2022 SOA Health Meeting

Session Description: Start your day off with for the opening panel session and prepare to gain insight from thought-provoking sessions. Join us for a special panel with experts sharing their perspectives on pharmaceutical industry trends and developments, including on patents and biosimilars, economics and gene therapies.

Panelists: Gabriela Dieguez, FSA, MAAA, Principal and Consulting Actuary, Milliman Drew Kirchner, FSA, Head of Pharmacy Economics for Integrated Medical, Cigna; Katie Martin, CEO, Health Care Cost Institute; Kerri Miller, National Account Executive, Blueprint Medicines; Susan Winckler, CEO, Reagan-Udall Foundation for Food and Drug Administration

Moderator: Greg Warren, FSA, FCA, MAAA, Partner & Consulting Actuary, Axene Health Partners

Session Description: Explore many specific areas that will be impacted, highlight those aspects likely to be under the IA magnifying glass, and find out how you can best prepare your IA teams to understand the changes and expedite the testing timeframes of their audits.

By attending the session, you will be able to:

• Understand general IA testing approach and framework.
• Identify and address the key processes and procedures likely to be impacted by accounting change.
• Build a communication plan that tailors the level of detail of documentation to the intended audience. (e.g., Leadership and BOD)
• Document decisions made and implemented with IA in mind.

Session Description: Following her first 100 days as the CMS Administrator, Chiquita Brooks-LaSure released her six strategic pillars for the agency. The Center for Medicaid and CHIP Services (CMCS) followed these pillars and laid out their priorities for states under the Biden-Harris administration. With these priorities established, recent 1115 submissions from several large states, including California, Massachusetts and New Jersey, may give insight to how CMS will operationalize their vision under this program authority.

This session will include presentations from past CMS staff and will cover the priorities for states under the new CMS administration, current themes in 1115 waiver submissions and/or approvals under this administration, and how these trends may influence future 1115 waiver submissions for other states.

By attending the session, you will be able to:

• Demonstrate understanding of the current administration’s strategic priorities for State Medicaid & CHIP programs.
• Identify trends in recent 1115 waiver submissions.

Session Description: In the game of chess, both players have perfect knowledge of the board. In poker, however, players deal with asymmetric information as well as the fact that your opponent can lie. There is an old expression that smart people are “playing chess when their opponents are playing checkers.” However, playing chess when your opponent is playing poker is a recipe for disaster (for the chess player, that is).

Parameter risk is more akin to poker than chess, and it is often overlooked in favor of volatility risk in stop loss and reinsurance pricing. Unlike volatility risk, however, parameter risk does not necessarily decrease as the group size increases. Understanding the impact of parameter risk can help avoid mispricing the risk at hand as well as the impulse to provide false precision. False precision can lead to poor underwriting decisions and financial losses. In this session, the presenters will provide examples of parameter risk as well as potential solutions to incorporate when building simulation models.

By attending this session you will be able to recognize potential areas of parameter risk and understand techniques to incorporate parameter risk in simulation modeling.

Session Description: In the time since the original proposal to move healthwriting companies from the blue blank to the orange blank, there have been several incremental updates to the blue blank by the NAIC Blanks Working Group to integrate portions of the orange blank into the blue blank. Meanwhile, the NAIC RBC Working Group has issued their proposal to change the health test for comment and appear to be moving forward with the proposal to revise the health test. This would obligate companies that write predominantly health business onto the orange blank rather than the blue blank, which they have historically used for reporting.

Discover background of the revised health test, the incremental updates to the blue blank that have been implemented recently, additional incremental updates proposed for upcoming blue blanks, and the current status of the Health RBC Working Group proposal to revise the health test. Hear observations about companies that have opted to 'take the plunge' and move to the orange blank ahead of the revised health test as well as companies that have opted to remain on the blue blank and incrementally update as new requirements are integrated into the Blue blank.

By attending the session, you will be able to:

• Understand the context of the initiative to revise the NAIC health test.
• Summarize the recent changes to the blue blank implemented by the Blanks Working Group that integrate portions of the orange blank into the blue blank.
• Summarize the upcoming proposed changes to the blue blank by the Blanks Working Group that integrate additional portions of the orange blank into the blue blank.
• Summarize the current status of the Health RBC Working Group proposal to revise the health test.
• Provide industry perspective on companies that have opted to move to the orange blank ahead of the revised health test and companies that have opted to remain on the blue blank until the NAIC requires it.

Session Description: Fully remote and hybrid environments are here to stay and actuarial leaders are continuing to evolve their styles and strategies to accommodate shifting needs. In order to build engaged and future-focused teams, leaders must refine their management approach and be intentional about helping employees build relationships, connect to culture, and lean into their futures with the organization. Listen as the panel shares their insights and experiences on how they have built loyalty and increased productivity among staff to meet business goals and move forward in the new working environment.

By attending this session, you will be able to:

• Understand the state of the actuarial talent market and changing employee expectations, and what it may mean for your department.
• Identify how to best support and engage your employees in a remote and/or hybrid work model.
• Apply strategies to enhance communication, lead with empathy and build trust among your team.
• Empower and energize your team to increase retention and overall productivity.

Session Description: The rules governing the framework of Affordable Care Act (ACA) marketplaces continue to be refined at the state and federal level. The catalyst for such changes has been a desire to improve markets, which has been primarily informed by data and experience in the ACA's first decade. This session will feature a panel of consulting actuaries, a state policy advisor who has influenced ACA legislation, and an attorney deeply involved in ACA risk adjustment litigation. Discussion will include new federal proposals, efforts to strengthen enforcement of rating compliance, new actuarial insights from public data, and the anticipated future implications for ACA markets.

By attending this session, you will be able to:

• Understand what precipitated risk adjustment lawsuits and how proposed federal rules address these concerns.
• Identify how state regulators are addressing premium misalignment between metal levels and shaping local policies.
• Develop new insights on publicly available data.
• Understand the implications these policy changes will have on the future of pricing health insurance benefits, consumer value and enrollment distributions in ACA marketplaces.
• Understand the primary factors leading to ACA market success.

Session Description: The introduction of new gene and cell treatments is not without scrutiny. Although these treatments are often curative, they come with a significant price tag. Health plan actuaries find themselves wondering if the intended outcome supports the cost and whether the potential medical cost savings will offset the high drug cost.

The Institute for Clinical and Economic Review (ICER) reviews results from clinical trials to produce a report evaluating the cost-effectiveness of new therapies. Depending on the results, the ICER report can be used by pharmaceutical companies to justify the high cost or by the health plan to do the opposite. Go beyond the ICER report and discuss an alternative method for valuing new drugs using nonmedical revenue streams, such as disability and nutrition benefits, and return-on-investment modeling.

By attending this session, you will have a better understanding of the nonmedical revenue streams, such as disability and nutrition assistance benefits, that may offset the cost of a drug and how those revenue streams can be incorporated into return-on-investment modeling.

Session Description: This training session will include lessons learned in 2021 and revisit a presentation given last year, discussing the new Actuarial Standard of Practice (ASOP56), which fills in the gap for guidance on Actuarial Modeling. Prior to ASOP 56, actuarial judgement reigned where standards and guidance lacked. Learn the foundation for designing, developing, modifying and validating a model according to SOA guidelines.

By attending this session, you will:

• Learn how to identify model’s intended purpose.
• Strategically extract input data and assumptions.
• Use the level of detail required in output data as a consideration for model design.
• Choose from SOA recommended validation techniques.

Dr. Saundra Dalton-Smith, Physician, Work-Life Integration Researcher & Award-Winning Author

She is the founder of Restorasis, a health tech start-up focusing on restoring healthy patient-provider relationships to improve health outcomes. As a wellness initiative consultant, Dr. Dalton-Smith helps organizations overcome burnout to create a culture of well-being. She is a board-certified internal medicine physician with over 20 years in practice near Birmingham, Alabama.

Session Description: What are the latest product trends impacting the critical illness, hospital indemnity, and accident insurance industries? A panel of product development experts will discuss how pricing has evolved, new approaches and trends that are impacting product design, and key considerations when bringing new ideas to market.

By attending this session, you will:

• Learn about changes in the market that will help them price products.
• Evaluate new approaches used in the voluntary market.
• Identify the issues that will make your products successful.

Session Description: Regression to the mean (RTTM) is inflating your health care intervention evaluations if you are not carefully managing it's omnipresent and significant impact RTTM is the statistical phenomenon which arises when comparing sequential data points when an initial observation is extreme or an outlier, and states that with no other intervention, future observations will be closer to the average. Members who had high costs last year will, on average, have lower costs this year, even in the absence of any intervention or clinical program, simply by 'regressing' to the mean. This means that if your clinical programs are simply targeting members who had adverse medical experience last year, you’re targeting the wrong people. And if your savings methodologies are simply last year’s costs minus this year’s costs, the savings are inflated.

By attending this session, you will be able to identify situations where RTTM will be a significant factor, how to eliminate its impact when performing retrospective evaluations, how to identify prospects for clinical intervention with RTTM in mind, and more.

Session Description: The past couple years during the pandemic have had a tremendous and costly impact on society’s collective mental health. What’s next? Examine patterns of MH/SA needs identified from living with COVID-19 for two years and discuss what MH/SA needs to expect in the future. Across society, mental health has been one of the most impacted areas of total health and wellness and has been highly publicized. What’s here to stay, and how does that impact how we think about mental health going forward? With increased publicity and campaigns to normalize MH/SA needs, what are the supply-side and demand-side limits?

By attending this session, you will be able to:

• Identify drivers of MH/SA services in the pandemic.
• Understand future expectations of MH/SA needs, with population specific considerations (ex. gender, business type, etc.).
• Analyze impact of increased awareness of MH/SA needs and reduced stigma.