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: 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are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context.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: 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: Come prepared for an engaging workshop where you will have the opportunity to share thoughts on and work through a variety of questions concerning how actuaries must adapt to account for newer underwriting and distribution practices. Seating will be limited for this workshop focused on life actuaries who price and set assumptions for products impacted by new underwriting tools and processes such as accelerated underwriting (AU) or direct-to-consumer (DTC) distribution.

Description: Health care has changed rapidly over the past couple of years. The pandemic has shifted consumer behavior in how and where they receive health care as well as consumer attitudes toward health care. Payers continue to design innovative solutions in responses to their patient’s needs and expectations. These changes in consumer behaviors and the responses by payers are expected to impact both health care cost and utilization. Discuss changes in health care that have emerged due to the pandemic and how they are expected to influence actuarial assumptions. Explore epidemiological models commonly used in the industry, the considerations when using these models, as well as the challenges with regards to gathering and interpreting relevant experience data. By attending this session, you will be able to: Identify shifts in consumer behavior that have emerged from the pandemic and describe how payers are responding to new patient expectations. Discuss how these post-pandemic changes by consumers and payers influence medical spending. Determine which actuarial assumptions are impacted and how and if the impact is expected to be temporary or permanent. Discuss considerations taken by actuaries and challenges faced when modelling actuarial assumptions post pandemic.

Description: Explore a general overview of the Medicare Advantage VBID hospice model, including program goal and a brief review of available information on plan participation in 2021 and 2022. Join us to learn how the program can support other elements related to health equity and address social determinants of health. You will be able to focus on how to improve quality of life and care using palliative, concurrent and/or transitional care and hospice services. Elevate your understanding with a summary of publicly available hospice experience data published by CMS, as well as a review of published research by the SOA and others related to hospice and end of life care. Finally, expect technical guidance regarding VBID model financial implications and proposed enhancements to the program as CMS transitions from the current model due to expire at end of 2024.

Description: This session will bring together public health care leaders in COVID-10 vaccine delivery from both the U.S. and the UK to discuss and compare operational implications of the COVID-19 vaccine rollout in their countries, and how those programs ultimately affected hospitalization utilization and mortality rates for members of their communities.

Description: Focus on how innovative health care organizations develop their value proposition for their intended buyers. Presenters will share information about their specific solution and the methods used to derive credible savings estimates, ROI, and performance guarantees. Learn about data utilized, the methods deployed, advantages, disadvantages, and buyers' reaction. This session is expected to be technical, highly informative, and interactive with audience members.

Description: In late 2021, U.S. Congress passed the Consolidated Appropriations Act (CCA), which requires group health plans and health insurers to submit information regarding the costs of prescription drug costs and other health care services each year to the federal government. Learn how this data can be useful to anyone responsible for forecasting and budgeting.

Description: The time has arrived for ASU 2018-12, otherwise known as Long-Duration Targeted Improvements (LDTI). For health insurance products, the ASU will require considerable efforts to make the necessary changes to valuation systems, procedures, assumptions, and/or methodologies in order to be in compliance. This session is designed to cover LDTI implications specific to carriers of long-term care and supplemental health products, including changes to how attained age rated products will be approached, allocating and discounting the claim liability (IBNR), and how the treatment of Profits Followed by Losses (PFBL) will evolve under LDTI. By attending this session, you will be able to: • Understand LDTI’s key impacts on long-duration health insurance products. • Recognize the treatment of attained age rated products under LDTI. • Comprehend the requirements of allocating the claim liability to cohorts. • Grasp the requirements pertaining to the discounting of the claim liability. • Understand how PFBL will evolve under the new standard.