Description: This session will include examples of healthcare claims and market data to be used for educational purposes to highlight trends in the insurance industry. It will also highlight opportunities to enforce existing laws around fraud and abuse, and areas for regulators and legislators to focus to address this growing problem. Finally, it will discuss recent law changes and highlight areas requiring additional regulatory intervention. Expect discussions of recent claim issues and laws in the healthcare market as well as emerging issues in healthcare. The presentation will be beneficial to healthcare professionals working for health insurers, healthcare providers, auditors, regulators and healthcare providers and will also cover professionalism related topics for actuaries.

Description: "Spread pricing is a pricing methodology where pharmacy benefit managers (PBMs) bill a payer one price but reimburses the dispensing pharmacy a lower price for the same prescription drug. PBMs have historically relied on spread pricing as a revenue source. However, a growing number of states are introducing and passing legislation prohibiting spread pricing for Medicaid and commercial clients. In addition, new entrants to the PBM and mail-order pharmacy space are disrupting the market by offering services that promote increased transparency and member satisfaction. Expect updates on recent legislative trends and market disruptions targeted towards increasing PBM drug pricing transparency. By attending this session, you will have a better understanding of how changing legislation and market disruptions may impact current pricing methodologies."

Description: This session will be centered around the roles and responsibilities of a valuation actuary. Learn the best practices of health actuaries, along with technical considerations and professionalism issues surrounding the calculation and reporting of health liabilities and reserves. This session will focus on key actuarial liability and reserve provisions, including Claims Unpaid and Premium Deficiency Reserves. In this session, explore new ideas about calculation methods and the importance of the underlying assumptions. You will also learn best practices and practical applications concerning reserve calculation discuss best practices regarding the preparation of an actuarial memorandum supporting a Health Annual Statement. This will include key considerations from the American Academy of Actuaries' Practice Note about documenting and supporting the actuarial calculations. The discussion will also present views and considerations from both the insurer's and the regulator's perspectives.

Description: Since the Affordable Care Act implemented minimum loss ratio provisions for health plans, several states have passed or at least considered minimum loss ratio regulation for dental plans. While such regulations are intended to improve insurer efficiency and promote value to consumers, they can have unintended negative consequences if the unique characteristics of the dental insurance market are not considered. Learn about this hot topic, including loss ratio basics, recent legislative activity in the dental loss ratio space, how dental differs from medical, and why those differences are critical to account for when trying to regulate loss ratios in that market.

Description: "Advancing health equity is one of the five strategic objectives outlined in the CMS Innovation Center's strategic objectives for the next ten years and is an increasing area of focus across many states. Focus in on recent developments in addressing Medicaid beneficiary needs related to social determinants of health (SDOH), health-related social needs (HRSN), and health disparities and inequities in Medicaid. Several states have introduced non-traditional benefits into their programs in recent years to address these areas, such as various types of housing supports, nutrition-related benefits, and enhanced/advanced case management support. Expect a discussion on the benefits introduced recently in states such as AZ, CA, MA, NC, and OR, including funding considerations around these benefits as well as the 1115 demonstration waiver authorities granted to these states to allow coverage for these non-traditional health care services.

Description: State Medicaid programs have broad flexibility to establish their own payment methodologies and rates for hospital services. Many states direct additional funding to populations, services, and hospitals where Medicaid comprises a disproportionate share of total business, or where there are other access concerns (e.g. rural providers). Actuaries can play a key role in determining where those additional funds would have the most benefit.

Description: Delve into the factors contributing to the rapid growth of high-cost medical treatments and how payers can manage the financial exposure that comes with them. Learn about the current and near-future state of million-dollar medical costs, as well as the trends shaping the industry. By attending the session, you will have a better understanding of the underlying drivers of high-cost treatments and will be equipped with practical strategies for mitigating their financial impact, including risk management techniques, cost containment measures, and new payment models. Additionally, you will be able to identify key considerations for implementing these strategies in their own organizations.

Description: Help consumers understand their rights in health care and understand how technology is embedded into the health care industry. On top of that, you will also hear about topics related to professionalism. During this webcast, you will learn about: ▪ An overview of the health insurance market ▪ Health care provider billing and contracting ▪ Recent trends with insurers and health care providers ▪ Identify areas of excessive billing and fraud ▪ The impacts of technology on billing practices ▪ An understanding pharmacy benefits, including discounts and rebates

Description: The cell and gene therapy marketplace is quickly evolving and continues to grow as a risk concern for governments, health plans, stop loss insurers and reinsurers. In this webinar, we discuss currently approved tissue, cell and gene therapies, the near-term pipeline, uptake considerations, case management processes, plan document and contract considerations, risk mitigation processes and programs, and network considerations.

Description: Hear an overview of recent results and potential scenarios that may impact the future of the ACA market. Review recent reported industry level profitability before transitioning to a discussion of how current market dynamics may influence the future profitability of this segment. Results from microsimulation economic models will be presented to help illuminate market shifts. Issues that will be explored include how ICRA availability might influence individual decision making, as well as how a move to level funding is impacting the small group market.