Description: Level funded products often target the small group market (2-50) and can result in many manual and tedious processes for underwriting to perform risk assessment. Learn how a carrier used technology to help automate risk assessment without the need for paper medical questionnaires, and exposed a risk engine for broker quoting to enable near real-time of pricing for risk-based products. The approach reduced labor and allowed underwriting to focus solely on fallout cases while also improving pricing consistency. Discuss broader trends in the health market for risk assessment, including new machine learning cost predictions that can be used for automation and better predictions of future costs. Discussion topics will include underwriting guidelines, business rules, risk scores, and machine learning. By attending this session, you will have a better idea of new trends in risk assessment for small groups where no claims experience is available. And, better understand business rules that are common in underwriting for flags for review as well as how risk scores and machine learning can be used during the underwriting process.

Description: Planning for retirement is at the top of many minds. How do I save? When is the right time? What are my plans? But what are the impacts of your health on retirement? Learn more about the effects of a healthy lifestyle on retirement in order to maximize life span. Review more in-depth findings from a recent report sponsored by the SOA Research Institute’s Aging and Retirement Strategic Research Program and conducted by the Vitality Group, as well as other expert insights.

Description: 2021 ImpACT Conference - Session 14E: Disparate Health Impact of Extreme Climate Events 2017-2020 10.29.21 Recording

Description: Health care continues to move from a fee-for-service model to a value-based care model. Hear from our expert panel on how actuaries can play a key role in the design and contracting of value-based agreements, monitoring experience and driving results, as well as measurement of value. The discussion will cover different structures currently in use, types of services covered (total cost of care, claim service lines, specialties, condition based, pharmacy products, etc), as well as nuances by market (Medicare FFS, MA, Commercial, Medicaid). The panel will discuss latest innovations in the value-based care space, as well as how COVID-19 has impacted these contracts. This interactive session will also allow you to ask your questions to our diverse group of panelists.

Description: Explore professionalism topics of specific interest to disability actuaries. It will include discussions of items such as business challenges, actuarial standards of practice, and methods to address problems in a proactive manner.

Description: Health is wealth, but much needed medical insurance for various needs is perceived solely for the wealthy and elusive to many. This webcast brings two highly regarded speakers in the health sphere to bust the myth that medical insurance is reserved for the wealthy and only covers known illnesses. The discussions will further dwell on products that are designed based on financial capability and customized needs while transgressing on risks and sustainability of creative products such as mental health.

Description: The Part D program is funded through a variety of government subsidies and manufacturer discounts. The federal reinsurance, initially designed as protection from catastrophic spending, became a primary source of subsidies for the program. When the Inflation Reduction Act (IRA) is fully implemented in 2025, the funding of Part D will realign to its original intent.

Description: Watch as presenters highlight the SOA's work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and state principals to determine appropriate underwriting margin components within Medicaid managed care rates. In addition, explore a brief description of the motivation for an underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in states where they operate.

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.

Description: Misalignment in value-based care approaches between payers and market segments (Medicare, Medicaid, self-funded employer groups, and commercial insurance) creates significant headwinds and friction for health care providers seeking to succeed in an environment that is moving toward more value-based care models and payment approaches. However, while multi-payer approaches in value-based care are critical to eliminating these misalignments, uptake in such programs has been lagging for a variety of reasons. Hear about lessons learned from a selection of specific multi-payer initiatives to understand what went well and what challenges were encountered in expanding these initiatives more broadly. You should be able to walk away from this session with an appreciation of the potential for multi-payer approaches and the challenges faced in gaining traction with them.