Description: The American Academy of Actuaries Health Solvency Subcommittee and the NAIC Health Risk-Based Capital (E) Working Group are in the process of analyzing and reviewing the H2-Underwriting Risk component and the managed care credit calculation in the health risk-based capital (HRBC) formula. Come learn what changes are ahead! While RBC is designed for solvency issues, also come hear about other ways health insurers manage their capital and surplus levels. Are others doing something you should try?

Description: In honor of Bob Barker's 100th birthday (December 12, 2023), we will examine the emerging development in the opaque world of health care prices. 'Referenced Based Pricing' has been a cost-cutting strategy applied by some self-insured employers, but administration, employee dissatisfaction with balance billing, and litigation have been barriers to growth. The new transparency data has yielded research indicating that 'cash prices' are lower than commercially negotiated rates in some areas. Dive in with industry experts as they discuss emerging trends of how consumers, employers, and health insurers will pay for health care services.

Description: Model design is an important part of being an actuary, and the SOA highlights the importance of the actuarial control cycle of model design, evaluation and monitoring. What tools are at our disposal for these steps? When should we be concerned or excited about model performance? Can we, and should we, use machine learning tools to assist with model improvement or development?

Description: The resumption of Medicaid redeterminations following the conclusion of the COVID-19 Public Health Emergency (PHE) represents a significant disruption across multiple lines of business in the health care market. While there has been much uncertainty regarding the timing and pace of the resumption of redeterminations, 2023 is beginning to bring clarity to the myriad questions posed by states, employers, managed care organizations (MCOs), and other interested stakeholders. Begin with a brief review of the latest developments regarding the end of the PHE and resumption of Medicaid redeterminations. Then, transition to a panel discussion on the various impacts that key stakeholders are starting to see, and expectations for short-term and long-term impacts to programs, plans, and businesses.

Description: The Casualty Actuarial Society (CAS), the Society of Actuaries (SOA) and the Society of Insurance Research (SIR) started developing research addressing diversity, equity and inclusion (DEI) topics. Join panelists as they briefly present an overview of their organization's DEI research and share their perspectives on common challenges facing all the stages of this research: - Planning relevant and timely research with a long timeline. - Getting appropriate data and resources to support your research. - Communicating research on topics that may be controversial.

Description: Are you interested in learning about technical changes to the risk adjustment methodology, Texas implementing effective rate review and premium alignment rules, new rules on standard benefits and network adequacy? Discover some of the reasons why the 2023 ACA marketplace will look much different in the first year of the Biden administration setting the tone with annual ACA rules. Listen to a panel of consulting actuaries and the Chief Actuary from the Texas Department of Insurance who are deeply involved in state and federal policy, risk adjustment methodology, and continuous monitoring of changing market dynamics. Explore new federal rules, efforts to strengthen enforcement of rating compliance, current considerations in risk adjustment methodology, and the ACA market outlook for 2023 and 2024.

Description: Gene therapy is a quickly evolving field and will continue to grow as a risk concern for many health plans, stop loss insurers and reinsurers. Currently, there are only two approved gene therapies in the U.S., but that number is expected to escalate starting in the fall of 2022. Revisit the experience plans have had with the first two gene therapies, discuss plan design and network considerations in light of gene therapy, and discuss the actual composition of the near-term pipeline along with a range of modeled financial impacts and considerations for payers.

Description: As actuaries, we're trained to see patterns in numbers and to design solutions that mitigate risk. While quantitative analysis and modeling are critical actuarial tools, looking at the numbers alone can lead to insurance products that don't succeed in the real world the way math says they should. With new digital technologies surfacing in the insurance space, we have more data at our fingertips than ever before, leading to a higher focus on doing quantitative research within insurance product design. Take back a step from quantitative research and discover qualitative research methodologies into your product development process to design solutions that meet real needs in the market. In a nutshell, qualitative research can surface issues early and help you answer questions such as: Can we really sell this product in the market? Why would someone buy this? How widespread is the need? How could your product be a solution you didn't intend?

Description: For decades the negotiated prices between health care providers, insurance carriers, and networks have been tightly-guarded trade secrets. That's quickly changing. Health care price transparency is now bipartisan-supported law. Gag clauses have been banned. Starting in January 2021 hospitals were subject to new rules requiring disclosure of the payment rates they receive from health plans to both consumers and the general public. So far, compliance has been mixed. Similar rules for payers become effective later in 2022 and 2023 for health plans and consumers. While entrenched interests are doing their best to stall transparency, unless the laws change, transparency is going to happen and will rock the commercial health insurance market, providing the long awaited opportunity for meaningful health care cost reductions. Learn more about price transparency laws and regulations, examine rocky implementation to-date, and discuss the role of self-insured employers in leading the market changes that will emerge from price transparency. By attending this session, you will be able to: - Name the applicable price transparency laws and rules. - See transparency as more than a list of new compliance requirements and consumer tools. - Anticipate that the downstream impacts of transparency on commercial health insurance will be profound. - Appreciate the increased power of self-insured employers.

Description: The declaration of the COVID-19 public health emergency in the US has led to increased Medicaid membership, which has affected the aggregate acuity of these populations. This session will cover considerations in how this change in acuity could be accounted for in Medicaid rate development. Additionally, the session will provide updates on current issues in Medicare payment policy, including Medicare Advantage and new payment models. By attending this session, you will be brought up to date on recent Medicare legislative and regulatory developments as well as the potential impacts of COVID-19-related Medicaid enrollment policies on the morbidity of this population.