Description: In this video Mitchell Momanyi, FSA MAAA presents an informative breakdown of Medicare Advantage plans, delving into the intricacies of this alternative to traditional Medicare. Covering the inception of Medicare Advantage and its evolution, Momanyi explores the managed care companies offering Part C coverage, emphasizing the role of provider networks coordinated care. Concluding with key considerations for beneficiaries, Momanyi stresses the importance of weighing the pros and cons between Traditional Medicare and Medicare Advantage, while also emphasizing the evolving nature of the Medicare landscape and the regulatory nuances influencing enrollment decisions. Conributors: Mitchell Momanyi, FSA, MAAA, Deana Bell FSA, MAAA, Matt Emery, FSA, CERA, MAAA, Jon Forster, ASA, MAAA

Description: Cover a variety of topics centered around the unsupervised learning technique called 'clustering'. The presenters will take you through a wide array of topics that range from 'What is Clustering?' to 'How can I use this technique to solve problems I didn't even know existed?' In the health care industry, everyone is looking for an edge in reducing total spend-cluster analysis finds the unambiguous in an ambiguous framework of results.

Description: Hear about the new hope biosimilars bring in helping payers and patients manage the rapidly growing pharmacy spend. The Big Event, encompassing multiple Humira biosimilars, launches in 2023 and could set the tone for how much biosimilars can be expected to contribute to solving our pharmacy spend challenges. What will be the financial impact of the Big Event and this coming wave? What can be done to maximize adoption of biosimilars? What strategies are available to maximize savings for payers and patients?

Description: High inflation rates can affect disability insurance in a variety of ways. Learn about rising price and wage inflation trends and why they are of interest to disability insurers. You will also hear presenters address topics such as recessionary pressures, the eroding value of benefits, wage growth, top-line trends and expense pressures. By attending the session, you will gain insight into how inflation should be considered in pricing, reserving and financial modeling.

Description: The presenters in this session will highlight the SOA’s work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and State principals to determine appropriate underwriting margins components within Medicaid managed care rates. Understand a brief description of the motivation for and underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in where they operate. By attending this session you will be able to: • Understand the role that Medicaid underwriting margin plays in Medicaid rate setting. • Understand the key components of Medicaid underwriting margin. • Understand the factors that necessitate underwriting margins. • Understand how to incorporate appropriate Medicaid underwriting margin levels in Medicaid rate setting.

Description: Increasingly, actuaries need to collaborate and partner with clinicians in order to be successful in value-based care and population health initiatives. Gaining credibility with professionals from different backgrounds, training and sometimes different objectives can be a challenge. Gain perspectives from actuaries and clinicians to discuss how to collaborate and achieve stronger results and outcomes. By attending this session, you will be able to: • Identify common scenarios where actuaries and clinicians need to collaborate. • Understand perspectives on how to partner and communicate with clinicians. • Describe successful strategies that take into account improvement of financial and clinical outcomes. • Understand how actuaries can provide valuable data to drive results and demonstrate outcomes.

Description: The COVID-19 pandemic helped accelerate many changes in the Health Care system that were already taking place. The major disruptions to the way providers operated was quite evident with shifting of focus away from elective services to create capacity for treating COVID-19. However, even before the pandemic, providers were adapting to changes in their environments.

Description: This SOA report describes the components of margin for calculating capitation rates in a Medicaid context along with practical issues that MCOs may face.

Description: 1959 SOA Regional Meetings in Atlanta and San Francisco. These panel discussions reviewed procedures, techniques and vehicles used to provide benefits to retired employees. The panels also discussed Group Insurance Dividends and Major Medical issues.

Description: This discussion focuses on sickness insurance and associated issues. From Transactions of Society of Actuaries 1950, Vol. 2, No. 2.