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 case study session where the speakers will describe a project where a major health system converted its provider distinct reimbursement (i.e., separate physician IPA and hospital capitation) to an integrated reimbursement involving global capitation. The session will discuss the strategic issues considered by the parties and how they evaluated them in their decision process. This session will provide attendees an example of how to approach this type of decision.

Description: Morbidity improvement has been a hot topic in the LTC market in the past year. This session will provide an update of studies performed in the industry to review historical data for morbidity improvement and considerations that actuaries should take when determining what level of morbidity improvement to include in their best estimate assumptions.

Description: Large claims have always been a major source of volatility in health care claims experience. In this session, the presenters will discuss techniques for analyzing large claims, predicting large claims and measuring the associated risk. The presenters will also discuss the early results of the SOA 5/50 research project which will examine the 5% of the population that accounts for 50% of the health care costs.

Description: Underwriting is one of several areas in the insurance industry being impacted by insurtech. In this session, we will hear from experienced experts in underwriting transformation. Digitization, machine learning and other approaches are among topics to be discussed.

Description: On December 21, 2018, the Centers of Medicare & Medicaid Services (CMS) released the final rule for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. 'Pathways to Success' makes sweeping changes and will push ACOs to assume financial risk more quickly. This session will discuss the key changes in the final rule, reasons why providers would remain in the program while being forced to downside risk, and how actuaries can add value to providers who will be taking on millions of dollars of risk in the coming years.

Description: Principal Analyst Laurie M. Orlov of the Aging in Place Technology Watch will present a roadmap for the technology and ITSS marketplace. She will explore where it has been, what it does best, where it is going, and the challenges it faces. She has been a leading researcher and independent analyst in this field for more than 20 years.

Description: This session describes the process payers and employers can use to evaluate emerging medical device technologies, recent or pending FDA submissions for prescription drugs and experimental treatments that impact patient care, resource utilization and health care expenditures. We will walk through the process of identifying and selecting impactful treatments (Horizon Scanning) and quantifying the financial cost of new technologies before they arrive in the market. These workflows can be leveraged by actuaries, healthcare economists, clinicians and pharmacists from a payer (Commercial and Medicare) and employer perspective for self-funded plans. We will also walk through some sample models that illustrate how costs for emerging technologies and treatments can be modeled.

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: There has been a proliferation of proposals to expand access to public health insurance plans, either to strengthen insurance markets under the Affordable Care Act (ACA) or to replace the ACA marketplaces or other health insurance programs altogether. These proposals range from creating a public plan that would operate alongside private plans in the ACA marketplaces, to allowing individuals to buy into Medicare or Medicaid, to expanding Medicare to all. The terms used to describe these various options are often used interchangeably but they would be structured differently and have different impacts depending on the implementation details. Panelists at this session will discuss the general approaches for expanding access to public plans and their potential implications.