Description: Today's provider reimbursement landscape

Description: Advancements in machine learning modeling as well as new sources of data coming to the fore help feed the burgeoning industry of InsurTech applications in underwriting. By attending this session, you will learn about the latest developments in InsurTech applications in life/health insurance underwriting.

Description: While the higher general inflation in the broader U.S. economy hasn't emerged in the healthcare market (yet); there is expectations for it to have a lagged impact especially as the full impact of COVID on suppressed utilization emerges. As the healthcare system transitions past COVID, overall costs are expected to trend higher due to overall inflationary pressures as well as new treatments such as the highly anticipated new gene and cell therapies often with costs over millions of dollars.As costs rise, more companies are looking to self-insure their health insurance to control cost increases and are leveraging innovative stop loss programs including captives. Captive insurance markets have seen significant growth and diverse implementations allowing companies to self-fund while managing the risk of large claims and increasing costs. Payers are also looking to control costs and implement value based payment schemes to bend the trend curve and manage costs. Medicare has also adopted new value based payment programs (ACO Reach) which will impact commercial payers and are important to understand. Come gain an understanding of the historical and projected future medical cost drivers including the projected impact of new therapies and then impact on the stop loss markets. Additionally, you'll gain a deeper understanding on how recent innovations in the stop loss market such as the growth in the captive market, level funded and aggregate only products have helped employers manage their costs and overall risk profile.

Description: En el seminario hablaremos sobre los nuevos flujos de tarificación, y nos enfocaremos en la inclusión del análisis geográfico en el proceso de modelado para optimizar la extracción del riesgo en modelos de Machine Learning.

Description: The cost of prescription drugs is top of mind for consumers, payers, and policymakers. While there have been many efforts to reduce pharmacy costs over the years, the problem remains. This begs the question “Where do we go from here?”. While each of the many policy proposals currently on the table help some people some of the time, none seem to address the root causes of rising prescription drug benefit costs.

Description: We will share the latest research from the Actuarial Innovation and Technology (AIT) Strategic Research Program, with a focus on research relevant to health actuaries. Attendees will learn about leading-edge technology that has impacts on actuarial functions, both broad and specific innovations and breakthrough technology, and the resulting impacts.

Description: In July of 2024, CMS will start operations on its new GUIDE model, designed to support people living with dementia and their unpaid caregivers. GUIDE is a TIN-centered model, offering a standardized approach to care with the goal of allowing people with dementia to remain in their homes for longer and improving their quality of life.

Description: Medicare Advantage Organizations (MAOs) have made dramatic changes to the benefits and plan premiums they've offered members over the past years. Hear about information on the changes to benefits and plan premiums offered over the past few years. Find out where these strategic items are currently (for CY2024 bid year) and get ideas on what might come in the next few years. Presenters will discuss recent proposals and rules from CMS that will impact the current and future landscape. They will also compare these items in relation to the fee-for-service (FFS) Medicare market. This session will help you gain a deeper knowledge of the Medicare Advantage, Prescription Drug Plan, and Medicare FFS landscape and walk away with some strategic thoughts on potential paths MAOs may take from here.

Description: Discuss the dramatically changing provider landscape, as well as the innovative solutions being leveraged by providers to address the intriguing opportunities and complex challenges. Among the questions to be answered are the following: How can providers capitalize on employers’ desire to contract directly with local providers? What's the path for providers to develop employer stop-loss (ESL) capabilities to maximize network value/impact? Can providers create a risk portfolio including ESL for local employers, their own employee plan, and other delegated risk arrangements such as Medicare Advantage? How can captive insurers support a provider's risk strategy?

Description: Are you a health actuary affected by recent developments in business practices and accounting standards that have created situations in which you may be involved in estimating balances under accounting rules that differ from those typically used by insurers? In this session you will learn about situations where non-insurance accounting regimes may intersect actuarial practice, with an intended focus on two particular topics.