Description: Introducing Random Effects into Risk Score Models

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: Broaden your understanding of how long-term care (LTC) is provided and brainstorm with other actuaries on ways to help society fund future LTC solutions. How we fund and provide LTC for our loved ones has changed over time and will evolve still by the time we retire. In this session we will explore the variety of ways that we fund LTC services: out of pocket and with informal care, Medicaid, lifeplan communities (Continuing Care Retirement Communities and and the Continuing Care at Home model), private LTC insurance and more. You will leave the session appreciating that providing long-term care is a key feature of our aging society and understand the variety of ways that we fund LTC today and may in the future.

Description: Health equity is taking a front row focus in many health arenas. Take a closer look at some of the efforts being used to ensure health equity. One area of interest to actuaries is value-based insurance designs (VBID). VBID can be incorporated into exchange plans. These innovations to prevent and treat disease have led to reductions in morbidity and mortality. Learn techniques to improve the quality of care and reduce barriers to high-value care in the form of high-cost sharing.

Description: Robert Eaton, FSA MAAA Principal at Milliman and Long Term Care expert will explain the basics of long term care insurance including its origins, evolution, and key components. Robert is an expert in his field and author of the textbook Insuring Long-Term Care. The video highlights the critical role of LTCI in assisting individuals with daily activities when their health deteriorates due to factors such as aging, injuries, or cognitive diseases. Contributors: Robert Eaton, FSA MAAA Danica Turner, FSA, MAAA, CERA, Scott Allen, FSA MAAA Jon Forster, ASA MAAA

Description: Medicare and Medicaid finance more than half of American health care. Medicare and Medicaid are at the forefront of nearly every major change in U.S. health care payments, from DRGs in the 1980s to today’s value-based care. Listen to a conversation with Bruce Pyenson, FSA, MAAA, who recently completed six years as a Medicare Payment Advisory Commission (MedPAC) commissioner and Stacey Lampkin, FSA, MAAA, who recently completed six years as a Medicaid and CHIP Payment and Access Commission (MACPAC) commissioner. Hear about programs’ current challenges, what changes the ex-Commissioners anticipate over the next few years, and how these changes might impact Medicare and Medicaid managed care plans, and spillover into employer-sponsored and individual commercial insurance. By attending this session, you will be able to appreciate the role of Medicare and Medicaid as health care payment change agents and foresee future health care payment changes.

Description: State Medicaid programs have broad flexibility to establish their own payment methodologies and rates for hospital services. Many states direct additional funding to populations, services, and hospitals where Medicaid comprises a disproportionate share of total business, or where there are other access concerns (e.g. rural providers). Actuaries can play a key role in determining where those additional funds would have the most benefit.

Description: Explore cutting-edge advancements in virtual care, including remote patient monitoring and care delivery in the metaverse, which build on the foundation that pandemic-era telehealth built. Gain a deep understanding of how these innovations are set to shape the future of telehealth and healthcare more broadly. By attending the session, you will be equipped with a roadmap of the key trends and opportunities in virtual care, and be able to identify potential challenges and solutions for their own organizations in leveraging these new tools.

Description: Experts from both the direct and reinsurance side of the table will provide an overview of final expense products and their key features, as well as share experiences that have informed best practices when designing, selling, managing, monitoring and reinsuring these products. Trends in distribution, underwriting tools and other competitive factors will be considered through the lens of managing risk while remaining competitive in the market.

Description: This session will discuss: • What is social insurance and advantages of financing LTSS that way • Design decision points for an LTSS program • Existing examples of programs in the US and Abroad • Challenges and differences in pricing state-based LTSS financial reform.