Description: Session 10C: Redesigning the U.S. Health Care System - You Vote

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: "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: "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: Plan Sponsor Perspective

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: 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: In today's growing supplemental health space, innovative benefit offerings are essential for both marketability and market competition. Discuss the latest trends in accident, critical illness, and hospital indemnity plan design, as well as the regulatory hurdles that can be involved when implementing these new benefits.

Description: Management service organizations (MSOs) in value-based care have expanded into far more locations in the health care ecosystem; some demonstrate value to both buyers and providers. Explore the role of these players in the health care ecosystem, their future outlook, and how actuaries can help them perform.