Description: This game-style session will test your knowledge on several topics related to Supplemental Benefits. Our panel of carrier representatives will offer a range of industry perspectives, and our live studio audience will learn new industry insights and have some fun!

Description: The following videos are from Matt Emery, FSA, MAAA, CERA. Matt is a Vice President of Actuarial at HarmonyCares. He is an avid SOA volunteer. Matt brings a background and expertise in Value Based Care, Medicare Advantage, and Pharmacy pricing. In this video Matt Emery delves into the transformative landscape of Value Based Programs within Medicare. With a keen eye on aligning regulators, insurers, and healthcare providers, emery highlights the stark differences between the traditional Fee-For-Service model (FFS) and the evolving paradigm of Value Based Care (VBC) He emphasizes VBC’s focus on incentivizing improved patient outcomes, cost-efficiency, and equity, underlining the critical role of CMS and its strategic goals for widespread adoption. Matt navigates through key programs like MSSP and REACh, showcasing their eligibility criteria, assignment methodologies, and approaches to calculating savings or losses, while shedding light on the nuanced tracks within these models that balance risk and reward for participating ACOs. Contributors: Matt Emery, FSA, MAAA, CERA; Mitchell Momanyi FSA, MAAA; Jon Forster ASA, MAAA.

Description: Estimating premium deficiency reserves (PDR) for medical insurance and other short-duration health products is an area that not only requires application of actuarial judgment, but also alignment between actuaries, accountants, and regulators. Significant diversity of practice exists across the industry on a number of key issues, among them: how to group products for PDR measurement purposes; which future premium & claim cash flows to include (time horizon); forecasting future membership change; which administrative expenses to include; and how to think about investment income. In many cases, practices that are common in the actuarial community may be met with skepticism by auditors and/or regulators, and vice versa. This session will showcase the existing diversity of practice observed in both U.S. GAAP and U.S. Statutory PDR estimation, articulating multiple points of view on the issues noted above with a focus on finding common ground between actuaries and accountants.

Description: Learn how insurers provide new opportunities for efficiency and value creation from product design and underwriting through customer engagement and claims. Glimpse some industry use cases for Gen AI and its outcomes as observed by the first movers.

Description: Health care continues to move from a fee-for-service model to a value-based care model. Hear from our expert panel on how actuaries can play a key role in the design and contracting of value-based agreements, monitoring experience and driving results, as well as measurement of value. The discussion will cover different structures currently in use, types of services covered (total cost of care, claim service lines, specialties, condition based, pharmacy products, etc), as well as nuances by market (Medicare FFS, MA, Commercial, Medicaid). The panel will discuss latest innovations in the value-based care space, as well as how COVID-19 has impacted these contracts. This interactive session will also allow you to ask your questions to our diverse group of panelists.

Description: Watch as presenters highlight the SOA's work on an updated Medicaid underwriting margin model. This research project includes the model along with a set of instructions and a paper describing the key components of underwriting margin, including cost of capital and risk margin. The model was created as a tool for Medicaid actuaries representing both MCO and state principals to determine appropriate underwriting margin components within Medicaid managed care rates. In addition, explore a brief description of the motivation for an underlying theory behind the model. Walk through different model inputs and run through some realistic scenarios that Medicaid actuaries may encounter in states where they operate.

Description: Virtual - Session 7C: February Is The Longest Month - Preparing the Orange Blank Actuarial Memo

Description: Session 8A: ORSA for Health Plans - Using ORSA to Drive Health Plan Risk Strategy

Description: Virtual - Session 7A: What Happens When ACOs Get SAHS-sy?

Description: Virtual - Session 8C: Climate Change - Are We at Risk Yet?