Description: Join us as we explore Medigap claims assumptions and more. What has been driving cost increases? Does the trend vary by market? How are area factors determined? What opportunities exist for niche carriers? This session will provide a fresh experience-based perspective on key pricing considerations and leave you with food for thought as you manage your business.

Description: After 10 years, the Affordable Care Act (ACA) risk adjustment program has evolved as the ACA has evolved. In recent years the Centers for Medicare and Medicaid Services (CMS) has focused on predictive accuracy over compensating for actuarial risk and has failed to address systemic issues such as insolvencies that created suboptimal outcomes for the ACA markets.

Description: How is extreme weather impacting you? If you live in California, you may have been impacted by the atmospheric rivers unleashing record-breaking rain and snow last winter. If you live in Canada or near Canada, you may have been impacted by the wildfires raging last spring. NASA has declared that the summer of 2023 was the hottest on record.

Description: In this session, you will learn about key cost drivers in pharmacy trends, including but not limited to: New high-cost drugs, including gene therapies, that treat rare and/or expensive conditions such as spinal muscular atrophy (SMA), inherited retinal disease, hemophilia A and B, Duchenne muscular dystrophy (DMD), sickle cell anemia and cerebral adrenoleukodystrophy (CALD) Other cost drivers in the prescription drug category, including the emergence of GLP-1s, digital therapeutics, targeted immunomodulators, accelerated approval drugs and expanded indications The implications of the end of the COVID-19 Public Health Emergency (PHE) on the costs of COVID-19 vaccines, testing and treatment claims Downward influences on pharmacy costs, such as the availability of new generic drugs and biosimilars Emerging trends in pharmacy benefits manager (PBM) contracting, the initial portion of this discussion will be led by a pharmacist and former state pharmacy director.

Description: After three decades of relatively stable overall inflation trends, the United States has seen significant increases over the last twelve months. What could this mean for inflation in the medical sector? Explore past patterns between the two phenomena, and what drivers stakeholders can monitor to be best aware of what could be coming.

Description: This session will share insights on how to effectively evaluate and price the management high-cost claimants from three views: clinical, payer, and provider. Can predictive analytics help with underwriting? What are effective clinical mitigation strategies? Can VBC arrangements be used to reduce total cost of care, and how can that be priced in?

Description: This session will focus on the introduction to Medicare Research Identifiable File (RIF) data and how you can turbocharge strategic decision-making for Medicare stakeholders. Through real-world examples, we unravel the practical applications of this data for plan sponsors, pharmacies, pharmacy benefit managers (PBMs), and drug manufacturers.

Description: On July 1, 2023, CMS began their latest Medicare Oncology program, Enhancing Oncology Model (EOM) which was the successor to the previous Oncology Care Model (OCM). Despite a high level of interest during the application period, this model has been met with limited participation, with only 44 participants at the start of the program.

Description: Health equity is an issue on the minds of actuaries and policymakers across the health insurance market. As such, a tremendous amount of time and brain power has been invested in understanding and quantifying these issues in public and private programs alike. While the specific results of health equity studies vary widely from one program to the next, the findings tend to reveal complicated issues with no obvious, off-the-shelf solutions.

Description: This topic will explore current and upcoming changes to the risk adjustment models and strategies for payers and risk bearing providers to reduce/avoid headwinds and potentially come out on top in the years ahead. We will discuss the timeline, nature and motivation for changes as well as the anticipated associated impacts.