Description: CMS has pioneered innovative strategies for Medicare and Medicaid to address Social Determinants of Health (SDOH). Employers can learn from these models to implement similar approaches for their employee populations. Learn how employers can understand and address SDOH, the incentives for doing so, and the broader benefits.

Description: Can you answer the question, 'What are the chances we will lose more than $1 million?' without saying, 'It depends'? If you miss a projection, can you estimate the chances that the miss was due to random variation versus an incorrect projection? Listen in as presenters demonstrate how to answer these questions and others using total risk analysis. Total risk analysis includes quantifying both the random variation risk and the projection risk associated with actuarial functions like pricing and reserving. After attending this session, you will be able to describe total risk analysis and to apply to many health actuarial functions.

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: Dive into the challenges of practitioners working across components that make up the Risk Management infrastructure with a variety of health, life and P&C insurers in this panel discussion webcast. Panelists will highlight how these insurers operate with the data and tools available to them and the existing challenges in interactions with an organization's leadership. Be part of this webcast that delves into the interplay between first- and second-line defense and how high levels of independence and professionalism can be achieved in a fast-moving, multi-discipline cross functional ERM role.

Description: "Can you answer the question 'what are the chances we will lose more than $1 million next year?' without saying 'it depends'? If you miss a projection, can you quantify the chances that the miss was due to random variation vs. an incorrect projection? ten in as presenters demonstrate how to answer these questions and others using total risk analysis. Total risk analysis includes quantifying both the random variation risk and the projection risk associated with actuarial functions like pricing and reserving. After attending this session, you will be able to describe total risk analysis, apply total risk analysis to many actuarial functions."

Description: ReMark's Global Consumer Study delivers 10 key insights to empower customers. Insurers can design products that meet customers' needs and enhance client experiences and add significant value to their business. At the same time with new products being launched seemingly continuously, it is important to take a step back and assess risk throughout the product management cycle.

Description: The following videos are from Matt Emery, FSA, MAAA, CERA. Matt is a Vice President of Actuarial at HarmonyCares. He is an avid SOA volunteer. Matt brings a background and expertise in Value Based Care, Medicare Advantage, and Pharmacy pricing. In this video Matt Emery delves into the transformative landscape of Value Based Programs within Medicare. With a keen eye on aligning regulators, insurers, and healthcare providers, emery highlights the stark differences between the traditional Fee-For-Service model (FFS) and the evolving paradigm of Value Based Care (VBC) He emphasizes VBC’s focus on incentivizing improved patient outcomes, cost-efficiency, and equity, underlining the critical role of CMS and its strategic goals for widespread adoption. Matt navigates through key programs like MSSP and REACh, showcasing their eligibility criteria, assignment methodologies, and approaches to calculating savings or losses, while shedding light on the nuanced tracks within these models that balance risk and reward for participating ACOs. Contributors: Matt Emery, FSA, MAAA, CERA; Mitchell Momanyi FSA, MAAA; Jon Forster ASA, MAAA.

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: 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: This session reviews the importance of using benchmarks in healthcare utilization management to improve organizational and patient outcomes and increase efficiency. It highlights how benchmarks can inform decisions about utilization management strategies and benefit members, payers, and providers. The presentation includes best practices, successful examples, and solutions to challenges, focusing on claim utilization, risk adjustment efficiency, quality metrics, and overall performance. Additionally, insights into the future of benchmarks and the value of analyzing the entire distribution of data for deeper insights will be shared.