Description: As value-based solutions evolve, it is more important than ever for providers to understand their performance and how it is measured, along with the drivers of success. Presenters will cover the evolution of past risk-transfer programs such as Medicare Shared Savings Program and Next Generation ACO. They will also discuss the new Primary Care First and Direct Contracting models recently announced by CMS.

Description: Discussion of direct primary care and how it helps with several challenges in health care today. DPC improves care coordination, improves outcomes, improves doctor and patient satisfaction, and reduces spending. DPC successes promote the view that primary care should not be covered by insurance; rather, it should be paid for directly.

Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Methods and assumptions used in the valuation of savings by external care vendors

Description: This interview article summarizes the work being done by a Health Section Strategic Initiative Committee.

Description: As providers are considering accountable and value based care models, it is critical to strategically think through how to achieve a sustainable business model into the future. This requires actuarial and clinical/provider capabilities to assess the care management and financial levers to help a client through the transition.

Description: This article from major US payers describes palliative care as a scaleable means of improving quality and reducing costs during serious and complex illness.

Description: This session will explore the various contracting techniques that CMS, providers, and employers are using to achieve their strategic objectives across both the Commercial and Medicare markets.

Description: This teaching session explores how variability in charges and costs can be measured so direct comparisons between institutions can be developed and how information can be used to develop reasonable reimbursement levels. Topics include creating & using outpatient hospital fee schedules, using relative value fee schedules to benchmark costs to aid in medical management and hospital tiering. From the Record of the Society of Actuaries, Volume 28, No. 2, Session 48

Description: This article provides an in-depth discussion of how subsidies are an integral part of affordability for individual health insurance under the Affordable Care Act, and, ultimately, impact the viability of the market.