Description: HIV is still a big public health concern, but there are therapies available to prevent infection before and immediately after exposure. As legislatures and the USPSTF considers adding these therapies to the list of preventive care covered without cost share, actuaries will need to estimate the impact on their care cost. The presenters will share an actuarial tool kit to estimate the impact of covering PrEP and PEP for different populations. Examples are provided and discussion is welcome.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: Tree models have been found to provide a good fit to group long term disability recovery and mortality rates. This research paper provides an overview of tree models, and details how they have been used for developing these rates.

Description: Healthcare costs have been rising faster than general inflation for many years. Early models that predicted this past pattern projected healthcare expenditure growth that continued to outpace total expenditure growth leading to the fallacious position that the whole of the US economy would ultimately be consumed by healthcare. This paper presents a long term healthcare trends resource model, prepared for the Society of Actuaries by Professor Thomas Getzen, that includes capacity constraints to ensure the long-term projection is rational. The motivation for creation of the model was driven by its potential usage as a resource for the estimation of reportable liabilities for retiree healthcare benefits as specified under FAS 106 and GASB 45 accounting statements.

Description: The Society of Actuaries' Pension Section and Health Section Research teams commissioned Professor Thomas E. Getzen of Temple University to construct a resource model for the projection of long term healthcare cost trends. The motivation for creation of the model was driven by its potential usage as a resource for the estimation of reportable liabilities for retiree healthcare benefits as specified under FAS 106 and GASB 45 accounting statements. This model, programmed in Microsoft Excel [xlsx format], projects per-person expenditures and growth rates through 2099 using a set of equations and assumptions developed by Professor Getzen with assistance from the Society of Actuaries Project Oversight Group appointed to oversee the effort. The model includes baseline assumptions as well as flexibility for user–inputted alternative assumptions.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: This three-part series provides an overview of the rapidly evolving and dynamic gene and cellular therapy landscape, from the clinical, historical, and risk transfer perspectives. It covers the actuarial considerations in pricing cell and gene insurance and reinsurance, the value assessment of the therapies, manufacturer pricing, and reinsurance cost.

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: 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: Using data from the Health & Retirement Study [HRS], a two-part medical claim prediction model is estimated for a cohort of survey respondents approaching Medicare-eligibility age. A High Deductible Health Plan [HDHP] with a companion Health Savings Account [HSA] is applied to simulated claims streams to model the build-up of HSA assets over the near-retirement years. Results show that the HSA is a grossly inadequate savings vehicle to provide for retiree medical care expenses at age 65. Moreover, HSA adequacy worsens exponentially with diminishing health status. Based on this simulation, it is apparent that Baby Boomers cannot adequately provide for the costs of medical care in retirement using HSAs exclusively.