Description: 2014 marked a new beginning for small group(SG) health insurance market ushered in with adjusted community rated products priced from a single risk pool. It was anticipated that the mandated pooling of the risk would result in higher rates, especially for healthier groups. It is the aim of this article to show whether that view bears out in the actual market rates and if it is higher, then by how much. The article provides a point in time(1st quarter 2025) comparison of premium rates under two segments of the small group market, namely Qualified Health Plans(QHP) available under the small group ACA market versus self-insured Multiple Employer Welfare Arrangements(MEWA) plans.

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: Get up to date on the current and potential use of artificial intelligence (AI) in the health care space. In this interactive session, you will learn how AI is being used today and discover its potential to reshape and revolutionize health care. Take advantage of the opportunity to find out how AI can influence patient experience in every phase of health care delivery, and join the conversation about the challenges and limitations that arise with the use of this technology.

Description: State Medicaid programs have broad flexibility to establish their own payment methodologies and rates for hospital services. Many states direct additional funding to populations, services, and hospitals where Medicaid comprises a disproportionate share of total business, or where there are other access concerns (e.g. rural providers). Actuaries can play a key role in determining where those additional funds would have the most benefit.

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: A panel of leading reinsurance executivesprovide perspective on topics to include market capacity, cell and gene therapy, COVID-19's impact on results, syndication arrangements, mergers and acquisitions, and how reinsurers view a variety of risk transfer opportunities.

Description: The true cost of a drug and its therapeutic outcome is impacted by a myriad of factors. This session will utilize case studies in high-cost, chronic diseases to illustrate to participants what factors can be critical to evaluating the true cost of a pharmaceutical intervention. Differing from session one, session two will focus on site of care, buy-and-bill aspects, and the differences between a medical and pharmacy benefit and how these factors ultimately impact the total cost of patient care.

Description: This session will explore a solution to manage health expenses, a bit like the retirement risk managed by the three-legged stool, that is coming from government benefits, employer pension plan, and registered retirement savings plan. The solution could be called a Registered Health Savings Account (RHSA), and could then complement public coverage, and group insurance coverage