Description: With the mandated health plan transparency files, health plans and providers are now able to substantially enhance their provider contracting efforts. Although the files are large and cumbersome they are market disruptors and provide new insights for provider contracting efforts. Explore a demonstration on the type of information now available and how it can be used to enhance this from both a health plan and health care provider perspective.

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.

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: This session will present three utilized underwriting models that can be used for mid-size employer group medical renewals. Key assumptions will be discussed including a significant focus on the stop loss risk since that is the major insured risk.

Description: Actuarial Roles in Health

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: Take your professional development to the next level, all in one place. Join SOA Board President Dave Dillon and fellow leaders for an inside look at Professional Development Edge+ (PD Edge+), the Society of Actuaries’ comprehensive subscription for continuing education, created by actuaries, for actuaries. Now, in its second year, PD Edge+ is trusted by 88 corporate subscribers to meet their continuing education needs. This webcast is designed for both current subscribers and those exploring what PD Edge+ has to offer. During the session, you’ll see how PD Edge+ simplifies earning CE credits and staying current on industry trends. Don’t miss this opportunity to discover how PD Edge+ can make your learning more engaging, convenient, and impactful.

Description: Patients with chronic conditions such as musculoskeletal pain, diabetes, and hypertension impact 50% of the US healthcare population, consume more than 85% of healthcare costs, and often require a higher volume of care, expensive imaging, testing, and emergency procedures, and long-term high-cost drugs. Managing these conditions through innovative digital health interventions provides a significant opportunity for higher-touch and more-effective management that will result in lower costs.