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: Review a recently completed research project for a multi-stakeholder data consortium on social determinants of health (SDOH). In this project, claims, external SDOH data, geospatial analysis, and machine learning models were used to examine several questions: How to identify SDOH vulnerabilities? How sensitive are the findings with respect to provider coding pattern variations? How much variability in cost can be explained by SDOH vs. morbidity? What are the key risk drivers revealed by machine learning models? The session will review the methodology and main findings from this project.

Description: Focus on how innovative health care organizations develop their value proposition for their intended buyers. Presenters will share information about their specific solution and the methods used to derive credible savings estimates, ROI, and performance guarantees. Learn about data utilized, the methods deployed, advantages, disadvantages, and buyers' reaction. This session is expected to be technical, highly informative, and interactive with audience members.

Description: Learn about key topics affecting actuaries working in the dental insurance space! The session will include valuable information for health actuaries looking to better understand how dental fits into Medicaid, Medicare, commercial, and ACA markets.

Description: As the healthcare industry becomes increasingly complex, actuaries are under pressure to analyze vast amounts of data and make informed decisions quickly. Artificial intelligence (AI) technologies like ChatGPT offer a promising solution, providing powerful tools for data analysis and natural language processing. Come explore the use of ChatGPT in actuarial analysis, focusing on healthcare applications. Begin with an introduction to ChatGPT and how it works, including its ability to understand and generate natural language responses. Then expect a discussion on the potential benefits of using ChatGPT in healthcare actuarial analysis, including improved accuracy, efficiency, and scalability. Through case studies and examples, we will demonstrate how ChatGPT can be used to analyze complex healthcare data sets, including electronic health records (EHRs), claims data, and patient surveys. We will also discuss how ChatGPT can be integrated with other AI tools, such as predictive modeling and machine learning, to enhance actuarial analysis. Finally, learn about some of the potential challenges and limitations of using ChatGPT in actuarial analysis, such as data privacy concerns and the need for human oversight. There will also be guidance on best practices for using ChatGPT in a healthcare actuarial context, including data preparation, model training, and interpretability.

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: This three-part series provides an overview of the rapidly evolving and dynamic gene and cellular therapy landscape, from the clinical, historical, and risk transfer perspectives. It covers the actuarial considerations in pricing cell and gene insurance and reinsurance, the value assessment of the therapies, manufacturer pricing, and reinsurance cost.