Description: The Medicare Advantage (MA) program is facing challenges in the coming years due to a number of headwinds: Star rating program changes, the Inflation Reduction Act (IRA), revenue pressures, mergers/acquisitions, and risk score model changes, just to name a few.

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: 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: 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: This session will cover the current and potential use of artificial intelligence (AI) in the health care space. Participate in this interactive session and learn how AI is being used today and discuss its potential to reshape and revolutionize health care. You will get an opportunity to learn how AI can influence patient experience in every phase of healthcare delivery and talk about the challenges and limitations that arise with the use of this technology.

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: 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: 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: Pharmacy prices are top of mind for many consumers, policymakers, and payers. There are many proposals out there about ways to reduce pharmacy costs, almost all of which involve price controls. Is that the right move? What about the unintended consequences of such regulation? Will fewer life-saving drugs be developed including fewer drugs that improve the quality of life? Are better financing alternatives out there? Explore the concept of value-based reimbursement for pharmacy prices, including the lessons learned from applying value-based concepts to hospital and physician value-based financing.

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?