Description: Social Insurance & Public Finance Section council members provide a recap of sessions from the 2021 SOA Health Meeting, with a focus on sessions covering Medicare, Medicaid, the ACA, and public policy. The authors include a description of SIPF Section-sponsored sections, including a session on the ACA and a session on CMS's Direct Contracting Model.

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: Help consumers understand their rights in health care and understand how technology is embedded into the health care industry. On top of that, you will also hear about topics related to professionalism. During this webcast, you will learn about: ▪ An overview of the health insurance market ▪ Health care provider billing and contracting ▪ Recent trends with insurers and health care providers ▪ Identify areas of excessive billing and fraud ▪ The impacts of technology on billing practices ▪ An understanding pharmacy benefits, including discounts and rebates

Description: Explore the findings from the research paper recently released by Milliman and the SOA, highlighting the growing need for support of informal/family caregivers. We will discuss both quantitative and qualitative data that illustrates not only the cost and burgeoning need, but the mental/emotional stressors that come along with this work.

Description: This document is a Request for Proposals (RFP) outlining a proposal request on the impact of the U.S. drug abuse epidemic on mortality, focusing on opioids. It provides details on the background, purpose, research objectives, proposal requirements, selection process, and conditions for submitting a proposal.

Description: Currently there are ten states in the U.S. —Rhode Island, California, New Jersey, New York, Washington, DC; Washington, Massachusetts, Connecticut, Oregon and Colorado —that have enacted Paid Family Leave. Paid Family leave is an employee funded state insurance program that provides wage replacement to eligible workers when they take time off of work to care for a seriously ill family member or to bond with a new child. Who pays the taxes? The employer or the employee? How will this effect short term disability benefit offerings in the work place? How does a Paid Family Leave plan get implemented? Is it up to the employee to file for the benefit through the unemployment office or does the employer file? At the state level, how is paid family leave reserved for? How is it administered? What job protections are there? How does this work with the Family Medical Leave Act? Get these and more questions answered. By attending this session, you should have an understanding of the state Paid Family Leave programs, what it means to future short term disability plans, and how the state accounts for this program.

Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

Description: "Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations."