Description: This report outlines the current wellness environment, the objectives of the wellness study and provides a summary of the overall study findings. This report is supplemented by the Research Summary Report, Survey Results, and Interviews with Researchers. This document includes a summary of key findings from each of the three phases.

Description: Similar to how states had made adjustments to their capitation rates to reflect acuity adjustments caused by the onset of the pandemic, states will need to modify the rates to reflect the unwinding since utilization patterns and average acuity per enrolled member will change. When the continuous coverage requirements set forth by the COVID-19 Public Health Emergency (PHE) ended, Medicaid-managed care programs across the country adopted various approaches to phasing out maintenance of effort (MOE) as a result of changes to the PHE-era continuous eligibility requirements. Phasing out the MOE requirement will ultimately result in members who no longer meet eligibility requirements losing their Medicaid coverage. Further, states are facing a wide variety of circumstances and are implementing diverse approaches to the MOE phase-out. This topic will be of significant interest to all actuaries and stakeholders of the capitation rate development process for Medicaid-managed care programs. Join us as we discuss the operationalization of the PHE unwind while referencing the SOA's research project which models the effects of the unwinding on Medicaid eligibility and population costs. You will learn about the various approaches that different states have adopted to manage the unwinding process, which will be instrumental for accurately pricing managed care rates.

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: This report evaluates the long-term mortality consequences of the COVID-19 pandemic from a cohort-based perspective using historical mortality data.

Description: This report analyzes insurance product design, morbidity trends, and pricing models for individuals with pre-existing illnesses in China to improve coverage for substandard health populations.

Description: Enjoy an in-depth walkthrough of the facets of the lab testing world in this webcast. The agenda will include a discussion on genetic testing, which focuses on its general background, current trends and tests in the pipeline, as well as a focus on the approaches to achieve savings in lab testing. Finally, expect to check out sample actuarial analyses that will be used to identify areas of focus in lab management. Join us and take a deeper look into lab work in the actuarial health industry.

Description: Explore SOA-sponsored research on Social Determinants of Health (SDOH) during the How Does Where You Live Impact Your Health webcast. Dive into SDOH data and modeling that will focus on cluster analysis. This will help determine the overall impact of your area's affect on your health and life. This webcast also covers an overview of the existing SDOH-related programs that may affect or intersect with health plan or provider SDOH initiatives. Discover the importance of the place you live and future impact of your overall health.

Description: Virtual - Session 1D: Pharmacy Risk Mitigation - Pricing, Programs, Pools, and Performance Guarantees

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: Session 10B: Comprehensive PBM Performance Evaluations Including TCOC Impact