Description: "Risk adjustment is an important aspect of establishing appropriate capitation rates. When a set of services is carved out for specific management under a sub-capitation, establishing appropriate adjustments for varying levels of underlying risk is more complicated. Dive into analytical and operational challenges and resolutions as presenters share more about developing a risk adjustment model specific to the carve-out of behavioral health services through a real-life case study. You will further explore a definition of the use case, availability of historical data sets, selection of the modeling approach, learnings from the iterative modeling process, and the potential application of the results. After attending this session, you will be able to: Understand why a behavioral health specific-risk adjustment model has business value Understand the unique challenges related to developing risk adjustment on member and cost subsegments Understand the impact of trade-offs between model complexity and interpretability in the context of implementation Increase awareness of data nuances and requirements unique to this type of project Describe analytic techniques that can be investigated for use in projects of similar business objectives"

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: Investigate the importance of collaboration with accounting, underwriting, sales, marketing and other professions as an actuary when you attend this webcast. Cross-functional positions can cause unique challenges to arise, like various experts attempting to balance growth and profitability. Discover an opportunity to learn about relevant ASOPs and dive deeper into contemporary examples that highlight specific professionalism issues that can develop.

Description: Develop a better understanding of specialty drug trends and their increasing healthcare costs for more than the past decade by attending this webcast. With the introduction of price competition, you will see changes in the market for biosimilar products and patent-protected drugs. For example, the drug Humira will be gaining 10 biosimilar competitors in 2023. Alone, Humira can represent over 20% of total pharmacy spend for health plans. Join us and discover how price competition is a turning point for the pharmaceutical industry and will define its direction for the next decade.

Description: Discover the multitude of risk transfer solutions and payment models available to health claims payers for cell & gene therapies in this Society of Actuaries webinar. Delving deeper into the topic, we will examine the different types of solutions, weigh their pros and cons, and explore the future prospects of this rapidly evolving area of the healthcare landscape. By expanding upon the pricing and risk exposure discussion from session two, this webinar provides valuable insights into the dynamic market for cell & gene therapies and its implications for actuaries.

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: Attendees will see how care coordination and navigation may improve outcomes when integrating across acute and long-term care needs within Medicare and Long-Term Care Insurance products.

Description: Anti-obesity medications have been met with reluctance from payers and employee benefits consultants who often lack analogs or empirical data to estimate the cost impact of new therapies coverage. Health plans considering coverage of anti-obesity medications will need to assess and manage the potential costs of covering these new therapies in context of their overall obesity management strategy, including coverage of nutrition counseling, weight management, and bariatric surgery.

Description: CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.

Description: Health care continues to move from a fee-for-service model to a value-based care model. Hear from our expert panel how actuaries can play key roles in designing and contracting value-based agreements, monitoring experience, and driving results, as well as measuring 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.) and nuances by market (Medicare FFS, Medicare Advantage, Commercial, Medicaid). Listen to presenters discuss latest innovations in the value-based care space, as well as how current events have impacted these contracts. In this interactive session you will also be able to ask our diverse panelists questions.