Description: As value-based solutions evolve, it is more important than ever for providers to understand their performance and how it is measured, along with the drivers of success. Presenters will cover the evolution of past risk-transfer programs such as Medicare Shared Savings Program and Next Generation ACO. They will also discuss the new Primary Care First and Direct Contracting models recently announced by CMS.

Description: The presenters will focus on best practices in drug claim management in North America. The presentation is geared toward Canadian practice and insights, but is useful for practitioners in the U.S. and elsewhere, as well.

Description: Legacy health insurance carriers are creating internal cutting-edge advancements through intrapreneurs. In this session, experienced intrapreneurs will discuss their roles within the health insurance industry.

Description: This session will explore the various contracting techniques that CMS, providers, and employers are using to achieve their strategic objectives across both the Commercial and Medicare markets.

Description: This session features a moderated discussion between medical professionals who are experts in long-term care. The presenters are outside the LTC insurance industry altogether, which will ensure that attendees receive a truly external perspective.

Description: The Individual Disability Experience Committee (IDEC) of the SOA has gathered industry data covering 2006-2015. The presenters will highlight findings on the recent industry experience compared to the 2013 Individual Disability Income Valuation Table (2013 IDIVT), including the impact of the recession on incidence and terminations. They will cover claim incidence and claim termination Actual to Expected (A/E) using 2013 IDIVT as the expected basis. The adequacy of the modifiers will also be discussed.

Description: The presenters will cover the variation in risk adjustment approaches used across state Medicaid programs and compare them to other Federal programs. Additionally, recent developments, such as the use of OCR to extract data from medical charts for risk adjustment, will be discussed.

Description: Numerous behavioral finance theories have emerged in recent years, many of which apply to insurance. The presenters look at key theories and their use in explaining, predicting and inducing behavior from the perspective of the health insurance customer journey.

Description: One of the Health Section's key focuses in 2019 is Initiative 18/11. Last year the SOA joined forces with the Kaiser Family Foundation (KFF) and the Healthcare Financial Management Association (HFMA) to answer the nagging question: “What can we do about the cost of healthcare?” A steering group has been formed to lead a research project as to what managed care companies can do to reduce costs without sacrificing quality. The project [called Managed Care 3.0 in the 18/11 paper] will examine historical models that have worked as well as investigate the impact that new technologies and care models may have on cost and quality, with the goal of better understanding the current environment and identify­ing potential risks and opportunities.

Description: The National Association of Worksite Medical Clinics reported that one-third of U.S. employers with 5,000+ employees sponsored worksite (onsite) health care centers in 2017, and 24 percent of employers with 500-4,999 either have or plan to implement onsite health care by 2019. This session will explore why onsite health care programs are gaining traction: • Why do employers sponsor onsite healthcare? • What objectives do they hope to achieve? • How does the evidence compare with these objectives?