Description: America’s healthcare results are lackluster and worsening despite enormous effort and investment over many decades. Spending, affordability, health, coverage, access, quality, and healthcare workforce results are suboptimal or poor. Too many are suffering, and the system is financially unsustainable. We need a new approach, a new way of thinking about healthcare financing and delivery.

Description: Address issues in value-based contract accounting from an actuarial perspective. In Medicare and ACA business, what issues does risk adjustment present to value-based contract accounting? In Medicare, what issues do Part D present in value-based contract accounting and what are possible solutions? What are the issues in the use of provider stop loss in value-based contract accounting? Are there issues in the timeliness of claims in value-based contract accounting? Are we giving providers enough information for them to manage their population? How do we deal with deficit accounts? What are the pros and cons of capitation, gainshare, and full risk in value-based accounting?

Description: Join our exciting panel of health actuaries, ready for any challenge! Got an ACA puzzle? We've got the answers! Tackling a valuation dilemma? We're here to crack it! Facing a professionalism quandary? We'll navigate the complexities! Dealing with regulatory worries? We're your guiding light! Every question is welcome - there's no such thing as a silly question! Learning Outcomes: - Attendees will have the opportunity to get answers to their questions.

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 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.

Description: This report presents Phase 2 of the 2024 IDEC Study, analyzing individual disability income (IDI) claim recovery and mortality rates from 2006-2014. It expands Phase 1's scope—previously limited to 90-day elimination and To Age 65-70 benefit periods—to include additional elimination and benefit periods, examining variations by diagnosis, occupation class, claim year, and gender.

Description: In the past months, as COVID-19 has forced the reduced activity in the U.S. economy there has been some very substantial, but varied effects on the U.S. healthcare system. There is a lot of potential for confusion amongst providers and patients with regards to decisions related to which services ought to be rendered and which ought to be deferred. Two specific agencies – the Centers for Medicare and Medicaid Services (CMS), and the American College of Surgeons (ACS) have put together some guidance to add more clarity towards what types of services should be provided and what types ought to be deferred. In addition, this paper includes a discussion on what types of services are most likely to be deferred, and which ones will accrue pent-up demand to be released when many of the deferred services become available again.

Description: The SOA has translated four of its AIT report summaries into both Traditional and Simplified Chinese. They are “Behavioral Science”, “Big Data and the Future Actuary”, “Cancer Genomics”, and “Cloud Computing and Machine Learning Uses in the Actuarial Profession.

Description: Come check out a diverse panel of health actuaries available to help guide you around the track for any question you may have. An ACA question - we have it covered! A valuation question - we will find a solution. A professionalism issue - we will make a ruling! A regulatory concern - we will help guide the way! No question is off limits! There are no stupid questions!

Description: This Society of Actuaries, working with LIMRA, Oliver Wyman and the American Council of Life Insurers, is releasing a series of pulse surveys aimed at obtaining a quick read on how the COVID-19 pandemic is impacting insurance companies and reinsurers.