Description: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

Description: Analyzing large quantities of raw complex data is often a challenge in the health care industry. During this webcast, there will be a demonstration of how unsupervised machine learning techniques can be applied to such data to help bring useful insights. This will include examples that use unsupervised learning techniques spanning dimensionality reduction, clustering and anomaly detection.

Description: The June 2021 Supreme Court ruling in California vs. Texas has significant ramifications on Affordable Care Act markets. This session will provide the actuarial community an overview of the ruling, the likely impact on health insurance markets, and potential legislation to address the ruling details.

Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

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: Medicare and Medicaid finance more than half of American health care. Medicare and Medicaid are at the forefront of nearly every major change in U.S. health care payments, from DRGs in the 1980s to today’s value-based care. Listen to a conversation with Bruce Pyenson, FSA, MAAA, who recently completed six years as a Medicare Payment Advisory Commission (MedPAC) commissioner and Stacey Lampkin, FSA, MAAA, who recently completed six years as a Medicaid and CHIP Payment and Access Commission (MACPAC) commissioner. Hear about programs’ current challenges, what changes the ex-Commissioners anticipate over the next few years, and how these changes might impact Medicare and Medicaid managed care plans, and spillover into employer-sponsored and individual commercial insurance. By attending this session, you will be able to appreciate the role of Medicare and Medicaid as health care payment change agents and foresee future health care payment changes.

Description: This document is a Request for Proposals (RFP) outlining a proposal request on the impact of the U.S. drug abuse epidemic on mortality, focusing on opioids. It provides details on the background, purpose, research objectives, proposal requirements, selection process, and conditions for submitting a proposal.

Description: "During the pandemic there has been provider burn out, early retirement, hospital consolidation, and lack of staff in step down facilities. It is taking longer to get appointments. Take a look at the impacts of this andat how this can affect quality ratings in Medicare. You can also explore meeting quality incentives in Medicaid and how the current requirements for these plan to say they have adequate networks. Will the provider shortage have an effect upon actuarial rate certifications? If so, how? Are there any forecasts for how long this shortage will last? What are the impacts to care giving to the Seniors and Medicaid beneficiaries as well as plan design changes? Those who are intermediate level Medicaid and Medicare actuaries are encouraged to attend. By attending this session, you will be able to: Have a good understanding of the current Medicare and Medicaid situation and its impacts Understand strategic ideas of how to keep quality of care and access to care available"

Description: This section presents book reviews and summaries of recent publications on a variety of topics.

Description: While states face a wide variety of circumstances and have implemented diverse approaches to the MOE phase-out, we revisit the conversation to discuss emerging experience across stakeholders as we examine the operationalization of the PHE unwinding as it relates to this major disruptor in the distribution of the healthcare enrollment.