Description: The presenters will provide updates on research being conducted under SOA sponsorship. This includes projects on the topics of Direct Primary Care and Patient Centered Medical Homes.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: While intended to assist health plan actuaries responsible for stress testing and ORSA filings, this session will also be informative for actuaries interested in communicating the impact of potential catastrophic events for health plans to their management and board. It will begin with a discussion of event thresholds for stress tests and their impact on capital and financial statements. Presenters will take a detailed look at several catastrophic event case studies (historical and hypothetical) in the following areas: healthcare specific (e.g. pandemic, specialty Rx), financial institution/credit market, operational/business, strategic and multi-event scenarios.</

Description: This is a brief report that summarizes recent changes in the prevalent medical loss ratio methodologies and also looks at some of the more recent experience of health insurers that filed medical loss ratio reports.

Description: This session discussion is about tools, techniques, and methods used by the health valuation actuary HVA in dealing with business projections, cash-flow analysis, valuation on nonguaranteed premium business, target surplus analysis, reinsurance and claim reserves. From Record of Society of Actuaries Vol. 18, No. 1A.

Description: This is a review of the publication entitled &#39;Medicare: Health Insurance for the Aged, 1969: Geographic Indices of Reimbursement by State and County.&#39; It is of value to health actuaries because it contains information as to the variation in health insurance claim costs by geographical areas within the United States.

Description: In this session we will discuss the impact of regulation changes that will allow members with End State Renal Disease (ESRD) to sign up for Medicare Advantage in 2021 for the first time. We will delve into the current basics of how ESRD works, the characteristics of the population that is currently on original medicare today, and a comprehensive look at what plan sponsors should be thinking about going into 2021.

Description: Insurance commissioners and deputy insurance commissioners will discuss current topics including health care reform, life insurance issues, risks in the major medical markets, voluntary products and other topics.

Description: Read this report to learn more about interpretable machine learning techniques for health insurance fraud detection.

Description: The always popular Medicaid Hot Topics session is back with discussions from an expert panel on the most riveting Medicaid topics of the year. These could include the following: • Medicaid Fiscal Accountability Proposed Regulations• Tennessee's Block Grant Proposal• ACA court battles: What are the potential impacts on Medicaid? • Pass-through payments are converting to directed payments: What is changing?• And more current topics of interest to Medicaid actuariesMedicaid is dynamic and it is difficult to stay current on all of the changes. This session provides insightful discussion into the major changes that impact actuaries and their companies or state clients.