Description: Renal disease is a very heterogenous medical condition whose end state is dialysis, a recurring cost intensive medical condition. Dialysis cost is one of the major medical cost drivers in USA. Insufficient and improper care management in the early stages of CKD (chronic kidney disease) leads to early incidence of end stage renal disease (ESRD) among CKD patients which not only leads to high medical costs, but also reflects poor health quality.

Description: This report details the method taken to develop the aggregate databases 2000-2016 Long-Term Care Intercompany Experience Study.

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.

Description: Research Sponsorship Opportunity: Post Pandemic Mortality by Generation

Description: Panelists from the home-based care industry will discuss the latest technology and services that enable and prolong the receipt of formal and informal care at home for the elderly and delay transitions to care facilities.

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: Getting people to think beyond retirement about future care needs and how they will be paid for is critical for a healthy aging plan. However, most people avoid the topic and make rushed decisions when finding long-term care services. Hear from experts in this advisory field explain what a successful plan looks like and what it takes to get people to plan ahead.

Description: This session will discuss: • What is social insurance and advantages of financing LTSS that way • Design decision points for an LTSS program • Existing examples of programs in the US and Abroad • Challenges and differences in pricing state-based LTSS financial reform.

Description: "Issues surrounding end-of-life and palliative care are not well understood and there is little research in the actuarial literature. From an actuarial perspective, however, end-of-life is important because of the significant cost to the healthcare system. Ian Duncan will discuss some of his research on the financial implications of end-of-life care, as well as the outcomes of a palliative care program. Dr. Matzo is an engaging personality with decades of experience in gerontology and palliative nursing, including training and teaching professionals in the field. Dr. Matzo focuses on educating the public on the importance and benefits of palliative care and hospice (care given in the final six months of life). In this session on “Palliative Care Public Education,” Dr. Matzo will give us an overview of the benefits of palliative care and how this knowledge empowers the individual to make important decisions about their healthcare options. Attendees will have the opportunity to discuss the role that the actuarial profession may play in this area."