Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

Description: This session discusses demographics of the uninsured & underinsured, needed core benefits, funding uncompensated care, state pools for high risk and near poor, the Massachusetts system, and the Kennedy-Waxman federal bills. From Record of the Society of Actuaries 1988 Vol. 14, No. 4B.

Description: This paper examines the impact at Harvard Pilgrim Health Care of the introduction of specialty networks, shift to mail-order prescriptions, shifts to generic prescriptions, and product mix shifts to overall pharmacy trend. From Prescription Drugs Monograph, M-HB04-1.

Description: This tables shows BMIs at common height and weight combinations.

Description: Telehealth enables the delivery of health care services to patients that are not in the same location as providers. Over the past decade, telehealth has been used increasingly to complement face-to-face patient encounters, and is particularly important to addressing health care needs in rural areas. Recent regulatory catalysts, particularly in the Medicare Advantage program, have served to elevate the visibility and importance of telehealth in the overall health care delivery system. Starting in 2020, Medicare Advantage plans can offer any clinically appropriate physician services through telehealth as part of the standard Medicare benefit. Network adequacy standards can also be met via telehealth providers under certain programs. This presentation will cover the basics of what constitutes telehealth, and provide tangible demonstrations of telehealth technology (simulating variations mediums through which services are delivered). We will cover the what, the why, and the where (anywhere) of telehealth in 2020.

Description: Part 1 of a 2-part series exploring implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA. Part 2 addresses the new enforcement safe harbor, how the regulations could impact the business of behavioral health care and the impending decisions for payors, employers, providers, and insureds.

Description: This article focuses on mandatory supplemental benefits offered by general enrollment plans and Dual Eligible Special Needs Plans (D-SNPs) Medicare Advantage plans from 2017 to 2021.

Description: This table shows the results of an attribution of the major contributing factors to the rate of mortality improvement in cardiovascular disease between 1980 and 2000.

Description: This is a discussion on group life and health products under conditions of inflation. It specifically highlights the development of alternative delivery systems such as Health Maintenance Organizations, the potential for further computerization of claim and record keeping, viability of new areas of coverage such as dental & vision and legal benefits, self-funding and administrative services only mechanisms, and the effect of inflation. From Record of the Society of Actuaries 1982, Volume 8, No. 1.

Description: This session describes the process payers and employers can use to evaluate emerging medical device technologies, recent or pending FDA submissions for prescription drugs and experimental treatments that impact patient care, resource utilization and health care expenditures. We will walk through the process of identifying and selecting impactful treatments (Horizon Scanning) and quantifying the financial cost of new technologies before they arrive in the market. These workflows can be leveraged by actuaries, healthcare economists, clinicians and pharmacists from a payer (Commercial and Medicare) and employer perspective for self-funded plans. We will also walk through some sample models that illustrate how costs for emerging technologies and treatments can be modeled.