Description: This panel discussion addresses Critical Illness product design, marketing, trends and lessons learned from other countries. From the Record of the Society of Actuaries, Volume 27, No. 2, Session 20

Description: 1993 SOA Spring Meeting, San Diego. This session was about the Latin-American insurance market. Topics included: 1. Size, growth, regulations, products, distribution, marketing. 2. Market entry, business strategies, cultural issues, local staffing. 3. Level of activity for U.S. companies.

Description: The session covers strategies and products health plans are developing to address consumer choice. From the Record of the Society of Actuaries, Volume 27, No. 1, Session 121

Description: The prospects for China's health insurance has increased significantly in 2018, incentivized by a series of favorable government policies to support the development of commercial health insurance. However, the market still lacks relatively mature products and services. Overall there is a common understanding in the industry that good coverage plus service is the foundation for health insurance future development, and product innovation plus care management is key for an insurance company to maintain sustainable development in the competition. In this presentation, Dr. Yang will discuss the market trend both at home and abroad with respect to health management as well as its impact on product design, pricing and cost control. With the development of internet and big data, today’s health actuary has a special role in taking advantage of the digital transformation and achieving a high-quality and efficient health care service model.

Description: This is a case study session where the speakers will describe a project where a major health system converted its provider distinct reimbursement (i.e., separate physician IPA and hospital capitation) to an integrated reimbursement involving global capitation. The session will discuss the strategic issues considered by the parties and how they evaluated them in their decision process. This session will provide attendees an example of how to approach this type of decision.

Description: In the current value-based care marketplace, there are various reimbursement models that tie payments for care delivery to the quality of the care provided. The purpose is clear – change reimbursement to focus on value by rewarding better outcomes and lower spending. However, implementation it is complex, and many challenges emerge during this transition for both providers and payers.Providers often lack sophisticated actuarial capabilities or clear understanding of the connection between finance and clinical operations. For these reasons, they enter risk arrangements without knowing how to strategically manage and mitigate risks and fully transfer the reimbursement changes into clinical decisions. For payers, a truly viable value-based payment model that rewards the most valuable providers needs a multidisciplinary approach and a solid financial model. Such a model also requires transparency and a clear transitional road map for providers to encourage participation and collaboration. In this session, we will discuss lessons learned through case studies of working with both providers and payers on value-based care issues. We will illustrate the current state of the complex financial structures by presenting examples of value-based financial models, feasibility analyses, and strategies to design a payment model beneficial to both providers and payers. We will also explore the clinical collaboration necessary to make it all work, as well as present some best practice strategies to facilitate strong payer-provider collaboration.

Description: "The ACA RADV Program will begin to impact issuers’ risk transfers in the 2018 benefit year (BY) – potentially significantly. The program is expected to continue into the 2019 BY and beyond. Therefore, health actuaries working in the ACA market need to understand this program and its potential impact.The session includes panel experts who will provide attendees with high-level overview of the program, discuss the findings from a national study, and RADV’s ultimate impact to risk transfers, as well as downstream impacts to financial and pricing decisions. The nationwide study is based on 300+ issuers’ 2016 RADV results and contains emerging insights into the new ACA RADV program otherwise unavailable. The panel’s agenda will include:1. A succinct overview of the ACA RADV Program will be provided2. Summary of a national 2016 ACA RADV pilot study results and its findings. 3. Preliminary results from a national 2017 RADV study will be discussed (or CMS published results if available prior to session). 4. Walkthrough of how RADV results impact the overall risk adjustment transfers in the ACA market. 5. Finally, the panel will discuss RADV impact to issuer’s financial accruals and pricing strategy. 6. General Q&A, discussion"

Description: This session is about managed-care provider networks: organizing networks, information needs, monitoring utilization and risk/reward methodologies. From Record of Society of Actuaries Vol. 19, No. 1A.

Description: 1993 SOA Spring Meeting, Boston. This session is about the marketing front, including demographic trends, impact on products, market research, market segments and distribution.

Description: On December 21, 2018, the Centers of Medicare & Medicaid Services (CMS) released the final rule for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. 'Pathways to Success' makes sweeping changes and will push ACOs to assume financial risk more quickly. This session will discuss the key changes in the final rule, reasons why providers would remain in the program while being forced to downside risk, and how actuaries can add value to providers who will be taking on millions of dollars of risk in the coming years.