Description: In this video Mitchell Momanyi, FSA MAAA presents an informative breakdown of Medicare Advantage plans, delving into the intricacies of this alternative to traditional Medicare. Covering the inception of Medicare Advantage and its evolution, Momanyi explores the managed care companies offering Part C coverage, emphasizing the role of provider networks coordinated care. Concluding with key considerations for beneficiaries, Momanyi stresses the importance of weighing the pros and cons between Traditional Medicare and Medicare Advantage, while also emphasizing the evolving nature of the Medicare landscape and the regulatory nuances influencing enrollment decisions. Conributors: Mitchell Momanyi, FSA, MAAA, Deana Bell FSA, MAAA, Matt Emery, FSA, CERA, MAAA, Jon Forster, ASA, MAAA

Description: The presenters in this session will highlight the SOA’s work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and State principals to determine appropriate underwriting margins components within Medicaid managed care rates. Understand a brief description of the motivation for and underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in where they operate. By attending this session you will be able to: • Understand the role that Medicaid underwriting margin plays in Medicaid rate setting. • Understand the key components of Medicaid underwriting margin. • Understand the factors that necessitate underwriting margins. • Understand how to incorporate appropriate Medicaid underwriting margin levels in Medicaid rate setting.

Description: Increasingly, actuaries need to collaborate and partner with clinicians in order to be successful in value-based care and population health initiatives. Gaining credibility with professionals from different backgrounds, training and sometimes different objectives can be a challenge. Gain perspectives from actuaries and clinicians to discuss how to collaborate and achieve stronger results and outcomes. By attending this session, you will be able to: • Identify common scenarios where actuaries and clinicians need to collaborate. • Understand perspectives on how to partner and communicate with clinicians. • Describe successful strategies that take into account improvement of financial and clinical outcomes. • Understand how actuaries can provide valuable data to drive results and demonstrate outcomes.

Description: 2021 Life Meeting - Session 8A: Use of Electronic Health Records in the Assessment of Life and Health Risks 9.1.21 Recording

Description: Cover a variety of topics centered around the unsupervised learning technique called 'clustering'. The presenters will take you through a wide array of topics that range from 'What is Clustering?' to 'How can I use this technique to solve problems I didn't even know existed?' In the health care industry, everyone is looking for an edge in reducing total spend-cluster analysis finds the unambiguous in an ambiguous framework of results.

Description: Hear about the new hope biosimilars bring in helping payers and patients manage the rapidly growing pharmacy spend. The Big Event, encompassing multiple Humira biosimilars, launches in 2023 and could set the tone for how much biosimilars can be expected to contribute to solving our pharmacy spend challenges. What will be the financial impact of the Big Event and this coming wave? What can be done to maximize adoption of biosimilars? What strategies are available to maximize savings for payers and patients?

Description: High inflation rates can affect disability insurance in a variety of ways. Learn about rising price and wage inflation trends and why they are of interest to disability insurers. You will also hear presenters address topics such as recessionary pressures, the eroding value of benefits, wage growth, top-line trends and expense pressures. By attending the session, you will gain insight into how inflation should be considered in pricing, reserving and financial modeling.

Description: Telehealth continues to be a story of unrealized potential than realized success. Find out what's pushing telehealth forward as a means of remote healthcare and the challenges its facing. Discuss questions, including: - Telehealth's role in expanding access to mental healthcare is clear, but what about other conditions? - Was access expanded for all patients or do modern delivery methods leave some patients behind - How do telehealth costs compare to in-person costs? - What happens to the value proposition if unit cost savings is off the table?

Description: 2021 Life Meeting - Session 5F: Premium Leakage - How Outdated Claims Systems are Losing You Money 8.31.21 Recording

Description: Learn the roles and responsibilities of a valuation actuary to help health actuaries learn best practices, technical considerations, and professionalism issues surrounding the calculation and reporting of health liabilities and reserves. Focus on key actuarial liability and reserve provisions, including Claims Unpaid and Premium Deficiency Reserves. Explore new ideas about calculation methods and the importance of the underlying assumptions. Examples will be provided to present best practices and practical applications concerning reserve calculation. A discussion of best practices regarding the preparation of an actuarial memorandum supporting a Health Annual Statement will be included to focus on key considerations from the American Academy of Actuaries’ Practice Note about documenting and supporting the actuarial calculations. The discussion will feature views and considerations from both the insurer’s and the regulator’s perspectives. By attending this session, you will be able to: • Understand the roles and responsibilities of the appointed actuary. • Identify what’s in scope for the actuarial opinion. • Understand actuarial qualification requirements. • Learn the statutory rules for establishing key actuarial liability provisions. • Understand the general purpose of financial reporting. • Understand best practices with reserve calculations and resources available, including relevant practice notes and Actuarial Standards of Practice. • Understand the sufficient documentation needed to support valuation work. • Understand the critical elements sought by regulators, auditors and other users of an actuarial memorandum.