Description: Enabling better care, mood management and even slowing and reversing memory loss for Alzheimer's and dementia care.

Description: 1999 SOA Regional Meeting, Atlanta. In this session experts from the regulatory environment and from the insurance industry discussed whether the public interest is best served by the states or the federal government being the primary regulators of insurance or some system of bifurcated regulatory authority shared between the states and the federal government.

Description: The days of reinsurance treaties bound by a handshake are long gone. Treaties have evolved into complex legal documents. The session will use a recently released study on recapture provisions as a starting point and will expand the discussion to other key treaty provisions. The focus will be on understanding the intentions, concerns and relative positions of both the direct company and the reinsurer so that a mutually beneficial compromise can be explored.

Description: Recently, actuaries have become more involved in formulary decisions due to high and variable pharmacy cost and utilization trends. How can actuaries and pharmaceutical manufacturers work together to better predict the market while covering key drugs? What discussions are currently taking place between manufacturers and payers? Is there value in these discussions that actuaries are missing? This presentation will provide both actuarial and manufacturer perspectives in order to create a mutual understanding that will begin to direct future conversations to benefit both stakeholders.

Description: Support systems and new solutions to enable caregivers to deliver better care and reduce personal stress.

Description: Shared savings deals are all the rage these days. Significant numbers of payers and provider groups in many markets around the U.S. want to engage in shared savings contracts covering commercial, Medicare and Medicaid patients. The fundamental question underlying a value-based contract is, for whom is the value accruing? Ostensibly, value is accruing to the sponsor—whether employer or public payer—but should be accruing to the provider as well. Often design flaws in value-based arrangements and contracts and/or the inability to execute in a value-based paradigm diminish the savings that could have accrued, create inequities in value or drive unintended consequences. This presentation will provide attendees with insights into how to design a workable value-based payment initiative, how to educate both payer and provider participants, and how to oversee the initiative’s operations. Specific topics will include: • Attribution logic: prospective, retrospective and the details in between • Risk adjustment: why one model doesn’t fit all arrangements, and even if it does, how do you implement? • Data and reporting: matching business needs to the payer’s willingness to be transparent and provider capabilities • Quality improvement as a component of payment: actionable and tied to the attributed population or just “out there?”

Description: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: Creating the complete view and management of the complex interactions between care providers, medicines and behavior.

Description: The U.S. health care industry has gone through a dramatic change during the past several years. The business model has moved from a risk selection model to a risk management model. People can shop online for their health care coverage. Everyone is welcome! Annual and lifetime dollar limits, underwriting and the pre-existing conditions exclusion are all in the history book now. Facing the challenges of the post-reform era, many health insurance carriers began using big data analytics on all aspects of their decision-making processes. The goal is to be able to compete on analytics in this quickly changing environment. However, becoming an analytics competitor is not easy. It requires the belief from the leadership and a group of dedicated analytical professionals to solve emergent business problems that existing strategies cannot address in an evolving market. These problems include marketing for acquisition and retention, coding accuracy, revenue growth, health care disparity, payment integrity, quality of care, health care cost reduction and, ultimately, personalized care management. In this section, audience will learn a basic understanding of the role of predictive analytics in US Healthcare marketplace.

Description: Companies with the intention of being the top, trusted source(s) in an information overloaded world.