Description: The session is based on an article of the same name featured in the January, 2023 issue of Health Watch. It gives a step-by-step method of how to apply the average paid PMPM method to calculate IBNR with zero run-out, as opposed to current methods, which generally require a three-month run-out period. Methods for obtaining confidence intervals for the IBNR estimates will also be discussed.

Description: Explore the role of inflation across health products, including medical plans, disability, and long-term care. Explore various drivers of cost trends, wage increase, and cost of care. Understand their role in the pricing and valuation of a product and how to manage the risk.

Description: This report is targeted to actuaries that are interested in identifying the adverse human health outcomes resulting from anthropogenic climate change. This is accomplished by providing a detailed framework to evaluate the impact of extreme heat on human health and identify the role that anthropogenic climate change has on extreme heat events. Although this document is designed around extreme heat, the concepts can be expanded to other climate-related events. As the primary focus of actuarial research is to promote human health and minimize the preventable economic burden, this document also provides recommendations to mitigate against excess heat related illness (HRI) due to extreme heat.

Description: A divisive confrontation over health care pricing is almost inevitable over the next few years. What will ultimately happen is a political decision, not an actuarial one—but it will have major consequences for the trend in health care costs and the divergence between public and private insurance premiums.

Description: The Society of Actuaries will host two great events for the health actuarial community, bringing together the industry’s leading actuaries, analysts and professionals to network and discuss impacts of the latest marketplace factors and trends.

Description: Pharmacy prices are top of mind for many consumers, policymakers, and payers. There are many proposals out there about ways to reduce pharmacy costs, almost all of which involve price controls. Is that the right move? What about the unintended consequences of such regulation? Will fewer life-saving drugs be developed including fewer drugs that improve the quality of life? Are better financing alternatives out there? Explore the concept of value-based reimbursement for pharmacy prices, including the lessons learned from applying value-based concepts to hospital and physician value-based financing.

Description: As actuaries, we're trained to see patterns in numbers and to design solutions that mitigate risk. While quantitative analysis and modeling are critical actuarial tools, looking at the numbers alone can lead to insurance products that don't succeed in the real world the way math says they should. With new digital technologies surfacing in the insurance space, we have more data at our fingertips than ever before, leading to a higher focus on doing quantitative research within insurance product design. Take back a step from quantitative research and discover qualitative research methodologies into your product development process to design solutions that meet real needs in the market. In a nutshell, qualitative research can surface issues early and help you answer questions such as: Can we really sell this product in the market? Why would someone buy this? How widespread is the need? How could your product be a solution you didn't intend?

Description: The declaration of the COVID-19 public health emergency in the US has led to increased Medicaid membership, which has affected the aggregate acuity of these populations. This session will cover considerations in how this change in acuity could be accounted for in Medicaid rate development. Additionally, the session will provide updates on current issues in Medicare payment policy, including Medicare Advantage and new payment models. By attending this session, you will be brought up to date on recent Medicare legislative and regulatory developments as well as the potential impacts of COVID-19-related Medicaid enrollment policies on the morbidity of this population.

Description: For decades the negotiated prices between health care providers, insurance carriers, and networks have been tightly-guarded trade secrets. That's quickly changing. Health care price transparency is now bipartisan-supported law. Gag clauses have been banned. Starting in January 2021 hospitals were subject to new rules requiring disclosure of the payment rates they receive from health plans to both consumers and the general public. So far, compliance has been mixed. Similar rules for payers become effective later in 2022 and 2023 for health plans and consumers. While entrenched interests are doing their best to stall transparency, unless the laws change, transparency is going to happen and will rock the commercial health insurance market, providing the long awaited opportunity for meaningful health care cost reductions. Learn more about price transparency laws and regulations, examine rocky implementation to-date, and discuss the role of self-insured employers in leading the market changes that will emerge from price transparency. By attending this session, you will be able to: - Name the applicable price transparency laws and rules. - See transparency as more than a list of new compliance requirements and consumer tools. - Anticipate that the downstream impacts of transparency on commercial health insurance will be profound. - Appreciate the increased power of self-insured employers.

Description: It’s well documented that oral health is correlated with overall health. An exciting array of new dental technologies is emerging, from virtual reality through AI to CRISPR. These ground-breaking advancements have the potential to revolutionize dentistry.