Description: Among the many impacts of the Inflation Reduction Act’s redesign of Medicare Part D will be a change in Part D cash flows. Plan sponsors have always had to balance the seasonality of prescription drug costs against reimbursement at various times from monthly subsidies, risk score true-up payments, rebates, manufacturer contributions, and CMS settlements, but the IRA is changing the pattern of cash flows in 2024, 2025, and beyond. Moreover, the risk-adjusted portion of CMS revenue is likely to grow in 2025, even as the Part D risk score model changes.

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: 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: 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.

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: 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: "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: Behavioral health is a leading concern for employers and employees, especially with increased needs and awareness in recent years. Expect to dive into the following questions: - How are disability carriers refining their offerings and approaches to meet this need for their clients? - How are carriers thinking about the psychosocial determinants of claim experience? - Where may there be linkages between mental health and physical disabilities? - How might new digital innovations in behavioral health care impact claims experience for disability insurance? - How can actuaries make a societal impact in helping to bring solutions to the mental health crisis? Join us for a panel discussion with group benefits carriers and industry experts to explore these and other questions on this important topic. You'll gain knowledge on the intersection of behavioral health and disability insurance and learn how carriers are exploring new approaches to improve outcomes for employers and employees.

Description: The regulatory and market dynamics of the ACA's second decade are more predicable than the first. Come hear the latest information from industry experts on the emerging trends in ACA marketplaces. You'll also discover an understanding about emerging federal and state policy that will have pricing and financial implications. Finally, you'll get to learn what actuaries need to know to be well prepared for actuarial practice in the ACA's second decade. Key learning objectives include: - Comprehending the historical dynamics in the ACA's first decade which will shape the future - Understanding the changing national premium landscape for 2024, the 11th year of ACA marketplaces - Having a strong grasp on how the ACA's second decade will differ from the first from an actuarial perspective