Description: In the time since the original proposal to move healthwriting companies from the blue blank to the orange blank, there have been several incremental updates to the blue blank by the NAIC Blanks Working Group to integrate portions of the orange blank into the blue blank. Meanwhile, the NAIC RBC Working Group has issued their proposal to change the health test for comment and appear to be moving forward with the proposal to revise the health test. This would obligate companies that write predominantly health business onto the orange blank rather than the blue blank, which they have historically used for reporting. Discover background of the revised health test, the incremental updates to the blue blank that have been implemented recently, additional incremental updates proposed for upcoming blue blanks, and the current status of the Health RBC Working Group proposal to revise the health test. Hear observations about companies that have opted to 'take the plunge' and move to the orange blank ahead of the revised health test as well as companies that have opted to remain on the blue blank and incrementally update as new requirements are integrated into the Blue blank. By attending the session, you will be able to: • Understand the context of the initiative to revise the NAIC health test. • Summarize the recent changes to the blue blank implemented by the Blanks Working Group that integrate portions of the orange blank into the blue blank. • Summarize the upcoming proposed changes to the blue blank by the Blanks Working Group that integrate additional portions of the orange blank into the blue blank. • Summarize the current status of the Health RBC Working Group proposal to revise the health test. • Provide industry perspective on companies that have opted to move to the orange blank ahead of the revised health test and companies that have opted to remain on the blue blank until the NAIC requires it.

Description: Many drugs, like the immunologic drugs used to treat inflammatory and oncologic conditions, are FDA-authorized to treat more than one condition. Given different conditions have varying clinical outcomes and costs, it is likely the same drug provides a range of value across multiple conditions. However, such drugs have traditionally had a single list price and corresponding payer net cost. Indication-based pricing and benefit design (IBPBD) is intended to address the variable clinical and economic value for the same drug across multiple treatment indications. As this trend continues to evolve, the determination of drug value by treatment indication will create risks and/or opportunities in pharmacy benefit design, ultimately impacting pharmacy PMPM forecasting and incurred costs. Learn from faculty as they: Provide the business context for IBPBD. Describe varying structural approaches. Discuss the market conditions that can motivate or demotivate payers. Explore operational barriers. Recommend a role for actuaries. To bring the discussion to life, a case study will be reviewed. By attending the session, you will be able to: • Describe the meaning of Indication-Based Drug Pricing and Benefit Design (IDPBD). • Understand the risks and opportunities with IBPBD. • Articulate the advantages and disadvantages of distinguishing the value of a drug by treatment indications.

Description: Find out more about the inforce product rate management process for health and LTC products. Requirements can vary by state, by issue era, and by product type and in some cases require filings to certify compliance on a regular basis. Discover recent trends in inforce rate management in the industry, including any changes seen coinciding with COVID-19 and its impacts to the regulators. By attending this session, you will be able to: • Describe or perform an inforce rate management for health products. • Understand the applicable state regulations. • Be informed of current industry trends for this work.

Description: Market researchers use cluster analysis to segment groups for targeted messaging. Law enforcement uses cluster analysis to identify high need neighborhoods to allocate resources effectively. Educators use cluster analysis to adapt their teaching methods to a particular group of students. More and more, health actuaries are using cluster analysis in their day-to-day work. Understand the basics of cluster analysis and potential applications through this session. By attending this session, you will be able to: • Describe the basic types of cluster analysis. • Explain health applications of cluster analysis. • Identify sources of additional information.

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: An update of selected key graphs from the Key Statistics section of previous COVID-19 briefs.

Description: Discuss the dramatically changing provider landscape, as well as the innovative solutions being leveraged by providers to address the intriguing opportunities and complex challenges. Among the questions to be answered are the following: How can providers capitalize on employers’ desire to contract directly with local providers? What's the path for providers to develop employer stop-loss (ESL) capabilities to maximize network value/impact? Can providers create a risk portfolio including ESL for local employers, their own employee plan, and other delegated risk arrangements such as Medicare Advantage? How can captive insurers support a provider's risk strategy?

Description: Medicare Advantage Organizations (MAOs) have made dramatic changes to the benefits and plan premiums they've offered members over the past years. Hear about information on the changes to benefits and plan premiums offered over the past few years. Find out where these strategic items are currently (for CY2024 bid year) and get ideas on what might come in the next few years. Presenters will discuss recent proposals and rules from CMS that will impact the current and future landscape. They will also compare these items in relation to the fee-for-service (FFS) Medicare market. This session will help you gain a deeper knowledge of the Medicare Advantage, Prescription Drug Plan, and Medicare FFS landscape and walk away with some strategic thoughts on potential paths MAOs may take from here.

Description: Are you a health actuary affected by recent developments in business practices and accounting standards that have created situations in which you may be involved in estimating balances under accounting rules that differ from those typically used by insurers? In this session you will learn about situations where non-insurance accounting regimes may intersect actuarial practice, with an intended focus on two particular topics.

Description: Hear a summary of the discussion from the Health Section's Pharmacy Partnership Forum in March 2023 entitled 'Reimagining Pharmacy Financing' where a multi-disciplinary group of clinicians, health economists, academics, and actuaries met and discussed the following questions: How do we define the value of prescription drugs? How do we measure the value of prescription drugs? How do we scalably and meaningfully apply the answers?