Description: For decades the negotiated prices between health care providers, insurance carriers, and networks have been tightly-guarded trade secrets. That's quickly changing. Health care price transparency is now bipartisan-supported law. Gag clauses have been banned. Starting in January 2021 hospitals were subject to new rules requiring disclosure of the payment rates they receive from health plans to both consumers and the general public. So far, compliance has been mixed. Similar rules for payers become effective later in 2022 and 2023 for health plans and consumers. While entrenched interests are doing their best to stall transparency, unless the laws change, transparency is going to happen and will rock the commercial health insurance market, providing the long awaited opportunity for meaningful health care cost reductions. Learn more about price transparency laws and regulations, examine rocky implementation to-date, and discuss the role of self-insured employers in leading the market changes that will emerge from price transparency. By attending this session, you will be able to: - Name the applicable price transparency laws and rules. - See transparency as more than a list of new compliance requirements and consumer tools. - Anticipate that the downstream impacts of transparency on commercial health insurance will be profound. - Appreciate the increased power of self-insured employers.

Description: The introduction of new gene and cell treatments is not without scrutiny. Although these treatments are often curative, they come with a significant price tag. Health plan actuaries find themselves wondering if the intended outcome supports the cost and whether the potential medical cost savings will offset the high drug cost. The Institute for Clinical and Economic Review (ICER) reviews results from clinical trials to produce a report evaluating the cost-effectiveness of new therapies. Depending on the results, the ICER report can be used by pharmaceutical companies to justify the high cost or by the health plan to do the opposite. Go beyond the ICER report and discuss an alternative method for valuing new drugs using nonmedical revenue streams, such as disability and nutrition benefits, and return-on-investment modeling. By attending this session, you will have a better understanding of the nonmedical revenue streams, such as disability and nutrition assistance benefits, that may offset the cost of a drug and how those revenue streams can be incorporated into return-on-investment modeling.

Description: The declaration of the COVID-19 public health emergency in the US has led to increased Medicaid membership, which has affected the aggregate acuity of these populations. This session will cover considerations in how this change in acuity could be accounted for in Medicaid rate development. Additionally, the session will provide updates on current issues in Medicare payment policy, including Medicare Advantage and new payment models. By attending this session, you will be brought up to date on recent Medicare legislative and regulatory developments as well as the potential impacts of COVID-19-related Medicaid enrollment policies on the morbidity of this population.

Description: Telehealth came to the forefront in a significant way during – 2020–2021, partially due to the pandemic. What is the reasonable expectation of future consumer use of telehealth? This virtual option has the ongoing potential to increase access to health care services to plausibly lower the cost of care. Furthermore, telehealth continues to evolve as a technology. Keeping current with advancements as well as consumer willingness to use this medium are important to the future of health insurance. By attending this session, you will learn about the latest advancements in telehealth as well as implications for cost of care due to consumer use.

Description: It’s well documented that oral health is correlated with overall health. An exciting array of new dental technologies is emerging, from virtual reality through AI to CRISPR. These ground-breaking advancements have the potential to revolutionize dentistry.

Description: Look beyond traditional reinsurance arrangements. Strategically crafted reinsurance structures can support new business and achieve a wide range of risk management and financial objectives. Consider creative ways to look holistically at your business to develop the most effective solutions. Combine in-force and new business? Yes! Individual and group? Of course. Multiple product types? That can work! Whether you are trying to free up capital, address an underperforming block or venture into a new line of business, there are reinsurance structures that can help. Look at a virtual case study with a panel of experts and consider the options for selecting and structuring a reinsurance transaction. View key elements such as scale, composition and market appetites. Look at a variety of products including life, annuity, PRT and long-term care. The panel includes representation from a carrier, a reinsurer and a reinsurance broker. Get the opportunity to weigh in on decision points using online polling software, whether in person or virtual.

Description: As actuaries, we're trained to see patterns in numbers and to design solutions that mitigate risk. While quantitative analysis and modeling are critical actuarial tools, looking at the numbers alone can lead to insurance products that don't succeed in the real world the way math says they should. With new digital technologies surfacing in the insurance space, we have more data at our fingertips than ever before, leading to a higher focus on doing quantitative research within insurance product design. Take back a step from quantitative research and discover qualitative research methodologies into your product development process to design solutions that meet real needs in the market. In a nutshell, qualitative research can surface issues early and help you answer questions such as: Can we really sell this product in the market? Why would someone buy this? How widespread is the need? How could your product be a solution you didn't intend?

Description: As the speed of technological innovation increases, actuarial leaders are trying to determine how to use emerging technologies to unlock more business value and improve competitive positioning. This includes enabling new capabilities, improving process efficiency, and increasing the effectiveness of human capital. The session will discuss what we are hearing from clients who are in the process of transforming their business, how they are approaching these transformations, and what they are focusing on. This will include different aspects of transformation, including visualization dashboards, data science applications, no-code platforms, automation, data, and the cloud. Find out how organizations are thinking of human capital and collaboration between actuaries, IT, and other professionals.

Description: At this panel discussion with the SOA Sustainable Development Goals (SDGs) Taskforce members, you will learn about the SOA's plans to partner with key local and global organizations to address societal issues such as health and well-being; decent work and economic growth; reduced inequalities; and climate action. Hear more about thetaskforce's action plan and the next phase of the engagement, which is centered on volunteer activities, namely moving forward with the SOA Innovation Team to launch the SOA SDG Incubator. Lastly, look at creating tangible opportunities for members to apply their current skills, transpose their experiences and add new skills contributing to solving for these critical issues.

Description: Pharmacy prices are top of mind for many consumers, policymakers, and payers. There are many proposals out there about ways to reduce pharmacy costs, almost all of which involve price controls. Is that the right move? What about the unintended consequences of such regulation? Will fewer life-saving drugs be developed including fewer drugs that improve the quality of life? Are better financing alternatives out there? Explore the concept of value-based reimbursement for pharmacy prices, including the lessons learned from applying value-based concepts to hospital and physician value-based financing.