Description: You will be reminded how to spot and avoid statistical biases and fallacies that are common to health care actuarial data and problems. We plan to explain various statistical biases and fallacies and for each show one or two examples of how they might pop up in healthcare data and what strategies can be used to avoid/account for them. Likely topics include simpson's paradox, regression to the mean, base rate fallacy, sampling bias, survivor bias, Berkson's fallacy, and others.

Description: This session series is sponsored by Zelis Shifting utilization of health services to efficient and high-value providers presents an opportunity to reduce harmful cascades of wasteful spending, ultimately freeing up funds for additional high-value services that will improve quality and member satisfaction. Identifying the right providers to put at the center of networks is challenging for any health care organization. How can you objectively determine which providers are delivering the greatest value when compared to their peers? And once those providers are identified, what’s next? Join Zelis and their partner HealthCorum to review a case study on a shared services organization where they leveraged statewide multi-payer claims data to produce provider level analytics, allowing for transparency into provider practice patterns at a granular level. By attending this session, you will be able to: - Create a fair methodology to benchmark providers. - Develop metrics and scores to identify high-value providers. - Produce actionable data to be used for network optimization strategies.

Description: What are the latest product trends impacting the critical illness, hospital indemnity, and accident insurance industries? A panel of product development experts will discuss how pricing has evolved, new approaches and trends that are impacting product design, and key considerations when bringing new ideas to market. By attending this session, you will: • Learn about changes in the market that will help them price products. • Evaluate new approaches used in the voluntary market. • Identify the issues that will make your products successful.

Description: As the ACA market evolves with changing regulatory and competitive landscape, the evaluation of risk and opportunity also advances. Discover new approaches to apply and determine key considerations when designing and pricing products in new markets or renewing policies in existing markets.

Description: Join this presentation covering the key provisions of the IRA which govern the selection of drugs for negotiation. We will also discuss what these changes mean for all Medicare Part D stakeholders, including: Government Beneficiary Part D Plans Drug Manufacturers Original Content:

Description: Attendees will learn what the Health Equity Index is, how it will be calculated, how it affects quality and Star metrics for Medicare Advantage plans, and how this could change the industry as a whole moving forward.

Description: Address how Medicare and Medicaid are integrated in DSNP plans, including: - Coordination of benefits - Model of Care - Care Coordination - Licensure - Difference between DSNPs and MMP plans - Pricing Assumptions - New proposals for more integration By attending this session, you will be able to understand how DSNP plans are integrated between Medicaid and Medicare and what CMS is doing to integrate them further.

Description: Hot topics for Medicare, including enrollment trends, enticing benefits, risk score projections, market strategy trends, formulary considerations, STAR rating changes, and COVID implications including vaccine/testing requirements Proposed/enacted changes to Part D from the Build Back Better (BBB) Act-CMS’s commitment to advancing equity in health and health care for all individuals Discussion of removing barriers to equal opportunity, health disparities, and closing health equity gaps, including collecting more and improved data on beneficiaries’ race, ethnicity and social determinants of health By attending this session, you will be further prepared for current and future changes in the Medicare Advantage program. Gather additional insight into future trends in policy changes and cost spending and to be more equipped to adapt to changes in the marketplace.

Description: "Spread pricing is a pricing methodology where pharmacy benefit managers (PBMs) bill a payer one price but reimburses the dispensing pharmacy a lower price for the same prescription drug. PBMs have historically relied on spread pricing as a revenue source. However, a growing number of states are introducing and passing legislation prohibiting spread pricing for Medicaid and commercial clients. In addition, new entrants to the PBM and mail-order pharmacy space are disrupting the market by offering services that promote increased transparency and member satisfaction. Expect updates on recent legislative trends and market disruptions targeted towards increasing PBM drug pricing transparency. By attending this session, you will have a better understanding of how changing legislation and market disruptions may impact current pricing methodologies."

Description: Investigate Deloitte's methodology to quantify the cost of health inequities attributable to racial bias, gender/sex bias and socioeconomic bias. We will illustrate the methodology by calculating total potential cost savings across different disease states and discuss both the role that actuaries play in addressing health inequity and the steps that organizations can take to activate health equity.