Description: "Direct medical costs for cancer care topped $209 billion nationally in 2020, accounting for a significant proportion of all health care expenditures in the U.S. Indirect costs are also significant, encompassing loss of productivity, wages, leisure time and decreased quality of life. The way cancer programs deliver and are reimbursed for care is rapidly changing. As the cost of cancer care continues to rise, several new value-based care programs - both public and private - have attempted to curb these rising costs. Learn about the current landscape of VBC oncology programs, several key challenges and opportunities with oncology analytics, as well as anticipated evolution of cancer care in the near future. Topics include: Current VBC oncology landscape, including a more detailed discussion on CMS' latest oncology program, Enhancing Oncology Model (EOM) Discussion on current challenges and opportunities with oncology analytics, including some advanced methodologies that have been developed based on documented clinical pathways to better understand cost drivers Future state of oncology care including emerging pharmaceuticals and novel therapies, personalized care regimens, and other clinical innovations"

Description: "Risk adjustment (RA) is a key component for CMS Medicare Advantage program and California Medicaid Managed Care program. While both RA programs follow generally accepted basic principles at a high level, their underlying methodologies and assumptions are also quite different. Due to recent events such as COVID-19 Public Health Emergency and Medicaid redetermination delay and restart, it adds complexity to Risk Adjustment. This is a hot topic in the industry and has significant impact to health plans. Keeping current with risk adjustment program changes and understanding the commonalities and differences of these two government risk adjustment programs is important to our health actuaries. Compare these two risk adjustment programs so you can learn key elements of a risk adjustment program, similarities and differences in methodology and assumptions , as well as special considerations due to serving different populations."

Description: "Court is in session and you are the jury! Follow along as challenging aspects of actuarial professionalism are explored in a court-like setting. Deliberate among your peers based on what you already know from your own experience as well as what you learn in this session, and then deliver your verdict accordingly. If you attended in the past, plan on joining again as we will have new material and updates for discussion. Who says learning about actuarial professionalism can't be fun? By attending the session, you will be able to: Apply actuarial professionalism concepts Identify key ASOPs for actuaries Explain significant aspects of the U.S. Qualification Standards"

Description: In late 2021, U.S. Congress passed the Consolidated Appropriations Act (CCA), which requires group health plans and health insurers to submit information regarding the costs of prescription drug costs and other health care services each year to the federal government. Learn how this data can be useful to anyone responsible for forecasting and budgeting.

Description: This session will review the latest developments in the Affordable Care Act (ACA) marketplace, including a discussion of hot topics, challenges, and opportunities on the horizon. Specific topics will include cost-sharing reductions (CSR) loading and the impact on subsidized rates across states (e.g., mandated loading in NM), the interaction of American Rescue Plan (ARP) subsidy expansion, and the impact once ARP-enhanced subsidies end.

Description: At the conclusion of the session, attendees will be able to understand the potential for using global population health mortality and morbidity data in actuarial contexts. Using the Global Burden of Disease project as a resource, this session will discuss how novel population health research can be used to complement and fill in the gaps of existing input data sources for actuarial analysis and modeling. Presenters will share the latest academic research on the topics of demography, life expectancy, health-adjusted life expectancy, causes of death and disability, comprehensive disease incidence and prevalence metric, measures of disease burden for patients and populations, modifiable risk factors where there are opportunities to make interventions and improve health outcomes, and disparities between and within populations. This research is globally comprehensive and comparable between different markets and disease areas. The session will cover the motivation and purpose of GBD, a brief description of the models used, and dive deep on some selected use cases in actuarial contexts. Audiences will leave with: 1. Understanding challenges and opportunities in measuring disease burden comprehensively and consistently 2. Understanding relevant health metrics, including the drivers of future mortality and morbidity 3. Ideas for applications of epidemiological research in your work

Description: Traditional Medicare [TM] has many coverage gaps and no out-of-pocket maximum. Most members must purchase a Medicare Supplement Plan and a Part D plan for pharmacy coverage. Over 50% of members have opted for a Medicare Advantage [MA] plan that replaces TM and the need to purchase a Supplement and (in most cases) a Part D plan. All this for less cost to the member, but at a greater overall cost to the federal government even though MA plans provide TM benefits for less than it costs the government. The attendee will learn why this occurs. However, given these facts, the focus of the session will be on the future of Medicare: namely, should the parameters regarding MA bids and payments be limited to what is paid for TM, or can we take the best administrative techniques of MA and TM to provide more robust benefits for all Medicare members at a cost no greater than the government is currently paying? Or is there an even better idea?

Description: Prescription drug markets are undergoing rapid change - significant policy changes implemented through the Inflation Reduction Act, Congressional interest in long-awaited 340b reform, and a growing direct-to-consumer market have already changed the landscape significantly. The ongoing effects of these changes will continue to evolve for many years. Hear from leading prescription drug actuaries and pharmacy policy experts on what these changes mean for prescription drug markets and US healthcare more broadly.

Description: Inspired by Seinfeld's Festivus celebration, our panel will conduct a lighthearted but technically robust airing of grievances related to the Medicare Star Rating program. Over the past decade, the Medicare Star Rating program has undergone an array of methodological changes.

Description: Plan Sponsor Perspective