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

Description: "Most patients enter the health care system through their primary care provider or through the Emergency Room or an Urgent Care Center. How an emergency room is structured, managed, and provides care is one of the major forces impacting the total cost of care. Yet it is often an after-thought and ignored by both health plans and health systems. In reality, the structured introduction of efficient practices can substantially reduce the quantity and cost of health care services. Further explore useful information to better understand and see how there are still substantial opportunities for improvement."

Description: Management service organizations (MSOs) in value-based care have expanded into far more locations in the health care ecosystem; some demonstrate value to both buyers and providers. Explore the role of these players in the health care ecosystem, their future outlook, and how actuaries can help them perform.

Description: Misalignment in value-based care approaches between payers and market segments (Medicare, Medicaid, self-funded employer groups, and commercial insurance) creates significant headwinds and friction for health care providers seeking to succeed in an environment that is moving toward more value-based care models and payment approaches. However, while multi-payer approaches in value-based care are critical to eliminating these misalignments, uptake in such programs has been lagging for a variety of reasons. Hear about lessons learned from a selection of specific multi-payer initiatives to understand what went well and what challenges were encountered in expanding these initiatives more broadly. You should be able to walk away from this session with an appreciation of the potential for multi-payer approaches and the challenges faced in gaining traction with them.

Description: Come discuss how reinsurers can work side by side with insurer to better develop products, and lift in the areas that reinsurers have more experience, help matching products with distributions (or vice versa) and provide advanced technologies associated with tools and software. The speakers will also present Direct to Consumer plan from various points of view, i.e., distributors, carriers, and reinsurers. Some case studies will also be presented where traditional reinsurers and asset-intensive reinsurers helped insurers bring products to life.

Description: The Part D program is funded through a variety of government subsidies and manufacturer discounts. The federal reinsurance, initially designed as protection from catastrophic spending, became a primary source of subsidies for the program. When the Inflation Reduction Act (IRA) is fully implemented in 2025, the funding of Part D will realign to its original intent.

Description: The momentum towards value-based care has increased focus on how payers attribute accountability for the cost and quality of member care to providers. The current landscape has a myriad of methodologies and accountable parties. Examine the ideal future state of attribution discussing trade-offs in goals (e.g., population coverage vs. member influence), accountable parties (e.g., should third-party vendors be involved?), and methodologies.

Description: "Examine the exciting possibilities for artificial intelligence (AI) in health care and its potential to transform the patient journey. You will learn about the various touchpoints where AI is being applied along the patient/care journey, including provider search tools, claims analysis, and fraud detection. By attending the session, you will be able to: Have a comprehensive understanding of the opportunities and challenges presented by AI in health care Evaluate the potential impact of AI on their own organizations Be equipped with strategies for effectively implementing AI solutions and maximizing their benefits for patients, providers, and payers"

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.