Description: This session will examine bias from a social science perspective. It will discuss the three types of systemic biases using the National Institute of Standards and Technology (NIST) model. The NIST model details the three types as historical bias, societal bias, and institutionalbias. The session will also provide several examples of each type to provide a framework for identifying the social structure of bias.

Description: Health equity is an issue on the minds of actuaries and policymakers across the health insurance market. As such, a tremendous amount of time and brain power has been invested in understanding and quantifying these issues in public and private programs alike. While the specific results of health equity studies vary widely from one program to the next, the findings tend to reveal complicated issues with no obvious, off-the-shelf solutions.

Description: This topic will explore current and upcoming changes to the risk adjustment models and strategies for payers and risk bearing providers to reduce/avoid headwinds and potentially come out on top in the years ahead. We will discuss the timeline, nature and motivation for changes as well as the anticipated associated impacts.

Description: The session will provide attendees with a framework of what goals to think about when building and utilizing a predictive modeling framework in New Sales and Renewal Underwriting mid-market, level funding, balance funding, and self-funding group health business.

Description: Attendees will learn what the Health Equity Index is, how it will be calculated, how it affects quality and Star metrics for Medicare Advantage plans, and how this could change the industry as a whole moving forward.

Description: "Spread pricing is a pricing methodology where pharmacy benefit managers (PBMs) bill a payer one price but reimburses the dispensing pharmacy a lower price for the same prescription drug. PBMs have historically relied on spread pricing as a revenue source. However, a growing number of states are introducing and passing legislation prohibiting spread pricing for Medicaid and commercial clients. In addition, new entrants to the PBM and mail-order pharmacy space are disrupting the market by offering services that promote increased transparency and member satisfaction. Expect updates on recent legislative trends and market disruptions targeted towards increasing PBM drug pricing transparency. By attending this session, you will have a better understanding of how changing legislation and market disruptions may impact current pricing methodologies."

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. By attending this session, you will: Understand the recent average and variation of industry performance in the ACA market segment. Describe current policy and market forces that are expected to impact this segment. Explain the range of market scenarios that may result due to these forces."

Description: During the past few years, performance, cost, and risk trends for Medigap products have undergone substantial changes. Some of these trends could ease cost pressures on Medigap insurers, while others might increase them. Part 1 of this Issue Brief article discusses current changing trends and considerations around about how they are impacting Medigap.

Description: Derek Ray shares his excitement on serving as Chair of the Health Section Council in 2024, including recent section achievements, upcoming activities and a call to action for volunteers to contribute their expertise to the SOA.

Description: Comparison of domestic and international PFML programs