Description: Disability and group life products can pose challenges for the valuation actuary due to the long-tail runout of traditional disability and group life waiver of premium claims, and due to the sensitivity of the reserves to small changes in assumptions. This session addresses a number of issues of interest to actuaries who work with these products, including recent experience trends and the new 2023 Group Life Waiver Valuation Table. Attendees will learn about best practices in the valuation of these products.

Description: How does where you live impact your health? The following research considers this question through the lens of social determinants of health (SDOH), which are factors relating to where you live or work that may impact your health. In the United States, there are geographical differences in SDOH which contribute to wide disparities in health status and outcomes. In particular, individuals who are negatively affected by SDOH may have an increased burden of disease, leading to a relatively high total cost of care and worse quality of life.

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: 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 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: 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: 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: 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: 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: The introduction of new gene and cell treatments is not without scrutiny. Although these treatments are often curative, they come with a significant price tag. Health plan actuaries find themselves wondering if the intended outcome supports the cost and whether the potential medical cost savings will offset the high drug cost. The Institute for Clinical and Economic Review (ICER) reviews results from clinical trials to produce a report evaluating the cost-effectiveness of new therapies. Depending on the results, the ICER report can be used by pharmaceutical companies to justify the high cost or by the health plan to do the opposite. Go beyond the ICER report and discuss an alternative method for valuing new drugs using nonmedical revenue streams, such as disability and nutrition benefits, and return-on-investment modeling. By attending this session, you will have a better understanding of the nonmedical revenue streams, such as disability and nutrition assistance benefits, that may offset the cost of a drug and how those revenue streams can be incorporated into return-on-investment modeling.