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 introduction of new gene and cell treatments is not without scrutiny. Although these treatments are often curative, they come with a significant price tag. Health plan actuaries find themselves wondering if the intended outcome supports the cost and whether the potential medical cost savings will offset the high drug cost. The Institute for Clinical and Economic Review (ICER) reviews results from clinical trials to produce a report evaluating the cost-effectiveness of new therapies. Depending on the results, the ICER report can be used by pharmaceutical companies to justify the high cost or by the health plan to do the opposite. Go beyond the ICER report and discuss an alternative method for valuing new drugs using nonmedical revenue streams, such as disability and nutrition benefits, and return-on-investment modeling. By attending this session, you will have a better understanding of the nonmedical revenue streams, such as disability and nutrition assistance benefits, that may offset the cost of a drug and how those revenue streams can be incorporated into return-on-investment modeling.

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.

Description: Telehealth came to the forefront in a significant way during – 2020–2021, partially due to the pandemic. What is the reasonable expectation of future consumer use of telehealth? This virtual option has the ongoing potential to increase access to health care services to plausibly lower the cost of care. Furthermore, telehealth continues to evolve as a technology. Keeping current with advancements as well as consumer willingness to use this medium are important to the future of health insurance. By attending this session, you will learn about the latest advancements in telehealth as well as implications for cost of care due to consumer use.

Description: It’s well documented that oral health is correlated with overall health. An exciting array of new dental technologies is emerging, from virtual reality through AI to CRISPR. These ground-breaking advancements have the potential to revolutionize dentistry.

Description: It's your first full day of productive learning! Start it off right with a delicious breakfast and warm welcome.

Description: The Variety of Short-Term Group and Health Benefits

Description: Knowing Dan and seeing him live his life in the community makes me a better Medicaid actuary. My experience as a Medicaid actuary makes me a better brother and guardian to Dan. I want to share our story and offer you our unique perspective on the Medicaid LTSS system through real-life examples. In this session, attendees can expect to learn about the following questions:

Description: Reference Based Pricing (RBP) efforts have increased in popularity as tools to reduce the cost of care. Now with the ability to use CMS health plan transparency information, organizations can estimate the impact of savings from the use of RBP. This session will share the results of an analysis of this in the form of a case study.

Description: This session will cover recent developments in paid family and medical leave (PFML) insurance in the US. We will provide an overview of existing and new PFML laws in states that have adopted leave legislation, and we will discuss the private insurance options in these states. In addition, we will provide an overview of PFML insurance offerings in states that have not passed leave laws, and we will discuss recent trends in PFML claim experience.