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: "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: "Hear an overview of recent results and potential scenarios that may impact the future of the ACA market. Review recent reported industry level profitability before transitioning to a discussion of how current market dynamics may influence the future profitability of this segment. Results from microsimulation economic models will be presented to help illuminate market shifts. Issues that will be explored include how ICRA availability might influence individual decision making, as well as how a move to level funding is impacting the small group market. By attending this session, you will: Understand the recent average and variation of industry performance in the ACA market segment. Describe current policy and market forces that are expected to impact this segment. Explain the range of market scenarios that may result due to these forces."

Description: With the mandated health plan transparency files, health plans and providers are now able to substantially enhance their provider contracting efforts. Although the files are large and cumbersome they are market disruptors and provide new insights for provider contracting efforts. Explore a demonstration on the type of information now available and how it can be used to enhance this from both a health plan and health care provider perspective.

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: Hear highlights from recently published and upcoming SOA Research, including work on specialty pharmacy and long-term impacts of COVID-19. You will get an overview focused 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: Review a recently completed research project for a multi-stakeholder data consortium on social determinants of health (SDOH). In this project, claims, external SDOH data, geospatial analysis, and machine learning models were used to examine several questions: How to identify SDOH vulnerabilities? How sensitive are the findings with respect to provider coding pattern variations? How much variability in cost can be explained by SDOH vs. morbidity? What are the key risk drivers revealed by machine learning models? The session will review the methodology and main findings from this project.

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.