Description: Early in his career, Ehren Nagel, FSA, MAAA, scoured through podcasts and articles about predictive analytics, long suspecting this was a field with potential for him.

Description: US pharmacy prices have entered a new era of growth driven by Specialty medications. A bevy of state and national regulations have been proposed to address pharmacy pricing, industry structure and transparency.Health actuaries will learn about US pharmacy pricing structure and how proposed legislation could affect future costs. Actuaries that have responsibility for pharmacy rate/budget setting, RFPs or trend projection will benefit from a deeper understanding of the US pharmacy market landscape and gain an international perspective.

Description: The presenters will cover the variation in risk adjustment approaches used across state Medicaid programs and compare them to other Federal programs. Additionally, recent developments, such as the use of OCR to extract data from medical charts for risk adjustment, will be discussed.

Description: What you need to know about risk scores to be competitive in the Medicare Advantage market.

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements

Description: Summary of testimony by an AAA Board member before a congressional subcommittee, as an expert on risk assessment and adjustment, especially in relation to Medicare risk contracting and HMO payments. She recommended: mitigating the geographical region values, credibility weights for payments to health plans, carving out high cost claim segments, reengineering the ACR methodology, shifting AAPCC methodology from fee-for-service toward competitive bidding, and further projects to improve risk methods.

Description: A discussion of fraud and abuse in the Medicare payment system, and steps to address these problems.

Description: This short article presents the latest SOA health research report on alternative payment models for high-cost curative therapies.

Description: Article explores why many integrated delivery systems are struggling and what actions they need to take to succeed.

Description: The presenters will focus on best practices in drug claim management in North America. The presentation is geared toward Canadian practice and insights, but is useful for practitioners in the U.S. and elsewhere, as well.