Description: Vast sums of private equity are flowing into start-ups intent on lowering healthcare trend. This presents a huge challenge for insurance company actuaries to stay current on such start-ups and the innovations they're advancing. Further, it can be overwhelming to evaluate the many vendors eager to sell their services to the company. This session will provide an overview of the start-up and private equity process, review some of the emerging innovators, and discuss approaches to evaluate their Return on Investment (ROI) as efficiently as possible.

Description: Read the June 2020 issue of Health Watch published by the Health Section. Newsletters provide practical information for the working actuary, articles on trends that impact sections and news about section activities.

Description: This Society of Actuaries Research Brief has been constructed to highlight some of the key features of the pandemic and contemplate the risks for the actuarial profession to consider in their work.

Description: Electronic Health Records, or EHRs, are a major worldwide initiative to eliminate paper recordings – including Attending Physician Statements (APSs) – of an individual’s medical history and current treatment.

Description: The presenters will compare and contrast the Canadian public (and, to a lesser extent, private) health care system in juxtaposition to U.S. health care. Specialized knowledge of either system is not required. The presentation will focus on cost containment strategies balanced against effective health care services. Differentiation of strategies, such as wellness and prevention in contrast to diagnosis and treatment, will be discussed.

Description: In this session we will discuss the impact of regulation changes that will allow members with End State Renal Disease (ESRD) to sign up for Medicare Advantage in 2021 for the first time. We will delve into the current basics of how ESRD works, the characteristics of the population that is currently on original medicare today, and a comprehensive look at what plan sponsors should be thinking about going into 2021.

Description: Presenters will address optimal new business written premium mix at the firm and state levels under varying competitive conditions. They will explore the use of mean-variance optimization to determine a company's optimal new business written premium mix for a given geographical area, predicting statewide product mixes using varying rate regulation scenarios, involving profit caps and measuring/testing a market's competitiveness for a given line of business. The scope of the ideas to be presented is international, applying to property, liability, individual and group life; individual and group health; disability and accidental insurance. Examples will be presented for general insurance in the United States

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: While intended to assist health plan actuaries responsible for stress testing and ORSA filings, this session will also be informative for actuaries interested in communicating the impact of potential catastrophic events for health plans to their management and board. It will begin with a discussion of event thresholds for stress tests and their impact on capital and financial statements. Presenters will take a detailed look at several catastrophic event case studies (historical and hypothetical) in the following areas: healthcare specific (e.g. pandemic, specialty Rx), financial institution/credit market, operational/business, strategic and multi-event scenarios.</

Description: Telehealth enables the delivery of health care services to patients that are not in the same location as providers. Over the past decade, telehealth has been used increasingly to complement face-to-face patient encounters, and is particularly important to addressing health care needs in rural areas. Recent regulatory catalysts, particularly in the Medicare Advantage program, have served to elevate the visibility and importance of telehealth in the overall health care delivery system. Starting in 2020, Medicare Advantage plans can offer any clinically appropriate physician services through telehealth as part of the standard Medicare benefit. Network adequacy standards can also be met via telehealth providers under certain programs. This presentation will cover the basics of what constitutes telehealth, and provide tangible demonstrations of telehealth technology (simulating variations mediums through which services are delivered). We will cover the what, the why, and the where (anywhere) of telehealth in 2020.