Description: This research project offers guidance and a model for actuaries to use when performing their professional services related to Medicaid (Title XIX) and Children’s Health Insurance Program (CHIP or Title XXI) managed care capitation rate setting, including, but not limited to, their certification on behalf of a state in accordance with the requirements for actuarial soundness as set forth in law, federal regulation, and CMS guidance, as well as the actuary’s professional obligations under the Actuarial Standard of Practice (ASOP) 49 issued by the Actuarial Standards Board.

Description: On March 22, 2022, the Wall Street Journal hosted its annual Health Forum, a virtual all-day event which included several sessions. This session was attended by experts across the healthcare space and attendees included many from the healthcare technology companies. This report summarizes the event.

Description: A study of whether tobacco, area and industry rating in one state may be reflecting unintended factors such as race, ethnicity or socioeconomic status. This study does not consider whether the rating factors accurately reflect underlying claims costs.

Description: The purpose of this analysis is to provide a practical set of changes to the incidence rate modifiers of the 2013 Individual Disability Income Valuation Table to reflect recent industry individual disability income (IDI) claim experience trends from 2005 through 2015. The goal is to have resulting 2005-2015 experience-based incidence modifiers in a workable format to facilitate its use.

Description: The presenters in this session will highlight the SOA’s work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and State principals to determine appropriate underwriting margins components within Medicaid managed care rates. Understand a brief description of the motivation for and underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in where they operate. By attending this session you will be able to: • Understand the role that Medicaid underwriting margin plays in Medicaid rate setting. • Understand the key components of Medicaid underwriting margin. • Understand the factors that necessitate underwriting margins. • Understand how to incorporate appropriate Medicaid underwriting margin levels in Medicaid rate setting.

Description: Increasingly, actuaries need to collaborate and partner with clinicians in order to be successful in value-based care and population health initiatives. Gaining credibility with professionals from different backgrounds, training and sometimes different objectives can be a challenge. Gain perspectives from actuaries and clinicians to discuss how to collaborate and achieve stronger results and outcomes. By attending this session, you will be able to: • Identify common scenarios where actuaries and clinicians need to collaborate. • Understand perspectives on how to partner and communicate with clinicians. • Describe successful strategies that take into account improvement of financial and clinical outcomes. • Understand how actuaries can provide valuable data to drive results and demonstrate outcomes.

Description: A study of whether tobacco, area and industry rating in one state may be reflecting unintended factors such as race, ethnicity or socioeconomic status. This study does not consider whether the rating factors accurately reflect underlying claims costs.

Description: Telehealth continues to be a story of unrealized potential than realized success. Find out what's pushing telehealth forward as a means of remote healthcare and the challenges its facing. Discuss questions, including: - Telehealth's role in expanding access to mental healthcare is clear, but what about other conditions? - Was access expanded for all patients or do modern delivery methods leave some patients behind - How do telehealth costs compare to in-person costs? - What happens to the value proposition if unit cost savings is off the table?

Description: Risk adjustment has been utilized for many years in different settings, primarily as a tool to help properly compensate insurers for the risks they take when enrolling members in their insurance plans.

Description: Learn the roles and responsibilities of a valuation actuary to help health actuaries learn best practices, technical considerations, and professionalism issues surrounding the calculation and reporting of health liabilities and reserves. Focus on key actuarial liability and reserve provisions, including Claims Unpaid and Premium Deficiency Reserves. Explore new ideas about calculation methods and the importance of the underlying assumptions. Examples will be provided to present best practices and practical applications concerning reserve calculation. A discussion of best practices regarding the preparation of an actuarial memorandum supporting a Health Annual Statement will be included to focus on key considerations from the American Academy of Actuaries’ Practice Note about documenting and supporting the actuarial calculations. The discussion will feature views and considerations from both the insurer’s and the regulator’s perspectives. By attending this session, you will be able to: • Understand the roles and responsibilities of the appointed actuary. • Identify what’s in scope for the actuarial opinion. • Understand actuarial qualification requirements. • Learn the statutory rules for establishing key actuarial liability provisions. • Understand the general purpose of financial reporting. • Understand best practices with reserve calculations and resources available, including relevant practice notes and Actuarial Standards of Practice. • Understand the sufficient documentation needed to support valuation work. • Understand the critical elements sought by regulators, auditors and other users of an actuarial memorandum.