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: 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: There have been a variety of proposals related to expanding eligibility for Medicare, ranging from a publicly funded program to a full buy-in option. This session will explore the actuarial implications of various buy-in proposals and the potential impact that such policy changes could have on the health care market landscape. In particular, we will discuss the ways in which program eligibility requirements, plan designs, provider reimbursement arrangements, network design, rating rules, and subsidies could affect premium levels and membership volume in a Medicare buy-in market, as well as the potential side effects on providers and existing health care markets.

Description: This is a discussion on group life and health products under conditions of inflation. It specifically highlights the development of alternative delivery systems such as Health Maintenance Organizations, the potential for further computerization of claim and record keeping, viability of new areas of coverage such as dental & vision and legal benefits, self-funding and administrative services only mechanisms, and the effect of inflation. From Record of the Society of Actuaries 1982, Volume 8, No. 1.

Description: This session discusses demographics of the uninsured & underinsured, needed core benefits, funding uncompensated care, state pools for high risk and near poor, the Massachusetts system, and the Kennedy-Waxman federal bills. From Record of the Society of Actuaries 1988 Vol. 14, No. 4B.

Description: This presentation from Session 86PD of the SOA 1996 Orlando Annual Meeting provides the physician perspective on ethical questions resulting from utilization review decisions infringing on physician decisions in providing health care. From the Record of the Society of Actuaries, Vol. 22, No. 3.

Description: In this presentation, Richard D. Lamm, former Governor of Colorado and currently Director of the Center for Public Policy and Contemporary Issues at the University of Denver, talks about the increasing costs of health care and why the miracles of American medicine have simply outpaced our ability to pay. From the Record of the Society of Actuaries Vol. 17, No. 3A.

Description: This session is about the impact of health-care reform on supplemental health insurance plans such as Medicare Supplement, Hospital, Cancer, etc. The session will also explore new opportunities for supplementary markets and products. Included is a discussion of the CHAMPUS and FEHBP. From Record of Society of Actuaries Vol. 19, No. 4B.

Description: This presentation from Session 8L of the SOA 1996 Colorado Springs Meeting is about analyzing the effectiveness of health care measures as reported by managed care organizations. The discussion focuses on HEDIS, a standardized definition for producing health plan report cards, primarily aimed at health maintenance organizations [HMOs]. From the Record of the Society of Actuaries, Vol. 22, No. 2.

Description: This presentation introduces the concepts and methods of trend analysis and a developed an Excel Software package for trend analysis.