Description: Challenges of Provider Reimbursement

Description: The health insurance industry has historically used several factors to develop premium rates. Many of these, e.g. gender rating, have been largely eliminated from health insurance rating practices by regulations as the Patient Protection and Affordable Care Act (ACA) because they were determined as inequitable. However, several other factors still remain as differentiators in premium rates charged to individuals and groups. In conjunction with the SOA, researchers studied whether there could be ‘ghost’ rating factors, like race, ethnicity, or socioeconomic status, that are inherently included in some of these remaining allowable factors. Review results and opportunities for future research. By attending this webcast, you will be challenged to think about traditional rating factors in a different way. Rather than focusing on whether certain factors are sound based on the underlying claims cost, this session will focus on whether or not these factors are impacting certain socioeconomic or racial/ethnic groups disparately.

Description: This session is designed to inform you about the current state of mental health and mental health care in the United States, as well as future trajectories. By exploring topics such as plan design, provider network, provider reimbursement, and other relevant channels, this session aims to enlighten everyone on existing challenges and the strategies being employed to tackle them. Notably, this will include and highlight proposed changes to the mental health parity. Additionally, attendees will hear from a mental health provider/academic on these topics to gain a non-actuarial perspective.

Description: In this video Matt Emery, FSA, MAAA, CERA delves into advancing Value-Based arrangements between plans and providers to uplift healthcare services. These initiatives aim to cut costs, refine coding accuracy, bolster quality measures, streamline care coordination, and enrich member benefits. Success hinges on engaging members effectively, executing robust cost strategies, utilizing predictive models, targeting specific populations, structuring payment plans, and optimizing data exchange for superior healthcare outcomes and enduring partnerships. Contributors: Matt Emery FSA, MAAA, CERA; Mitchell Momanyi FSA, MAAA; Jon Forster ASA, MAAA

Description: "The script is for a Medicare session by the Society of Actuaries, led by Danica Turner, which introduces how revenue works on Part D. It covers the various cash flows and subsidies that Part D plans receive, including direct subsidies, federal reinsurance, and low-income subsidies. The session also explains the different phases of coverage and the upcoming changes due to the Inflation Reduction Act in 2025. The goal is to provide a high-level understanding of the revenue and payment calculations for Part D plans.

Description: The Tri-Agency published the final rule on short-term limited duration insurance and fixed indemnity coverage at the beginning of April. We’ll break down the new rule, approaches to complying with the new requirements, and what implications it could have for the supplemental health market moving forward.

Description: Join mental health experts (e.g., providers, academics) as they engage in an interview-style conversation designed to inform you about the current state of mental health in the U.S. and potential pathways for improving mental health care and mental health insurance benefits. Through discussion of plan design, provider network, provider reimbursement and other relevant channels, you'll find ways you can use these channels to help enhance an individual's access to care, improving their health and overall quality of life.

Description: Join in and learn to describe the changes in provider contracting that are emerging in the post-COVID marketplace. Examples include: - Carrier transparency files - Increase sophistication of provider negotiators - Additional sources of data - Market issues increasing urgency - Demanding new contracting models

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.

Description: Explore the findings from the research paper recently released by Milliman and the SOA, highlighting the growing need for support of informal/family caregivers. We will discuss both quantitative and qualitative data that illustrates not only the cost and burgeoning need, but the mental/emotional stressors that come along with this work.