Description: The supplemental health market is changing. Carriers are looking to simplify claims processes, proactively identify missed claim opportunities, and reduce barriers to claim payment. As a result, more and more companies are looking at ways to use data from medical diagnostic and treatment codes. Take an introductory look at the most used medical codes—ICD (9 and 10), CPT, and HCPCS. Discuss the history and purpose of each code system and decipher the structure. Dive into how medical codes can be used in the supplemental health market (automatic claims adjudication, fraud identification, pricing), as well as common pitfalls encountered when using medical coding. By attending this session, you will have a basic understanding of the different types of medical codes, their actuarial applications, and common pitfalls.

Description: CPT, NCCI, ICD, CCI, DRG, APC, PTP – understanding healthcare claims involve a dizzying array of code sets and payment methodologies, and yet the claim form is the intersection of health plan affordability, provider payment, and data analysis. This webcast will cover: • The code sets used in medical coding • Types of correct coding policies implemented by CMS and commercial payers • Payment integrity strategies to drive health plan affordability • Data analytics approaches leveraging medical coding knowledge

Description: 2021 ImpACT Conference - Session 5C: Transforming Health Insurance Through Consumer-Centric Products 10.26.21 Recording

Description: The COVID-19 pandemic has had an impact on all aspects of daily life and its impact extends to how disability incidence may play out in the future. Product profitability will be shaped by how morbidity patterns, interest rate levels and other key drivers will play out into the future. In this session, our panel will discuss COVID’s impact on IDI morbidity experience as observed over the past 18 months, offer comparisons and insights in light of other insurance lines of business, and share emerging information on the on-going effects of Long COVID. Highlights will also include how regional differences and implications for insurers as the industry moves further into the COVID vaccine era.

Description: Health care has changed rapidly over the past couple of years. The pandemic has shifted consumer behavior in how and where they receive health care as well as consumer attitudes toward health care. Payers continue to design innovative solutions in responses to their patient’s needs and expectations. These changes in consumer behaviors and the responses by payers are expected to impact both health care cost and utilization. Discuss changes in health care that have emerged due to the pandemic and how they are expected to influence actuarial assumptions. Explore epidemiological models commonly used in the industry, the considerations when using these models, as well as the challenges with regards to gathering and interpreting relevant experience data. By attending this session, you will be able to: Identify shifts in consumer behavior that have emerged from the pandemic and describe how payers are responding to new patient expectations. Discuss how these post-pandemic changes by consumers and payers influence medical spending. Determine which actuarial assumptions are impacted and how and if the impact is expected to be temporary or permanent. Discuss considerations taken by actuaries and challenges faced when modelling actuarial assumptions post pandemic.

Description: Discuss changes in group life waiver of premium claim recovery and mortality experience since the 2005 table was released, the development of the 2023 table, and the new statutory valuation standard approved by the National Association of Insurance Commissioners (NAIC).

Description: Get highlights from recently published and upcoming research from the SOA Research Institute, including work on specialty pharmacy and the long-term impacts of COVID-19. Presenters will focus on the financial impacts of these issues as well as trends and other actuarial considerations.

Description: As the medicine practice continues to evolve, join us for this webcast to receive up-to-date information about the incorporation of scientific advancements and emerging evidence into the field. The creation of innovative treatments and the focus on improving patient outcome can cause information and price shocks, which will be one of the covered topics. Expect to utilize this webcast as an introduction to precision medicine, which is a genetics-based approach to healthcare. Speakers will share their experiences in demonstrating cost-effectiveness and promoting reimbursement with this new approach.

Description: This session will bring together public health care leaders in COVID-10 vaccine delivery from both the U.S. and the UK to discuss and compare operational implications of the COVID-19 vaccine rollout in their countries, and how those programs ultimately affected hospitalization utilization and mortality rates for members of their communities.

Description: Anti-obesity medications have been met with reluctance from payers and employee benefits consultants who often lack analogs or empirical data to estimate the cost impact of new therapies coverage. Health plans considering coverage of anti-obesity medications will need to assess and manage the potential costs of covering these new therapies in context of their overall obesity management strategy, including coverage of nutrition counseling, weight management, and bariatric surgery.