Description: In preparing claims reserves in the annual statement, health insurers and their opining actuaries will generally include a provision for adverse deviation (PAD) in their reserved amount in order to satisfy language in both in the National Association of Insurance Commissioners (NAIC) Health Annual Statement Instructions and in Actuarial Standards of Practice. This article explores the total level of PAD (both implicit and explicit margin combined) included in the reported claims reserves by examining NAIC filing data from 2016 through 2022.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: It's your first full day of productive learning! Start it off right with a delicious breakfast and warm welcome.

Description: Prepare for an interactive session around how members choose a Medicare Advantage Plan, and how actuaries can help be part of the discussion! You will participate in a decision-making activity to set the stage for understanding member selection. Then, dive into an actuarial analysis of the 2023 Medicare Advantage competitive landscape, with an emphasis on what benefits drive membership decisions. This presentation will evaluate plan components prevalent amongst the strongest plan offerings in the market, including supplemental benefit prevalence, member cost sharing, and the underlying benefit value. You will better understand which benefits drive the most significant membership changes, as well as how to think about what the most impactful benefit changes will be for 2024.

Description: Gain a clearer understanding as a provider and a payer discuss the insights gained from being involved in value-based care. Learn about the payer's perspectives on how to develop a value-based contract, the negotiation process and the support they provide the provider. Discover the provider's perspectives on how value-based contracts have impacted them, the analytics they are developing and the collaboration with the payer.

Description: A diverse panel of health actuaries will be available to answer any attendee questions. An ACA question, we have it covered! A valuation question, we will find a solution. A professionalism issue, we will make a ruling! A regulatory concern, we will help guide the way!! No question is off limits! There are no stupid questions!

Description: Overview of call center and digital sales platforms for the development of distribution strategy in the individual insurance market.

Description: When designing and pricing a healthcare product, it is not only important to know how to model frequency and severity, but it is essential to understand human behavior. Of course, the issue of anti-selection in medical insurance is well known as individuals know more about their health and prior expenditures than an insurer does. This type of behavior is certainly rational, and to be expected.

Description: Inspired by other financial savings products available to Canadians, this article describes a potential solution for financing future health expenses with the creation of a Registered Health Savings Account (RHSA). This solution has been thought on the basis of four premises : 1- Individual Accountability for Health Expenses; 2- Early Savings Leads to More Accumulation; 3-PreferredTax Treatment for Personal Health Savings; 4- Complementing current public and private health systems; Main elements of the RHSA are described (Contributions, Accumulation, Utilization of account, Management by financial institutions).RHSA'S expected balances and some other results under three scenarios (a person in good health, one in poor health, and one with unexpected death at age 45) are summarized in a table. Health expenses deducted yearly from RHSA's balance were estimated using total, per capita, provincial government health expenditures by age-band for Canada, in 2020, from the Canadian Institute of Heath Information’s (CIHI), which account for 71.8% of total expenditures, that is public + private. Thus 28.2% of total expenditures were used for private health expenditures, then forecasted to 2024 and projected using a 4% annual trend. Some objections to the solution explored were anticipated as well as some refutations to these objections.

Description: "Examine the impact of traditional deductibles on health care equity and the need for innovative plan designs. You will learn about the limitations of consumer-driven health care costs broadly today, as well as alternative cost-sharing approaches that have been successful in driving consumerism without exposing members to high costs. By attending the session, you will be able to: Have a clearer understanding of the issues surrounding deductibles Be equipped with practical ideas for creating more equitable and effective cost-sharing solutions Assess the feasibility and potential impact of implementing these solutions for your own organization"