Description: Recent health-care cost trends have exhibited significant variability by insurer, geographic area and type of benefit. Employers and insurers are increasing co-pays and reimposing managed care provisions. How have these factors affected the measured trend. From the Record of the Society of Actuaries, Volume 30, No. 1, Session 17

Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

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 session discussion is about methods of managing care, what methods have been most effective, experience to date under managed care products, are savings being generated, employer acceptance of managed care products, provider acceptance of managed care products, what will future managed care programs look like. Includes a discussion on utilization review and management, From Record of the Society of Actuaries 1988 Vol. 14, No. 1.

Description: This session discussion is about AIDS for health actuaries, contract limits, underwriting practices, regulations on underwriting, claim reserving, recent experience and future outlook. From Record of the Society of Actuaries Vol. 15, No. 1.

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 panel discussion session focuses on health care alternatives with the objective to improve care and reduce costs. Includes discussion on national programs, managed care

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