Description: The panel will discuss several product challenges including modeling hybrid/combo long-term care products, modeling benefit options that are difficult to model using deterministic methods, modeling current situs of care versus original situs of care, monitoring assumptions, streamlining experience studies within the Long-duration Targeted Improvements (LDTI) framework, and model decision making with limited credible data. The panel will then move into solutions observed to address some of the aforementioned challenges and the future of long-term care modelling

Description: Session 3B: Actuarial Principles in Action – Pharmacy Benefits

Description: Develop a better understanding of diversity, equity and inclusion (DEI) across the financial services and risk management industry, with a focus on actuaries. Panelists will address topics such as industry-wide diversity efforts, as well as current challenges facing diverse groups. Come listen to these panelists share perspectives on attracting, fostering, retaining and increasing diverse actuarial talent, in addition to the SOA’s DEI goals in the coming years.

Description: Explore the value and cost of prescription drugs, how they should be defined and measured and the effects various stakeholders in the pharmacy ecosystem can have on these factors in the latest webcast. You'll investigate the impact of coverage, formulary and rebate negotiations and related benefit design. Find out how actuaries can answer questions related to the prescription drug industry, in addition to improving the access, quality and affordability of prescription drugs in the United States. Join us for this webcast and come learn about value-based contract design, negotiations, implementation and administration for prescription drugs.

Description: Keynote Speaker: J.D. Kleinke, Author and Medical Economist J.D. Kleinke has been instrumental in the creation of four health care information organizations; has served on the Boards of several health care companies; and spent many years advising both sides of the political aisle on non-partisan, practical approaches to health policy and legislation.

Description: The Inflation Reduction Act represents the largest change to the Medicare Part D program since its inception in 2006. With a complete redesign of the Part D program coming in 2025 (the next bid cycle), there are health plan, operational and analytical challenges that lie ahead. In this session, you will: Hear highlights on some of the key changes occurring in 2025 Learn about key considerations for health plans and other stakeholders in the Medicare and commercial markets Discover potential winning strategies and potential analyses that could inform those strategies

Description: "Risk adjustment is an important aspect of establishing appropriate capitation rates. When a set of services is carved out for specific management under a sub-capitation, establishing appropriate adjustments for varying levels of underlying risk is more complicated. Dive into analytical and operational challenges and resolutions as presenters share more about developing a risk adjustment model specific to the carve-out of behavioral health services through a real-life case study. You will further explore a definition of the use case, availability of historical data sets, selection of the modeling approach, learnings from the iterative modeling process, and the potential application of the results. After attending this session, you will be able to: Understand why a behavioral health specific-risk adjustment model has business value Understand the unique challenges related to developing risk adjustment on member and cost subsegments Understand the impact of trade-offs between model complexity and interpretability in the context of implementation Increase awareness of data nuances and requirements unique to this type of project Describe analytic techniques that can be investigated for use in projects of similar business objectives"

Description: Understand the role of food based interventions in health care. Learn the difference between produce prescription and medically tailored meals. Review new policies that will affect Medicare and Medicaid populations. Evaluate the possibility of health cost savings due to these interventions.

Description: "This talk will evaluate the present pace of evolution in actuarial data management due to economic and demographic pressures, evolving regulatory/compliance requirements, AI and the growing need to have advanced analytic capabilities. We will evaluate each factor briefly to isolate their impact on actuarial data management, highlighting risks and opportunities for actuaries and IT teams supporting actuaries. Attendees will gain insights into the factors affecting changes in actuarial data technologies, understand key differences between centralized and decentralized data management approaches, including their impact on data quality, governance, performance, and scalability. The session will highlight some pain points of centralization, such as the integration of actuarial transformation initiatives with IT processes, juggling data complexity and business logic, and the limited creativity and agility due to interdependencies between components and evaluate how emerging concepts such as actuarial data stores tackle the 'centralization' problem. We will also cover a real-life use case covering the evolution of actuarial data management and challenges identified in previous parts of the presentation. The session will avoid going into any specific solution details: it will address current challenges due to broad shifts, then evaluate newer concepts, corresponding risks and opportunities. - Understand key macro and micro drivers impacting actuarial data management - Understand centralized and decentralized approaches to actuarial data management - Evaluate the concept of an actuarial data store - Coordinate better with IT teams to deliver changing actuarial data technology needs"

Description: Learn from panelists from different companies as they come together to discuss their experiences.