers.
  • Identify ways in which these programs have been successful, and the challenges that remain.

 

Session Coordinator(s) Lindsy Marie Kotecki, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Education & Research Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Ian Duncan, FSA, FIA, FCIA, FCA, MAAA

Presenter(s): Gregory G. Fann, FSA,MAAA,FCA; Ted Frech III, Ph.D.; Ed Weisbart, MD, CPE, FAAFP

Experience Level: Intermediate

CPD: 1.80

Country Relevance: USA

Description:
By the time of the Health Meeting, the new Trump administration and Congress may have repealed the Affordable Care Act. The potential replacement for the ACA may not be passed and will present many challenges to actuaries who are working in the health benefits area. This session will deal with technical (i.e. statistical, mathematical, underwriting, etc.) questions that arise from the need to replace the ACA with a more stable program.

Learning Outcomes:
At the conclusion of this session, attendees will learn about options for the replacement to the ACA as well as likely implications for the technical side of their work in the new environment.

Session Coordinator(s) Ian Duncan, FSA, FIA, FCIA, FCA, MAAA

Facilitator(s)

11:15 a.m. – 12:45 p.m.

Join your fellow meeting attendees at this networking lunch. Catch-up with colleagues and friends, discuss previous sessions and make new acquaintances.

The luncheon is included in your registration fee. You may register your guest(s) for the luncheon by including $75 per person with your registration fee. Admission tickets are available for purchase at the meeting as space permits. Refunds will not be given.

Session Coordinator(s)

Facilitator(s)

1:00 p.m. – 2:30 p.m.

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Brendan Cavanaugh, FSA, MAAA; Joanne E. Fontana, FSA, MAAA; Samuel Rockwood, FSA, MAAA; Ruth Ann Woodley, FSA, MAAA

Experience Level: All

CPD: 1.80

Country Relevance: USA

Description:
In a time of uncertainty and potential change in the dental marketplace, this session will cover timely topics affecting dental insurance such as how ACA changes could impact dental, dental in Medicare and Medicaid, innovations in product or network, and the evolving role of the dental actuary. Specific topics may be changed as we hope to cover the most current issues at the time of the meeting and would welcome audience suggestion of topics. This session will be facilitated by dental actuaries as an interactive roundtable discussion so please come ready to share your thoughts and experiences or listen in to dental experts discussing relevant issues.

Learning Outcomes:
At the conclusion of this session, attendees will be able to share and gain knowledge about current relevant topics important to dental actuaries.

Session Coordinator(s) Joanne E. Fontana, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Society of Actuaries and Health Section

Competency: Results-Oriented Solutions

Moderator(s): Maryn McKenna, Journalist, author, TED speaker

Presenter(s): Nicole Iovine; Kristi Kuper, Sr. Clinical Manager, Infectious Diseases, Vizient; Rebecca Owen, FSA, MAAA; Rachel Slayton, Mathematical Modeling Unit Lead, Health, CDC

Experience Level: All

CPD: 1.80

Country Relevance: Non-nation specific

Description:
This session will contain a multidisciplinary panel of experts to discuss the impact of antibiotic-resistance bacteria on the healthcare industry. With the Centers for Disease Control and Prevention reporting at least 2 million infections a year, resulting in 23,000 deaths, drug-resistant super bugs appear to be on the rise While Methicillin-resistant Staphylococcus aureus (MRSA) infections, one of many super bugs, cost about $10 billion to treat annually, this is an expensive issue which has the potential to magnify with the onslaught of new drug-resistant organisms. This panel will provide valuable knowledge for actuaries identifying excess utilization and seeking to manage costs stemming from these infections, such as:

  • Analysis of the impact of antibiotic-resistant bacteria and super bugs on healthcare costs;
  • An understanding of the specific implications for clinicians, prescription drugs and healthcare facilities;
  • Insight into how predictive modeling can help track and mitigate the spread of infections; and
  • Recommendations for factoring antibiotic-resistance into effective health delivery system operations.

Learning Outcomes:
At the conclusion of this session, attendees will be able to understand:

  • The impact of antibiotic-resistant bacteria and super bugs on healthcare costs;
  • The specific implications for clinicians, prescription drugs and healthcare facilities;
  • How predictive modeling can help track and mitigate the spread of infections; and
  • Recommendations for factoring antibiotic-resistance into effective health delivery system operations.

 

Session Coordinator(s) Sarah Kossek

Facilitator(s)

Session Sponsor(s): Health Section, Disability Special Intrest Group

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Mark R. Yoest, FSA, MAAA

Presenter(s): Jeffrey L. Schuh, FSA, MAAA, ACIA; Mark R. Yoest, FSA, MAAA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
The field of predictive modeling has significant potential for disability insurance. Possible applications include claim modeling, underwriting, pricing, and experience analysis. The panelists in this session describe a variety of current and potential future applications of predictive modeling methods to the field of disability insurance. Attendees are encouraged to pose questions and share experiences.

Learning Outcomes:
At the conclusion of the session attendees will learn about current practices in predictive modeling for disability insurance and explore future applications.

Session Coordinator(s) Mark R. Yoest, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section and Predictive Analytics and Futurism Section

Competency: External Forces & Industry Knowledge

Moderator(s): Gregory G. Fann, FSA, FCA, MAAA

Presenter(s): Gregory G. Fann, FSA, FCA, MAAA; Hans Leida, FSA, MAAA; Erica Rode, PhD, ASA, MAAA

Experience Level: Intermediate

CPD: 1.80

Country Relevance: USA

Description:
Risk adjustment under the Affordable Care Act has had a somewhat rocky start. Results from 2014 and 2015 have surprised health planners and state regulators alike. The Centers for Medicare and Medicaid Services (CMS) have received feedback from stakeholders concerned that the program may be having unintended consequences as well as failing to achieve its goal of stabilizing premium rates and removing incentives for carriers to engage in risk selection. While CMS has been vigorously defending the program from its critics, it has also been making significant changes to the program. Currently, states are considering whether to implement their own programs or to pursue ways in modifying the outcomes of the federal risk adjustment calculation after the fact. This session will cover the latest developments of this fast evolving program, as well as any new developments under the Trump administration and a Republican Congress. It will cover both current and potential changes to the program, as well as strategies that successful organizations use to model and manage their risk-adjusted lines of business.

Learning Outcomes:
At the conclusion of this session, attendees will be understand the results of the current risk adjustment methodology, how that will change in the future, and what this might mean for future market dynamics.

Session Coordinator(s) Gregory G. Fann, FSA, FCA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Marc David Lucas, ASA

Experience Level: Intermediate

CPD: 1.80

Country Relevance: USA

Description:
An analysis of the impact of in home assessments, including risk adjustment, renewal rates & voluntary attrition, care management, mortality, CAHPS scores, Star Ratings and effectiveness of incentives and service level agreements on conversion rates and outcomes as well as a comparison/contrast between commercial small group, commercial individual, and Medicare in home assessment strategies

Learning Outcomes:
At the conclusion of this session, attendees will able to:

  • Identify opportunity for in home assessments beyond risk adjustment,
  • Determine optimal strategies for different lines of business, and
  • Evaluate impact of in home assessments

 

Session Coordinator(s) Marc David Lucas, ASA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Andrew Morrison Webster, ASA, MAAA

Presenter(s): Brian Chaney; Richard Ferrans, ScM, MD; David Klebonis, Chief Operating Officer; Andrew Morrison Webster, ASA, MAAA

Experience Level: Advanced

CPD: 1.80

Country Relevance: USA

Description:
The National Association of ACOs (NAACOS) and the Association of Academic Medical Colleges (AAMC) contracted a team of actuaries and clinicians to perform the most comprehensive study on provider risk published to date. The combined clinical and actuarial perspective is unique as it's needed to succeed under clinically and financially integrated reimbursement models. Highlights from the study include:

  • A summary of care management approaches followed by top-performing Accountable Care Organizations (ACOs), data sources commonly used for patient risk identification and stratification, and industry-wide challenges experienced by ACOs.
  • 17 in-depth interview profiles of the top-performing ACOs across the nation including top academic and physician-led ACOs.
  • A scientific literature search and selected article summaries defining clinical and actuarial best practices in risk identification and management https://www.aamc.org/download/470456/data/riskid.pdf

Co-authors of the study, Richard Ferrans and Andrew Webster, ASA, MAAA, will deliver the key results from the study to the health actuarial community including:

  • Successes & challenges experienced by ACOs
  • The difference between risk adjustment and risk identification
  • Common methods used by physicians to construct and validate risk identification algorithms
  • The importance of psychosocial and socioeconomic risk factors when identifying patients for medical management

Learning Outcomes:
At the conclusion of this session, attendees will able to:

  • Identify success factors and challenges experienced by ACOs and providers participating in bundled payments;
  • Design risk identification algorithms used to optimize the assignment of patients to medical management programs, and
  • Apply risk identification algorithms within the context of a health system, using provider data sources including EMRs and self-reported patient data.

Session Coordinator(s) Andrew Morrison Webster, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Johnathan Lyle O'Dell, ASA, MAAA

Presenter(s): Fred Karlinsky, JD; Eric J. King, FSA, MAAA; Teresa Russ Winer, FSA, MAAA

Experience Level: All

CPD: 1.80

Country Relevance: USA

Description:
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. A variety of views will be shared, including those from regulators and companies. At the conclusion of this session, attendees will be able to identify important health regulatory updates for non-health benefit plans.

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

  • Determine the impact of recent Federal guidance;
  • Understand the impact of recent litigation;
  • Identify the key issues regarding voluntary products; and
  • Understand recent changes to valuation tables.

 

Session Coordinator(s) David M. Dillon, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

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

Presenter(s): Robert T. Eaton, FSA, MAAA; Anita Recchio, FSA, MAAA; Pieter Williams, General Counsel, Regulatory Insurance Advisors, LLC

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
Health insurers are increasingly looking to non-Major Medical products to round out their portfolios and combination products have become a very popular option. This session will give an overview of the variety of combination products available. These products are typically supplemental health policies coupled with other health or life insurance products, such as AD&D, term life policies with health riders, waiver of premium life products, and group life policies with health riders such as critical illness, long-term care, and chronic illness. The panelists will describe the advantages and disadvantages of having these products in the health insurer's portfolio. Finally the presentation will review some actuarial aspects of pricing these combination products.

Learning Outcomes:
At the conclusion of this session, the audience will:

  • Understand what combination products are available in the market;
  • Describe the advantages and disadvantages of these products, and
  • Explain how actuaries price combination products in the health portfolio.

 

Session Coordinator(s) Robert T. Eaton, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Canadian Track

Competency: External Forces & Industry Knowledge

Presenter(s): Kwame Mario Hew Smart, FSA, FCIA; Ellen E. Whelan FSA, FCIA

Experience Level: Beginner – Intermediate

CPD: 1.80

Country Relevance: USA and Canada

Description:
Employer sponsored retiree benefits are threated to disappear. Faced with an aging population, longer life expectancy and escalating health care costs, governments are looking for ways to reduce and offload costs. Unless we are prepared to pay higher taxes to cover this, health care costs may shift to the private sector. Group plan sponsors and retirees will pay a heavy price. Plan sponsors and plan members all have different views and interests in these programs which must be considered and weighed with the consequences of not having a plan. With a focus on Canada, this session examines issues faced by governments and employers related to escalating health care costs for retiree benefits and more appropriate long-term sustainable solutions.

Learning Outcomes:
At the conclusion of this session, the audience will be able to consider issues and alternatives faced by employers and governments that sponsor retiree benefits and more appropriate long term sustainable plans that can be developed and implemented that will meet everyone's needs.

Session Coordinator(s) Kwame Mario Hew Smart, FSA, FCIA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Jessica Grado

Presenter(s): Zachary Christian Aters, ASA, MAAA; Sabrina H. Gibson, FSA, MAAA; Steve Schramm

Experience Level: All

CPD: 1.80

Country Relevance: USA

Description:
The proposed block grants for Medicaid programs may resolve some concerns surrounding Medicaid rate of growth and long term sustainability of the various programs. However, this approach to funding Medicaid programs also brings potential unintended consequences and questions from an actuarial perspective. This session will explore the pros and cons of using block grants to fund Medicaid, discussing specific issues such as

  • How such a funding mechanism relates to actuarial soundness,
  • Potential impact on provider community and access to care for members,
  • Potential impact on participating managed care organizations (MCOs),
  • Need for efficiency and quality measurements, and
  • Considerations when developing a methodology to determine the amount of block grant for each program

Learning Outcomes:
At the conclusion of this session, attendees will be able to introduce the idea of block grants to a broader audience, while utilizing specifics surrounding actuarial soundness, financial impacts to participating MCOs, unintended consequences to the Medicaid programs surrounding the provider community and access to care.

Session Coordinator(s) Zachary Christian Aters, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Financial Reporting Section

Competency: External Forces & Industry Knowledge

Moderator(s): Lisa Marie Parker, ASA, MAAA

Presenter(s): Lisa Marie Parker, ASA, MAAA; Lindsey Pittman; Steven Williams, CFE, CPA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
Actuaries are known for looking out the back window to see where an insurance company is going. This session will focus on the actuarial review of prospective and other non-financial reporting risks. Included will be viewpoints from both regulators and industry reps regarding an actuary's perspective on risks such as underwriting, pricing, liquidity, catastrophe and best practices for integration. Presenters will share recent examples of significant contributions toward the examination of prospective risks and the benefits of utilizing an actuarial specialist.

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

  • Understand the issues involved with the prospective risk of an insurance company,
  • Take the results of analysis for future decision making, and
  • Identify all types of risk that insurance companies face

 

Session Coordinator(s) David M. Dillon, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Entrepreneurial & Innovation Section

Competency: External Forces & Industry Knowledge

Presenter(s): Jiangxia (Ivy) Dong, FSA, MAAA; Maria S. Knox, ASA, MAAA; Joseph P. Slater, FSA, MAAA; Andrew Varano, FSA, MAAA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
A panel of presenters from actuaries at Collective Health, Nuna, Axene Health Partners, and Clover Health to present, followed by a Q&A session. Each would go over:

  1. Unique (non-traditional) aspects of their roles, including new technologies and tools
  2. Benefits of working with emerging technologies
  3. Challenges and lessons learned
    • Blending roles and enhanced capabilities working with Data Scientists;
    • Applying new data sources to solve problems;
    • Process and considerations for evaluating new technologies;
    • Bringing a more holistic approach to assessing value, and
    • Applying the actuarial skill set outside of traditional insurance.

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

  • Gain better understand of emerging opportunities for actuaries to work with new technologies and in non-traditional environments,
  • Identify opportunities to develop new skills to keep up with our evolving profession.

 

Session Coordinator(s) Andrew Varano, FSA, MAAA

Facilitator(s)

2:30 p.m. – 3:00 p.m.
3:00 p.m. – 4:30 p.m.

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Darrell D. Spell, FSA, MAAA

Presenter(s): Randall C. Finn, FSA, MAAA; Darrell D. Spell, FSA, MAAA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
The critical illness market continues to be very active with a large number of carriers, offering a wide variety of products. In this session, we will discuss key trends and anticipated future developments. Presenters will address any current concerns regarding the impact on critical illness insurance from changes in D.C.

Learning Outcomes:
At the conclusion of this session, attendees will be able to understand the current market for critical illness and the potential for change.

Session Coordinator(s) Darrell D. Spell, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Julie A. Peper FSA, MAAA; Suzana-Grace Sayre, FSA, MAAA, CERA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
In this session, we will share high level findings from perhaps the biggest study to date involving actual ACA data. The presenters will discuss trends affecting the success of ACA health plans, who have been the biggest winners and losers on the exchanges, and how these observations influence health plan strategy going forward. We will also discuss how some states are analyzing their data to better understand drivers of market instability and to support data-driven policy decisions. The results of one state's analysis will be presented. The intended audience is healthcare actuaries, state regulators and those involved in the development, pricing, review and/or policy setting of ACA plans.

Learning Outcomes:
At the conclusion of this session, attendees will learn up to date statistics and trends regarding the implementation of the ACA, and where the market may be heading.

Session Coordinator(s) Syed Muzayan Mehmud, ASA, FCA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Thomas Daniel Murawski, FSA, MAAA

Experience Level: All

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
Unlike medical claims, dental claims rarely contain diagnostic information to allow for the analysis of health outcomes, best practices, and necessity and efficacy of treatment. Fortunately, changes are coming -- at this session, you will learn about the efforts underway to implement standardized dental diagnosis coding and the opportunities this presents to actuaries working in the dental industry.

Learning Outcomes:
At the conclusion of this session, attendees will:

  • Understand the current state of dental diagnosis coding,
  • Understand the efforts underway to create a standardized diagnosis code set, and
  • Understand the potential for better analysis once these codes are implemented

 

Session Coordinator(s) Joanne E. Fontana, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Canadian Track

Competency: External Forces & Industry Knowledge

Presenter(s): Vincent Ng, MBA, PMP, Rph

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
This session introduces cutting-edge uses of technology in the health care sector. Attendees need not have specialized knowledge in information technology (IT) in order to benefit from the information presented. Examples are provided from a Canadian context, but potentially apply to a wide geographic spectrum.

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

  • Enumerate recent technology developments
  • Examine their uses
  • Evaluate costs and benefits of their utilization

 

Session Coordinator(s) Ben Marshall, FSA, FCIA, CERA, MAAA, J.D.

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: Results-Oriented Solutions

Moderator(s): Gerry Smedinghoff, ASA, ACA, MAAA

Presenter(s): Hans Leida, FSA, MAAA; Gerry Smedinghoff, ASA, ACA, MAAA; Ryan Wilson, Vice President of Managed Care, HealthSouth

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
This session will present best practices in design and management of risk adjustment programs. Experts will discuss approaches to improve member and provider engagement, and to align incentives among the many internal departments involved. Health insurers in the ACA marketplace, Medicare Advantage, and Medicaid managed care have their revenue adjusted for their relative morbidity risk. Additional reforms such as, MACRA and the CCIIO bundled payment initiatives will bring a similar transformation to provider reimbursement. Providers have historically relied upon a limited patient view, comprised only of the care they provide. This leads to the belief that their patients are sicker and cost more, and that are provided the highest level of quality care. While many plans are able to identify missing diagnoses, engaging with members and providers to fill those gaps have become much harder. Clinical risk adjusted measurement reporting systems can create longitudinal profiles of patients, which can help push risk adjusted revenue down to network provider contracts to compare providers across their peers, through normalized results and evidence based standards and benchmarks.

Learning Outcomes:
At the conclusion of this session, attendees will understand the differences between the commercial, Medicare, and Medicaid risk adjustment programs, while learning how leading carriers are working to improve risk adjustment outcomes. Case studies of longitudinal Total Cost of Care (TCoC) claim analysis will be presented, demonstrating how the studies need to be designed, the results should be interpreted, and the data needs to be refined to create risk-adjusted metrics suitable for designing value-based and bundled contracts.

Session Coordinator(s) Gerry Smedinghoff, ASA, ACA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Joint Risk Management Section (CAS, CIA and SOA)

Competency: Strategic Insight and Integration

Moderator(s): Marcus Andrew Such, ASA, MAAA

Presenter(s): Brian Joseph O’Neill, FSA, MAAA, CERA; Michael Ruiz; David Yonathan Shleifer, ACAS, MAAA

Experience Level: Intermediate - Advanced

CPD: 1.80

Country Relevance: International

Description:
Companies that have been successful with ORSA implementation have taken time to understand its components and have used it as an opportunity to enhance their own risk and capital frameworks in order to drive business value from the ORSA process. In today's low interest rate environment, companies are trying hard to manage costs and improve underlying profitability. We will discuss how the ORSA process has helped companies further understand their risk profiles and risk appetite, as well as how best to manage the risks they face in order to drive value and avoid loss.

Learning Outcomes:
At the conclusion of this session attendees will learn to:

  • Identify practical solutions to risk quantification
  • Emphasize materiality

 

Session Coordinator(s) Mario E. DiCaro, FCAS, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Presenter(s): Richard Lieberman; David Anthony Neiman, FSA, MAAA

Experience Level: Intermediate

CPD: 1.80

Country Relevance: USA

Description:
With the advent of a new administration that is at very least, rhetorically committed to dismantling a large section of the ACA, Medicaid will become an even more prominent source of last resort coverage. Over the last few years, Medicaid managed care programs have imposed more stringent requirements and more aggressive financial incentives tied to quality measurement and encounter data submission. Upwards of 64 million Americans are covered by Medicaid, with the majority of them enrolled in a Medicaid managed care organization (MCO). There is little consistency across states as to which quality measures are included in a composite of measures eligible for financial sanctions or bonuses. In many states, the amount of capitation withheld or liquidated damages can range from a low of 0.5% to a high of 5%. Many states have limited Medicaid MCO surpluses to 3 percent, while placing as much as 5 percent at risk threatens an MCO's financial viability. States that utilize quality improvements to determine the proportion of member an MCO receives (via state auto-assigned algorithms) non-refunded capitation with holds will not get MCO attention.

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

  • Calculate the impacts on quality improvement and encounter data submission requirements have on MCO revenues;
  • Apply potential bonuses or sanctions to modeling of the viability of state capitation rates;
  • Identify MCO operational strategies for the collection and submission of encounter data necessary to ensure overall financial viability.

 

Session Coordinator(s) Richard Lieberman

Facilitator(s)

Session Sponsor(s): International Section and Health Section

Competency: Results-Oriented Solutions

Moderator(s): James Patrick Hazelrigs, ASA, MAAA

Presenter(s): Chris Pallot; Jeremiah D. Reuter, ASA, MAAA; Michael Sisti

Experience Level: All

CPD: 1.80

Country Relevance: Non-Nation Specific

Description:
Value based care is fundamentally changing the way care is delivered around the world. This session will explore the approaches US and UK providers are taking to provide care to their populations while managing the newly introduced risks of value based care contracts.

Attended to hear a diverse range of provider perspectives on the new era of value based care as a UK hospital executive, US hospital executive, and a provider actuary with both US and UK experience talk about how their approaches to healthcare have changed. Such changes include in how patients access care, the coordination of care across the healthcare continuum, and how the introduction of risk to providers has changed the way care is managed for patients.

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

  • Better evaluate risk in value based care contracts between providers and payers;
  • Explain how providers in the US and UK are managing value based care contracts through new approaches to providing care and development of competencies traditional to payers;
  • Develop an understanding of how value based care is changing how providers manage risk through coordination of care;
  • Identify the challenges providers face in managing care in the new era of value based care

 

Session Coordinator(s) Jeremiah D. Reuter, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Society of Actuaries and Health Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Rebecca Owen, FSA, MAAA

Presenter(s): Sabrina H. Gibson, FSA, MAAA; Rebecca Owen, FSA, MAAA; Juliet Michelle Spector, FSA, MAAA

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
This session focuses on practical health research projects sponsored by the Health Section's Research Committee with the following probable publications: Guide to Medicaid Margins: Components and Consideration in Calculating Margins; Analysis of Provider Networks in the Exchange Markets, with a particular focus on the role of narrow networks. An overview of SOA risk adjustment research comparing the performance of different models.

Learning Outcomes:
At the conclusion of this session, attendees will learn what major research papers have been published since the last Health Meeting, as well as those in progress. They will have an opportunity to suggest new topics for research.

Session Coordinator(s) Rebecca Owen, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): American Academy of Actuaries

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Lo Linda Chow, FSA, MAAA; Christopher J. Giese, FSA, MAAA

Experience Level: All

CPD: 1.80

Country Relevance: USA

Description:
The increasing growth in state Medicaid budgets due in part to the long-term care (LTC) needs of a growing elderly population combined with the low level of penetration into the potential market by private LTC insurance, have prompted a number of proposals for reforms in the way LTC is financed in the United States. Proposed reforms can be expected to address both public and private financing mechanisms, as well as mechanisms involving both types of financing. Join our panelists as they discuss a recent Academy issue brief that defines the criteria that must be addressed for any LTC financing reform proposal.

Session Coordinator(s) Heather E. Jerbi

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Mark Costello, FSA, MAAA; Curt Zepeda

Experience Level: Beginner - Intermediate

CPD: 1.80

Country Relevance: USA

Description:
A number of changes are sweeping the healthcare landscape. Such changes include potential changes to the Affordable Care Act, the acquisition of small medical practices by healthcare corporations, the role of nurse practitioners and physician's assistants, and demands for automation and productivity improvements. All of these influence the income and job satisfaction of physicians. This session explores these trends and the potential impact on disability and group life programs.

Learning Outcomes:
At the conclusion of this session, attendees will gain an understanding of recent healthcare trends and identify the potential impact on disability and group life insurance.

Session Coordinator(s) Leo Tinkham

Facilitator(s)

4:45 p.m. – 6:15 p.m.
Don't miss this annual networking opportunity. Relax, mingle and build professional connections and new friendships. Share your professional experiences with your peers and meet potential clients at this fun and useful event. Meeting badges are required for attendees and registered guests.

Session Coordinator(s)

Facilitator(s)