Description: Our three panelists represent a cross section of the health-care industry. The topics they will each discuss will include a range of broad to specific types of health-care innovation, and they will describe the process of showing value related to the innovation discussed. From Record of Society of Actuaries, Vol. 22, No. 2.

Description: The panel will provide an update on current developments in the financial transfer of risk under alternative managed care arrangements. The panel will also discuss the emerging issues with respect to capitation arrangements. From the Record of the Society of Actuaries, Vol. 21, No. 4a.

Description: Many new and innovative companies are leveraging technology to improve the effectiveness of the care provided to patients. They are employing better tools to identify patients who can benefit from specific programs that best meet the patient's need. They are also dramatically increasing the use of these programs by guiding plan members through the maze of offerings to match them with the programs that will be most beneficial to them. Employers are making these third party programs available to their members and Medicare Plans are using these new tools to identify emerging health risks for early intervention and more accurate risk scoring. This session will explore some examples of these programs, how they are being effectively integrated into the operations of health plans and how the results of these programs are being measured.The speakers will be:Raj Behal, MD, MPH,Chief Quality Officer, One Medical. Raj leads the quality and safety, value and innovation, and data science teams at One Medical. One Medical is changing the way primary care is delivered with a concierge approach with technology seamlessly woven into their offering. This includes booking appointments on line, virtual face to face care, accessible medical records and health reminders.Mylea Charval,Ph.D., CEO and Founder, Savonix. Savonix is a next generation cognitive assessment platform that brings clinical, evidence-based, and all mobile digital assessment of cognitive and emotional function. These capabilities are critical for early identification of the onset of dementia and for the proper risk assessment of seniors enrolled in Medicare Advantage Plans.Ed Cymerys, FSA, Advisor. Ed will serve as moderator. Over the last six years Ed has served as an advisor to a number of early stage technology companies looking to improve the way health benefits are being delivered.Dave Sotelo, FSA, MAAA, Actuarial Manager, Collective Health, Inc. Collective Health is an integrated solution that allows self-funded employers to administer their health plans, control costs, and take care of their people -- all in one place. They have effectively integrated more than 70 distinct third party solutions for self-funded employers and are rigorously assessing the impact of these programs

Description: This session will recap the history of the involvement of the actuarial profession in the debates on health care reform. From the Record of the Society of Actuaries, Vol. 21, No. 4b.

Description: Presenters at session 99 OF of the Maui II Spring Meeting discuss current issues involved in providing stop-loss coverage for provider-sponsored organization PSOs, managed care health plans, and self-funded groups. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.

Description: One of the Health Section's key focuses in 2019 is Initiative 18/11. Last year the SOA joined forces with the Kaiser Family Foundation (KFF) and the Healthcare Financial Management Association (HFMA) to answer the nagging question: “What can we do about the cost of healthcare?” A steering group has been formed to lead a research project as to what managed care companies can do to reduce costs without sacrificing quality. The project [called Managed Care 3.0 in the 18/11 paper] will examine historical models that have worked as well as investigate the impact that new technologies and care models may have on cost and quality, with the goal of better understanding the current environment and identify­ing potential risks and opportunities.

Description: The presenters will discuss recent regulatory changes that allow some long-term care benefits to be included in Medicare Advantage plans. Hear an overview of what has become available in the market and what might happen in the near future.

Description: Panelists at this session of the SOA 1997 Palm Desert Spring Meeting provide an overview of the business of medicine from both a hospital and a physician viewpoint. Topics include defining the mission, uncompesated care, impact of Medicare/Medicaid, expenses, scheduling and relationships with managed care organizations.

Description: This panel will present the perspectives of state government, federal government, and health maintenance organizations HMOs with respect to Medicaid risk contracting. From the Record of the Society of Actuaries, Vol. 21, No. 4b.