Agenda Day Two | SOA

Monday, June 25
6:00 a.m. – 4:00 p.m. Registration is open for all meeting attendees. Session Coordinator(s) Facilitator(s)
6:30 a.m. – 7:30 a.m. A breakfast buffet is available for all meeting attendees. Session 1: Disability Special Interest Group Breakfast Presentation(s): View Presentation Session Sponsor(s): Health Section, Disability Special Interest Group Moderator(s): Daniel D. Skwire, FSA, MAAA Presenter(s): Daniel D. Skwire, FSA, MAAA This breakfast session provides an opportunity for disability insurance actuaries to network with their colleagues from around the industry. The program will include an update on activities of the Disability Special Interest Group during the past year, along with highlights from recent industry research. This session is intended for current and prospective practitioners in the disability insurance field. *This breakfast is open to all meeting attendees free of charge. If you plan to attend, you must register in advance.* Session Coordinator(s) Daniel D. Skwire, FSA, MAAA Facilitator(s) Session 2: Education & Research Breakfast Presentation(s): View Presentation Session Sponsor(s): Education & Research Section Moderator(s): Charles S. Fuhrer, FSA, MAAA, FCA Presenter(s): Brian M. Hartman, ASA The Education and Research Section will offer a presentation on section activities as well as description of next actuarial research conference. It will also offer a great chance to network with other section members. *This breakfast is open to all meeting attendees free of charge. If you plan to attend, you must register in advance.* Session Coordinator(s) Charles S. Fuhrer, FSA, FCA, MAAA Facilitator(s)
7:30 a.m. – 9:00 a.m. Session 5: Opening General Session Keynote Speaker: Roni Zeiger Former Chief Health Strategist, Google Co-Founder CEO, Smart Patients Roni Zeiger, former Chief Health Strategist at Google, works at the cutting edge of technology, healthcare and human experience. At Google, he developed innovative digital medical services like online medical records and Google Flu Trends. Roni’s experience in digital health makes him one of the foremost speakers on how the internet is transforming modern healthcare. Session Coordinator(s) Facilitator(s)
9:30 a.m. – 11:00 a.m. Session 7 Buzz Group: Get REAL Leadership: Disruptive Conversations That Work! Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Leadership & Development Section Competency: Communication Presenter(s): Jennifer Barley, PCC; Karen Sullivan, MA, PCC Experience Level: All Often we are faced with situations that call for a new way of communication that breaks us out of the “same ole same ole“ mentality. Challenges arise when we have conflict with others, when we need to give feedback, or we have to help shift others to a more positive way of thinking without getting all Kumbaya-ish (we know you’re intrigued now!). In this Get REAL workshop you will learn about healthy, productive conflict, as well as how to give feedback in a way that will actually win friends and influence people. Learning Outcomes: Discover what prevents us from healthy conflict and conversations Learn how to identify what you are trying to communicate Understand what is your default style when it comes to unhealthy conflict Gain insights on how to show up to conflict in a different way Develop skills that will enhance your communication around any topic you need to cover Country Relevance: Non-Nation Specific Session Coordinator(s) Joanne Ryan, FSA, MAAA Facilitator(s) Session 8 Lecture: Future of Medicare Advantage: Trends of an Expanding Market Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Strategic Insight and Integration Moderator(s): Greg V. Sgrosso, FSA, MAAA Presenter(s): Haitham Aly; David Hayes, FSA, MAAA, Greg. V. Sgrosso, FSA, MAAA Experience Level: Intermediate This session will address the current landscape of the Medicare Advantage market with a focus in future trends due to an increase in the Medicare eligible population. An emphasis will be placed on Medicare eligible enrollment due to the baby boomer population, Part C and D Medicare spending and cost trends, evolving creativity in provider contracting and future benefit package and premium changes. With increased popularity in Medicare Advantage, additional oversight will be placed on future changes in policy and reducing the financial burden for beneficiaries. An intermediate knowledge of the Medicare Advantage program is recommended. Learning Outcomes: Attendees will be further prepared for current and future changes in the Medicare Advantage program. Attendees will gather additional insight into future trends in policy changes and cost spending and will be more equipped to adapt to changes in the marketplace. Country Relevance: USA Session Coordinator(s) Gregory V. Sgrosso, FSA, MAAA Facilitator(s) Session 9 Panel Discussion: Medicaid 101: A Brief History of Time Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Jennifer L. Gerstorff, FSA, MAAA Presenter(s): Nick Bauman; Jennifer L. Gerstorff, FSA, MAAA; Julia K. Lerche, FSA, MAAA; Taylor A. Pruisner FSA, MAAA; Stephanie A. Williams, FSA, MAAA Experience Level: Beginner This interactive panel will engage the audience to demystify Medicaid by giving several perspectives and historical observations of the evolution of the Medicaid program and its divergence into 50+ complex programs covering: Approximately half of all US births -low-income children, pregnant women, and families Low-income adults Aged, blind, or disabled individuals Partial benefits that improve public health initiatives Learning Outcomes: Attendees will come away with an understanding of the history of the Medicaid program. Country Relevance: USA Session Coordinator(s) Jennifer L. Gerstorff, FSA, MAAA Facilitator(s) Session 10 Panel Discussion: Small Group and SHOP Market: Things You Should Know Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): John Price, MAAA, FCA Presenter(s): Dylan Ascolese, FSA, MAAA; Zachary M. Davis, FSA, MAAA; John C. Oliver Experience Level: Intermediate As the federal government debates the health care system in the U.S.—specifically the future of the Affordable Care Act (ACA)—the majority of media coverage and attention has focused on the uncertain future of the individual market. This session shines the spotlight on the potential impacts health care reform may have on the small employer market. Additionally, hear from experts on small group requirements, ratings, multiple plans issued to one employee, valid groups, eligible groups, eligible employees, census data and participation requirements. Learning Outcomes: At the conclusion of the session, attendees will be able to: Determine the impact of recent federal guidance on small employers Understand the details of new rules concerning small group coverage Identify the key issues regarding success in the SHOP Country Relevance: USA Session Coordinator(s) David M. Dillon, FSA, MAAA Facilitator(s) Session 11 Panel Discussion: Credibility Issues for Long Term Disability Insurance Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Technical Skills & Analytical Problem Solving Presenter(s): Paul L. Correia, FSA, CERA, MAAA; Tasha S. Khan, FSA, MAAA Experience Level: Intermediate Historical experience is used by group disability insurers to inform their pricing, underwriting and reserving work. Understanding the statistical credibility of that experience is crucial to making well-informed decisions. The panelists in this session provide a detailed discussion of credibility analysis specific to long-term disability insurance, including a summary of recent SOA research on the topic. Learning Outcomes: Attendees will learn about methods available to analyze the credibility of disability insurance experience and be able to apply these methods in their own work. Country Relevance: Non-Nation Specific Session Coordinator(s) Paul Luis Correia, FSA, CERA, MAAA Facilitator(s) Session 12 Teaching Session: Actuarial Storytelling Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Communication Presenter(s): Jeremy Engdahl-Johnson; Johann K. Leida, FSA, MAAA Experience Level: All Health actuaries are part of important social narratives around the world. And with a complex field like actuarial science, sometimes the ability to effectively tell a story is the difference between success and failure. This session looks at the psychological and cultural roots of how we construct stories and explores how we can become better writers and storytellers. It includes tangible examples from across the actuarial field. Learning Outcomes: Attendees will leave this session equipped with new tools for writing, storytelling, and articulating complex topics. We also guarantee some laughs. Country Relevance: Non-Nation Specific Session Coordinator(s) Marilyn McGaffin, ASA, MAAA Facilitator(s) Session 13 Interactive Forum: Puzzled By Supplemental Benefits? Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Reinsurance Section Competency: Strategic Insight and Integration Moderator(s): Stephen Rowley Presenter(s): William S. Bade, FSA, MAAA; Stephen Rowley Experience Level: Beginner–Intermediate Join this fun interactive session on supplemental benefits. Attendees will participate in solving the supplemental benefits puzzle through a discussion of opportunities, risk, challenges and pitfalls associated with critical illness, accident and hospital indemnity products. Our panel of experts will help guide the discussion while sharing their perspectives throughout the session. Learning Outcomes: Attendees will gain a broad understanding on the challenges, risks and rewards of the supplemental benefits (CI, Accident, and HIP) suite of products. Country Relevance: USA Session Coordinator(s) Jean-Marc Fix, FSA, MAAA Facilitator(s) Session 14 Open Forum: Dental Actuarial Roundtable Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Joanne E. Fontana, FSA, MAAA Presenter(s): Thomas J. Leibowitz, FSA, MAAA; Yi-Ling Lin, FSA, MAAA, FCA; Tom Murawski, FSA, MAAA; Martha M. Stubbs, ASA, MAAA Experience Level: All This session will highlight current topics in dental actuarial work. A roundtable of actuaries working in different areas of the dental industry will present and comment on current regulatory, pricing, product and network issues affecting commercial and public dental insurance, sharing their professional experience with attendees. Audience participation is encouraged. Learning Outcomes: At the conclusion of the session, attendees will be able to describe and understand key issues facing actuaries working in the dental insurance space. Country Relevance: USA Session Coordinator(s) Joanne E. Fontana, FSA, MAAA Facilitator(s) Session 15 Panel Discussion: Benefit Modeling Madness Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Technical Skills & Analytical Problem Solving Moderator(s): Joseph P. Slater, FSA, MAAA Presenter(s): Hobson D. Carroll, FSA, MAAA; Joshua R. Strupcewski, ASA, MAAA; Dustin D. Tindall, FSA, MAAA Experience Level: Intermediate We will discuss the issues that are driving the increasing complexity of health benefit plans. We will also describe the traditional tools used to value health benefit plans and how those tools handle the more complex health benefit plans. Finally, we will review the new generation of benefit plan valuation models being developed to address the more complex plan health benefit plans. Learning Outcomes: At the conclusion of the session, attendees will be able to identify and describe complex health benefit plans and compare the tools used the value them. Country Relevance: USA Session Coordinator(s) Joseph P. Slater, FSA, MAAA Facilitator(s) Session 16 Open Forum: Drug Pipeline Impact on Future Claims Costs Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Entrepreneurial & Innovation Section Competency: Strategic Insight and Integration Presenter(s): Michael T. Hunter; Mehboob A. Khoja, FSA, MAAA Experience Level: Intermediate The specialty drug market has exploded and payers (commercial, government, employers and re-insurers) are struggling to understand the financial impact of new drugs in the pipeline. This session is intended to meet the needs of actuaries focused on drug benefit trends and leveraging predictive modeling tools to better forecast the financial impact of new drugs. Learning Outcomes: At the conclusion of this session, attendees will be able to understand the implications of specialty drug costs on future claims costs, how segmentation and modeling techniques can be used to better predict individual member costs and the ability to develop strategies for controlling costs. Country Relevance: USA Session Coordinator(s) Joseph Boschert Facilitator(s) Session 17 Panel Discussion: The Impact of Competing Products on ACA Markets Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Gregory G. Fann, FSA, MAAA, FCA Presenter(s): Pedro L. Alcocer, FSA, MAAA; Gregory G. Fann, FSA, MAA, FCA; Patrick Paule Experience Level: All Federal regulations are allowing new product opportunities for individuals and employer groups. This session will explore Association Health Plans, short-term medical plansand other products that might attract enrollment away from ACA market. Panelists will discuss the impact on the uninsured rate and risk pool implications resulting from the expansion of these markets. Learning Outcomes: At the conclusion of the session, attendees will be able to: Describe the alternative products available to ACA enrollees, Understand the potential impact on pricing and enrollment in ACA market; and Explain the potential migration effects from ACA products and the uninsured population into competing products. Country Relevance: US Session Coordinator(s) Gregory G. Fann, FSA, FCA, MAAA Facilitator(s) Session 18 Teaching Session: Understanding Healthcare Consumerism Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): SOA Competency: Strategic Insight and Integration Moderator(s): Ronald E. Bachman, FSA, MAAA Presenter(s): Ronald E. Bachman, FSA, MAAA Experience Level: Intermediate–Advanced How to understand the multi-generational evolution of healthcare consumerism that lowers costs, improves quality of care, increases access to care, and adds convenience and choice of treatment options and providers. Recent industry studies and trends are provided. Class includes worksheets, tools and textbook and internal consulting processes to improve developing health plans. Learning Outcomes: Understanding the differences between health care consumerism and consumer directed health care. How to prepare an employer to optimize the value of health care consumerism Understanding the five developing generations of health care consumerism How to develop products and services that fully engage plan members Additional free materials are available in a follow up website and a video textbook Country Relevance: USA Session Coordinator(s) Ronald E. Bachman, FSA, MAAA Facilitator(s)
11:15 a.m. – 12:45 p.m. Session 20: Networking Lunch Join your fellow meeting attendees at this networking lunch. Catchup 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. Session 23 Open Forum: Health Plan Payment in Regulated Health Insurance Markets Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Michael Cohen, Ph.D. Presenter(s): Thomas McGuire; Richard Van Kleef Ph.D. Experience Level: All Around the world, health insurance markets are organized around principles of ‘regulated competition’. Examples include the U.S. marketplaces, Medicare Advantage and the health insurance exchanges in the Netherlands, Switzerland and Germany. In these markets, insurers compete on the price and quality of health plans subject to regulation to achieve social objectives. The performance of these markets crucially depends on the health plan payment system, which typically includes community-rated premiums, risk-adjustment and, sometimes, other plan payment features. The design of these systems greatly varies across settings. The goal of this session is to equip participants with a conceptual basis and practical tools to understand the functioning of plan payment systems. The session consists of three parts. First, Harvard University professor Thomas McGuire will introduce the audience to the objectives associated with regulated competition and with health plan payment in particular. Second, Erasmus University Rotterdam professor Richard van Kleef will guide the audience through design aspects and evaluation metrics, using examples and data from the Dutch basic health insurance, which includes one of the most sophisticated payment systems in the world. Third, both speakers will engage with the audience to discuss ongoing issues and reforms, with John Bertko from Covered California as moderator. Learning Outcomes: At the conclusion of the session, attendees will be able to: Describe the objectives of health plan payment in regulated health insurance markets; Apply metrics to evaluate and compare the outcomes of health plan payment systems; and Explain ongoing issues and reforms in health plan payment design. Country Relevance: Non-Nation Specific Session Coordinator(s) Thomas McGuire Facilitator(s) Session 24 Panel Discussion: Hot off the Press: The Latest ACA Developments Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Gregory G. Fann, FSA, MAAA, FCA Presenter(s): Gregory G. Fann, FSA, MAAA, FCA; Catherine M. Murphy-Barron; Austin Nimocks; Patrick Paule Experience Level: All This session will explore the latest ACA developments both at the federal and state level. An interactive environment will allow attendees to discuss state specific topics and share their thoughts on potential implications. Learning Outcomes: At the conclusion of the session, attendees will be able to understand the latest ACA developments at the federal and state level, and have an understanding of legislative or regulatory implications. Country Relevance: USA Session Coordinator(s) Gregory G. Fann, FSA, FCA, MAAA Facilitator(s) Session 25 Interactive Forum: Make Risk Your Friend – Next Generation Claim Prediction Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Results-Oriented Solutions Moderator(s): Nickolas J. Ortner, FSA, MAAA Presenter(s): Elena V. Black, FSA, EA, MAAA, FCA Experience Level: Beginner– Intermediate Moving beyond simple measurements (participation and counts) to next level data and metrics, this session will discuss how next generation claim prediction works and how the emerging innovations differ from today's simple analyses; who (companies and individuals) may benefit; why it's increasingly relevant and critical in today's world; and considerations to keep in mind before (or when) you dive in. Audience members should take away from the session a baseline understanding for developing their own next generation predictive models and educating their constituencies about the needs, challenges and opportunities that may evolve from such modeling. Learning Outcomes: At the conclusion of the session, audience members should possess a deeper understanding of the critical elements needed to: Elevate their claim risk prediction, prioritization, and management capabilities; Educate their constituencies about the need, challenges and opportunities that may evolve from such modeling; and Develop and enhance their own next generation predictive models. Country Relevance: USA Session Coordinator(s) Nickolas J. Ortner, FSA, MAAA Facilitator(s) Session 26 Panel Discussion: MA– PD Market: Entry and Expansion Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Strategic Insight and Integration Presenter(s): Audrey L. Halvorson, FSA, MAAA; Jon M. Hendrickson, FSA, MAAA Experience Level: Intermediate As the Medicare Advantage – Part D market becomes more competitive and the Baby Boom generation continues to age into Medicare, organizations are evaluating entry into and increasing their presence in the MA– PD market. This sessions provides key milestones that entrepreneurs need to meet to launch their own MA– PD plan, describes key components of feasibility analysis, and discusses an overview of operational considerations when expanding into new types of coverage or new service areas. Learning Outcomes: Understand key milestones that need to be accomplished in starting your own health plan Identify opportunities where actuaries can provide input to inform otherwise non-actuarial decisions Stoke your curiosity about entrepreneurship in the insurance industry Identify key metrics for feasibility analyses Evaluate the profitability potential and break-even point of an expansion proposal Determine what operational analyses will need to be considered for an expansion of coverage Country Relevance: USA Session Coordinator(s) Jonathan Mark Hendrickson, FSA, MAAA Facilitator(s) Session 27 Interactive Forum: Is Your Integrated Delivery System Throwing Away Free Money? Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Strategic Insight and Integration Presenter(s): Timothy K. Murray, FSA, MAAA; Karan Rustagi, FSA, MAAA Experience Level: Intermediate This webcast will demonstrate how good actuarial work can influence high-level C-suite decisions and ultimately drive greater collaboration between payers and provider within an integrated delivery system. This webcast uses Medicare Advantage bid development to illustrate how payers and providers can produce fact-based arguments to seek reimbursement arrangements that support the goals of the integrated delivery system. We also explore our experience with some of the challenges that prevent integrated delivery systems from realizing their full potential. Learning Outcomes: Strategic Insight and Integration, Results-Oriented Solutions, Technical Skills and Analytical Problem-Solving Country Relevance: USA Session Coordinator(s) Karan Rustagi, FSA, MAAA Facilitator(s) Session 28 Workshop: Blockchain Innovation in Healthcare Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Technology Section Competency: Technical Skills & Analytical Problem Solving Presenter(s): Tom Murawski, FSA, MAAA; Karena M. Weikel, ASA, MAAA Experience Level: Intermediate Will Blockchain revolutionize healthcare? The technology underlying blockchain fuels decentralization. Blockchain is recognized by many to be a foundational technology, on par with the invention of the microprocessor and the Internet, and has the potential to transform many industries. This session will include a review of how blockchain technology works, current applications and potential future applications of blockchain in the healthcare system. Actuaries who are focused on population health, value based payment models, risk adjustment, medical economics and healthcare analytics should familiarize themselves with this emerging technology. Learning Outcomes: Attendees will be able to explain the concept of Blockchain technology. Attendees will evaluate and determine how Blockchain can be used in health care. Attendees will describe the impact Blockchain is having on other industries. Attendees will identify industries and countries impacted by Blockchain. Country Relevance: USA Session Coordinator(s) Karena Marie Weikel, ASA, MAAA Facilitator(s) Session 29 Workshop: Individual Disability Insurance Discussion Group Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Daniel D. Skwire, FSA, MAAA Presenter(s): Margaret Cormier, FSA, MAAA; Daniel D. Skwire, FSA, MAAA Experience Level: Intermediate–Advanced Individual disability insurance is a specialized niche and there are significant complexities related to pricing, underwriting and reserving. This session provides practitioners in this field a chance to participate in a moderated discussion with colleagues from around the industry. It is intended for current and prospective participants in this market. Learning Outcomes: Attendees will gain an understanding of current issues in the individual disability market and have the opportunity to pose questions to others in the business. Country Relevance: Non-Nation Specific Session Coordinator(s) Daniel D. Skwire, FSA, MAAA Facilitator(s) Session 31 Panel Discussion: NADP’s Work on Dental Diagnosis Terminology and Why Health Actuaries Should Care Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Presenter(s): Timothy L. Brown; Joanne E. Fontana, FSA, MAAA Experience Level: All In this session, Tim Brown of National Association of Dental Plans will discuss his organization’s work toward establishing a universal diagnosis coding terminology for dental claims and how the use of dental diagnosis codes can transform the dental benefits industry. Joanne Fontana of Milliman will provide an actuarial perspective on the potential advances in dental and integrated medical/dental claims analysis once dental diagnosis code data becomes widely available. Learning Outcomes: At the conclusion of this session, participants will have a better understanding of advances in dental diagnosis coding and the potential for actuarial analysis using dental diagnosis code data. Country Relevance: USA Session Coordinator(s) Joanne E. Fontana, FSA, MAAA Facilitator(s) Session 32 Panel Discussion: ACA Uncertainty and New Product Opportunities Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Marketing & Distribution Section Competency: External Forces & Industry Knowledge Presenter(s): Alan Ingley; Darrin Tulley Experience Level: All This session discusses the future of ACA’s exchanges around the current political landscape. As uncertainty grows around the future of ACA as key competitors exiting the market and choices are getting limited for consumers. The panel will discuss the market opportunities created by this uncertainty and possible solutions such as high deductible health plans in conjunction with supplemental health products, etc. Learning Outcomes: This session will discuss the volatility in ACA market place and potential new product opportunities including supplemental products. Country Relevance: USA Session Coordinator(s) Kamran A. Malik, ASA, MAAA Facilitator(s) Session 33 Panel Discussion: Key Medicaid Experience Analytics: From Data to Action Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Technical Skills & Analytical Problem Solving Moderator(s): David A. Neiman, FSA, MAAA Presenter(s): Zachary C. Aters, ASA, MAAA; Henry S. Burden, ASA, MAAA; Thomas J. Garrity, ASA, MAAA; Taylor A. Pruisner, FSA, MAAA Experience Level: Beginner–Intermediate The session will explore optimal Medicaid data management development and specific analytics to support the spectrum of Medicaid managed care financial management: reporting, forecasting and rate negotiations. The emphasis will be on how to be prepared to answer the what happened and why it happened to inform the key questions around will it continue and how do we address it strategically. Actual case studies will highlight success stories that supported operational and rate negotiation strategies. The session is intended for Medicaid managed care actuaries working to develop comprehensive data management and analytics for financial management functions to support strategy development. Learning Outcomes: At the conclusion of the session, the attendees will be able to: Design data marts leveraging internal and external data sources; Develop analytics specific to the financial management of Medicaid managed care; and Identify opportunities to leverage analytics for rate negotiations. Country Relevance: USA Session Coordinator(s) David A. Neiman, FSA, MAAA Facilitator(s) Session 34 Panel Discussion: Initiative 18/11: What Can We Do About the Cost of Health Care? Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Joe L. Wurzburger, FSA, MAAA Presenter(s): Joan C. Barrett, FSA, MAAA; Larry Levitt; Brian E. Pauley, FSA, MAAA Experience Level: All This session will describe the SOA's Initiative 18/11: What can we do about the cost of health care? The session will also present findings and action steps. The discussion is likely to center on what is driving costs from a disease burden, clinical capabilities and administrative and finance point of view. Learning Outcomes: Learn about the initiative and understand it's findings. Country Relevance: USA Session Coordinator(s) Joan C. Barrett, FSA, MAAA Facilitator(s)
2:30 p.m. – 3:00 p.m. A refreshment break is available for all meeting attendees.
3:00 p.m. – 4:30 p.m. Session 37 Panel Discussion: Critical Illness: How Do You Price This Stuff? Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Technical Skills & Analytical Problem Solving Presenter(s): Jennifer O. Howard, FSA, MAAA; Kayla Rooney, ASA; Alexander J. Schuh, FSA, MAAA Experience Level: Beginner More and more carriers are entering the critical illness space but very few have credible data for pricing these new products. In this session, we will discuss considerations in developing these new products, available data and applicable adjustments to such data and step through a sample calculation of the claim costs of a critical illness benefit trigger. Learning Outcomes: At the conclusion of the session, attendees will be able to determine the appropriateness of data for pricing a new critical illness plan, identify modifications to the data for an insured population and demonstrate the development for calculating claim costs for a sample benefit. Country Relevance: USA Session Coordinator(s) Jennifer Howard, FSA, MAAA Facilitator(s) Session 38 Panel Discussion: Use of Big Data to Optimize Plan Design Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Strategic Insight and Integration Moderator(s): David V. Axene, FSA, CERA, FCA, MAAA Presenter(s): Jordan Armstrong; David V. Axene, FSA, CERA, FCA, MAAA; Timothy W. Smith, ASA, MAAA Experience Level: Intermediate Actuaries can utilize consumer information to help optimize benefit plan design to pro-actively impact health care costs and utilization of benefits. This session will present a recent case study showing how this was accomplished. This makes use of "personas", detailed health care analytics, actuarial health cost models, etc. This is based upon actual client project. Learning Outcomes: Instructive session to learn how to make practical use of consumer-based big data and impact patient behavior through strategic benefit design. This session will include practical approaches to accomplish this. Country Relevance: USA Session Coordinator(s) David V. Axene, FSA, CERA, FCA, MAAA Facilitator(s) Session 39 Panel Discussion: Social Determinants of Health: An Actuarial Perspective Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Jordan Paulus, FSA, MAAA Presenter(s): Ralph J. Perfetto Jr., Ph.D.; Mason Roberts, ASA; MAAA, MBA; Ksenia Whittal, FSA, MAAA Experience Level: Beginner–Intermediate As the health care community increasingly recognizes that socioeconomic factors have a significant impact on health outcomes, greater attention is being placed on understanding and addressing social determinants of health in an effort to achieve greater health quality. This session will discuss efforts by payers and health programs to understand the impact on healthcare costs of social determinants of health such as inadequate housing and transportation. We will also present examples of actionable steps that organizations are using to manage these risks and improve the health of their member population. Learning Outcomes: At the conclusion of the session, attendees will be able to: Describe the relationship between socioeconomic factors and health outcomes; Evaluate efforts to understand the impact of social determinants and improve the health of various populations; and Design programs and payment arrangements to identify and address health outcomes impacted by social determinants. Country Relevance: USA Session Coordinator(s) Jordan Paulus, FSA, MAAA Facilitator(s) Session 40 Open Forum: Women's Leadership Forum - And Men Come Too! Credits: 1.80 CPD Session Sponsor(s): Health and Actuary of the Future Sections Competency: Leadership Presenter(s): Margaret A. Meister, FSA, MAAA; David Mendelsohn Experience Level: All The SOA Inclusion and Diversity Committee and The Actuary of the Future, in affiliation with the Women's Insurance Networking Group (WING), present the Fourth Annual Women's Leadership Forum. Margaret Meister, FSA, CEO, Symetra will share her career journey from FSA to CEO to inspire and educate on how women can achieve their full leadership potential and the important role that all genders have in achieving that outcome. We welcome all genders to join us for this engaging and thought-provoking forum. Learning Outcomes: Identify thoughts and actions that are preventing women to achieve their full leadership potential Apply thoughts and actions so that all genders can succeed in the actuarial profession. Country Relevance: Non-Nation Specific Session Coordinator(s) Olga T. Jacobs, FSA, MAAA Facilitator(s) Session 41 Panel Discussion: Is it Time to Review Your Trend Model? Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Technical Skills & Analytical Problem Solving Moderator(s): Joan C. Barrett, FSA, MAAA Presenter(s): Joan C. Barrett, FSA, MAAA; Bethany McAleer, FSA, MAAA Experience Level: All Most health plans have a system to project pricing trends, but given today's dynamic environment, the system may need to be reviewed and refreshed. In this session, the presenters will discuss methods to determine if changes are worth the effort, a review of techniques for determining trend, key factors that may impact trends in the near future and techniques for adapting trend models to measure risk and determine actionable steps to reduce costs. In addition, longer terms factors will be discussed in some detail. Learning Outcomes: Describe the key components of trend Develop risk measurement techniques within a trend model Identify areas to reduce costs Identify long term factors impacting trends Country Relevance: Non-Nation Specific Session Coordinator(s) Joan C. Barrett, FSA, MAAA Facilitator(s) Session 42 Workshop: Group Life and Disability Discussion Group Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Nina Han, FSA, MAAA, CERA Presenter(s): Thomas M. Casalena, FSA, MAAA; Anthony E. LaSala, FSA, MAAA Experience Level: Intermediate This session provides an opportunity for participants in the group life or disability business to have an open discussion with their colleagues on a variety of topics. Examples may include pricing, underwriting, reserving, and experience trends. The session is intended for current or prospective participants in the group life or disability business and active participation is encouraged. Learning Outcomes: Attendees will have the opportunity to interact directly with other actuaries in the group life and disability business. Country Relevance: Non-Nation Specific Session Coordinator(s) Daniel D. Skwire, FSA, MAAA Facilitator(s) Session 43 Buzz Group: Valuation Hot Topics - Let's Buzz Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Presenter(s): Ashlee Mouton Borcan, FSA, MAAA; Nancy J. Hubler, ASA, MAAA; Annette V. James, FSA, MAAA, FCA; Jack S. Keck, FSA, MAAA; Douglas T. Norris, FSA, MAAA Experience Level: All This session, run in a buzz group format, will allow the audience to discuss a wide variety of important valuation issues from both blue book and orange book financial statements as well as hot topics in GAAP and tax reform updates. 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 health valuation. Country Relevance: USA Session Coordinator(s) Ashlee Mouton Borcan, FSA, MAAA Facilitator(s) Session 44 Panel Discussion: Recent SOA Health Research Projects Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Steven C. Siegel, ASA, MAAA Presenter(s): James M. Dolstad, ASA, MAAA; Adam R. Singleton, FSA, MAAA; Julie M. Witt, FSA, MAAA, FCA Experience Level: Beginner-Intermediate The SOA’s Health Section is committed to providing research for its members and other practitioners that result in information, data, or tools that are accessible and useful. This session will provide a brief overview of SOA Health Section research projects as well as in-depth presentations of selected recent ones. The topics for in-depth presentations include the Impact of MACRA and Provider Networks in and out of Exchanges. Learning Outcomes: At the conclusion of the session, attendees will gain a better understanding of current SOA health research projects and prompt them to think about what other health care-related research may be useful to them. Attendees may also communicate ideas for future research and potentially become involved in SOA research as a volunteer reviewer or engaged researcher. Country Relevance: USA and Canada Session Coordinator(s) Steven C. Siegel, ASA, MAAA Facilitator(s) Session 45 Panel Discussion: Staying Ahead of the Star Rating Curve Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: External Forces & Industry Knowledge Moderator(s): Suzanna-Grace Sayre, FSA, MAAA, CERA Presenter(s): Danielle J. Beierle, ASA, MAAA; Timothy K. Murray, FSA, MAAA Experience Level: Intermediate Medicare Advantage (“MA”) organizations are heavily incentivized to improve the quality of healthcare and pharmacy services via the star rating program. This session will discuss the importance of MA plans quality star ratings, review some of the strategies plans use to accurately predict measure-level star ratings, and recommend tips for actuaries to ensure they are maximizing potential plan revenue and maintaining flexibility with benefit packages. During this discussion, we will also review the process that CMS uses to develop Star measure cut-points and calculate the overall star rating of each contract. Recently, CMS has proposed significant policy and technical changes starting for contract year 2019, particularly around CMS calculations of star ratings in the case of contract consolidations. We will discuss the impact that these new regulations could have on issuers and the MA market at large, as well as some historical context for why these changes have been proposed. Given the various challenges and opportunities that insurers face with their star rating programs, this session will be informative and beneficial for healthcare actuaries with any involvement in Medicare Advantage product area. Learning Outcomes: Better understand and interpret the star rating measure and contract-level star rating calculations Determine what strategic opportunities are available for improving or maintaining a plan’s star rating. Benefits from this include the ability to maximize potential revenue and maintain benefit flexibility Identify the various CMS proposed regulatory changes surrounding star ratings and describe their impact on overall plan revenue Country Relevance: USA Session Coordinator(s) Tim Murray, FSA, MAAA Facilitator(s) Session 46 Panel Discussion: Crystal Ball Forecast – The Future of LTSS/LTC Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Long Term Care Insurance Section Competency: External Forces & Industry Knowledge Presenter(s): Rhonda K. Ahrens, FSA, MAAA; Jenny L. Gerstorff, FSA, MAAA; Christopher J. Giese, FSA, MAAA; Benjamin Veghte, Ph.D. Experience Level: Beginner–Intermediate This is a joint session covering: a high-level summary of the current state of private and public LTC/LTSS financing, a recap of some current reform activities and live polling questions on statements of future trends.Questions will lead to interactive discussion from panelists and audience on views of the future. Learning Outcomes: Describe the current state of public and private financing Explain current reform activities Understand future trends for LTC/LTSS financing Country Relevance: USA Session Coordinator(s) Rebecca Tipton, FSA, MAAA Facilitator(s) Session 47 Lecture: Health Reserve Setting Presentation(s): View Presentation Credits: 1.50 CPD Session Sponsor(s): Financial Reporting Section Competency: Technical Skills & Analytical Problem Solving Moderator(s): Marilyn M. McGaffin, ASA, MAAA Presenter(s): David A. Berry, FSA, MAAA; Lisa M. Parker, ASA, MAAA, Andrew Z. Smith, ASA, MAAA Experience Level: Beginner This session will present how to set health claims reserves, covering the basic methodologies. Among considerations that will be discussed during the reserve setting process are the following topics: claims inventory, payment schedule per month, low-paid claims when the month ends in a holiday, distortion of payment patterns with significant claims reprocessing, provider submission patterns, seasonality impacted by the initial year of the Affordable Care Act and retroactive membership adjustments in Medicaid program. Learning Outcomes: At the conclusion of the session, attendees will be able to evaluate health claim reserves with a robust list of considerations to use to refine their estimates. Country Relevance: USA Session Coordinator(s) JoAnn Bogolin, ASA, FCA, MAAA Facilitator(s) Session 48 Lecture: Understanding the ACA's RADV Audit Process Presentation(s): View Presentation Credits: 1.80 CPD Session Sponsor(s): Health Section Competency: Technical Skills & Analytical Problem Solving Moderator(s): Johann K. Leida, FSA, MAAA Presenter(s): Maria L. Leth, ASA, MAAA; Erica Rode, Ph.D., ASA, MAAA Experience Level: Intermediate This session will provide an overview of the 2016 risk adjustment data validation (RADV) pilot audit, review the CMS audit results (targeted for release in the spring of 2018), explain the calculation that will be used to adjust future risk adjustment transfer payments and review any finalized or proposed changes to the audit process. Learning Outcomes: Come away from the session with an understanding of the RADV audit process, challenges and risk adjustment transfer payment impact. Country Relevance: USA Session Coordinator(s) Maria Lynn Leth, ASA, MAAA Facilitator(s)
4:45 p.m. – 6:15 p.m. Networking Reception Relax, mingle and build professional connections at this fun and useful event. Meeting badges are required for attendees and registered guests. Session Coordinator(s) Facilitator(s)