The MP4 audio recordings synchronized with the presenter slides are available to purchase for the entire meeting through the SOA store. The MP4 downloads provide excellent training, are eligible for fulfillment of your CPD requirement and allow you to view sessions you may have missed. View the sessions online anytime or download the MP4 files to your mobile device for portable listening.
Join us for the third annual Health Meeting Fun Run/Walk. Enjoy a morning beach run or walk, led by a professional personal trainer and motivationalist. Begin with a dynamic warm-up and then start your run/walk as the sun rises over the beautiful beach. Afterwards, cool down with a post run stretch session.
The nonrefundable fee of $20 per person. Sign up when you register.
Keeping up with the tradition of book reviews at the L&D breakfast, we are putting a slight spin on it and doing a deeper dive into a classic, personal development book by Tony Robbins, called "Unlimited Power." There's no doubt that starting the day with a morning dose of tapping into your personal power can set the stage for what happens for you throughout the day. You're going get the 360 view of the book along with some thought-provoking themes and interactive fun activities. It's not called Unlimited Power for nothing….are you ready to step into you powerful state? Hey, Tony changes lives on a regular basis….this can be your day…who knows!
This breakfast is open to all meeting attendees at no charge. Please be sure to register in order to receive a ticket.
Session Sponsor(s): Long Term Care Insurance Section
Presenter(s): Robert T. Eaton, FSA, MAAA
Enjoy this opportunity to network with members of the Long Term Care Insurance Section and learn about section activities while enjoying breakfast. Section council members will share recent and ongoing initiatives and they will solicit your feedback.
This breakfast is open to all meeting attendees at no charge. Please be sure to register in order to receive a ticket.
This will be short presentation of section activities during the last year as well as the 2017 Actuarial Research Conference. This will by enough time for section members to informally discuss education and research topics in small groups at round tables. Since this is the Health meeting there will be some emphasis on Health topics.
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) Charles S. Fuhrer, FSA, MAAA, FCA
Presenter(s): Erika Deann Holmes, FSA, MAAA; Andrew Erwin Kirchner, FSA, MAAA; Tracy Anne Margiott, FSA, MAAA
Experience Level: Intermediate
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
As prescription drug costs continue to increase, health plans are faced with the challenge of how to manage pharmacy benefits. This session will cover strategies used in health plans to successfully manage pharmacy benefits. Key pillars in a successful pharmacy benefit management (PBM) program include assessing corporate benefit strategy, responding to emerging market trends, monitoring internal claims experience, and performing industry benchmarking. This session will highlight current strategies to optimize benefits while managing prescription drug trend rates through benefit design, clinical programs, vendor management and strategic planning. Awareness of these dynamics will enable health plans to take on a proactive approach to manage pharmacy benefits.
Learning Outcomes:
At the conclusion of this session attendees will understand the importance of PBM contract monitoring and management, as well as effective approaches for ongoing PBM monitoring and management.
Session Sponsor(s): Health Section and Predictive Analytics Section
Competency: External Forces & Industry Knowledge
Moderator(s): Missy A. Gordon, FSA, MAAA
Presenter(s): Missy A. Gordon, FSA, MAAA; Roger Loomis, FSA, MAAA; Sarah Prusinski, ASA, MAAA
Experience Level: Intermediate - Advanced
CPD: 1.80
Country Relevance: USA
Description:
Under reserving, underpricing, and excessive growth are responsible for the majority of financial impairments in the insurance industry. What can the industry learn from stress testing and predictive modeling to alter future behavior? As the regulatory environment becomes more complex, the role of an analyst has expanded and has become much than reviewing financial statements. This session will discuss all the new risks that must be assessed and monitored to stay abreast of current trends.
Learning Outcomes:
At the conclusion of this session, attendees will be able to understand the intricacies of modeling future financial performance and assess the results of complex systems for use in future decision making.
Session Coordinator(s) Josh Anton Hammerquist, ASA, MAAA
Competency: Technical Skills & Analytical Problem Solving
Moderator(s): Evan Morgan, ASA, MAAA
Presenter(s): Syed Muzayan Mehmud, ASA, MAAA, FCA
Experience Level: Beginner - Intermediate
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
Data is fast becoming a crucial asset, and the companies that leverage it have an edge over others. Knowing tools and techniques is important, however, the application of the skill is crucial to the success of a predictive modeling effort. Ideas are important, but execution is all-important. In this session, we will explore the steps and considerations involved in the development of effective healthcare predictive models.
Learning Outcomes:
Attendees will learn the key steps and important considerations involved in developing and communicating an effective predictive modeling solution to a challenging problem.
Presenter(s): Alex Forrest; Shawn Hartman; Dustin David Tindall, FSA, MAA
Experience Level: Beginner - Intermediate
CPD: 1.80
Country Relevance: USA
Description:
As cost sharing for commercial health insurance plans increase, some individuals are seeking additional coverage through increasingly popular gap insurance policies. This sessions will explore the gap insurance market, examine consumer preferences, and discuss potential pitfalls for insurance carriers. The latest market activity and modeling techniques will also be explored.
Learning Outcomes:
At the conclusion of this sessions, attendees will be able to:
Design gap insurance products;
Describe considerations of entering this market; and
Evaluate profitable opportunities
Session Coordinator(s) Gregory G. Fann, FSA, FCA MAAA
Presenter(s): Matthew Harker, MBA, MPH; Susan E. Pantely, FSA, MAAA; Jeremiah D. Reuter, ASA, MAAA
Experience Level: All
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
Patient attribution is arguably the most critical component of value-based contracts since the choice of attribution methodology impacts financial benchmarking, performance measurement, and the key areas of risk that are shifting in health delivery accountability. We will discuss the transfer of risk from payers to providers and how the attribution methodology defines that risk. The fundamental way in which attribution drives both payment and delivery prioritization will be a cornerstone of population health and value-based care, regardless of which types of reforms proliferate over the next decade. This session will present the results of a joint research project on patient attribution between the Society of Actuaries and the Duke-Margolis Center for Health Policy.
Learning Outcomes:
At this conclusion of the sessions, attendees will be able to:
Understand the importance of attribution to patients, payers, and providers as the fundamental mechanism for aligning accountable care delivery with payment.
Understand how the details of attribution methodologies influence product churn, accountability, and payer dependency.
Understand the influence of attribution on financial benchmarking and performance measurement, which payers and providers must establish in order to implement actionable reporting to meet contract expectations.
Identify the value of financial risk associated with various attribution methodologies, as well as how that risk is transferred between payers and providers.
Session Coordinator(s) Jeremiah D. Reuter, ASA, MAAA
Competency: Technical Skills & Analytical Problem Solving
Presenter(s): Joseph Farago
Experience Level: Beginner - Intermediate
CPD: 1.80
Country Relevance: Canada
Description:
In recent years there has been a growing focus on pharmaceutical cost growth and drug spend. This session will provide a closer look into the Canadian pharmaceutical market growth trends and its place in overall health care costs. The focus will be centered on the private payer market with a detailed look into future growth trends and forecasting. During this presentation, Joe will share the 2016-18 Canadian private market forecasting model.
Learning Outcomes:
At the conclusion of the sessions, attendees will be able to:
Have a better understanding of the historical trends which are shaping the current environment in drug costs;
Leverage the 2016-18 private market forecast towards future drug sales trending models development
Session Coordinator(s) Ben Marshall, FSA, FCIA, CERA, MAAA, J.D.
Session Sponsor(s): Leadership & Development Section
Competency: Communication
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:
As navigating the world of business grows increasingly complex, open-minded leaders believe courage, creativity, straightforwardness, and genuineness are among the most important competencies needed for any organization. This session will set a foundation to create a common language and framework to enhance any conversation.
Communication happens every day and everywhere, and includes everyday conversations, managing conflict, and working in team; even the conversations you have with yourself! What messages are you sending? What messages are you hearing? How does your worldview influence your communication? This breakout session gives theories and practical applications regarding communication that will clearly raise your awareness of your own communication, and gives you the understanding of how to effectively improve your style. We will cover everyday conversations, as well as those oh-so-difficult conversations you're putting off.
Learning Outcomes:
At this conclusion of the sessions, attendees will be able to:
Clearly identify what breaks down communication, what triggers you, and how to view a conversation from a different perspective;
Create a problem-solving approach from a solutions mindset to communicate with confidence; and
Set priorities and communicate those priorities to others.
Session Coordinator(s) Joanne Ryan, FSA, MAAA
Facilitator(s)
Session Sponsor(s): Health Section
Competency: Strategic Insight and Integration
Moderator(s): William S. Bade, FSA, MAAA
Presenter(s): William S. Bade, FSA, MAAA; Frank Vitiello, CEO, Vitech
Experience Level: Intermediate
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
The technology of the past is no longer adequate in today's dynamic insurance markets. Carriers and distribution partners in group and worksite markets are investing in new systems and third party vendors to administer and/or enroll benefits. These new technology solutions alleviate carrier problems and create efficiencies--while creating new problems for actuaries. All actuaries working in the group and worksite markets will leave this panel discussion with a clear understanding of how technology is solving specific group and worksite market problems, how technology systems influence billing, claim, underwriting, actuarial, etc. functions, and how the financials of enrollment technology are changing. The panel discussion will be led by thought leaders from technology and brokerage firms.
Learning Outcomes:
At the conclusion of this session, attendees will be able to
Identify key technology partners;
Explain the problems these partners solve, and
Create an action plan for developing and/or funding these partnerships.
Competency: Technical Skills & Analytical Problem Solving
Moderator(s): Rebecca B. Scotchie, FSA, MAAA
Presenter(s): Peter A. Heinrichs, FSA, MAAA; Rebecca B. Scotchie, FSA, MAAA
Experience Level: Beginner - Intermediate
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
This session reviews enterprise risk management (ERM) concepts including the idea of a company's risk appetite, applying these concepts to the practical issues involved in managing a disability insurance line of business. What are risks and risk levels to be managed within boundaries set by a company? What types of external factors are important considerations for disability insurance versus other product lines? How might the notion of risk diversification affect a disability insurer's product or marketing strategy? The panelists will consider both individual and group disability products in this discussion.
Learning Outcomes:
At the conclusion of this session, attendees will gain an understanding of ERM concepts and their application to disability insurance products.
Session Coordinator(s) Rebecca B. Scotchie, FSA, MAAA
Presenter(s): Barbara White Klever, FSA, MAAA; Cori E. Uccello, FSA, MAAA, FCA; Shari Westerfield, FSA, MAAA
Experience Level: All
CPD: 1.80
Country Relevance: USA
Description:
The 2016 election ushered in a new administration and Republicans now control the House, Senate, and White House. As a result, efforts to repeal the Affordable Care Act shifted to crafting more detailed replace and repair proposals. The Academy met with congressional staff and government regulators immediately after the election to discuss the potential consequences of various proposals put forth and these meetings have continued. Join our panelists for a more in-depth discussion of the current status of changes to the ACA as well as highlights from Academy efforts to inform and influence these public policy debates.
Session Sponsor(s): Health Section and Social Insurance & Public Finance Section
Competency: Technical Skills & Analytical Problem Solving
Moderator(s): Marlene Therese Howard, FSA, MAAA
Presenter(s): Richard Lieberman; Bradley Bruce Armstrong, FSA, MAAA
Experience Level: Intermediate - Advanced
CPD: 1.80
Country Relevance: USA
Description:
Navigating Medicaid managed care requires an experienced professional to evaluate and/or question how the risk adjustment model establishes payment levels, the role that encounter data plays in terms of both submission and the state's handling of the data, and the importance of encounter data necessary to enhance capitation payment levels and/or avoid financial sanctions imposed by states.
This session will explore various scenarios related to the quality of available managed care encounter data and potential implications on managed care program risk adjustment. We will describe various risk adjustment methodologies, with particular focus on Chronic Illness & Disability Payment System (CDPS), CDPS+MedicaidRx, and the Johns Hopkins Adjusted Clinical Groups (ACG) System. Collectively, these three risk adjustment approaches cover a vast majority of Medicaid states that employ risk adjustment.
Learning Outcomes:
At the end of this session, attendees will be able to:
Distinguish between the various Medicaid risk adjustment models and how they perform;
Understand the key role played by encounter data and the essential need for MCOs to focus on data integrity and completeness;
Explain potential implications of data quality on Medicaid managed care risk adjustment; and
Appreciate the nuances of how risk adjustment systems are operationalized in various Medicaid states.
Presenter(s): Julia Friedman, FSA, MAAA; Matthew Kranovich, FSA, MAAA
Experience Level: Intermediate
CPD: 1.80
Country Relevance: USA
Description:
This session evaluates the Medicare Advantage (MA) marketplace using a value based approach that includes the impact of both benefits and premium. This session will help users understand the key drivers of plan value. Included will be, real world examples of how a plan sponsor utilized a value based approach to determine benefits. This session is targeted to any actuaries interested in the MA market or those interested in a value based approach to understanding the health insurance market.
Learning Outcomes:
At the conclusion of this session, attendees will be able to focus a plan's benefit decisions using a value based approach, and to better evaluate the competition.
Presenter(s): Alex Bagby, ASA, MAAA; Man Hoi Calvin Chow, FSA, MAAA, CERA; Darrell D. Spell, FSA, MAAA
Experience Level: Beginner - Intermediate
CPD: 1.50
Country Relevance: USA
Description:
In this session, the presenters and the audience will discuss key product packages necessary to be competitive in the worksite market. There are a variety of product designs and offerings that can be utilized to enter the market space; this variety of approaches will be compared. This session will cover the interactions between various product types.
Learning Outcomes:
At the conclusion of this session, the audience will understand the important of a worksite offering package rather than a piece-mail offering of worksite products. Additionally audience members will understand the variety of approaches that can be used to enter and market in the workplace.
Session Coordinator(s) Darrell D. Spell, FSA, MAAA
Presenter(s): Janet Anderson; Nik Tehrani, Ph.D.; Connie B. Weisman
Experience Level: All
CPD: 1.50
Country Relevance: USA and Canada
Description:
BioTech and InsurTech start-ups are introducing innovative ways to utilize technology to monitor and improve consumer health. Technology can simplify and promote proactive consumer involvement in their own health monitoring and treatment. Monitoring expenses are low and the cost of subsequent acute disease management is reduced. Several start-ups will discuss their programs.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Appreciate the multitude of technology initiatives being undertaken to impact health and wellness;
Identify how this technology can improve consumer health; and
Evaluate the impact on health insurance costs.
Session Coordinator(s) Richard J. Tucker, FSA, MAAA
Session Sponsor(s): Health Section, Society of Actuaries
Competency: External Forces & Industry Knowledge
Presenter(s): Stacey Muller, FSA, MAAA, James T. O’Connor, FSA, MAAA
Experience Level: Intermediate
CPD: 1.50
Country Relevance: USA
Description:
This session will present the results of the Spring 2017 Robert Wood Johnson Actuarial Challenge, which gave actuaries a chance to submit approaches towards increase the stability in the individual health insurance market. The challenge elicited innovative ideas and proposals from informed actuaries to move the individual insurance market further toward the goal of universal access to quality health services and providers in a financially secure and stable way with consideration of the costs the solution places upon individuals, employers, health care providers, taxpayers (present and future), and other health sector stakeholders.
Learning Outcomes:
At the conclusion of this session, attendees will:
Learn what reforms were proposed, as well as the financial results of those proposals that were modeled;
Compare them with the approaches currently evolving - or that have already taken place - in the individual market at present; and
Discuss the results with other informed stakeholders.
Description:
This session reviews the results of the most recent annual Canadian health study by Greenshield. The 2017 GSC Health Study, "Come Health or High Water," will address bio-similars, use of anti-depressants and plan design challenges. Results are typically useful to U.S. and other practitioners as well as Canadian practitioners. Participants will be made aware of key trends since the last study, as well as significant observations for future monitoring and assessment.
Learning Outcomes:
At the conclusion of this session, attendees will:
Review results of latest annual health study.
Compare trends from prior studies.
Determine areas for further research.
Session Coordinator(s) Ben Marshall, FSA FCIA CERA MAAA J.D.
Presenter(s): John Doak; Kathleen Hittner, MD; J. P. Wieske
Experience Level: All
CPD: 1.50
Country Relevance: USA
Description:
Insurance commissioners will discuss a variety of current topics including health care reform, risks in the major medical markets, voluntary products and other topics. Following this session, attendees will be able to identify issues that are on the mind of the regulatory agencies and the different approaches used across the country.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Understand the perspectives of state insurance departments
Compare and contrast the different approaches to state based health insurance regulation
Session Sponsor(s): Predictive Analytics and Futurism Section
Competency: Technical Skills & Analytical Problem Solving
Moderator(s): Joan C. Barrett, FSA, MAAA
Presenter(s): Jill S. Herbold, FSA, MAAA; Robert Anders Larson, FSA, MAAA; Erica Rode, ASA, MAAA
Experience Level: Intermediate
CPD: 1.50
Country Relevance: Non-Nation Specific
Description:
Health actuaries are familiar with the concept of risk scores to predict medical claims costs, but risk-adjustment can apply to more specific areas of health care utilization. This session discusses techniques and motivations for creating risk scores tailored to other business objectives. The session will feature two case studies: one on creating custom risk scores to help determine appropriate primary care panel sizes for a provider organization, and one on using service category risk scores for a Medicare Advantage plan working to capitate providers. We will discuss the technical and business challenges related to developing and applying these non-traditional risk scores.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Understand the business problems that can be addressed by innovative risk scores.
Understand the challenges of using a transactional data set without corresponding exposure months.
Understand why predicting office visit utilization requires different techniques than predicting claims costs.
Understand how service category risk scores are developed and how they relate to total risk scores.
Session Coordinator(s) Robert Anders Larson, FSA, MAAA
Presenter(s): Susan R. Sames, FSA, MAAA; Amy Suzanne Whinnett, FSA, MAAA
Experience Level: Beginner - Intermediate
CPD: 1.50
Country Relevance: Non-Nation Specific
Description:
This session discusses the most recent findings of the SOA's Group Life Mortality Committee and describes intended future research. Learn how mortality is driven by geography, income level, and education. See the impact of motor vehicle accidents and drug overdoses on mortality in different age groups. Trade ideas on future mortality trends.
Learning Outcomes:
Attendees will learn about recent group life mortality research by the Society of Actuaries and explore recent mortality trends.
Presenter(s): Tyler Andrew Engel, ASA, MAAA; David M. Liner FSA, MAAA, CERA; Thomas Daniel Murawski, FSA, MAAA
Experience Level: All
CPD: 1.50
Country Relevance: USA
Description:
The US healthcare system is a complex and dynamic web of stakeholders. Understanding how stakeholders respond to incentives provides entities with a strategic advantage. This session will include a discussion of the factors that influence stakeholder behavior and an empirical approach to better understand what drives stakeholder behavior through the use of various case studies.
Learning Outcomes:
At the conclusion of this session, attendees will be able to understand key forces that influence stakeholder behavior and identify approaches to better understand stakeholder behavior.
Session Coordinator(s) Thomas Daniel Murawski, FSA, MAAA
Session Sponsor(s): Financial Reporting Section and Health Section
Competency: Strategic Insight and Integration
Moderator(s): Andrea Bykerk Christopherson, FSA, MAAA
Presenter(s): Rowen B. Bell, FSA, MAAA; Andrea Bykerk Christopherson, FSA, MAAA; Annette V. James, FSA, FCA, MAAA
Experience Level: Intermediate - Advanced
CPD: 1.50
Country Relevance: USA
Description:
This session will discuss early warning signs of insurance company insolvencies and provide a practical approach to application and tips in dealing with potential insolvencies. Additionally, this session will look at information that is embedded in the Health Insurance NAIC Annual Statement. It will include a review of an annual statement and risks that are found within in it. Learn from discussion by users of the Statement on how they use and interpret the information provided. At the conclusion of the session, attendees will be able to understand the intricacies of the annual statement reporting.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Understand the intricacies of annual statement reporting;
Interpret complex financial results and assess the risks involved; and
Identify when insurance companies are facing financial insolvencies
Session Sponsor(s): Social Insurance & Public Finance Section
Competency: Technical Skills & Analytical Problem Solving
Moderator(s): Timothy J. Feeser, FSA, MAAA
Presenter(s): David Beshara, Pharm; Jennifer L. Gerstorff, FSA, MAAA; John Selig, VP, Lewin Group
Experience Level: All
CPD: 1.50
Country Relevance: USA
Description:
This session will provide insight on how the economic cycles, growth versus recession, affect Medicaid enrollment, with a focus on prior cycle impacts on enrollment pre-ACA. In addition, forecasts will be provided on potential impacts on Medicaid enrollments as a result of a potential upcoming growth or recessionary cycle, considering the recent growth in Medicaid enrollment via the ACA expansion.
Learning Outcomes:
Attendees will gain an understanding of how Medicaid eligibility is affected by economic cycles which affect employment levels, and hence Medicaid enrollment.
Session Coordinator(s) Timothy J. Feeser, FSA, MAAA
Presenter(s): Julia Kraemer Lerche, FSA, MAAA; Rebecca Owen, FSA, MAAA; Shereen Joy Sayre, ASA, MAAA; Sara Corrough Teppema, FSA, MAAA
Experience Level: Beginner
CPD: 1.50
Country Relevance: USA
Description:
The field of public health does important work around the world in keeping populations safe and healthy. There is much that the actuarial profession can learn and bring into our practice as we work toward the triple aim of improving the health care experience, improving population health and reducing costs. This session will review some examples of public and population health initiatives and their economic and business case. It will also talk about the work of the SOA's Public Health Task force and how actuaries can get involved in their communities.
Learning Outcomes:
At the conclusion of the session, attendees will be able to:
Understand the meaning of public health and population health and why actuaries need to pay attention
Apply the outcomes of public health initiatives to actuarial practice Identify opportunities to apply actuarial practice to serve communities and bolster public health
Session Coordinator(s) Sara Corrough Teppema, FSA, MAAA
Facilitator(s)
11:30 a.m. – 1:00 p.m.
Amy Cuddy, Author and Associate Professor, Harvard Business School
Social psychologist Amy Cuddy is a Harvard Business School professor,
New York Times
bestselling author, and Young Global Leader at the World Economic Forum. She is author of
Presence: Bringing Your Boldest Self to Your Biggest Challenges.
Focusing on the power of nonverbal behavior, prejudice and stereotyping, the delicate balance of trustworthiness and strength, and the ways in which people can affect their own thoughts, feelings, and behaviors, she teaches thousands of people how to become more present and influential (and satisfied) in their professional and personal lives.
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 Sponsor(s): Leadership & Development Section and Actuary of the Future Section
Competency: Leadership
Moderator(s): Margaret Resce Milkint
Presenter(s): Andrea Bykerk Christopherson; FSA, FCA, MAAA; Amy Cuddy, Associate Professor, Harvard Business School; Lawrence R. Smart, FSA, MAAA; Deborah Watkins
Experience Level: All
Section Representative: Laura J. Wiland, FSA, MAAA
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
The SOA Inclusion and Diversity Committee and The Actuary of the Future, in affiliation with the Women's Insurance Networking Group (WING), presents the Third Annual Women's Leadership Forum. This forum will focus on female leadership topics including insights into redefining and finding success. It will feature keynote presentation from Deborah Watkins, Chief Executive Officer of Care Bridge International-a focused healthcare company offering analytics and predictive modeling on complex medical data. The session will include a panel of female and enlightened male leaders, including Amy Cuddy, author of Presence, and Larry Smart, Chief Actuary at Wellcare.
We welcome all genders to join us for this engaging, thought-provoking forum.
Learning Outcomes:
Identify inclusion & diversity challenges. Learn and apply strategies to eliminate such challenges.
Session Coordinator(s) Olga T. Jacobs, FSA, MAAA
Facilitator(s)
Session Sponsor(s): Health Section
Competency: External Forces & Industry Knowledge
Moderator(s): Ashlee Mouton Borcan, FSA, MAAA
Presenter(s): Ashlee Mouton Borcan, FSA, MAAA; Jason B. Bushey FSA, MAAA; Victor Castellanos; Stephen Rowley
Experience Level: All
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
This session, ran in a buzz group format, will allow the audience to discuss a wide variety of important issues from product development, market trends and observations, current and future regulatory environment, statutory and GAAP changes and much more! This session will involve high level of audience participation and interaction.
Learning Outcomes:
At the conclusion of this session, the audience will have a better understanding of current issues in the supplemental health marketplace.
Presenter(s): Matthew Edward Mayan, FSA, MAAA; Brandy Nicole Millen, ASA, MAAA; Todd M. Wanta, FSA, MAAA
Experience Level: Intermediate
CPD: 1.80
Country Relevance: USA
Description:
We will review the past, present, and future of specialty medications and pharmacy networks in Medicare Part D. After reviewing key specialty products and metrics, we will examine the specialty pipeline, describe innovative proposals to help contain costs, and discuss other developments impacting specialty costs. In the second half, we will review the development of preferred pharmacy networks and their future. Topics include quality networks and how they are designed, the use of direct and indirect remuneration (DIR), and how pharmacies have reacted to both.
Learning Outcomes:
At the conclusion of the session, attendees will be able to:
Identify key specialty products and product classes contributing to specialty cost;
Explain ways plan sponsors are lowering specialty prescription drug costs;
Evaluate the impact of emerging developments on specialty cost in Medicare Part D.
Description:
This session will explore pharmaceutical manufacturer perspectives on economic value and how the health economic and outcomes research and actuarial professions can work together to bridge understandings of economic value between the payer and manufacturer industries. These professions are based on similar calculus-based statistical foundations, but often diverge in practice. As these professions find common ground, efficiencies in the health care system can be gained.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Understand pharmaceutical manufacturer perspectives on economic value definitions
Evaluate the comprehensive economic value specific prescription drugs provide relative to their competitors or treatment alternatives
Develop strategies to optimize the overall economic value of prescription formulary designs
Session Coordinator(s) Gregory L. Warren, FSA, FCA, MAAA
Competency: Technical Skills & Analytical Problem Solving
Presenter(s): Daniel Berty; Suzanne Lepage
Experience Level: Intermediate
CPD: 1.80
Country Relevance: USA and Canada
Description:
This session focuses on best practices in drug claim management in North America. Content is geared toward Canadian practice but is useful for practitioners in the U.S. as well. Content focuses on areas of interest that have been identified from recent surveys of and feedback forms received from health insurance practitioners.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Identify drug claim management techniques
Evaluate their effectiveness, determine ways to seek improvement
Session Coordinator(s) Ben Marshall, FSA, FCIA, CERA, MAAA, J.D.
Presenter(s): David M. Dillon, FSA, MAAA; Brent Plemons; J. P. Wieske
Experience Level: All
CPD: 1.80
Country Relevance: USA
Description:
In this session, participants will find out the latest information on the plan year 2018 changes under the Affordable Care Act. This session will include insight from both Federal and state-based representatives regarding risk adjustment modifications, rate review, and all plan management issues. Panelists will discuss anticipated changes as well as possible future ACA modifications.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Understand the implications of the changes to the 3R programs on financial reporting and pricing
Estimate the impact of anticipated membership changes
Understand the changes in expected morbidity as a result of ACA changes
Moderator(s): Ernest Gerald Jaramillo III, ASA, FCA, MAAA
Presenter(s): Patricia M. Bazin; Adam Golden, MD, MBA; Ernest Gerald Jaramillo III, ASA, FCA, MAAA; Bruce Kinosian; Christina Wong
Experience Level: Intermediate
CPD: 1.80
Country Relevance: USA
Description:
Medicaid's role in providing long term supports and services (LTSS) to the elderly population continues to increase year after year. This session discusses how the Medicaid LTSS market may continue to change in this time of whirlwind political changes and healthcare reforms.
Learning Outcomes:
At the conclusion of the session, attendees will be able to:
Understand the history of LTSS in Medicaid;
Review the difference between fee-for-service and managed LTSS;
Discuss the various LTSS settings of care available;
Explore state-specific differences and implications of future care, including the impact of block grants to the system.
Session Coordinator(s) Jennifer L. Gerstorff, FSA, MAAA
Presenter(s): Matt Holman, Principal, Market Development, Echo Health Ventures; Brian John Ritchie, FSA, MAAA
Experience Level: All
CPD: 1.80
Country Relevance: Non-Nation Specific
Description:
New technologies, apps, and healthcare companies are entering the health care landscape at a rapid pace while changing the way that health care is being delivered, how consumers engage the health care system, and how analytics are performed. Attend this session if you are interested in learning about the impact of some of these changes on the health sector, the insurance industry, and practice of the actuarial profession.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Describe technological changes influencing health care
Explain how these changes impact the industry
Understand how the practice of the actuarial profession will be altered
Session Coordinator(s) Brian John Ritchie, FSA, MAAA
Presenter(s): Cory Joseph Gusland, FSA, MAAA; Yanin Peck Morgan, FSA, MAAA; Thomas Nolan, ASA, MAAA
Experience Level: Intermediate
CPD: 1.80
Country Relevance: USA
Description:
CMS is encouraging providers to engage in risk sharing arrangements with programs like the Qualified Participant status under MACRA. We will review the emerging outcomes under the CMS Medicare Shared Savings Program (MSSP) and Next Generation (NextGen) ACO programs, with an eye on implications for upcoming program years, including a look at the current state of the proposed MSSP Track 1+ alternative. We will also discuss the interaction of these programs with the MACRA requirements and provisions, while focusing on specific impacts to providers.
Learning Outcomes:
At the conclusion of this session, attendees will be more familiar with the MSSP and NextGen programs and the emerging outcomes of participating health systems. Attendees will also better understand how these programs interact with MACRA and its requirements, and understand implications for provider systems.
Session Coordinator(s) Cory Joseph Gusland, FSA, MAAA
Presenter(s): Alfred A. Bingham Jr., FSA, MAAA; Gregory Gierer; Hans Leida, FSA, MAAA; Karan Rustagi, ASA, MAAA
Experience Level: Intermediate
CPD: 1.50
Country Relevance: USA
Description:
With the election of President Trump and a Republican Congress, it's a safe bet significant changes are coming to many of the programs that were just implemented under the Patient Protection and Affordable Care Act. Come hear a panel of experts discuss the latest political and regulatory developments affecting the future of the commercial, Medicare, and Medicaid markets. We will discuss opportunities for health actuaries. We will review the lessons we have learned from the ACA that actuaries must keep in mind going forward.
Learning Outcomes:
At the conclusion of the session, attendees will be able to:
Explain the latest changes to laws and regulations affecting the commercial, Medicare, and Medicaid markets
Identify ways in which their organizations may need to prepare for these changes
Have a basic understanding of the political forces shaping health policy in the U.S.
Presenter(s): Steven B. Abbs, ASA, ACA, MAAA; Ken Ehresmann FSA, MAAA; Theresa Russ Winer, FSA, MAAA
Experience Level: All
CPD: 1.50
Country Relevance: Non-Nation Specific
Description:
Telehealth has received increased focus in recent months for its promise in treating patients across vast distances - even spanning the globe - and potentially lowering the cost of care. This session will expand upon a recent
Contingencies
feature article by providing more detail and examples of telehealth's current use internationally, including behavioral health. The speakers will also go beyond the content of the article to provide a quantitative review of the dollar impact of telehealth, as well as an update of current and proposed legislation affecting the adoption of telehealth, both at the federal and state levels.
Session Sponsor(s): Education and Research Section
Competency: Technical Skills & Analytical Problem Solving
Moderator(s): Paul Luis Correia, FSA, CERA, MAAA
Presenter(s): Mervyn Kopinsky, FSA, EA; Paul Luis Correia, FSA, CERA, MAAA; David A. Wall, FSA, MAAA
Experience Level: Intermediate
CPD: 1.50
Country Relevance: USA
Description:
In 2008 the SOA LTD experience committee published a new termination table to replace the 1987 GLTD table. In 2012, the AAA published a new valuation table and valuation standard using the SOA experience table from 2008.
In this session we will compare the latest actual to expected results relative to these tables with experience data submitted through 2012. In addition we will explore various predictive modeling approaches applied to this latest SOA study.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
The 2008 experience table and the 2012 valuation table
How recent experience is trending relative to these tables
New variables that have studied in this most recent analysis
Some current predictive analytics approaches that are being applied to LTD claim termination studies
Presenter(s): Adrian L. Clark, FSA, MAAA; David Benjamin Koenig, FSA, MAAA
Experience Level: Beginner - Intermediate
CPD: 1.50
Country Relevance: USA
Description:
This session will provide background on the mechanics of the Medicare Advantage risk adjustment program for both Part C and Part D. It will also dive into the details of some of the current concerns within the program. Specifically, it will focus on the ongoing transition from RAPS to EDS as the source of diagnosis information as well as the current legal concerns over recent DOJ lawsuits against insurers regarding their diagnosis submission practices. Time will be provided for questions and answers.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Explain CMS' current diagnosis submission and risk score calculation process at a high level for the HCC and RxHCC risk score models
Describe the current state of the transition to EDS as the sole source of risk adjustment diagnosis information
Explain the business and legal risk involved in diagnosis submission and risk score improvement activities
Presenter(s): Kevin E. Dotson FSA, MAAA; David Allen Myers, ASA; Daniel P. Santmyer FSA, MAAA; Timothy Willard Smith, ASA, MAA, MS
Experience Level: All
CPD: 1.50
Country Relevance: Non-Nation Specific
Description:
In this session we will introduce and define the roles of a healthcare provider actuary, leaning heavily on the work of the value based care strategic initiative. Specifically we will review:
Goal of the initiative which is to identify the necessary foundation for actuaries to support healthcare providers in their value-based care (VBC) activities.
Provider environment and how their business is changing
Affordability
ACA/Triple Aim
MACRA, etc.
What skills and other resources will enhance providers' success in the emerging VBC world, including performing a review of the three strategic initiative focused domains?
What skills do actuaries have that can benefit providers?
How are these skills being applied in the provider space and where can we anticipate an increase in demand in the future?
Learning Outcomes:
Provide education about the current and future environment of healthcare providers.
Identify and educate across multiple VBC areas within provider organizations where actuaries can make significant contributions to their businesses.
Introduce the VBC strategic initiative and share the foundational topics that providers need to acquire for their organization.
Identify the anticipated future needs of providers based on the current trajectory of VBC activities.
This session is not a pre-requisite for participating in the workshop (Sessions 114 and 129) but it is recommended.
Session Coordinator(s) Jay Patrick Hazelrigs, ASA, MAAA
Session Sponsor(s): Marketing & Distribution Section and Leadership & Development Section
Competency: Communication
Moderator(s): Nickolas J. Ortner, FSA, MAAA
Presenter(s): Nickolas J. Ortner, FSA, MAAA, Geoffrey C. Sandler, FSA, MAAA
Experience Level: All
CPD: 1.50
Country Relevance: Non-Nation Specific
Description:
In today's era of increasing reliance on technology, "old school" abilities like business and interpersonal skills are increasingly important to actuaries at all corporate levels who seek to expand their roles and careers. During this interactive forum, actuaries with experience in non-traditional roles will discuss why and where new opportunities for actuaries are emerging in the marketplace, as well as tips and insights actuaries can use to increase their value and elevate their profile in the workplace.
Presenters will share specific ideas and real world examples, while encouraging audience members to share their own experiences.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Identify new opportunities for actuaries in non-traditional roles;
Apply practical approaches to increasing their own value in the workplace; and
Competency: Technical Skills & Analytical Problem Solving
Presenter(s): Timothy B. Moran ASA, MAAA; Kimiko Tam
Experience Level: Intermediate
CPD: 1.50
Country Relevance: Non-Nation Specific
Description:
This session briefly touches on the history of pandemics and pandemic modeling, followed by a discussion of modern methods for pandemic modeling. Specific topics include, the most important vectors to model, how to weight and prioritize them, and how to deal with co-dependencies. Panelists will discuss risk concentrations in group life insurance and use sample data to illustrate modeling approaches, while addressing the potential use of reinsurance to mitigate risk. Time will be provided for questions and answers.
Learning Outcomes:
At the conclusion of this session, attendees will be able to identify pandemic risk factors for group life and evaluate potential analytical and risk mitigation methods.
Session Sponsor(s): Health Section and Joint Risk Management Section (CAS, CIA and SOA)
Competency: External Forces & Industry Knowledge
Moderator(s): Christopher Jason Merkel, FSA, MAAA
Presenter(s): Kristi M. Bohn, FSA, EA, MAAA, MSPA; Jim Morris, CPA, CFE, CGMA, CICA; Christopher Michael Slaybaugh, FSA, MAAA
Experience Level: Beginner - Intermediate
CPD: 1.50
Country Relevance: USA
Description:
The panel will provide a unique forum for regulators and chief risk officers to discuss how to best incorporate ORSA and ERM information into the financial examination and analysis process. There will be a discussion of the importance of each section of the ORSA as well as how to best leverage key information within each section. The panel will also discuss the lessons learned through the ORSA pilot project as well as the 2015 ORSA submissions, including best practices and improvements to the current process.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Evaluate the impact of ORSA and ERM on health insurance companies.
Identify the key issues as seen by state regulators and chief risk officers.
Session Coordinator(s) Mario E. DiCaro, FCAS, MAAA; David M. Dillon, FSA, MAAA
Session Sponsor(s): Canadian Track and Joint Risk Management Section (CAS, CIA and SOA)
Competency: External Forces & Industry Knowledge
Presenter(s): Daniel Berty; Shannon DeLenardo
Experience Level: Beginner - Intermediate
CPD: 1.50
Country Relevance: Non-Nation Specific
Description:
This session provides insights into fraud and abuse risk in the health insurance industry, including an examination of techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Understand current fraud and abuse issues
Examine costs
Determine prevention and detection techniques
Session Coordinator(s) Ben Marshall, FSA, FCIA, CERA, MAAA, J.D.
Facilitator(s)
Session Sponsor(s): Health Section
Competency: External Forces & Industry Knowledge
Presenter(s): Matthew James Hayes, FSA, MAAA
Experience Level: Beginner - Intermediate
CPD: 1.50
Country Relevance: USA
Description:
This session will review new developments in the Part D pharmacy network space. This includes quality networks and how they are designed, the use of direct and indirect remuneration (DIR), how preferred networks have changed, along with other current topics impacting this space. In regards to quality networks, this session will include how they are designed and how pharmacies have reacted. In the DIR space, we will dig into how pharmacies have reacted. Regarding preferred networks, we will review their history, how they have changed, and where might their future go.
Learning Outcomes:
At the conclusion of this session, attendees will be able to:
Define what makes up a quality based network;
Compare different preferred network strategies; and
Explain how DIR impacts Part D.
Session Coordinator(s) Matthew James Hayes, FSA, MAAA
