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.

Description: The Affordable Care Act (ACA) changed the health insurance value proposition for lower-income Americans. Consequently, the uninsured rate has dropped dramatically since the implementation of ACA marketplaces and the expansion of state Medicaid programs to a broader eligibility group. It is not difficult to connect the change in financial dynamics to the increase in health insurance coverage. At the same time, many Americans remain uninsured due to non-financial barriers. Identifying solutions to further reduce the uninsured rate is more difficult than intuitively 'spending more federal money'.

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: Discuss various analytics and use cases using payer published reimbursement contract data under federal mandate of Transparency in Coverage. These contract rates are publicly available in machine readable format (MRF) starting July 1, 2022, and refreshed monthly. By attending the session, you will have a better understanding of the state-of-art development and analytics using MRF data, including the technologies used to extract and analyze huge MRF files, validation and limitations of published rates, and their use cases.

Description: This session will be centered around the roles and responsibilities of a valuation actuary. Learn the best practices of health actuaries, along with technical considerations and professionalism issues surrounding the calculation and reporting of health liabilities and reserves. This session will focus on key actuarial liability and reserve provisions, including Claims Unpaid and Premium Deficiency Reserves. In this session, explore new ideas about calculation methods and the importance of the underlying assumptions. You will also learn best practices and practical applications concerning reserve calculation discuss best practices regarding the preparation of an actuarial memorandum supporting a Health Annual Statement. This will include key considerations from the American Academy of Actuaries' Practice Note about documenting and supporting the actuarial calculations. The discussion will also present views and considerations from both the insurer's and the regulator's perspectives.

Description: Since the Affordable Care Act implemented minimum loss ratio provisions for health plans, several states have passed or at least considered minimum loss ratio regulation for dental plans. While such regulations are intended to improve insurer efficiency and promote value to consumers, they can have unintended negative consequences if the unique characteristics of the dental insurance market are not considered. Learn about this hot topic, including loss ratio basics, recent legislative activity in the dental loss ratio space, how dental differs from medical, and why those differences are critical to account for when trying to regulate loss ratios in that market.

Description: In this panel discussion, actuarial leaders in the stop-loss marketplace provide their perspectives on recent stop-loss trends. Learn about the most current issues facing self-funded plans and their stop-loss coverage. Take part in a deeper discussion on this topic and more at Oysters, Beers & Large Claim Solutions on Tuesday, June 27, from 4:30-5:30 p.m. PT. This happy hour, featuring drinks and tasty Pacific Northwest oysters will include a discussion on the large claims impacts on the health care market.

Description: "Discuss research conducted at the Cleveland Clinic to understand levels of anxiety and depression across Northeast Ohio. Specifically, learn how advanced analytical techniques were utilized with social media data from Twitter and Google to estimate the need for psychological support by geography and overtime. The panel will go further to demonstrate how natural language processing (NLP) and machine learning could be used to make operational decisions at a leading health care provider."

Description: Explore key findings of an SOA-funded research paper on telehealth that will be published in 2023. The COVID-19 pandemic initially caused some health care delivery to shift away from in-person transactions to a more digital form of transactions, including telehealth, e-mails, remote patient monitoring and other forms of communication.

Description: Get highlights from recently published and upcoming research from the SOA Research Institute, including work on specialty pharmacy and the long-term impacts of COVID-19. Presenters will focus on the financial impacts of these issues as well as trends and other actuarial considerations.