Description: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: On December 21, 2018, the Centers of Medicare & Medicaid Services (CMS) released the final rule for Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program. 'Pathways to Success' makes sweeping changes and will push ACOs to assume financial risk more quickly. This session will discuss the key changes in the final rule, reasons why providers would remain in the program while being forced to downside risk, and how actuaries can add value to providers who will be taking on millions of dollars of risk in the coming years.

Description: Enterprise Risk Management is often thought to be synonymous with managing an insurance company toward financial objectives with a focus on insurance-specific risks. Some might argue though that operational risks are the crux of all risks confronted by an insurance company and ultimately drive the company’s outcomes.Operational risk is the risk of impact on financial outcomes due to operational events, involving internal systems, personnel, procedures or controls, and also external events. Operational risk exists in all business activities, covering fraud, human error, accounting errors, legal actions and system failures. All of these activities could occur during the course of conducting day-to-day business operations. Additionally, insurance executives must consider the pace of change in the external environment and potential impacts on their business. This presentation is focused on operational risks, current and emerging, faced by health insurance companies.

Description: "The ACA RADV Program will begin to impact issuers’ risk transfers in the 2018 benefit year (BY) – potentially significantly. The program is expected to continue into the 2019 BY and beyond. Therefore, health actuaries working in the ACA market need to understand this program and its potential impact.The session includes panel experts who will provide attendees with high-level overview of the program, discuss the findings from a national study, and RADV’s ultimate impact to risk transfers, as well as downstream impacts to financial and pricing decisions. The nationwide study is based on 300+ issuers’ 2016 RADV results and contains emerging insights into the new ACA RADV program otherwise unavailable. The panel’s agenda will include:1. A succinct overview of the ACA RADV Program will be provided2. Summary of a national 2016 ACA RADV pilot study results and its findings. 3. Preliminary results from a national 2017 RADV study will be discussed (or CMS published results if available prior to session). 4. Walkthrough of how RADV results impact the overall risk adjustment transfers in the ACA market. 5. Finally, the panel will discuss RADV impact to issuer’s financial accruals and pricing strategy. 6. General Q&A, discussion"