Description: "This video by Danika Turner is an introduction to Medicare Advantage revenue, specifically focusing on how Part C revenue works for individual Medicare Advantage plans. It explains how health plans participating in the Medicare Advantage program are paid by the Centers for Medicare and Medicaid Services (CMS), including the impact of Star ratings, risk adjustment, and county-level CMS benchmark rates on revenue. The session aims to simplify the main variables of the revenue calculation and uses conceptual examples for individual MA plans, excluding certain populations like Employer Group Waiver Plans and members with End-Stage Renal Disease or in hospice. The video also covers the basics of Medicare-covered services, mandatory and optional supplemental benefits, and the calculation steps for determining CMS Part C revenue per member per month.

Description: Over the last 10 years, Artificial Intelligence (AI) healthcare foundation models have made tremendous strides when it comes to delivering highly accurate predictive results when compared to traditional models. This is especially true for models developed and trained on the ‘language’ of healthcare. When trained on healthcare data sequences (claims, EHR, CPT, ICD, pharmacy, lab, etc.), these models deliver far more accurate results as to WHAT beneficiary-level health events will occur and even WHEN they will occur.

Description: The objective of this session is to explore the fast-growing segment of healthcare that is provider enablement. Value-based care (VBC) in its original form was an alignment between providers and payers to deliver on the triple aim of cost of care, experience of care, and health of populations (more recently the quintuple aim including health equity and provider experience).

Description: Pharmacy continues to be one of, if not the, fastest growing services in both public and private health plans. Between new blockbuster drugs and gene therapies coming to the market at a record pace expanded indications for drugs already on the market, and rapid cost inflation across numerous therapeutic categories, plan sponsors are constantly looking for new and innovative ways to keep pharmacy costs under control.

Description: This session will explore the financial health of rural hospitals, especially as it relates to the impact of payer cost containment strategies and government policies. Since 2005, more than 100 rural hospitals have closed and 600 more are at risk.

Description: How do social determinants of health (SDOH) affect health outcomes in the United States, how might SDOH factors be incorporated into financing and risk adjustment of Medicaid, and what implications might this have for market participants?

Description: This session will provide an overview of the landscape of accident and health insurance valuation. Attendees will gain an understanding of key concepts and various actuarial techniques employed in the valuation of accident and health insurance policies. By incorporating real-world perspectives and experiences, this presentation equips attendees with actionable knowledge to enhance their understanding and approach to accident and health valuation in an ever-evolving insurance landscape.

Description: A study of whether tobacco, area and industry rating in one state may be reflecting unintended factors such as race, ethnicity or socioeconomic status. This study does not consider whether the rating factors accurately reflect underlying claims costs.

Description: The presenters give a history lesson on the origin of CMS Medicare star ratings, including why this demonstration was originally created and how the program has worked over the years. The discussion will cover both the evolution of the underlying measures and the financial impact to Medicare Advantage stakeholders. By attending the session, you will have a stronger understanding of how member experience and outcome-based measures can be factored into the funding within a health care system to better align incentives among various stakeholders.

Description: How do we take a Minimum Viable Products (MVP) approach to launch new insurance products? Join this moderated discussion and focus on three key development aspects: Distribution, Systems, and the design and pricing of the Insurance product itself. Come discuss reasons to choose an MVP approach and how it solves many of the product launch challenges.