Health

Podcast

    Risk Medicare Advantage Risk Scores: Transition to encounter data

    September 19, 2017

    Length: 13:17

    Sponsor: Health Section

    Description:

    The Medicare Advantage market is currently in the middle of a multi-year transition from the existing Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS) for calculating risk scores. CMS has stated that ultimately EDS will be the sole diagnosis data source for Medicare Advantage organizations' risk scores and revenue. Dave Dillon, FSA, MAAA, interviews Deana Bell, FSA, MAAA, on the topic and they discuss how the transition has shown to have a financial impact on Medicare Advantage revenue and how actuaries are well equipped to help.

    To open podcast in a new window, click here .

    Health Section - Influence Training for Actuaries

    September 19, 2017

    Length: 16:13

    Sponsor: Health Section

    Description:

    During this podcast, Dave Dillon interviews Andrew Sykes about his non-traditional path to actuarial work and helping actuaries to develop the skills to influence other people to take specific actions based on their work.

    To open podcast in a new window, click here .

    Bayes’ Theory - a Powerful Analytical Tool Unleashed by Actuaries

    September 08, 2017

    Length: 25:13

    Sponsor: Health Section

    Description:

    Bayes' Theory has been used to find a lost hydrogen bomb, break the German WWII code, identify smoking as a cause of lung cancer and heart disease, establish merit rating in insurance, and enable computers to "learn" and "make decisions." But each time it was used, the techniques were not published, and the theory was allowed to die. Actuaries played a prominent role throughout history in originally discovering Bayes' Theory and resurrecting it to solve practical problems. Roy Goldman brings to life this actuarial history in his Contingencies article "Bayes' Gift," based on the book The Theory that would not Die by Sharon Bertsch McGrayne.

    To open podcast in a new window, click here .

    Health Section Strategic Initiative: Commercial Healthcare, What’s Next?

    August 23, 2017

    Length: 15:34

    Sponsor: Health Section

    Description:

    During this podcast, Joe Wurzburger interviews Dave Dillon about the Health Section Council's initiative concerning healthcare reform. They discuss how the SOA is addressing education and research concerning the important issues in the ever changing health insurance landscape.

    To open podcast in a new window, click here .

    The Role of the Actuary in Public Health: A New SOA Health Section Initiative

    July 12, 2017

    Length: 13:52

    Sponsor: Health Section

    Description:

    The field of public health does important work around the world in keeping populations safe and healthy. This podcast will explain how the SOA Health Section's strategic initiative on public health is working to educate and connect actuaries with the world of public health.

    To open podcast in a new window, click here .

    Telemedicine: What’s it all About?

    June 30, 2017

    Length: 8:39

    Sponsor: Health Section

    Description:

    During this podcast, Dave Dillon interviews Jackie Lee about an article she coauthored on telemedicine. They discuss how the current telemedicine landscape and why actuaries should be paying attention into these types of services as it has potential pricing impacts.

    To open podcast in a new window, click here .

    Do Employees Make Sensible Health Insurance Choices?

    March 21, 2017

    Length: 21:31

    Sponsor: Health Section

    Description:

    Dave Dillon, FSA, MAAA interviews Randy Herman, FSA, MAAA about the November 2016 Health Watch article  "Review: Do Individuals Make Sensible Health Insurance Decisions? Evidence From a Menu With Dominated Options" that he co-authored. They discuss the sub-optimal health insurance choice decisions made by employees, methods to improve decision quality and how concepts from behavioral finance theory might help explain the results.

    To open podcast in a new window, click here .

    MACRA: Medicare Supplement in 2020 and Beyond

    March 16, 2017

    Length: 10:30

    Sponsor: Health Section

    Description:

    This podcast gives a brief overview of the payment systems being introduced by MACRA as well as the changes to Medicare Supplement.

    To open podcast in a new window, click here .

    Level Funding: An Alternative to the ACA for Small Groups

    November 03, 2016

    Length: 17:22

    Sponsor: Health Section

    Description:

    Joe Slater FSA, MAAA talks about how under the Affordable Care Act (ACA), all groups with 50 or less employees will eventually be subject to the ACA's modified community rating rules. While some groups will see lower premiums than they would have without the ACA, others will see significant premium increases. Though self-funding has historically only been a realistic option for groups with at least a few hundred employees, the premium disruption and potential loss of business caused by the ACA has incentivized insurance carriers and third party administrators to develop self-funded product offerings for small groups. These products are commonly referred to as Level Funding products.

    To open podcast in a new window, click here .

    Private Exchange Update

    October 14, 2016

    Length: 17:14

    Sponsor: Health Section

    Description:

    Dave Petta, FSA, MAAA and Karen Shelton, FSA, MAA discuss their article on Private Exchanges published in the May 2015 issue of HealthWatch   Listen as they describe the tenets of Private Exchanges, how they differ from Public exchanges and their current outlook.

    To open podcast in a new window, click here .

    Direct Primary Care: Good for What Ails Us

    October 05, 2016

    Length: 16:33

    Sponsor: Health Section

    Description:

    This podcast features Dave Dillon, FSA, MAAA interviewing Gayle Brekke, FSA, MAAA on the topic of Direct Primary Care, a topic which is also covered in her article in the May issue of Health Watch.  This podcast introduces the direct primary care model, and outlines how it can improve care coordination, ensure that chronic conditions are well-controlled, reduce health care spending and improve the doctor/patient relationship.  

    To open podcast in a new window, click here .

    Medicaid Encounter Data

    September 21, 2016

    Length: 19:03

    Sponsor: Health Section

    Description:

    This podcast features Dave Dillon, FSA, MAAA interviewing Sabrina Gibson, FSA, MAAA, and Jenny Gerstorff, FSA, MAAA on the topic of Medicaid encounter data, a topic which is also featured as the cover article of the latest edition of In the Public Interest . They discuss how various stakeholders collect, transfer, and use encounter data to understand healthcare benefits provided under managed Medicaid programs throughout the country.

    To open podcast in a new window, click here .

     

    Rate Review

    July 15, 2016

    Length: 18:30

    Sponsor: Health Section

    Description:

    In this podcast, Dave Dillon, FSA, MAAA interviews Kristi Bohn, FSA, MAAA, EA, MSPA on a state regulators insight regarding rate reviews.

    To open podcast in a new window, click here .

    ACA Sustainability: Are the Solutions at the State Level?

    September 06, 2016

    Length: 12:33

    Description:

    Dave Dillon, FSA, MAAA interviews Greg Fann, FSA, FCA, MAAA on his May 2016 Health Watch article "Section 1332 Waivers: Coming Soon to a State Near You?". This discussion covers the process of states applying for waivers of ACA rules, the role of actuaries in the process, current state activities, and the potential market benefits of innovative solutions.

    To open podcast in a new window, click here .

    Keys to Successful Payment Reform

    May 18, 2016

    Length: 15:38

    Sponsor: Health Section

    Description:

    In this podcast, Dave Dillon, FSA, MAAA interviews Juliet Spector, FSA, MAAA on payment reform models. The discuss key risks, important payment reform team members, and pricing. Juliet also gives her opinion on whether she thinks payment reform will be successful.

     

    To open podcast in a new window, click here .

     

     

    Critical Illness Insurance Overview

    April 04, 2016

    Length: 15:15

    Sponsor: Health Section

    Description:

    Dave Dillon, FSA, MAAA interviews Rex Durington, FSA, MAAA on his December 2015 Health Watch article: Critical Illness Pricing Overview - 2015 Update. The discussion covers the growing popularity of the product and topics from benefit design to product filing.

    To open podcast in a new window, click here .

     

    A Federal Perspective on Rate Review

    March 25, 2016

    Length: 20:18

    Sponsor: Health Section

    Description:

    Dave Dillon, FSA,MAAA interviews Brent Plemons, a Health Insurance Specialist in the Rate Review Division of CCIIO, to get an inside look at the role of the Federal Regulator.  They also discuss changes to the filing process and URRT for 2017, as well as common problems seen in the prior year's rate filings.

    To open podcast in a new window, click here .

     

     

    Health Plans Discover Risk Management: What getting ready for ORSA did for us

    December 29, 2015

    Length: 14:03

    Sponsor: Health Section

    Description:

    Joe Wurzburger interviews Mark Jamilkowski, Todd Daniels, and Kurt Wrobel about their session from the 2015 SOA Annual Meeting covering ORSA for health plans. The guests reflect back over the primary lessons learned both from their own experiences with ORSA as well as from the Annual Meeting session itself. Listeners will be able to gain insight from three of the industry's leaders that they can apply to their own ORSA reports going forward.


     

    To open podcast in a new browser, click here.  

     

    ACA@5 An Actuarial Retrospective

    December 14, 2015

    Length: 20:23

    Sponsor: Health Section

    Description:

    Rowen Bell provides his insight on the concept and development of the ACA @ 5 An Actuarial Retrospective.  

    ACA@5 An Actuarial Retrospective  


     

    To open podcast in a new browser, click here.  

     

    Interview with Karan Rustagi

    December 14, 2015

    Length: 9:06

    Sponsor: Health Section

    Description:

    The affordable care act created a provision for states to offer a Basic Health Plan as an affordable coverage for members with incomes up to 200% of federal poverty level. However, very few states showed interest and only a couple offered the plan. Gain insights into why more states did not implement a basic health plan from an actuary who analyzed the financial impact of implementing this plan in the state of Massachusetts.

    ACA@5 An Actuarial Retrospective  


     

    To open podcast in a new browser, click here.  

     

    The Truth Seeking Debate

    September 08, 2015

    Length: 12.12

    Sponsor: Health Section

    Description:

    This podcast focuses on one the most important problems in analytic research - the development of biased analysis by researchers. In the podcast, Kurt first highlights the problem by describing an internal debate among economists regarding their own biases and how it is connected to their research. With this debate as background, Kurt then discuss how actuaries can avoid many of the pitfalls encountered by economists in doing their work - particularly when it applies to the most challenging aspects of public policy.

    Article from June/July issue of The Actuary .

     

    To open podcast in a new window, click here .

     

    Cause/Effect and Health Actuaries: New Challenges from Health Reform

    September 08, 2015

    Length: 21:48

    Sponsor: Health Section

    Description:

    Health reform comes with many new rules for actuaries. It also brings actuaries unstructured challenges, such as providing an opinion on whether a particular program saves money. While actuaries have advantages over other professions for such problems, traditional approaches can easily lead the actuary astray. Hear about the right kind of thinking and methods from two non-traditional actuaries at the forefront of actuarial cause and effect analysis.

    Article from the May issue of Health Watch .

     

    To open podcast in a new window, click here .

     

    2015 Health Meeting: Session 12 Latest on the ACA: From the Industry, Congress, and the Supreme Court

    June 23, 2015

    Length: 12:42

    Sponsor: Health Section

    Description:

    In this episode Greg Fann interviews Victor Davis and Georgia Attorney General Sam Olens, two panelists at the 2015 SOA Health Meeting, who presented the latest legislative, legal, and market complications related to the Affordable Care Act. They discuss current proposed federal legislation, potential scenarios with either outcome of King v. Burwell, and actuarial challenges projecting risk adjustment settlements.

    To open podcast in a new window, click here .

     

    Interview with Dave Nieman

    March 31, 2016

    Length: 12:42

    Sponsor: Health Section

    Description:

    Rebecca Owen has a conversation with Dave Nieman about the nature of dual eligible members for specific government sponsored programs.

    To open podcast in a new window, click here .

     

    Professionalism for Health Actuaries - Interview with Dave Wells

    March 25, 2015

    Length: 18:05

    Sponsor: Health Section

    Description:

    Dan Bailey interviews Dave Wells who recently presented at the 2014 SOA Annual Meeting on Professionalism for Health Actuaries in the post ACA era of health reform. For those who could not attend his presentation, this episode will provide you with highlights from Dave's session.


     

    To open podcast in a new browser, click here.

     

    If We Knew Then What We Know Now: ACA Enrollment - Interview with Gregory Fann

    January 26, 2015

    Length: 21:24

    Sponsor: Health Section

    Description:

    Dan Bailey interviews Gregory Fann who recently presented at the 2014 SOA Annual Meeting on If We Knew Then What We Know Now: ACA Enrollment. For those who could not attend his presentation, this episode will provide you with highlights from Greg's session.

     

    To open podcast in a new browser, click here .

     

     

    ACA Health Rate Review - Interview with Dave Dillon

    December 16, 2014

    Length: 15:59

    Sponsor: Health Section

    Description:

    Dan Bailey interviews Dave Dillon who recently presented at the 2014 SOA Annual Meeting on ACA Health Rate Review. For those who could not attend his presentation, this episode will provide you with highlights from Dave's session.

     

    To open podcast in a new browser, click here .

     

     

    ACA Implementation and Strategies in 2017 and Beyond - Interview with Jim O'Connor

    December 16, 2014

    Length: 16:17

    Sponsor: Health Section

    Description:

    Dan Bailey interviews Jim O'Connor who recently presented at the 2014 SOA Annual Meeting on ACA Implementation and Strategies in 2017 and Beyond. For those who could not attend his presentation, this episode will provide you with highlights from Jim's session.  

     

    To open podcast in a new browser, click here .

     

     

    Back

    Legend

    Communication

    Demonstrating the listening, writing and speaking skills required to effectively address diverse technical and nontechnical audiences in both formal and informal settings.

    Professional Values

    Adhering to standards of professional conduct and practice where all business interactions are based on a foundation of integrity, honesty and impartiality.

    External Forces & Industry Knowledge

    Identifying and incorporating the implications of economic, social, regulatory, geo-political and business changes into the design and delivery of actuarial solutions.

    Leadership

    Initiating, innovating, inspiring, creating or otherwise acting to influence others regardless of level or role toward a common goal.

    Relationship Management & Interpersonal Collaboration

    Creating mutually beneficial relationships and work processes toward a common goal.

    Technical Skills & Analytical Problem Solving

    Applying the actuarial knowledge, skills and judgment required to provide value-added services.

    Strategic Insight & Integration

    Anticipating trends and strategically aligning actuarial practice with broader organizational business goals.

    Results-Oriented Solutions

    Providing effective problem solving that addresses relevant interests and needs.