Agenda Day Four

Wednesday, June 27
6:00 a.m. – 10:30 a.m.
6:00 a.m. – 7:15 a.m.

Presentation(s): View Presentation

Session Sponsor(s): Health Section

Moderator(s): Sarah C. Osborne, FSA, MAAA, FCA

Presenter(s): Lynn Barr, MPH

Representatives from Health Section Council leadership will give an update on Council activities and initiatives.  Following council updates will be the feature presentation, Scaling ACOs for Success by Lynn Barr, CEO of Caravan Health.  More than 80 percent of all ACOs are too small to succeed under downside risk. Because of their size, ACOs experience savings and losses of plus or minus 10-20 percent, simply due to statistical variation in health care spending and in risk scores. This session will highlight a solution to this problem through a successful model of nesting multiple, smaller ACOs within a collaborative ACO model. During this presentation, attendees will discover the proven population health management model that consistently beats the benchmarks and produces quality scores above 90 percent.

This breakfast is open to all meeting attendees free of charge. If you plan to attend, you must register in advance.

Session Coordinator(s) Sarah C. Osbourne, FSA, MAAA

Facilitator(s)

7:30 a.m. – 9:00 a.m.

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Moderator(s): Christopher A. Schmidt, FSA, MAAA

Presenter(s): Jeffrey J. Burke, ASA; Christopher A. Schmidt, FSA, MAAA; Mike Van Den Eynde

Experience Level: All

The cost of health care in the U.S. has been on an unsustainable rise for some time driven by fundamental delivery and financing challenges. Health plans need to seek greater control and effectiveness of care management resources, while consumers are demanding care be more personalized and patient-centric. Health plans need to use data analytics to identify opportunity areas with the most potential for reducing costs through care model redesign. Understanding key care model trends, design concepts, and steps for developingand enhancing comprehensive care design models will help lead to reduced costs for health plans.

Learning Outcomes:

  • How can you identify key areas to focus on for care model redesign?
  • What are key trends in care models?
  • What are key future design concepts for care models?
  • What are the key first steps health plans should be taking to improve their care models?

Country Relevance: USA

Session Coordinator(s) Chris Schmidt, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Education & Research and Predictive Analytics and Futurism Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Charles S. Fuhrer, FSA, MAAA, FCA

Presenter(s): Charles S. Fuhrer, FSA, MAAA, FCA; Andrew J. Mackenzie, ASA MAAA

Experience Level: Beginner – Intermediate

Intro to general consumer decision making with reference to behavioral economics research

  • Applicability of these concepts to health plan elections
  • What makes health elections unique from other consumer decisions
  • Why offer choice?
  • Discussion research specific to medical plan choice
  • Ability to predict choice using statistical models
  • Ability to influence choice using decision support

Learning Outcomes:

  1. Understand the difficulty of predicting plan choice
  2. Be able to design programs that help members make optimum choices
  3. Be more aware of various behavioral economics techniques for choice of plan

Country Relevance: USA

Session Coordinator(s) Charles S. Fuhrer, FSA, FCA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Entrepreneurial & Innovation Section

Competency: External Forces & Industry Knowledge

Moderator(s): Achilles M. Natsis, FSA, MAAA

Presenter(s): John. H. Rogers, ASA, MAAA; Jane Wang

Experience Level: Intermediate

This session will provide an overview of the key trends and health industry innovations in relevant global markets. The speakers will provide a perspective on the underlying factors of these trends and lessons learned by carriers and benefit providers. This session will also address how their respective evolving industry may impact or drive change in other global markets.

Learning Outcomes:

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

  1. Evaluate how their level of innovation and evolving market trends compare globally
  2. Identify lessons learned, leading practices or innovative business models that can be leveraged in their market
  3. Identify opportunities to collaborate with partners in and outside of the health industry

Country Relevance: International

Session Coordinator(s) Melissa Carruthers, FSA, FCIA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Kevin L. Pedlow, ASA, MAAA, FCA; Mathew, H. Smith, FSA, MAAA

Experience Level: Intermediate

Many MA-PD (Medicare Advantage - Part D) organizations have related party financial arrangements. These arrangements can be in the form of shared financial interests with a contracted provider organization, a corporate parent that provides administrative services, or similar arrangements. When filing bids, CMS (Centers for Medicare and Medicaid Services) requires these arrangements to be priced in one of a handful of methodologies, and documented according to specific criteria. This session discusses how these arrangements work, both for medical and administrative services agreements, as well as CMS requirements for each of these arrangements.  We will present the different related party methods that CMS allows, discuss situations where each may be applicable, and demonstrate how to incorporate each of them into your bids.  We will also present the perspective of CMS auditors on these issues.  This will include covering all documentation requirements and a discussion on adequate qualitative and quantitative support submitted with the initial bid submission. The course will also cover the requirements for signed attestations and unique requirements for Part D pharmacy expenses paid to related parties.

Learning Outcomes:

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

  1. Evaluate how related party arrangements work for MA-PD organizations, and recognize a related party arrangement where one exists;
  2. Apply any of the pricing methodlogies allowed by CMS for related party arrangements and understand how a plan's particular circumstances can constrain or expand their options for related party pricing; and
  3. Document their related party arrangements to be in compliance with CMS regulations.

Country Relevance: USA

Session Coordinator(s) Matthew H. Smith, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): SOA and Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Traci L. Hughes, ASA, MAAA

Presenter(s): Kristi M. Bohn, FSA, MAAA, EA, MSPA; Michael Cohen Ph.D.; Danielle W. Hilson, FSA, MAAA; Julie A. Peper, FSA, MAAA

Experience Level: Beginner – Intermediate

This session will discuss the flexibility that states have in shaping their individual and small group health insurance markets. This includes areas such as essential health benefits, changes to risk adjustment models, implementing reinsurance programs and others that we will discuss. Several of these initiatives may involve states submitting 1332 innovation waivers. We will discuss the experience we have had in helping states submit their 1332 waivers, including how the process works in general and more specifics of the anticipated impact of the waivers. In addition, we will discuss the impact that these changes may have on market stability. Finally, we will  cover what trends in state flexibility may be happening in the near future that include policies that influence both the individual market and Medicaid program. The session will meet the needs of healthcare actuaries with any involvement in private insurance (i.e. individual or small group markets) and potentially Medicaid programs.

Learning Outcomes:

  1. Identify the options and flexibility that states have in shaping their healthcare marketplaces. 
  2. Explain what 1332 waivers are and how states can use them to increase options and flexibility in their marketplaces. 
  3. Understand the impact the various initiatives may have on the stability of the market. 

Country Relevance: USA

Session Coordinator(s) Danielle Hilson, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Eric J. Carlson, FSA, MAAA; Leo D. Tinkham

Experience Level: Beginner–Intermediate

The world of medical underwriting and evidence of insurability is changing quickly.  In recent years carriers have invested heavily in technology and less invasive techniques in an effort to speed decision time, reduce costs, improve consistency, and improve accessibility to buyers.   This session will review recent changes and discuss changes currently under development.

Learning Outcomes:

Attendees will understand ways to speed decision time, reduce costs, improve consistency, and improve accessibility to buyers.  Attendees will be equipped to champion these ideas in their own companies.

Country Relevance: USA

Session Coordinator(s) Leo Tinkham

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Puneet Budhiraja, ASA, MAAA; Sudha Shenoy, FSA, MAAA, CERA; Steven J. Tutewohl, FSA, MAAA

Experience Level: Intermediate

As the healthcare industry evolves toward improving quality outcomes through innovative funding arrangements, Medicaid markets have begun exploring the spectrum of risk-sharing arrangements between Medicaid providers and health plans. The panel will provide multiple perspectives on topics such as value-based purchasing, accountable care organizations, innovative state programs, and the feasibility/risk appetite of Medicaid providers.

Learning Outcomes:

Understand provider considerations in accepting risk contracts under the range of various funding models being used in Medicaid to improve quality while reducing cost through provider incentives.

Country Relevance: USA

Session Coordinator(s) Sudha Shenoy, FSA, CERA, MAAA

Facilitator(s)

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): Julie A. Andrews, FSA, MAAA; Torrie K. Fields, MPH

Experience Level: Intermediate

This session will discuss the unique challenge of managing costs of high risk members in the individual market. We will review historical state-based regulation to manage these costs, as well as the more recent approaches to reduce risk through risk-adjustment and reinsurance. We will discuss the advantages and disadvantages of each program. In addition, we will  coverthe options that states are now considering to stabilize the individual market through 1332 waivers, which include condition-based and parameter-based reinsurance programs. Finally, we will present the results of our analyses on the potential premium impact of each of these programs. This session will be informative and beneficial for healthcare actuaries with any involvement in the individual market.

Learning Outcomes:

  1. Explain traditional methods for managing high-risk members.
  2. Understand the current approaches that states are considering to stabilize their markets and mitigate the costs for high-risk members.
  3. Review the impact of various reinsurance program designs in the individual market.

Country Relevance: USA

Session Coordinator(s) Suzanna-Grace Sayre, FSA, CERA, MAAA,

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): AAA

Competency: External Forces & Industry Knowledge

Presenter(s): Alfred A. Bingham, Jr., FSA, MAAA; Joyce E. Bohl, ASA, MAAA; Juan L. Herrera, FSA, MAAA

Experience Level: Intermediate

This panel will focus on the proposed rules issued by the Trump Administration on association health plans (AHPs); short-term, limited duration insurance (STLDI); and health reimbursement arrangements (HRAs). The Academy has been engaged with analysis and commenting since President Trump first issued an executive order on October 12 to instruct expanded access and availability of AHPs, STDLI and HRAs. This session will explore what the implications are of moving forward with each and the latest news about where things currently stand.

Country Relevance: USA

Session Coordinator(s) David Linn

Facilitator(s)

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Presenter(s): Adam Gronsky, MHMS; Marc D. Lucas, ASA

Experience Level: Beginner – Intermediate

Too often programs are directly measured for their impact without consideration for how they will effect other programs. Even an in-home assessment performed on Dec. 31 will have an effect on retrospective reviews either through the documentation of a condition that eliminates the need to retrieve and review records or through identification of co-morbidities that will create new opportunities and chases. Similarly, the results of a retrospective review may identify or eliminate future targets for in home assessments. These consequences should be part of value propositions and associated forecasts as well as optimally coordinating different strategies. This panel will explore short-term and long-term impact of various applications of NLP on retrospective and prospective strategies in several case studies.

Learning Outcomes:

  • Know what Natural Language Processing is
  • Know what a Jacobian is
  • Consider multivariate models that evaluate the impact of changes of multiple variables simultaneously in a dynamic system

Country Relevance: USA

Session Coordinator(s) Marc D. Lucas, ASA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Rhonda K. Ahrens, FSA, MAAA

Presenter(s): Keith A. Epperson, ASA, MAAA; Shumei R. Kuo, FSA, MAAA; Brad A. Ober, FSA, MAAA; Lisa M. Parker, ASA, MAAA, PIR

Experience Level: Intermediate

This session will provide information to actuaries from a regulatory perspective concerning pricing risk. This will cover all types of health insurance products from major medical, voluntary, to long-term care.  Attendees will learn from both pricing actuaries and regulators on what they need to know about factors that determine or influence pricing, interaction with the actuaries, market conduct considerations, competitive effect on pricing and other regulatory concerns.

Learning Outcomes: 

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

  • Understand the issues involved with prospective pricing risks for an insurance company;
  • Take the results of analysis for future decision making; and
  • Understand what state regulators look for while assessing the pricing risks of insurance companies. 

Country Relevance: USA

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

Facilitator(s)

9:00 a.m. – 9:30 a.m.
9:30 a.m. – 11:00 a.m.

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Results-Oriented Solutions

Moderator(s): John C. Lloyd, FSA, MAAA

Presenter(s): Richard M. Gamret, FSA, MAAA; Derek Pederson; Roger T. Schacht, FSA, MAAA

Experience Level: Beginner – Intermediate

Medicare Advantage represents a relatively low margin product compared to the volatility of potential financial outcomes. Reporting of current financial results requires several actuarial and financial projections. It is an excellent example of the control cycle in which actuaries can create critical metrics, measure outcomes, and offer solutions based on emerging issues. Items discussed include:

  • Critical metrics in the financial management of Medicare Advantage plans;
  • Role of Part C and D projections in financial management; and
  • The importance of matching of risk-based revenue against emerging morbidity.

Learning Outcomes:

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

  • Identify critical metrics in managing the product;
  • Describe specific projections required to evaluate current performance measures; and
  • Explain issues associated with the CMS risk-based revenue proposition.

Country Relevance: USA

Session Coordinator(s) John C. Lloyd, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Jill Van Den Bos, ASA, MAAA

Presenter(s): J. Nile Barnes, PharmD; Stoddard Davenport; Jordan Paulus, FSA, MAAA

Experience Level: Beginner – Intermediate

Opioid addiction in America has grown to become a national crisis with overdose now the leading cause of death for Americans under 50. This session will review trends in the epidemic, including the impact on different demographic groups. Presenters will consider the efficacy of policy efforts to address the epidemic. Finally, we will review the benefits and costs of opioid use disorder treatment options.

Learning Outcomes:

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

  • Interpret trends in the growth of the opioid epidemic in America;
  • Evaluate policy efforts to combat the opioid crisis; and
  • Compare the costs and benefits of opioid use disorder treatment options.

Country Relevance: USA

Session Coordinator(s) Jordan Paulus, FSA, MAAA

Facilitator(s)

Credits: 1.80 CPD

Session Sponsor(s): Financial Reporting Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): John C. Caruso, FSA, MAAA; Chia Yi Chin, ASA, MAAA; Karena M. Weikel, ASA, MAAA

Experience Level: Intermediate – Advanced

We will have a panel discussion on risk adjustment with a focus on case studies. Topics include obtaining useful data, estimation techniques, assessing uncertainty, interaction with other liabilities and communication with management. This will be a moderated discussion and we will aim to have audience involvement, votes and encourage sharing insights.

Learning Outcomes:

  • Identify the key drivers of risk adjustment transfer payments and describe methods of obtaining and analyzing data to create estimates. 
  • Apply lessons learned through case studies.

Country Relevance: USA

Session Coordinator(s) Scott Jones, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): SOA

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Dave M. Liner, FSA, MAAA, CERA

Experience Level: Beginner

Machine learning is rapidly transforming how many industries function. This session will describe the evolving machine learning landscape, provide a pedagogical introduction to common machine learning methods and identify how actuaries can use machine learning to gain better insight. Many machine learning methods are built on principles that many actuaries have acquired through basic actuarial education.

Country Relevance: Non-Nation Specific

Session Coordinator(s) Dave M. Liner, FSA, CERA, MAAA

Facilitator(s)

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Professional Values

Moderator(s): Joe L. Wurzburger, FSA, MAAA

Presenter(s): Ashlee M. Borcan, FSA, MAAA; David M. Dillon, FSA, MAAA; Olga T. Jacobs, FSA, MAAA; Joe L. Wurzburger, FSA, MAAA

Experience Level: All

Court is in session and you are the jury!  Follow along as challenging aspects of actuarial professionalism are explored in a court-like setting. Deliberate based on what you already know from your own experience as well as based on what you learn in this session and then deliver your verdict accordingly. Who says learning about actuarial professionalism can't also be fun?

Learning Outcomes:

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

  • Apply actuarial professionalism concepts;
  • Identify key ASOPs for health actuaries; and
  • Explain significant aspects of the U.S. Qualification Standards.

Country Relevance: Non-Nation Specific

Session Coordinator(s) Joe Wurzburger, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Matthew Clark, Liesl Turner; Robert F. Wade, FSA, MAAA

Experience Level: Beginner –Intermediate

Description:

The employment world is changing and many of these changes impact the disability insurance business. From robotics and automation, to artificial intelligence and machine learning,  humans are being replaced as laborers and problem solvers. Jobs that humans still perform are being offshored to cheaper labor markets or moved into the 'gig' economy, both of which change the nature of how group insurance is sold, underwritten and managed.

Learning Outcomes:

Attendees will learn how the economy is changing the nature of work and the nature of traditional employer - employee relationships.  Attendees will be equipped with ideas about how to position their companies for these changes.

Country Relevance: USA and Canada

Session Coordinator(s) Leo Tinkham

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Marketing & Distribution Section

Competency: External Forces & Industry Knowledge

Presenter(s): Michelle M. Haines, ASA, MAAA; Stephen Rook, FSA, MAAA; Anil Sanwal

Experience Level: All

This session will give an insight to various types of supplemental health products in the USA and how they compare to similar products in Canada and around the world.  Attendees will be able to understand the differences in benefit design, regulatory environments, pricing challenges, marketing and distribution of these products.

Learning Outcomes:

This session will compare and contrast Supplemental Health Products in USA and other countries around the world.  What can we learn from success/failures of similar products in other countries and how they relate the products here in US.

Country Relevance: International

Session Coordinator(s) Kamran A. Malik, ASA, MAAA

Facilitator(s)