Description: Session 4D: A Year of Change for Medicare Advantage

Description: Life insurance products have evolved over time from the early mutual aid societies paying benefits when members died to comprehensive products covering a range of financial needs over an individual’s lifecycle. While some life insurance benefit riders have been offered for decades and are well-established, recent years have seen a number of accelerated benefit riders being introduced by carriers for a growing range of covered triggers. Join us as we discuss these acceleration and extended benefit riders, trends and innovations in the space, and discuss challenges and actuarial considerations in designing, pricing, and modelling them. We will also explore issues carriers have experienced, how to consider the interactions between these benefits and the underlying mortality coverage, reinsurance considerations, and more!

Description: This session will provide an overview of the challenges found in understanding and managing the medical drug benefit based on standard claims data. Participants will learn what makes coding medical drugs challenging and how to navigate some of the pitfalls when conducting analyses on this important segment of utilization and cost trend.

Description: This session will provide an overview of the landscape of accident and health insurance valuation. Attendees will gain an understanding of key concepts and various actuarial techniques employed in the valuation of accident and health insurance policies. By incorporating real-world perspectives and experiences, this presentation equips attendees with actionable knowledge to enhance their understanding and approach to accident and health valuation in an ever-evolving insurance landscape.

Description: This webcast will explore the shifting landscape of healthcare costs. It will cover healthcare trend basics, recent developments, and what’s ahead. Drawing from comprehensive data analysis and industry insights, this presentation promises to equip attendees with actionable knowledge to navigate the complex terrain of healthcare expenses effectively.

Description: How do we take a Minimum Viable Products (MVP) approach to launch new insurance products? Join this moderated discussion and focus on three key development aspects: Distribution, Systems, and the design and pricing of the Insurance product itself. Come discuss reasons to choose an MVP approach and how it solves many of the product launch challenges.

Description: The momentum towards value-based care has increased focus on how payers attribute accountability for the cost and quality of member care to providers. The current landscape has a myriad of methodologies and accountable parties. Examine the ideal future state of attribution discussing trade-offs in goals (e.g., population coverage vs. member influence), accountable parties (e.g., should third-party vendors be involved?), and methodologies.

Description: The presenters give a history lesson on the origin of CMS Medicare star ratings, including why this demonstration was originally created and how the program has worked over the years. The discussion will cover both the evolution of the underlying measures and the financial impact to Medicare Advantage stakeholders. By attending the session, you will have a stronger understanding of how member experience and outcome-based measures can be factored into the funding within a health care system to better align incentives among various stakeholders.

Description: "This video by Danika Turner is an introduction to Medicare Advantage revenue, specifically focusing on how Part C revenue works for individual Medicare Advantage plans. It explains how health plans participating in the Medicare Advantage program are paid by the Centers for Medicare and Medicaid Services (CMS), including the impact of Star ratings, risk adjustment, and county-level CMS benchmark rates on revenue. The session aims to simplify the main variables of the revenue calculation and uses conceptual examples for individual MA plans, excluding certain populations like Employer Group Waiver Plans and members with End-Stage Renal Disease or in hospice. The video also covers the basics of Medicare-covered services, mandatory and optional supplemental benefits, and the calculation steps for determining CMS Part C revenue per member per month.

Description: Over the last 10 years, Artificial Intelligence (AI) healthcare foundation models have made tremendous strides when it comes to delivering highly accurate predictive results when compared to traditional models. This is especially true for models developed and trained on the ‘language’ of healthcare. When trained on healthcare data sequences (claims, EHR, CPT, ICD, pharmacy, lab, etc.), these models deliver far more accurate results as to WHAT beneficiary-level health events will occur and even WHEN they will occur.