Description: In this video Mitchell Momanyi, FSA MAAA presents an informative breakdown of Medicare Advantage plans, delving into the intricacies of this alternative to traditional Medicare. Covering the inception of Medicare Advantage and its evolution, Momanyi explores the managed care companies offering Part C coverage, emphasizing the role of provider networks coordinated care. Concluding with key considerations for beneficiaries, Momanyi stresses the importance of weighing the pros and cons between Traditional Medicare and Medicare Advantage, while also emphasizing the evolving nature of the Medicare landscape and the regulatory nuances influencing enrollment decisions. Conributors: Mitchell Momanyi, FSA, MAAA, Deana Bell FSA, MAAA, Matt Emery, FSA, CERA, MAAA, Jon Forster, ASA, MAAA

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: In this video led by Mitchell Momanyi, FSA, MAAA, the types of Medicare products available is discussed. This two major types are traditional Medicare and Medicare Advantage. It discusses how traditional Medicare encompasses Parts A and B, covering various inpatient and outpatient services but not long-term care or prescription drugs, which fall under Part D. The video details deductibles, cost-sharing structures, and options like Medigap plans that assist with Traditional Medicare’s out-of-pocket expenses. Mitchell emphasizes clarity and understanding while sharing his expertise in this comprehensive overview.

Description: The big event of 2023 is the launch of multiple Humira biosimilars, which began in January with the arrival of Amgen’s Amjevita on the market. The launch of Amjevita kicks off the process of changing the specialty drug marketplace in the United States. The expectation of the full impact of this big event is very hopeful, but there is still uncertainty several months after its beginning. Humira is the highest-selling drug in the world and has been since 2013 (Figure 1)—except for when COVID-19 projects temporarily surpassed it. The world is eagerly awaiting the launch of multiple biosimilar drugs to compete with Humira and hopefully bring more competitive pricing to the benefit of payers and patients everywhere.

Description: On March 6, 2023, The Wall Street Journal hosted its Health Forum, a hybrid all-day event. The virtual meeting featured 11 different events. This white paper focuses on those events. The sessions were informative and fast-paced, with each one providing a quick hit of relevant and cutting-edge information around health care.

Description: Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event. Savings from biosimilars have accelerated significantly in the past few years. There has been a number of relatively recent biosimilar launches that can help to shape our expectations of the financial impact that could result from this year’s big event.

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: In this session, Deana Bell, FSA MAAA provides a comprehensive introduction to the Medicare Risk adjustment Program. Deana is a Principal & Consulting Actuary in the Seattel office at Milliman. She has been working with Medicare Advantage throughout her career as an actuary. Her expertise includes actuarial opinions, pricing, rating, reserving, medical underwriting, benchmarking, and risk adjustment projects. IN this session she sheds light on how Medicare Advantage health plans are compensated by the Centers of Medicare and Medicaid Services (CMS) through risk adjusted revenue. She highlights the significance of risk adjustment in ensuring financial stability for Medicare Advantage plans. Contributors: Deana Bell, FSA MAAA ; David Koenig, FSA, MAAA, John Dawson, FSA, MAAA, Jon Forster, ASA, MAAA

Description: In this video Scott Allen, FSA, MAAA discusses the Medicare Advantage Part C bid template. The template helps Medicare Advantage plans estimate costs and premiums, comparing their bids to CMS benchmarks. It’s a complex process involving worksheets that project costs, calculate revenue requirements, and determine rebates, ultimately influencing the plan’s benefits, premiums, and competitiveness in the market. Contributors: Scott Allen, FSA, MAAA, Eric Milner, ASA, MAAA, Danica Turner, FSA, MAAA, Jon Forster ASA, MAAA

Description: On March 6, 2023, The Wall Street Journal hosted its Health Forum, a hybrid all-day event. The virtual meeting featured 11 different events. This white paper focuses on those events. The sessions were informative and fast-paced, with each one providing a quick hit of relevant and cutting-edge information around health care.