Description: Prior to the global pandemic, investment in new health technologies had already reached an all-time high. As the world begins to emerge from COVID-19, what new technologies will next take root in the health care system and how will those affect medical costs? This session will review recent research from the SOA Health Section on how new technologies are spread and adopted. Particular focus will be given to emerging modes of consumer engagement and highly-focused gene and cell therapies that are breaking new ground in combating rare diseases. (We plan on focusing on 2 technologies like Consumerism or Telehealth & Gene & Cell Therapy depending on availability of speakers or if there are other sessions in this virtual meeting covering the same topic)

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: 2021 ImpACT Conference - Session 2D Value-Based Models for Home-Based Care and Digital Health 10.25.21 Recording

Description: Come explore an in-depth overview of telehealth to set context and navigate the continuing expansion of telehealth and its integration into the healthcare delivery system. You will examine the forces that shape telehealth offerings and expect a view of the possible futures of this evolving modality.

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: 2021 Life Meeting - Session 5F: Premium Leakage - How Outdated Claims Systems are Losing You Money 8.31.21 Recording

Description: Discuss various analytics and use cases using payer published reimbursement contract data under federal mandate of Transparency in Coverage. These contract rates are publicly available in machine readable format (MRF) starting July 1, 2022, and refreshed monthly. By attending the session, you will have a better understanding of the state-of-art development and analytics using MRF data, including the technologies used to extract and analyze huge MRF files, validation and limitations of published rates, and their use cases.

Description: Help consumers understand their rights in health care and understand how technology is embedded into the health care industry. On top of that, you will also hear about topics related to professionalism. During this webcast, you will learn about: ▪ An overview of the health insurance market ▪ Health care provider billing and contracting ▪ Recent trends with insurers and health care providers ▪ Identify areas of excessive billing and fraud ▪ The impacts of technology on billing practices ▪ An understanding pharmacy benefits, including discounts and rebates

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: This session series is sponsored by Zelis Claim analytics produces valuable insights about provider cost, quality, and referral patterns. Provider networks can be created around high-value providers to improve clinical outcomes while lowering the cost of care. Programs to improve provider performance and/or incentivize members to choose high-value providers exist, but how do you bring all of this together to achieve desired outcomes? Join us to learn how to leverage provider level analytics to build and optimize a network with high-value providers at the center. Analyze the network for competitiveness and adequacy and demonstrate progress toward network cost saving goals to key stakeholders by modeling claim data for a member population. Finally, ensure the success of your network through an incentive program that shifts utilization to those high performing providers. By attending this session, you will be able to: - Build a realistic provider network with high-value providers at the center. - Evaluate the overall financial impact of network build and optimization efforts. - Learn about an innovative member incentive program.