Description: As we entered 2014, actuaries became familiar with three risk stabilizing mechanisms in the early years of the ACA marketplaces, colloquially known as 'the 3Rs'. As we enter 2024, there is renewed focus on rating compliance and risk adjustment. Speakers will highlight pricing considerations when determining cost-sharing reduction premium loads as well as related issues pertaining to risk adjustment and metal tier pricing.

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.

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: "Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations."

Description: "Through both informed policy debate and opinionated social media, there are many current event health topics actively discussed and debated. The question remains... how does one separate out subjective information, seek objective analysis, and at the same time consider where there might be more research needed to come to conclusions? This session will use several current event topicsas examples and discover insights as to where research has been performed, what it may or may not cover, and also note where lines are still blurred and may need further details to be studied. Topics that may be discussed include: How valuable and exact is the use of risk-adjustment for Medicare Advantage What is the health and mortality impact of receiving COVID-19 vaccinations"

Description: "Informal caregiving is far more costly than many people realize. And not just in the immediate future. Current demographic trends suggest that caregiving will become even more necessary and costly as the Baby Boomers continue to age and require more support and services. In 2022, the SOA engaged Milliman, Inc. to conduct an analysis of the need for informal caregiving and its impacts on employees, employers, and other stakeholders. The purpose of this research was to educate stakeholders, policymakers, and other interested parties on the realm of informal caregiving, as well as how the challenges associated with providing informal care of all kinds might be addressed. Discover key findings and themes from the research project, as well as stories highlighting the various forms this role can take, and solutions currently being developed around the country. An open discussion on ways our profession can impact this growing need with the work we do every day in our respective roles will also be included."

Description: The article first tries to determine a consensus view of what social security should accomplish and then tries to measure how well the current level of benefits succeeds in meeting these goals. Assessing benefit adequacy is an essential element in putting the overall program on a sound financing footing.

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: 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.