Description: In today’s marketplace, consumers are driven by research, reviews and ease-of-use more than before. They want to be empowered in their buying decisions and are turning their backs on insurance agents as the source of information for their buying decisions. The direct-to-consumer (D2C) platform addresses the expectations of the modern consumer and provides an opportunity for insurers to automate and execute underwriting in real time with better results than has been seen with traditional processes—and at significantly lower costs. D2C not only helps insurers by improving processes, reducing costs and maximize sales; it can also be used to provide a range of services through an online platform to increase customer engagement. Driven by the need to remain competitive and against the threat of new entrants, insurers foresee extensive use of direct-to-consumer channels as an alternative distribution method. However, to remain competitive they must throw away their outdated thinking and become future-oriented in the acquisition of customers. This starts with understanding D2C models in the insurance industry.

Description: When compared to 10 developed countries, the US ranks last in overall health care performance, highlighted by per capita spending that is 50% greater than the next country and last place rankings in efficiency, equity, and healthy lives. Escalating costs and decreasing affordability continue to pose the primary challenge in U.S. healthcare as cost pressures are increasing for all who pay for healthcare: health plans, governments, employers, and consumers. From 2010 to 2015, the average health plan medical loss ratio increased from 86% to 90% and average employee contributions to premiums increased by 24%. This session will investigate how health plans could bend the cost curve by focusing on solutions such as medical/Rx cost reduction opportunity assessments, VBC maximization, PBM relationship maximization, care model redesign, provider/health plan collaboration, and next generation product design.

Description: Overview of public health (responsibilities, funding, challenges) and discussion of the role actuaries can play in achieving population health goals.

Description: This session will provide an overview of the various types of critical illness and long term care plans in the U.S. market. It will highlight key factors to consider for effective product design and risk management for these types of products.

Description: The cost of health care in the U.S. has been on an unsustainable rise for some time driven by fundamental delivery and financing challenges. Health plans need to seek greater control and effectiveness of care management resources, while consumers are demanding care be more personalized and patient-centric. Health plans need to use data analytics to identify opportunity areas with the most potential for reducing costs through care model redesign. Understanding key care model trends, design concepts, and steps for developingand enhancing comprehensive care design models will help lead to reduced costs for health plans.

Description: Market Overview: As uncertainty continues to circulate about the Affordable Care Act (ACA), the Student Health Insurance Plan (SHIP) market may be a product niche worth understanding and is developing given its fit for issuer demands for stability now and investments that make sense for the long term.

Description: "The Centers for Medicare and Medicaid Services (CMS) has implemented a variety of episode-based payment models. Each model has a unique financial risk profile based on episode definition, implicit and explicit risk adjustment and other features. Of particular interest, are the various ways risk adjustment is handled in these different models. Attendees will learn about the different risk arrangements and how the actuarial skill set is relevant to value-based payments. Additionally, real life examples will give insight into the practical application of these models. Ultimately, attendees will come away with a deeper understanding of key methodological issues that can apply not just to Medicare but across the healthcare spectrum as the transition away from fee-for-service and toward value-based reimbursement continues.At the conclusion of the session, attendees will be able to:• Demonstrate knowledge of CMS episode-based payment models and their risk features;• Apply actuarial insights to value-based payment methodologies; and• Understand value-based payments from the provider perspective."

Description: Upon completion of this activity, participants will be able to: • Identify the current challenges and opportunities to improve diabetes care to reduce the risk of acute and chronic complications; • Recognize the feasibility of preventing type 2 diabetes and the need to develop and support prevention programs; • Identify strategies to improve diabetes control in racial/ethnic minorities who are at a particularly high risk of developing diabetes and its complications; and • Recognize the influence of biological,psychological, emotional, social, financial and cultural factors in the development and course of the disease.

Description: Actuaries can utilize consumer information to help optimize benefit plan design to pro-actively impact health care costs and utilization of benefits. This session will present a recent case study showing how this was accomplished. This makes use of "personas", detailed health care analytics, actuarial health cost models, etc. This is based upon actual client project.

Description: A look at how LTCI policyholders behave, or may behave, in light of their policy benefits and various decision points in the life of the policy.