Description: Misalignment in value-based care approaches between payers and market segments (Medicare, Medicaid, self-funded employer groups, and commercial insurance) creates significant headwinds and friction for health care providers seeking to succeed in an environment that is moving toward more value-based care models and payment approaches. However, while multi-payer approaches in value-based care are critical to eliminating these misalignments, uptake in such programs has been lagging for a variety of reasons. Hear about lessons learned from a selection of specific multi-payer initiatives to understand what went well and what challenges were encountered in expanding these initiatives more broadly. You should be able to walk away from this session with an appreciation of the potential for multi-payer approaches and the challenges faced in gaining traction with them.

Description: Paid Family and Medical Leave (PFML) benefits have expanded rapidly in recent years as an increasing number of states have required employers to provide these benefits to their employees. Examine recent developments in PFML benefits, for example, the presenters will provide information on which states are introducing or considering PFML programs, what types of benefits are provided, what types of data is available to monitor experience, and what challenges programs have encountered.

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: After 10 years, the Affordable Care Act (ACA) risk adjustment program has evolved as the ACA has evolved. In recent years the Centers for Medicare and Medicaid Services (CMS) has focused attention on predictive accuracy over compensating for actuarial risk and has failed to address systemic issues such as insolvencies that created suboptimal outcomes for the ACA markets.

Description: Can you answer the question, 'What are the chances we will lose more than $1 million?' without saying, 'It depends'? If you miss a projection, can you estimate the chances that the miss was due to random variation versus an incorrect projection? Listen in as presenters demonstrate how to answer these questions and others using total risk analysis. Total risk analysis includes quantifying both the random variation risk and the projection risk associated with actuarial functions like pricing and reserving. After attending this session, you will be able to describe total risk analysis and to apply to many health actuarial functions.

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: The Part D program is funded through a variety of government subsidies and manufacturer discounts. The federal reinsurance, initially designed as protection from catastrophic spending, became a primary source of subsidies for the program. When the Inflation Reduction Act (IRA) is fully implemented in 2025, the funding of Part D will realign to its original intent.

Description: Explore professionalism topics of specific interest to disability actuaries. It will include discussions of items such as business challenges, actuarial standards of practice, and methods to address problems in a proactive manner.

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: With a decade of experience, mature Affordable Care Act (ACA) marketplaces continue to undergo significant changes amidst record enrollment levels. State activity has ramped up and similar themes have emerged. For example, an increasing number of states have either established or are considering operating their own exchange.