Description: Actuaries historically modeled new launches in pharmaceuticals by anticipating the expected change to the market basket. This became more complicated with the recent launches of gene and cell therapies as they address rare diseases. Rare conditions have low total member volume to study and some do not currently have a diagnosis code to identify them within claims data. Addressing this modeling challenge has been growing more important in the recent years with the number of therapies launching. What has the health care industry, and more specifically health care, done to enhance modeling and how should this be altered for the future? Additionally, historic modeling has sometimes incorporated a level of direct medical treatment cost offsets where studies have shown lower treatment costs are achievable. Can gene and cell financial modeling include cost offsets as well? And if so, what are suggested precautions or limitations to this effort?

Description: Cover a variety of topics centered around the unsupervised learning technique called 'clustering'. The presenters will take you through a wide array of topics that range from 'What is Clustering?' to 'How can I use this technique to solve problems I didn't even know existed?' In the health care industry, everyone is looking for an edge in reducing total spend-cluster analysis finds the unambiguous in an ambiguous framework of results.

Description: Hear about the new hope biosimilars bring in helping payers and patients manage the rapidly growing pharmacy spend. The Big Event, encompassing multiple Humira biosimilars, launches in 2023 and could set the tone for how much biosimilars can be expected to contribute to solving our pharmacy spend challenges. What will be the financial impact of the Big Event and this coming wave? What can be done to maximize adoption of biosimilars? What strategies are available to maximize savings for payers and patients?

Description: High inflation rates can affect disability insurance in a variety of ways. Learn about rising price and wage inflation trends and why they are of interest to disability insurers. You will also hear presenters address topics such as recessionary pressures, the eroding value of benefits, wage growth, top-line trends and expense pressures. By attending the session, you will gain insight into how inflation should be considered in pricing, reserving and financial modeling.

Description: The momentum towards value-based care has increased focus on how payers attribute accountability for the cost and quality of member care to providers. The current landscape has a myriad of methodologies and accountable parties. Examine the ideal future state of attribution discussing trade-offs in goals (e.g., population coverage vs. member influence), accountable parties (e.g., should third-party vendors be involved?), and methodologies.

Description: How do we take a Minimum Viable Products (MVP) approach to launch new insurance products? Join this moderated discussion and focus on three key development aspects: Distribution, Systems, and the design and pricing of the Insurance product itself. Come discuss reasons to choose an MVP approach and how it solves many of the product launch challenges.

Description: The presenters give a history lesson on the origin of CMS Medicare star ratings, including why this demonstration was originally created and how the program has worked over the years. The discussion will cover both the evolution of the underlying measures and the financial impact to Medicare Advantage stakeholders. By attending the session, you will have a stronger understanding of how member experience and outcome-based measures can be factored into the funding within a health care system to better align incentives among various stakeholders.

Description: This project models and forecasts premature cardiovascular mortality, with a focus on two main risk factors - obesity status and education attainment level. It investigates the role of obesity and education in determining age-sex-specific premature cardiovascular mortality.

Description: During the past few years, performance, cost, and risk trends for Medigap products have undergone substantial changes. Some of these trends could ease cost pressures on Medigap insurers, while others might increase them. Part 1 of this Issue Brief article discusses current changing trends and considerations around about how they are impacting Medigap.

Description: In this session, you will learn about key cost drivers in pharmacy trends, including but not limited to: New high-cost drugs, including gene therapies, that treat rare and/or expensive conditions such as spinal muscular atrophy (SMA), inherited retinal disease, hemophilia A and B, Duchenne muscular dystrophy (DMD), sickle cell anemia and cerebral adrenoleukodystrophy (CALD) Other cost drivers in the prescription drug category, including the emergence of GLP-1s, digital therapeutics, targeted immunomodulators, accelerated approval drugs and expanded indications The implications of the end of the COVID-19 Public Health Emergency (PHE) on the costs of COVID-19 vaccines, testing and treatment claims Downward influences on pharmacy costs, such as the availability of new generic drugs and biosimilars Emerging trends in pharmacy benefits manager (PBM) contracting, the initial portion of this discussion will be led by a pharmacist and former state pharmacy director.