Description: This session describes the process payers and employers can use to evaluate emerging medical device technologies, recent or pending FDA submissions for prescription drugs and experimental treatments that impact patient care, resource utilization and health care expenditures. We will walk through the process of identifying and selecting impactful treatments (Horizon Scanning) and quantifying the financial cost of new technologies before they arrive in the market. These workflows can be leveraged by actuaries, healthcare economists, clinicians and pharmacists from a payer (Commercial and Medicare) and employer perspective for self-funded plans. We will also walk through some sample models that illustrate how costs for emerging technologies and treatments can be modeled.

Description: Beginning with the 2019 Benefit Year, CMS (the Centers for Medicare and Medicaid Services) has provided guidance that allows Medicare Advantage Plan Sponsors much greater flexibility in tailoring benefits to promote clinical, care management, and financial goals. The guidance allows for a broader menu of supplemental benefits and also enables plans to target benefit enhancements to beneficiaries afflicted with specific disease states. This session explores the ramifications of the policy changes on Plan Sponsors and beneficiaries, and discusses the different ways that Plan Sponsors are taking advantage of the additional flexibility.

Description: Predictive Analytics and Epigenetics are two of the most impactful driving forces for the future of healthcare, precision medicine, and insurance. Learn why this is true, how if will change the way our industry operates, and how you can stay viable and contribute to the betterment of humanity while also protecting the actuarial profession from obsolescence. Learn how personalized medicine keying off genetic testing is saving life insurers big dollars. The only limit seems to be testing access for their insureds.

Description: Direct Primary Care (DPC) is a newer model of primary care delivery in which patients or employers pay for care directly on a membership basis; insurance and other third-party payment is not used. Early studies show significantly improved patient health outcomes and lower expenditures for DPC patients compared with similar patients receiving traditionally delivered primary care. Additional research is needed to better understand physician perspectives about the model and the role of patient selection in early results.In this session we discuss research projects that may shed light on the DPC model and on whether early results indicate more about the model or about the patients who use it.We discuss an SoA research project that interviews DPC physicians to better understand their views about the model and its early results. We also discuss a paper that analyzes characteristics of patients who receive primary care from a DPC physician and compares them to characteristics of patients who receive primary care in more traditional ways. This cross-sectional study surveys all adult patients of a convenience sample of several DPC practices. Variables include demographics, socio-economic status (SES), type of additional coverage (if any), whether DPC fees are paid by an employer, and self-reported health status. The Medical Expenditure Panel Survey is the main source of comparison data. For a given cohort of demographics and additional coverage, we determine whether DPC patients have similar health status, demographics and SES as non-DPC patients. This study will provide insight into the degree of selection into DPC by observable patient characteristics.

Description: The last three decades have witnessed an important rise in number of people with diabetes in Asia, especially Type 2 Diabetes. Like no other common condition, numerous innovations are currently entering the healthcare system that will soon have a significant impact on management of the condition. This presentation explores the role played by sensors/wearables, artificial intelligence, new drugs and diabetes apps. We assess the realistic potential of such advancements and give an outlook on medium-term pricing and product development.

Description: This session will describe best practices for the preparation of the actuarial memorandum that supports the statement of actuarial opinion that is part of a health annual statement and review highlights of the new (2019) practice note on this topic. Presenters will represent different perspectives to discuss the components of an actuarial memorandum and use examples to present best practices and practical application of the information presented in the practice note.

Description: Discussion and Opinion on how randomness affects measurement of provider contracting risk-sharing agreements

Description: This article outlines and summarizes research from Swiss Re about the prevalence of the Health Protection Gap throughout Asia, with a particular focus on China. Authors Robert Burr and David Zhang share key statistics on the scope of the gap, which is more than 800Bn USD in China alone, and discuss the role that technology and private-public partnership can play in reducing this gap over time. Readers will come away with an understanding of the scale of the problem within the Asia region as well as new ideas on how to solve similar problems within their own region.

Description: Med Supp

Description: A panel of practicing actuaries and policy analysts will discuss the 'big issues' that could affect the actuarial profession in the future, and suggest ideas on how the actuarial profession could adapt to these challenges. This will be an interactive session where attendees can expect to have an opportunity to weigh in through polling questions and discussion. Topics touched will include: socialized medicine, artificial intelligence, the competition from data scientists, data commoditization, disruption from new entrants into the healthcare insurance space, and more.