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

Description: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.

Description: The article provides insights about the need for revolutionary actuaries in Saudi Arabia due to the reform that is happening across the kingdom under all sectors. Then I talk briefly about the health sector and the transformation that is happing in the sector, and how qualified health actuaries can contribute to this health reform.

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: 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.