Agenda Day Three

Tuesday, June 26
5:00 a.m. – 7:00 a.m.

Check back for further details.

The nonrefundable fee of $20 per person. Sign up when you register.

Session Coordinator(s)

Facilitator(s)

6:30 a.m. – 4:00 p.m.
6:30 a.m. – 7:30 a.m.

Presentation(s): View Presentation

Session Sponsor(s): Leadership & Development Section

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

Introvert, Extrovert or Ambivert, Oh My!

How All Three are Important and Valuable

So when it comes to being an introvert, extrovert or an ambivert, which of the three are you? How do you know? How well can you identifying traits in others? And the bigger question is: does it matter? It does.

The more you learn about introverts, extroverts and the new kid on the block (no worries we won’t be singing!) ambivert, the more you might realize you’ve misunderstood some of these concepts.  Being an introvert, being an extrovert or having a balance of the two get to the heart of who a person is: how they work, how they live and how they interact with people at home or at work. 

How insightful would it be for you to know which way you lean as well as which way the people you interact with everyday have a tendency toward (although you probably have an inkling) with our “Quiet Quiz” (Hello we at an actuarial conference so of course we have an assessment)? We will also share our “slightly silent” brainstorming technique.

This fun breakfast with Jenn Barley and Karen Sullivan of KickStart Your Edge is the perfect mix of interaction as well as reflection, which will give Wheaties a run for their money as the breakfast of champions!

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

Session Coordinator(s) Joanne Ryan, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Session Sponsor(s): Actuary of the Future and Predicitve Analytics Section

Moderator(s): Douglas T. Norris, FSA, MAAA

This event is intended to provide an opportunity for members of the Actuary of the Future and Predictive Analytics and Futurism sections to network with other members, as well as a format to provide an opportunity to discuss hot topics in either/both sections. It is intended for actuaries registered in either section, as well as those interested in either section.

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

Session Coordinator(s) Timothy van Laarhoven, ASA, MAAA

Facilitator(s)

Session Sponsor(s): Long Term Care Section

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

The LTC Council Section Leadership will provide an update of current happenings and priorities related to 2018 initiatives.

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

Session Coordinator(s) Rebecca Tipton, FSA, MAAA

Facilitator(s)

8:00 a.m. – 9:30 a.m.

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Leadership & Development Section

Competency: Professional Values

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

Experience Level: All

The workplace can be a hot bed of varying degrees of ethical dilemmas, challenges and situations that show up regularly.  A key driver of unrivaled executive presence (which you don’t have to be an executive to actually have) is professionalism. Professionalism is about how you handle situations that come up in the workplace that aren’t your run of the mill, black and white, yes or no answers…sometimes these require you to be outside your comfort zone.  In this Get REAL workshop, you will work through sticky situations and discuss how to handle them, hear what the conversations sound like, be able to identify the stories you’re creating and know what to do if you are the lone wolf on the topic.

Learning Outcomes:

  • Discover what qualifies as a sticky situation
  • Learn how to assess a situation to determine what course of action to take
  • Learn what other professionals would do in the same situation
  • Develop skills that will enhance your communication around the topic
  • Create strategies on how to develop a best practices guide to improve the overall expectations and culture of your workplace

Country Relevance: Non-Nation Specific

Session Coordinator(s) Joanne Ryan, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Education & Research Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Zoe Gibbs; Brian M. Hartman, ASA

Experience Level: Beginner–Intermediate

This session will examine and compare various ways (both statistical and machine learning) to predict which members will have high claims in a near future year. Very high cost members are rare enough to require large volumes of claims data on a well dispersed population to create a satisfactorily robust actuarial predictive model of their prevalence and severity. This information is not easily available to many of the groups interested in profiling high cost members, such as accountable care organizations, actuaries working for smaller insurers, reinsurers, health economists, independent consulting actuaries and researchers working in an academic setting. With access to multiple large datasets, we are able to begin to answer some questions.

Learning Outcomes:

  1. Understand how to profile high cost claimants
  2. Predict health care costs for high claims
  3. Price individual stop-loss policies

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): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Bryan F. Miller, FSA, MAAA

Presenter(s): Jay M. Jaffe, FSA, MAAA; Bryan F. Miller, FSA, MAAA; Stuart D. Rachlin, FSA, MAAA

Experience Level: Beginner–Intermediate

The year is 2020. Like in 1790, when the US debated where to put its capital, another group of leading citizens has gathered, this time to discuss the nation’s health care crisis. The ACA’s impact is fading and the American economy is still being crippled by the cost of health care. Fortunately, the politicians who have been given the Herculean task of solving the health care crisis have invited a small group of distinguished actuaries to be in “the room where it happens.” The actuaries have been invited as professionals whose Code of Professional Conduct requires them to “act in the public interest.”

You are one of the invited actuaries and have been asked to help design an actuarially sound US health system. What do you say?

Learning Outcomes:

Attendees should gain insight into various opinions of the possible courses the ACA might follow. This would be useful for actuaries in insurance companies, regulatory agencies or those who may need to purchase ACA coverage for themselves.

Country Relevance: USA

Session Coordinator(s) Bryan F. Miller, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): SOA

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Edward C. Cymerys, FSA, MAAA

Presenter(s): Frank Cheung, ASA, MAAA; Susan E. Pantely, FSA, MAAA; James F. Walbridge, FSA, MAAA

Experience Level: All

As new initiatives emerge that are geared toward making it much easier for members to navigate the healthcare system many actuaries would expect utilization to increase.  However, some emerging experience is showing plan sponsors with lower trend with services provided in more appropriate settings.  Also, new more powerful analytical tools which are able to connect members that engage with the new member decision making support tools with the services that they receive helps give some insight into the drivers behind this result.  A panel with an actuary from a  start-up implementing this concierge approach,  an actuary from Kaiser and an actuary from Milliman with discuss these findings.  An article on this topic will also appear in the June Health Watch publication. implementing a concierge approach

Learning Outcomes:

  1. Evaluate the impact of programs designed to help members navigate the health delivery system
  2. Identify new tools to connect member engagement with subsequent services provided.
  3. Design programs to help increase member satisfaction while better controlling trend.

Country Relevance: USA

Session Coordinator(s) Edward C. Cymerys, 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): Jennifer M. Fleck, FSA, MAAA; Steve Rulis, FSA, MAAA

Experience Level: Beginner–Intermediate

A subcommittee of the SOA Group Life Committee conducted a study of group life waiver morbidity and mortality.  Jennifer Fleck and Steve Rulis will present the results of the study. Participants will be familiar with the process, findings, analysis, and conclusions of the recently completed SOA Group Life Waiver Study.

Learning Outcomes:

Participants will be familiar with the process, findings, analysis, and conclusions of the recently completed SOA Group Life Waiver Study.

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): Randall C. Finn, FSA, MAAA; Christin Kuretich, Darrell D. Spell, FSA, MAAA

Experience Level: Intermediate

Ever since the ACA was passed, there has been upheaval in the supplemental benefits market.  This has driven many changes for critical illness and other important supplemental products.  Which of these changes are fads and which are actually trends that are driving the market? Join us as we discuss the changes in the market and identify the ones that really matter.

Learning Outcomes:

Identify key changes affecting the supplemental benefits market. Evaluate the importance of competitor actions. Use the knowledge to help evaluate adjustments that attendees should consider for their own portfolios.

Country Relevance: USA

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

Facilitator(s)

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): Lauren E. Onderisin, FSA, MAAA; Ryder F. Riess; Christopher A. Schmidt, FSA, MAAA

Experience Level: All

When compared to 10 developed countries, the US ranks last in overall health care performance, highlighted by per capita spending that is 50 percent  greater than the next country and last place rankings in efficiency, equity and healthy lives. Escalating costs and decreasing affordability continue to pose the primary challenge in U.S. health care as cost pressures are increasing for all who pay for health care: health plans, governments, employers and consumers. From 2010 to 2015, the average health plan medical loss ratio increased from 86 to 90 percent and average employee contributions to premiums increased by 24 percent. This session will investigate how health plans could bend the cost curve by focusing on solutions such as medical/RX cost reduction opportunity assessments, VBC maximization, PBM relationship maximization, care model redesign, provider/health plan collaboration and next generation product design.

Learning Outcomes:

  • Gain knowledge around the affordability issues impacting the health care market
  • Learn how to identify cost reduction opportunity quick hit areas of focus
  • Understand the need to create tailored value based strategic frameworks
  • Learn the reasons to evaluate relationships with providers to create collaborative arrangements that promote population health management
  • Appreciate the need to define personalized care models
  • Recognize how to address strategic, financial and operational aspects of the pharmacy business and maximize PBM relationships
  • Comprehend how to refine existing networks and build new networks to address emerging market needs

Country Relevance: USA

Session Coordinator(s) Chris Schmidt, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): SOA and Long Term Care Section

Competency: External Forces & Industry Knowledge

Moderator(s): John O’Leary

Presenter(s): Cindy Malone; John O’Leary; Eileen J. Tell, MPH

Experience Level: Beginner–Intermediate

This session will present the results of a research project sponsored by the SOA and initiated as a followup to an event held by the SOA for the Long Term Care Think Tank. The SOA engaged MaddockDouglas, Inc. to explore the feasibility of two new product concepts for consumers to finance long term care needs. The research includes qualitative results based on consumer focus group discussions and online surveys of consumers about the concepts. Results also include the derivation of different price points for the product concepts and U.S. sales forecasts in the first two years of introduction.  Attendees will have a greater understanding of viability of these proposed product concepts as well as on the ongoing work of the LTC Think Tank.

Learning Outcomes:

  • Understand the approach for evaluating new product concepts
  • The motivation for developing new LTC product concepts
  • An evaluation of the proposed viability of the product concepts and their estimated market impact

Country Relevance: USA

Session Coordinator(s) Steven C. Siegel, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Presenter(s): Adam J. Barnhart, FSA, MAAA; Hillary H. Millican, FSA, MAAA; Simon J. Moody, FSA, MAAA

Experience Level: Intermediate

Risk-sharing arrangements in Medicare Advantage are becoming more sophisticated and prevalent.  This session will discuss general considerations when entering into these agreements, common ways to structure these agreements and different perspectives of various parties involved.  This session will also discuss the complications surrounding Part D in risk-sharing arrangements.  This session is targeted towards actuaries working with providers or health plans in risk-sharing arrangements or those looking to learn more about these agreements.

Learning Outcomes:

At the conclusion of this session, attendees will better understand risk-sharing arrangements, especially those including Part D.  Attendees will be able to identify important considerations in risk-sharing agreements and will be able to apply the information discussed to create more strategic arrangements in the future.

Country Relevance: USA

Session Coordinator(s) Hillary H. Millican, 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): Chris Dickerson; Barry Jordan, ASA, MAAA

Experience Level: Intermediate

The use of health status-based risk adjustment is a common practice in healthcare, in particular for Medicaid programs as part of capitation rate development. With more and more emphasis being placed on alternative payment methods including sub-capitation and incentive arrangements which cover a specific subset of services within the Medicaid program, the use of new or re-calibrated risk adjusters that are geared to predict the utilization of specific services, shows more and more potential. While this is not in itself a new concept, we will be presenting on our findings of calibrating existing risk adjustment products to focus on a specific set of professional services. We will share the results of how calibration of risk adjustment tools towards a specific set of physician services this approach correlates amongst multiple states, as well as discuss some of the potential uses of this approach as states and health plans continue to emphasize effective payment strategies specific to a subset of  services.

Learning Outcomes:

  1. Identify the need for re-calibrating risk adjustment models for use in specific scenarios  
  2. Explain the use of risk adjustment in payment reform initiatives 
  3. Compare the correlation of standard risk  adjustment models to a model re-calibrated for a specific subset of services
  4. Evaluate the applicability of customized risk tools across data sets

Country Relevance: Non-Nation Specific

Session Coordinator(s) Barry Jordan Jr., ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): SOA

Competency: Results-Oriented Solutions

Presenter(s): Anne Jackson, FSA, MAAA; Jessica M. Naber, FSA, MAAA

Experience Level: Intermediate–Advanced

The SOA engaged a team at Milliman to evaluate potential risk sharing arrangements between payers and manufacturers related to high cost technologies.  This presentation will review key findings from that work effort.  We expect to use specific disease areas to compare and contrast the utility of alternate reimbursement approaches and to extrapolate those observations to broad characteristics of disease states and therapies.  The project team includes actuaries with US and single payer system expertise.  The application of the reimbursement approaches will be evaluated in both contexts.

Learning Outcomes:

It is unlikely there is a “one size fits all” solution that is ideal for all payer systems and therapies.  The purpose of the research, in part, is to identify the risk mitigation offered by the reimbursement approaches and understand how those align to: characteristics of the disease areas and therapies, and payer segments in the U.S. and elsewhere.

Country Relevance: International

Session Coordinator(s) Anne Jackson

Facilitator(s)

10:00 a.m. – 11:15 a.m.

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Presenter(s): Yuliya Babushkina; Warren M. Cohen, FSA, MAAA; Jacob B. Efron, FSA, MAAA

Experience Level: Intermediate

A significant portion of group disability and life insurance coverages are offered on a voluntary basis, with premiums paid by the employees.  Specific plan designs may include fully voluntary coverage as well as core buy-up and supplemental plans.  This session discusses a variety of issues related to voluntary plans, including pricing, underwriting, market growth, enrollment and more.

Learning Outcomes: 

Attendees gain an understanding of current issues and challenges in the voluntary group life and disability markets.

Country Relevance: Non-Nation Specific

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

Facilitator(s)

Credits: 1.50 CPD

Session Sponsor(s): Marketing & Distribution Section

Competency: Strategic Insight and Integration

Presenter(s): William S. Bade, FSA, MAAA; Kevin Poynter; Michael Prendes, FSA, MAAA

Experience Level: All

Hospital indemnity is an area of high growth in the worksite market.  As the market becomes more crowded, key players have turned toward differentiation to support top line growth.  This session will explore how plan designs vary across carriers, how these differences can create competitive advantages and/or disadvantages, and what carriers should be looking to do in the future to keep up with the fast pace of product development.

Learning Outcomes:

At the conclusion of the session, attendees will be able to identify the key players and plan designs in the hospital indemnity market, determine the value of benefits within a plan design and design benefit packages that exploit competitive advantages.

Country Relevance: USA

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

Facilitator(s)

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): David M. Dillon, FSA, MAAA

Presenter(s): Nancy Atkins; Michael Conway; Allen Kerr; Kent Sullivan

Experience Level: Beginner–Intermediate

Insurance commissioners will discuss a variety of current topics including health care reform, risks in the major medical markets, voluntary products and other topics. At the conclusion of the 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 the session, attendees will be able to identify issues that are on the mind of the regulatory agencies.

Country Relevance: USA

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

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Alfred A. Bingham, Jr., FSA, MAAA; Syed M. Mehmud, ASA, MAAA, FCA

Experience Level: All

This session will describe insights gained from studying data from the first three (2014–2016) years of Affordable Care Act data. The data comes from a unique and landmark study led by Syed that collected detailed EDGE data across the nation. The session will describe new tools and techniques deployed to analyze the data, as well as high level conclusions.

Learning Outcomes:

This session will describe insights gained from studying data from the first three years of the Affordable Care Act. There are wide-ranging views on what it takes to succeed in the tumultuous ACA markets. A large scale and detailed study of ACA experience reveals key insights into that question.

Country Relevance: USA

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

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Mark M. Zanecki, ASA, MAAA

Experience Level: Intermediate–Advanced

Actuaries typically estimate insurance liabilities with models focused on triangle development patterns and other assumptions that comprise standard practice(s) of modern actuarial analyses. Advances in computing technology has led to improvements including stochastic methods, finer segmentation and frequent analysis, but machine learning/predictive methods hold the promise of improved accuracy and reliability. By using machine learning/predictive modeling build on  GPU servers, we can expect extraordinary advances that will fundamentally transform actuarial analyses in the years ahead. We will begin with a brief overview of advanced modeling methods to estimate claim level liabilities. We'll also review the challenges of claim level analysis and the benefits of claim triage to identify key characteristics early in the analysis of claims.  We will then proceed to a review of a first-generation application of machine learning to actuarial reserve analysis.

Learning Outcomes:

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

  1. Explain how analytical methods can improve loss reserving models
  2. Identify predictive modeling approaches to loss reserving
  3. Apply advanced enterprise risk framework that integrates reserving risk and pricing risk.

Country Relevance: USA

Session Coordinator(s) Mark M. Zanecki, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): John I. Mange, FSA, MAAA

Presenter(s): Lisa Macon Harrison, MPH; Jason W. McKinley, FSA; Sara C. Teppema, FSA, FCA, MAAA

Experience Level: All

Public health is a rich and vast field that seeks to improve health and health care for all members of society.  Actuaries can learn much from public health activities to enhance our practice.  Members of the SOA health section public health task force, including public health professionals and actuaries, will review initiatives that can connect public health activities to the actuarial profession.

Learning Outcomes:

  • Gain awareness in public health
  • Apply public health activity to actuarial work

Country Relevance: Non-Nation Specific

Session Coordinator(s) Sara Teppema, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

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

Presenter(s): Zachary C. Aters, ASA, MAAA; Sabrina H. Gibson, FSA, MAAA; Mary K. Hegemann, FSA, MAAA; Chris Priest; Michelle L. Raleigh, ASA, FCA, MAAA

Experience Level: All

Medicaid is always a hot topic! Almost every week there are changes to the program with new waivers being submitted or approved. This session will discuss the rapid changes to Medicaid programs with their implications on actuarial sound rate setting. It will also discuss other important and timely Medicaid topics. Examples of topics that may be discussed are:

  • Potential changes to Medicaid funding
  • Considerations for managed Medicaid rate development for the new waiver programs
  • Increased state flexibility in Medicaid – What does that mean?
  • Impact of recent implementation from the mega rule requirements 
Join us for an informative and lively group discussion.

 

Learning Outcomes:

Increase knowledge on the recent emerging topics around the Medicaid program.

Country Relevance: USA

Session Coordinator(s) Sabrina H. Gibson, FSA, MAAA

Facilitator(s)

Credits: 1.50 CPD

Session Sponsor(s): AAA

Competency: Professional Values

Moderator(s): Audrey L. Halvorson, FSA, MAAA

Presenter(s): Matthew P. Chamblee, FSA, MAAA, CERA; Rick Lassow, FSA, MAAA

Experience Level: All

This session will review new components of ASOPs number 5 and 42 of which health actuaries need to be aware.  ASOP 5 is Incurred Health and Disability Claims, and ASOP 42 is Determining Health and Disability Liabilities Other Than Liabilities for Incurred Claims. Practicing actuaries must be aware of all ASOPs so come learn what's new.

Learning Outcomes:

Professionalism credits for qualification purposes. Understand the changes to the ASOPs number 5 and 42.

Country Relevance: USA and Canada

Session Coordinator(s) Audrey L. Halvorson, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): David Dobberfuhl, FSA, MAAA; Johann K. Leida, FSA, MAAA

Experience Level: All

This session is intended to address the impact that risk adjustors can have on value-based payments between payers and providers. We will present case studies to analyze real world examples and illustrate how big of an impact risk adjustment has on the final payment, and how those payments vary by the adjustor used. We will also present possible solutions for this problem.

Learning Outcomes:

  1. Explain how risk adjustment is used in value-based payments 
  2. Evaluate the impact of a given risk adjustor on the final payment in a value-based agreement 
  3. Apply alternative methods to reduce the impact of risk adjustment on the final payment

Country Relevance: USA

Session Coordinator(s) David Dobberfuhl, FSA, MAAA

Facilitator(s)

Session Coordinator(s)

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Long Term Care and Predictive Analytics and Futurism Section

Competency: External Forces & Industry Knowledge

Moderator(s): Jonathan D. White, FSA, MAAA, CERA

Presenter(s): Missy A. Gordon, FSA, MAAA; Brian M. Hartman, ASA

Experience Level: Beginner–Intermediate

Predictive modeling is no stranger in the world of health insurance.  The primary focus of such analysis for medical insurance has been on the near future and disease management.  However, this session will discuss how predictive analytics has been used to develop projection assumptions for long-term care insurance by applying experience adjustments to a benchmark.  This session will examine how predictive modeling can be used to overcome challenges with traditional actual-to-expected studies and how it produces more statistically robust projection assumptions.  It will also explore how to use predictive modeling to understand the range of potential error in the projection assumption and whether emerging experience is deviating materially from your assumptions.  The discussion will focus on morbidity assumptions for long-term care insurance, but the concepts can translate to various other assumptions (e.g., mortality) and other lines of business (e.g., disability, life and Medicare supplement) where one wants to experience adjust a benchmark assumption.

Learning Outcomes:

  • Understand how predictive analytics has been used to develop projection assumptions for long-term care insurance
  • Examine how predictive modeling can be used to overcome challenges with traditional actual-to-expected studies
  • Explore how to use predictive modeling to understand the range of potential error in the projection assumption

Country Relevance: USA

Session Coordinator(s) Rebecca Tipton, FSA, MAAA

Facilitator(s)

11:30 a.m. – 1:00 p.m.

Howard RossHoward Ross   

Unconscious Bias and Diversity Expert

A seminal thought leader on identifying and addressing unconscious bias, best-selling author Howard Ross is one of the nation’s most influential diversity consultants and workplace experts, specializing in corporate culture change, leadership development and managing diversity.

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)

1:15 p.m. – 2:45 p.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): Gnana K. Kanisan, ASA; Nick Massiello; Christopher A. Schmidt, FSA, MAAA

Experience Level: All

Inpatient volumes have declined nationally by  eight percent since 2008and growth in outpatient and ambulatory services is expected to exponentially increase. This is being fueled by technology advances, payment model pressure and physicians wanting greater control over care provided. Understanding how to identify and prioritize services to shift to cheaper care settings can lead to significant savings for a health plan. A health plan can assess what services could shift and when through episodic analysis, assess if providers have capacity and readiness for accelerated site of service shifts and determine if there are gaps in provider capacity and services.

Learning Outcomes:

  • Identify analyses that can identify shifts in location of care, determine what services are shiftingand where they are going
  • Understand how episodic analysis can identify
  • Understand how to evaluate the strategic repositioning of care and services that can safely be performed at lower acuity settings
  • Appreciate how to assess provider market share threats and opportunities relative to traditional and non-traditional 

Country Relevance: USA

Session Coordinator(s) Chris Schmidt, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

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

Presenter(s): Kenneth L. Clark, FSA, MAAA; Robert E. Himmelstein, ASA, MAAA

Experience Level: Beginner–Intermediate

Recently passed legislation referred to as MACRA (Medicare Access and CHIP Reauthorization Act of 2015) will, among other things, affect the Medicare Supplement industry in calendar year 2020. Specifically, the Part B deductible can’t be covered. Therefore, Plan F (in addition to C) will no longer be an option for individuals newly eligible for Medicare starting Jan. 1, 2020.  However, inforce policyholders will be able to keep their current versions of Plan F and individuals eligible for Medicare prior to Jan. 1, 2020 (i.e., not “newly eligible”) can purchase the current version of Plan F on or after Jan. 1, 2020. There is the obvious and not so obvious impact on the Medicare Supplement market. The obvious impact is that Plan G will replace Plan F as the primary offering in the market. Not so obvious is that the market for Plan F won't go away completely for several years. In addition, the morbidity shift on respective plans due to changes in applicant profiles will have implications on future experience. The session will discuss the underlying drivers and plausible future scenarios.

Learning Outcomes:

At the conclusion of the session, attendees will be able to understand the impact of MACRA and determine the key considerations for a given carrier and evaluate the possible directional impact and scale on specific plans.

Country Relevance: USA

Session Coordinator(s) Kenneth L. Clark, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Kristi M. Bohn, FSA, MAAA, EA, MSPA

Presenter(s): Jan Graeber, ASA, MAAA; Katherine J. Matthews, ASA, MAAA; Stephen P. Melek, FSA, MAAA

Experience Level: Beginner–Intermediate

This session reviews some of the statistical and regulatory findings relating to mental health parity implementation and particularly focuses on the lack of parity when design and operations come under the lens of actual outcome-based data. As the quantitative and non-quantitative mental health parity requirements apply to nearly all commercial major medical health plansand even some states' Medicaid programs, this session offers a lot of insight (and warnings!) for many health actuaries.

Learning Outcomes:

At the conclusion of this session, attendees will be able to describe the most likely areas of possible non-compliance with mental health parity, and evaluate plan designs and managed care processes to better ensure compliance in advance.

Country Relevance: USA

Session Coordinator(s) Kristi M. Bohn, FSA, EA, MAAA, MSPA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Michael Gill; Bethany McAleer, FSA, MAAA; Timothy W. Smith, ASA, MAAA

Experience Level: Beginner–Intermediate

With advances in cloud computing, led by Amazon's Web Services (AWS), the traditional & structured data warehouse is giving way to the unstructured data lake. The cloud environment provides greater automation of scalable size and processing power. Data lakes in the cloud environment allows for the analytics framework and intelligence to be applied to your raw data in real time, not through the creation of additional data warehouse layers that delay the process. For your downstream analytics, this means greater flexibility in how you store and access your data, faster run times for advanced processes and increased intelligence with the ability to easily integrate non-claims data into your reporting. This session will look at data lakes from a technical perspective, as well as discuss the analytical and actuarial opportunities within the cloud environment.

Learning Outcomes:

  1. Evaluate whether a data lake would be useful for their organization
  2. Explain how a data lake works differently than a data warehouse, and what that means for their work as an actuary and analyst
  3. Describe various examples of unstructured data and how these could be incorporated into actuarial and analytical models

Country Relevance: Non-Nation Specific

Session Coordinator(s) Tim W. Smith, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Sarah J. Chansky, FSA, FCIA; Pete J. Miller, ASA, MAAA

Experience Level: Beginner–Intermediate

The session will review the history of U.S. mortality and mortality improvement using data from the SOA, Social Security and other reliable sources. The session will pay special attention to causes of recent headwinds to mortality improvement with a special focus on the rise of accidental poisonings as a cause of death.

Learning Outcomes:

Attendees will become familiar with U.S. mortality and mortality improvement trends over time.  The study will distinguish between  group life insured population trends and total population trends.  Additionally, the study will focus on increasingly common causes of death, such as accidental poisoning, how it is bending the mortality improvement trendline and expectations for future influence on the trend.

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): Ashlee Mouton Borcan, FSA, MAAA; Stephen Rook, FSA, MAAA; Richard D. Schaefer, FSA, MAAA; Joe L. Wurzburger, FSA, MAAA

Experience Level: All

This session, run 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.

Country Relevance: USA

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

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Professional Values

Moderator(s): Jennifer L. Gerstorff, FSA, MAAA

Presenter(s): Kevin T. Geursten, FSA, MAAA; Colby R. Schaeffer, ASA, MAAA

Experience Level: Beginner–Intermediate

Medicaid rate setting involves balancing the needs of multiple stakeholders to produce actuarially sound rates. This session will focus on perspectives of the rate setting process from varying points of view. Key areas of discussion involve:

  • Selection and adjustment of base data
  • Identifying and quantifying membership issues
  • Selection of trend and managed care savings
  • Administrative expense load development
  • Documentation and disclosure
  • Handling differences of opinion professionally
  • How different parts of the process relate to ASOPs and AAA precepts

The format of this session will focus on a brief panel discussion followed by audience questions.

Learning Outcomes:

At the conclusion of this session, attendees should be able to identify how the ASOPs define and shape Medicaid rate setting.  In addition, participants will have a deeper understanding of the various perspectives on the rate setting process, and how to manage differences of opinion in a professional setting.  The ultimate goal is to have varying stakeholders within the actuary community to focus on best practices.

Country Relevance: USA

Session Coordinator(s) Kevin T. Geurtsen, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Moderator(s): Daniel Muldoon, MA

Presenter(s): Rebecca Johnson, MBA; Daniel Muldoon, MA

Experience Level: Beginner–Intermediate

Value-based payment models, including episode and bundled payment models create financial incentives to reduce spending, but they also create concerns over potential stinting of necessary treatments. Often, these models include an explicit adjustment for new technologies or very expensive treatments. In this session, we will present on the Center for Medicaid Services' ONcology Care Model (OCM, which includes an explicit adjustment for novel oncology therapies to reduce the incentive to avoid high cost novel therapies, and also on value-based payment arrangements for Medicaid special needs plans. In this session, we will provide an overview of both initiatives, and we will present claims data analysis that demonstrates how different mechanisms to account for new or expensive treatments can affect participants' performance. This session is intended to meet the needs of actuaries who are focused on all aspects of value-based payment, including the design of alternative payment models and who work with providers to analyze the opportunities that alternative payment models create.

Learning Outcomes:

  • Attendees will be able to identify key aspects of developing financial targets in alternative payment models.
  • Attendees will be able to explain how adjusting for new therapies can provide financial protection in alternative payment models.
  • Attendees will be able to explain how adjusting for new therapies can provide financial protection in alternative payment models.
  • Attendees will be able to evaluate differences between alternative methodologies for adjusting for new therapies or technologies.  

Country Relevance: USA

Session Coordinator(s) Daniel Muldoon

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Results-Oriented Solutions

Moderator(s): Kelsey L. Stevens, FSA, MAAA

Presenter(s): James P. Hazelrigs, ASA, MAAA; Aaron P. Jurgaitis, ASA, MAAA; Jeremiah D. Reuter, ASA, MAAA; Juliet M. Spector, FSA, MAAA

Experience Level: Beginner– Intermediate

This session will consist of real-life learnings and discussions that relate directly to the SOA ‘Value-Based Care’ initiative  - The Role of the Health Care Provider Actuary, a Strategic Initiative of the SOA Health Section.  The initiative’s focus is on building the necessary foundation for health care actuaries to support health care providers in managing their value- based care arrangements.  See the article “Value-Based Care: The Role of the Health Care Provider Actuary” in the February 2018 edition of Health Watch for further information. The learnings will be delivered by a panel of experts who support providers in a multitude of subject areas.

Learning Outcomes:

Attendees should have a better understanding of the current provider environment and how their business is changing as a result of external influences like ACA, MACRA, etc. They should walk away with a clear understanding of the skill sets (high level) that are needed for providers to be successful in the new VBC world, particularly which of these skills are currently being fulfilled by actuaries and which are expected to increase in demand in the future.

Country Relevance: USA

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

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Results-Oriented Solutions

Moderator(s): Joseph P. Slater, FSA, MAAA

Presenter(s): John L. Culkin, ASA, MAAA; Ian G. Duncan, FSA, FIA, FCIA, MAAA, FCA; Douglas T. Norris, FSA, MAAA

Experience Level: Intermediate–Advanced

A panel of health insurance actuaries will describe their policy proposals to reform the individual ACA market and make it the  stable and sustainable Individual Health Insurance marketplace that covers the largest number of people at the lowest possible cost. Policy provisions discussed could include high risk pools, revised age curves, changes in the coverage and benefit mandates, etc.

Learning Outcomes:

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

  1. Explain policy ideas to build a more sustainable and stable individual health insurance market in the United States;
  2. Describe how proposed policy provisions would lower premiums and increase the number of insured; and
  3. Identify the issues that some believe are unfavorably impacting the individual ACA marketplace.   

Country Relevance: USA

Session Coordinator(s) Joe P. Slater, 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): Elena V. Black, FSA, EA, MAAA, FCA; Yi-Ling Lin, FSA, MAAA, FCA

Experience Level: Intermediate

In health, complex business problems are being tackled with a wide range of predictive analytics techniques, from traditional risk assessment linear regressions to innovative machine learning methodologies. One such example is applying a gradient boosting machine (tree-based) learning technique to predict a population’s health plan elections amongst a menu of available plan options and pricing. Exploring and understanding mathematical underpinnings of methodologies, utilized in predictive analytics, is one necessary step in harnessing the power of this new actuarial toolbox. Demystifying the “black box” is necessary but not sufficient. An entire chain of necessary steps is required: formulating relevant business problems in the right way, understanding and visualizing the data and potential trends, applying appropriate optimization tools, and finally, interpreting modeling results to solve the business problem at hand. In this session, we illustrate these steps through case studies. We will discuss the attributes of business problems in health area that can greatly benefit from sophisticated machine learning and other analytical techniques. We demonstrate how these algorithms are applied, leading to results that aid in an informed decision-making process. We will show how data exploration and visualization can lend a powerful hand in understanding not only your data but modeling results.

Learning Outcomes:

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

  1. Describe and imagine other ways in which predictive analytics could be applied in health insurance outside of risk scoring/identification
  2. Identify types of business problems suitable for predictive analytics; and
  3. Have a basic understanding of a couple of the algorithms used and why they were chosen.

Country Relevance: USA

Session Coordinator(s) Yi-Ling Lin, FSA, FCA, MAAA

Facilitator(s)

2:45 p.m. – 3:15 p.m.
3:15 p.m. – 4:30 p.m.

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

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

Experience Level: All

According to the Mayo Clinic, research has shown that sitting behind a desk or wheel of a car/truck significantly increases the risk of cardiovascular disease.  This session will use data to explore this hypothesis as well as other common assumptions in the context of worksite accident, critical illness, and hospital indemnity products. In addition, the session will provide an overview of important diagnosis codes and how an understanding of diagnosis coding can be combined with medical data to revolutionize product pricing.

Learning Outcomes:

At the conclusion of the session, attendees will be able to demonstrate knowledge of common diagnosis codes, identify specific pricing issues in the worksite market and develop solutions to specific pricing issues in the worksite market.

Country Relevance: USA and Canada

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

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Moderator(s): Kevin Sigman, FSA, MAAA

Presenter(s): Eli Greenberg, ASA, MAAA

Experience Level: All

Orthopedic related costs are a consistent cost driver for health plans. It is estimated that seven to 10 percent of adults suffer from back pain. This analysis focuses on the treatment sequence after the initial diagnosis of back pain with a focus on contrasting the behavior of patients who end up having surgery versus those that avoid surgery. The analysis incorporates considerations related to place of entry into the healthcare system, treatment options, drug use and demographics. Ultimately the analysis leads to the key member decisions and decision timing as well as the employer design opportunities that exist to optimize this treatment sequence.

Learning Outcomes:

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

  1. Define and explain the optimal treatment sequence for back pain, plus identify suboptimal treatment patterns.
  2. Interpret and compare sequential treatment patterns for lower back pain.
  3. Design and develop incentives to maximize the optimal treatment sequence and calculate their expected value. 

Country Relevance: USA

Session Coordinator(s) Eli Greenberg, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Results-Oriented Solutions

Moderator(s): John I. Mange, FSA, MAAA

Presenter(s): Kristi M. Bohn, FSA, MAAA, EA, MSPA; Hobson D. Carroll, FSA, MAAA; Mehboob A. Khoja, FSA, MAAA; Brent W. Seiler, FSA, MAAA

Experience Level: Intermediate

In 2017, the Health Section’s Strategic Initiatives Committee formed the Self-Insurance Task Force (SITF). In this session, the SITF presents its white paper that was written  by actuaries working in the self-insured industry for health actuaries unfamiliar with self-insurance in areas such as regulation, consulting and risk mitigation, including stop-loss insurance.  The white paper explains what it means to self-insure and delves into topic areas such as self-insurance terminology, advantages and disadvantages of self-insurance and issues the benefits consulting actuary should address before recommending to their clients that they consider self-insuring their employee benefits plan. The white paper also describes risk transfer tools from the perspectives of both the plan sponsor and the stop-loss insurer, including potential coverage gaps, rating, underwriting, reserving and corporate product strategies. Time will be allowed for questions or comments from the audience.

Learning Outcomes:

Attendees will understand the:

  • Importance of self-insurance in the commercial and private health insurance marketplaces;
  • Primary roles actuaries play in the self-insurance market sector; and 
  • Regulatory and technical nuances between traditional fully-insured and self-insured approaches to employee health benefits.

Country Relevance: USA

Session Coordinator(s) Hobson D. Carroll, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): SOA

Competency: External Forces & Industry Knowledge

Moderator(s): Deana K. Bell, FSA, MAAA

Presenter(s): Deana K. Bell, FSA, MAAA; Nancy J. Hubler, ASA, MAAA, Annette V. James, FSA, MAAA, FCA

Experience Level: Beginner– Intermediate

This session will describe best practices in the preparation of the actuarial memorandum that supports the actuarial opinion that is part of a health annual statement.  Presenters will discuss the components of an actuarial memorandum,  what it means to provide sufficient documentation and disclosure for another actuary practicing in the same field to evaluate the work.

Learning Outcomes:

At the conclusion of this session, attendees will be able to prepare an actuarial memorandum that meets the requirements set forth in the NAIC Annual Statement instructions and meets the needs of many regulators and other users of the actuarial memorandum.  Attendees will understand the critical elements regulators look for and what level of detail to include supporting each item in the opinion.

Country Relevance: USA

Session Coordinator(s) Nancy J. Hubler, ASA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: Technical Skills & Analytical Problem Solving

Presenter(s): Jeffrey S. Bowden, FSA, MAAA; Mark J. Costello, FSA, MAAA

Experience Level: Beginner– Intermediate

Attendees will learn about the various uses for predictive models in disability insurance. Panelists will discuss both theoretical approaches and actual applications in beta or production today. The session will explore text mining in the management of disability claims and text mining in evaluating medical records. The session will discuss the use of multivariable in disability pricing and risk selection.

Learning Outcomes:

Participants will understand theoretical and applied approaches to using predictive models to supplement various functional tasks in the disability insurance business.

Country Relevance: USA and Canada

Session Coordinator(s) Leo Tinkham

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Joint Risk Management Section

Competency: Strategic Insight and Integration

Moderator(s): Marcus A. Such, ASA, MAAA

Presenter(s): Manchiu Chan, FSA, MAAA: Marizze C. Seeth, ASA; Christopher Suchar, FCAS, MAAA

Experience Level: Intermediate

Most states have adopted NAIC Own Risk Solvency Assessment (ORSA) model act since it went into effect in 2015. Insurance companies meeting the premium threshold must submit ORSA reports to their respective regulators.

A well-structured Enterprise Risk Management framework plays a critical role helping companies prepare for ORSA and mitigate through today’s rapidly changing market and regulatory environment.

Meanwhile, Economic Capital Models (ECMs) are emerging as a tool which is better suited for an assessment of risk capital and prospective solvency that not only satisfies ORSA requirements, but also positions a company to go beyond that to help support better management decisions around capital allocation.

With a focus on health insurance companies, this presentation will review:

  1. What ORSA is and why it is needed?
  2. How to set up and utilize an ERM framework to help health companies assess and mitigate risks.
  3. Comparison between ECM and other risk assessment approaches: advantages and shortcomings
  4. How to utilize ECM output for capital adequacy and risk tolerance analysis
  5. How to utilize ECM output for capital allocation and help company achieve its business objectives

Learning Outcomes:

  1. Understand the key requirements of ORSA
  2. Demonstrate on how to set up a successful ERM framework for health companies
  3. Describe the challenges in quantifying the risk exposures for ORSA report and the limitations of some common risk assessment approaches
  4. Demonstrate on how to use a well-structured ECM to improve risk assessment for ORSA report
  5. More fully understand how go beyond ORSA requirements to help management make better informed strategic decisions about capital allocation and increase the profitability of the company

Country Relevance: Non-Nation Specific

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

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): Jim Toole, FSA, MAAA, CERA, FCA

Presenter(s): Alison Hare; Jennifer A. Horney, Ph.D., MPH; Robert Morrow, MD

Experience Level: All

Recent weather disasters such as Hurricane Harvey have highlighted the importance of public health activities and vulnerabilities of communities after a disaster.  Post-disaster public health experts will discuss this important topic at the intersection of public health and risk.  The session will outline the various vulnerabilities that disasters expose: physical, social, environmental and where these overlap.  It will discuss risks to communities, as well as community resilience and recovery efforts.  Finally, it will review the impact on health care providers and payers.

Learning Outcomes:

  • Identify potential downstream health effects of weather emergencies
  • Describe social determinants of health during both stable and emergency periods

Country Relevance: Non-Nation Specific

Session Coordinator(s) Sara Teppema, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.80 CPD

Session Sponsor(s): Health Section

Competency: Strategic Insight and Integration

Moderator(s): Marilyn M. McGaffin, ASA, MAAA

Presenter(s): Sean Karbowicz; Gregory L. Warren, FSA, MAAA, FCA

Experience Level: Beginner-Intermediate

This session defines pharmacy transparency and delves into how it can be used to complement conventional pharmacy management programs. The session will discuss how to engage both consumers and providers in the use of pharmacy transparency models. The speakers demonstrate methods to assist with value based care for pharmacy – getting the consumer, pharmacist and physician to work together to define the right treatment for the individual to achieve better drug adherence, resulting in more engaged consumers, better health outcomes and provider loyalty. This session will also discuss methods to measure impacts of pharmacy solutions on claims and how to translate these cost savings into lower premiums.

Learning Outcomes:

At the conclusion of the session, attendees will be able to identify pharmacy transparency and solutions. The attendee will be able to explain how pharmacy transparency helps with value based care and be able to evaluate these cost savings into lower premiums.

Country Relevance: USA

Session Coordinator(s)

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): SOA

Competency: External Forces & Industry Knowledge

Presenter(s): Drew Kirchner, FSA, MAAA; Keith R. Klimek, FSA, MAAA

Experience Level: Beginner – Intermediate

The session will have three primary sections. The first section will define biosimilar pharmaceuticals, introduce key nomenclature and explain how these products are typically utilized and reimbursed.  The second section will describe potential scenarios regarding the cost trends in a therapeutic class if a biosimilar enters the market. The third section will summarize the presentation and explain how to use the information for collaborating with trade relation departments and forecasting medical cost trends.

Learning Outcomes:

  1. Define the provider reimbursement arrangements for infusible pharmaceuticals.
  2. Develop ability to evaluate the potential impact of biosimilars on medical cost trends.
  3. Equip actuaries with background needed to collaborate with pharmaceutical trade relations departments.

Country Relevance: USA

Session Coordinator(s) Keith R. Klimek, FSA, MAAA

Facilitator(s)

Presentation(s): View Presentation

Credits: 1.50 CPD

Session Sponsor(s): Health Section

Competency: External Forces & Industry Knowledge

Moderator(s): James P. Hazelrigs, ASA, MAAA

Presenter(s): Aaron P. Jurgaitis, ASA, MAAA; Kelsey L. Stevens, FSA, MAAA

Experience Level: Intermediate

In an effort to reform how health care is delivered and paid for, value-based programs are intended to incentivize providers to focus on the quality of care, rather than the quantity of care, that they provide for their patients. Medicare has been a leader when it comes to tying payment to value. This session will provide an overview of some of the payment and delivery system reforms that exist in Medicare today. It will evaluate early indicators of improvement in patient outcomes and reduction in medical costs. Finally, it will explore the future direction of the major programs offered directly through CMS and through the Center for Medicare & Medicaid Innovation. his session is intended to meet the needs of actuaries who are focused on value- based design and/or Medicare.

Learning Outcomes: 

  • Compare various Value Based Care Design Initiatives
  • Evaluate the pros and cons of alternative payment models 
  • Explain how proposed changes could impact Medicare beneficiaries, plan sponsors and providers

Country Relevance: USA

Session Coordinator(s) Kelsey L. Stevens, FSA, MAAA

Facilitator(s)