Description: HIV is still a big public health concern, but there are therapies available to prevent infection before and immediately after exposure. As legislatures and the USPSTF considers adding these therapies to the list of preventive care covered without cost share, actuaries will need to estimate the impact on their care cost. The presenters will share an actuarial tool kit to estimate the impact of covering PrEP and PEP for different populations. Examples are provided and discussion is welcome.

Description: Telehealth enables the delivery of health care services to patients that are not in the same location as providers. Over the past decade, telehealth has been used increasingly to complement face-to-face patient encounters, and is particularly important to addressing health care needs in rural areas. Recent regulatory catalysts, particularly in the Medicare Advantage program, have served to elevate the visibility and importance of telehealth in the overall health care delivery system. Starting in 2020, Medicare Advantage plans can offer any clinically appropriate physician services through telehealth as part of the standard Medicare benefit. Network adequacy standards can also be met via telehealth providers under certain programs. This presentation will cover the basics of what constitutes telehealth, and provide tangible demonstrations of telehealth technology (simulating variations mediums through which services are delivered). We will cover the what, the why, and the where (anywhere) of telehealth in 2020.

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: CMS provides a significant and growing amount of information that can be leveraged by actuaries. Between the public use and research files CMS makes publicly available, large amounts of information that can be assimilated to help understand the who, what, when, where and how of Medicare. With the CMS allowance of supplemental benefits to address SDOH, adding SDOH data into your data landscape is critical to better understand your members' cost drivers. The presenters will focus on the depth and breadth of data available, summarize any restrictions on the use of the data, and identify areas where access to the new data can provide more meaningful insights.

Description: This article provides an overview of behavioral economic theory as it relates to health and welfare insurance plans and provides summaries of two sample applications of the theories: enrollment in health insurance exchanges created by the Patient Protection and Affordable Care Act, and product design considerations in light of vast health illiteracy.

Description: Feature article with helpful hints on video conferencing and more!

Description: The Society of Actuaries has developed and released a health care forecast model to illustrate the potential impact of the COVID-19 outbreak on insurance plan health care costs in the United States. Users of the model may include insurance company actuaries seeking an additional reference point for 2021 cost development, regulatory actuaries seeking additional insights and validation of costs as part of rating submissions for 2021, and insurance purchasers seeking a deeper understanding of the forces driving 2021 health care costs and premiums. The model is not intended as a replacement for existing modeling tools developed by insurers or regulators. Rather, the model’s primary purpose is to illustrate the key outbreak-related forces that are affecting the trajectory of health care costs. In addition the model can provide a common reference point to facilitate dialogue with respect to the regulatory review of 2021 health insurance rate filings.

Description: The purpose of this document is to inform the user of the 2021 Health Care Cost Model about the sources of data, other reports, and assumptions which were used to populate this report and drive some of the key considerations.

Description: This session features a moderated discussion between medical professionals who are experts in long-term care. The presenters are outside the LTC insurance industry altogether, which will ensure that attendees receive a truly external perspective.

Description: On average, contracts receiving their first star rating receive 3.20 stars, compared to existing or established contracts receiving 3.90 stars on average. This 0.70 disparity in quality ratings creates significant hardship on new contracts when this lower star rating decreases their payments in the following calendar year. This article explores the disparity in Medicare Advantage Star Ratings between contracts receiving their first star ratings (“New” contracts) and existing contracts, including: 1. Understanding what happens to Medicare Advantage Payments when contracts receive lower star ratings? – What is the Star Rating cliff and why does it matter to new contracts? 2. Explaining when a contract receives their first star rating and how much enrollment this requires – When does the Star Rating cliff occur? 3. Noting which specific star measures “New” contracts struggle with, including those contracts under large parent organizations, contracts with rapid growth, and all other new contracts. – How can my contract avoid the Star Rating cliff?