Description: CPT, NCCI, ICD, CCI, DRG, APC, PTP – understanding healthcare claims involve a dizzying array of code sets and payment methodologies, and yet the claim form is the intersection of health plan affordability, provider payment, and data analysis. This webcast will cover: • The code sets used in medical coding • Types of correct coding policies implemented by CMS and commercial payers • Payment integrity strategies to drive health plan affordability • Data analytics approaches leveraging medical coding knowledge

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: 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: With the mandated health plan transparency files, health plans and providers are now able to substantially enhance their provider contracting efforts. Although the files are large and cumbersome they are market disruptors and provide new insights for provider contracting efforts. Explore a demonstration on the type of information now available and how it can be used to enhance this from both a health plan and health care provider perspective.

Description: The COVID-19 pandemic has had an impact on all aspects of daily life and its impact extends to how disability incidence may play out in the future. Product profitability will be shaped by how morbidity patterns, interest rate levels and other key drivers will play out into the future. In this session, our panel will discuss COVID’s impact on IDI morbidity experience as observed over the past 18 months, offer comparisons and insights in light of other insurance lines of business, and share emerging information on the on-going effects of Long COVID. Highlights will also include how regional differences and implications for insurers as the industry moves further into the COVID vaccine era.

Description: As the medicine practice continues to evolve, join us for this webcast to receive up-to-date information about the incorporation of scientific advancements and emerging evidence into the field. The creation of innovative treatments and the focus on improving patient outcome can cause information and price shocks, which will be one of the covered topics. Expect to utilize this webcast as an introduction to precision medicine, which is a genetics-based approach to healthcare. Speakers will share their experiences in demonstrating cost-effectiveness and promoting reimbursement with this new approach.

Description: This will be the most fun you'll ever have learning about applying rigorous credibility standards in the real world! Measuring provider performance is crucial to value-based care, but no one wants to be told their data is not credible-so, what's an actuary to do? This session will mix in-depth theory with the messy realities of program implementation to give you tools for the real world. Whether or not you have ASOP 25 framed on your bedside table, you'll walk away from this session ready for the next time a business partner insists that 50 members 'is absolutely credible'.

Description: The dental and dental insurance industries continue to experience significant innovation advancements in a variety of areas including claims, customer acquisition, teletechnology applications, AI for dental disease progression and more. These advancements are occurring at the dental office as well as within dental insurance companies. Hear about some of the latest innovations in the dental and dental insurance spaces andl gain an understanding as to how cutting-edge developments will impact dental actuarial.

Description: The COVID-19 pandemic will have a lasting impression on all forms of life, annuity, and A&H insurance. Individual and group disability insurance are no exception. Examine how U.S. group and individual disability insurers have been impacted by the pandemic and how they are preparing for an uncertain future. Oliver Wyman will team up with experts from the insurance industry to discuss insights on the impact of COVID-19 on disability insurance, including results from Oliver Wyman’s 2022 industry survey. Learn about the past, current, and future expected impacts of COVID-19 on: - Claim experience (including mortality, incidence, recovery and SSDI offsets) - Reserving - Scenario testing - Insurer operations (e.g., claims adjudication, recertification) - Sales and persistency By attending this session, you will be able to: - Understand how disability insurers have been impacted by the pandemic across multiple facets. - Identify where and how U.S. disability insurance carriers are adapting to the new and evolving environment. - Discover how carriers see disability insurance evolving as the COVID-19 pandemic continues.

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.