Description: The article describes the insurance industry's preparation for pandemic events and the public finance response.

Description: This article explores the disruptive applications of blockchain, an emerging technology, and its impact on the pharmacy benefit space, and pharmacy benefit managers (PBM).

Description: MHPAEA prohibits health plans from imposing financial requirements or treatment limitations on behavioral health benefits that are more restrictive than those applied to medical and surgical benefits. MHPAEA's regulations define treatment limitations to include nonquantitative treatment limitations (NQTLs), which are benefit design features that are not numerical, but otherwise limit the scope or duration of benefits.

Description: The presenters will provide updates on research being conducted under SOA sponsorship. This includes projects on the topics of Direct Primary Care and Patient Centered Medical Homes.

Description: HIV is still a big public health concern, but there are therapies available to prevent infection before and immediately after exposure. As legislatures and the USPSTF considers adding these therapies to the list of preventive care covered without cost share, actuaries will need to estimate the impact on their care cost. The presenters will share an actuarial tool kit to estimate the impact of covering PrEP and PEP for different populations. Examples are provided and discussion is welcome.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: While intended to assist health plan actuaries responsible for stress testing and ORSA filings, this session will also be informative for actuaries interested in communicating the impact of potential catastrophic events for health plans to their management and board. It will begin with a discussion of event thresholds for stress tests and their impact on capital and financial statements. Presenters will take a detailed look at several catastrophic event case studies (historical and hypothetical) in the following areas: healthcare specific (e.g. pandemic, specialty Rx), financial institution/credit market, operational/business, strategic and multi-event scenarios.</

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: Technical report to accompany Fifty States, Fifty Stories: A Decade of Health Care Reform Under the Affordable Care Act.