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.

Description: Explore the value and cost of prescription drugs, how they should be defined and measured and the effects various stakeholders in the pharmacy ecosystem can have on these factors in the latest webcast. You'll investigate the impact of coverage, formulary and rebate negotiations and related benefit design. Find out how actuaries can answer questions related to the prescription drug industry, in addition to improving the access, quality and affordability of prescription drugs in the United States. Join us for this webcast and come learn about value-based contract design, negotiations, implementation and administration for prescription drugs.

Description: As the medicine practice continues to evolve, join us for this webcast to receive up-to-date information about the incorporation of scientific advancements and emerging evidence into the field. The creation of innovative treatments and the focus on improving patient outcome can cause information and price shocks, which will be one of the covered topics. Expect to utilize this webcast as an introduction to precision medicine, which is a genetics-based approach to healthcare. Speakers will share their experiences in demonstrating cost-effectiveness and promoting reimbursement with this new approach.

Description: High performance providers and in turn networks are often a prerequisite for a highly competitive product. If performance is lacking, the ability to offer a competitive product on the street can be significantly hampered. Learn from a case study how an actuary might measure performance and compare and/or rank network providers on multiple concrete factors. Discussed comparators will include efficiency, care management effectiveness, market attractiveness (enrollment changes), inclusion in other health plan networks, etc. By attending this session, you will be able to use principles discussed in this session to more effectively evaluate provider networks for their employer.

Description: A priori, one would expect In Home Assessments (IHA) and Telehealth (TH) Encounters to identify some conditions that lead to actions that keep a member or two out of the Emergency Room. Similarly, one would expect Care Management and Disease Management engagement to ultimately influence some improvement in documentation that leads to more accurate Risk Adjustment. The business cases for these activities are often siloed to only the primary activity. The relationship between risk adjustment and care management is often more recognized as competing interests - one generally relying on utilization and the other trying to reduce it. Business cases can change dramatically when profiling has a more complete picture. This session will explore some techniques and share some observations - positive and negative - of the interactions between CoC and Risk Adjustment.

Description: Keynote Speaker: J.D. Kleinke, Author and Medical Economist J.D. Kleinke has been instrumental in the creation of four health care information organizations; has served on the Boards of several health care companies; and spent many years advising both sides of the political aisle on non-partisan, practical approaches to health policy and legislation.

Description: Those with ADL and/or cognitive needs and their family caregivers are in great need of support across their acute medical and long-term care custodial requirements. Today many entities are supporting families with integrated care delivery and financing approaches.

Description: Measuring the interplay between climate risk and morbidity and mortality is complex and often requires a multidisciplined team approach to meeting objectives. In this session, presenters discuss their journey and the twists and turns encountered in examining the link between wildfires, air quality, pollution, and morbidity and mortality implications. In addition to sharing their insights about the process, presenters will provide results from their, such as: - Mortality and morbidity risk trends influenced by climate change, wildfires, and air quality issues - Regional, risk class, socioeconomic, and temporal variations in these trends - Projections based on the observed trends and their implications for the future - The impacts on specific causes of morbidity and mortality, such as respiratory disease, cancer, and cardiovascular disease By attending this session, you will gain a better understanding of the following: - Implications of the study for life and health insurers - Key risk factors for individuals affected by air quality issues, the drivers for morbidity and mortality impact, and differences between the general and insured population - Process, data, models, and considerations needed for examining the mortality and morbidity consequences of climate risks like wildfires

Description: Mental health and VBC have individually been buzzwords within the health community for many years, but rarely together. In this ‘ask the expert’ forum nothing is off limits, but these scintillating topics are a guarantee: unabated demand for mental health services post-pandemic, decreasing provider supply, rising provider burnout, access to care, management of chronic conditions, & medical/behavioral integration concepts including data fragmentation.

Description: The Centers for Medicare and Medicaid Services (CMS) implemented significant changes to the Medicare Star Ratings that are expected to result in cost savings to CMS. The 2024 Star Ratings were recently released in October 2023 which was the beginning of these changes where future changes will impact 2026 and 2027 Star Ratings.