Description: Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations.

Description: Paid Family and Medical Leave (PFML) benefits have expanded rapidly in recent years as an increasing number of states have required employers to provide these benefits to their employees. Examine recent developments in PFML benefits, for example, the presenters will provide information on which states are introducing or considering PFML programs, what types of benefits are provided, what types of data is available to monitor experience, and what challenges programs have encountered.

Description: Essay reforming uninsured health care.

Description: 2021 ImpACT Conference - Session 1B: Mental Health Care in a Virtual World 10.25.21 Recording

Description: Explore SOA-sponsored research on Social Determinants of Health (SDOH) during the How Does Where You Live Impact Your Health webcast. Dive into SDOH data and modeling that will focus on cluster analysis. This will help determine the overall impact of your area's affect on your health and life. This webcast also covers an overview of the existing SDOH-related programs that may affect or intersect with health plan or provider SDOH initiatives. Discover the importance of the place you live and future impact of your overall health.

Description: This section presents book reviews and summarizes recent publications on subjects that include U.K. social insurance, financing of hospital care, state examinations of life companies, approximate valuation of life and health insurance, mortality forecasting, and valuing estate tax.

Description: As we entered 2014, actuaries became familiar with three risk stabilizing mechanisms in the early years of the ACA marketplaces, colloquially known as 'the 3Rs'. As we enter 2024, there is renewed focus on rating compliance and risk adjustment. Speakers will highlight pricing considerations when determining cost-sharing reduction premium loads as well as related issues pertaining to risk adjustment and metal tier pricing.

Description: Analyzing large quantities of raw complex data is often a challenge in the health care industry. During this webcast, there will be a demonstration of how unsupervised machine learning techniques can be applied to such data to help bring useful insights. This will include examples that use unsupervised learning techniques spanning dimensionality reduction, clustering and anomaly detection.

Description: The June 2021 Supreme Court ruling in California vs. Texas has significant ramifications on Affordable Care Act markets. This session will provide the actuarial community an overview of the ruling, the likely impact on health insurance markets, and potential legislation to address the ruling details.