Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: Pharmacy prices are top of mind for many consumers, policymakers, and payers. While there have been many efforts to reduce pharmacy costs over the years, many believe these efforts only helped us cope with the symptoms of the problem without providing a comprehensive cure for the underlying causes of this problem. The Society of Actuaries Health Section sponsored this Pharmacy Partnership Forum to gather multi-disciplinary experts in the pharmacy ecosystem. This report shares the insights and learnings that emerged from this group of health economics outcomes researchers, clinical pharmacists, medical doctors, health actuaries, benefits consultants and brokers, and their collective thoughts on advancing this exploration for society’s benefit.

Description: Hear from Kevin Pierce, FSA MAAA on the key components on the Inflation Reduction Act as it relates to Medicare Part D. Kevin is a Senior Consulting Actuary at Milliman and a top industry speaker on this subject. Kevin has extensive industry experience in actuarial, finance, and strategic projects, providing market intelligence and strategy support for clients across the health care industry. He outlines key provisions of the act, such as a complete redesign of the benefit, inflation rebate payments from pharmaceutical manufacturers,, and Medicare’s ability to negotiate drug prices. Kevin touches on the changes in costs and complexities for beneficiaries, pharmaceutical manufacturers, the federal government, and health insurers. Contributors: Kevin Pierce, FSA MAAA, Mitchell Momanyi, FSA, MAAA, Deana Bell, FSA, MAAA, Jon Forster, ASA, MAAA

Description: Prepare for an interactive session around how members choose a Medicare Advantage Plan, and how actuaries can help be part of the discussion! You will participate in a decision-making activity to set the stage for understanding member selection. Then, dive into an actuarial analysis of the 2023 Medicare Advantage competitive landscape, with an emphasis on what benefits drive membership decisions. This presentation will evaluate plan components prevalent amongst the strongest plan offerings in the market, including supplemental benefit prevalence, member cost sharing, and the underlying benefit value. You will better understand which benefits drive the most significant membership changes, as well as how to think about what the most impactful benefit changes will be for 2024.

Description: Actuaries team up with Payers and Providers, to share insight into their data-driven approaches for improving health plans' CMS Medicare Star Ratings, which leverage experiential analytics to create solutions. 'Experience' is the king-it is broader umbrella, which includes and addresses engagement, cultural competency, equity, cost, and lastly, 'quality'. By attending this session, you will be better equipped to turn real-life data into actionable business solutions-essentially, data science in action. Further, you will better appreciate the importance of stars and risk adjustment in the Medicare Advantage space, along with the consequences of coming up short.

Description: Learn more about Health Care Sharing Ministries (HCSMs) and their functionality as health insurance. These nonprofit companies pool money from participating members to assist with members' healthcare coverage. Further exploring HCSMs, some of the offered arrangements of this plan operate differently and with a unique regulatory framework. HCSM enrollment has grown 1000% since solidification as a law in the ACA. By signing up for this webcast, you can discover why HCSMs are becoming a key component of the individual market in some states.

Description: "Can you answer the question 'what are the chances we will lose more than $1 million next year?' without saying 'it depends'? If you miss a projection, can you quantify the chances that the miss was due to random variation vs. an incorrect projection? ten in as presenters demonstrate how to answer these questions and others using total risk analysis. Total risk analysis includes quantifying both the random variation risk and the projection risk associated with actuarial functions like pricing and reserving. After attending this session, you will be able to describe total risk analysis, apply total risk analysis to many actuarial functions."

Description: "Examine the impact of traditional deductibles on health care equity and the need for innovative plan designs. You will learn about the limitations of consumer-driven health care costs broadly today, as well as alternative cost-sharing approaches that have been successful in driving consumerism without exposing members to high costs. By attending the session, you will be able to: Have a clearer understanding of the issues surrounding deductibles Be equipped with practical ideas for creating more equitable and effective cost-sharing solutions Assess the feasibility and potential impact of implementing these solutions for your own organization"

Description: ReMark's Global Consumer Study delivers 10 key insights to empower customers. Insurers can design products that meet customers' needs and enhance client experiences and add significant value to their business. At the same time with new products being launched seemingly continuously, it is important to take a step back and assess risk throughout the product management cycle.

Description: On March 22, 2022, the Wall Street Journal hosted its annual Health Forum, a virtual all-day event which included several sessions. This session was attended by experts across the healthcare space and attendees included many from the healthcare technology companies. This report summarizes the event.