Description: Challenges of Provider Reimbursement

Description: As health insurance self-funding becomes more popular among smaller group sizes, risk is evolving for the MGUs, stop loss writers, and reinsurers that cover them. Assessing more small groups at lower attachment points means rethinking traditional stop loss underwriting techniques.

Description: Cost is a key outcome metric used by actuaries and others to determine the value of a benefit or program in health insurance. However, typically, costs assessed include only the direct costs of the program, not any indirect costs or savings, such as those associated with reduced spending on other services.

Description: In this session, we will review how the previous and current concerns of pharmacy actuaries will affect the forecasting and review of upcoming pipeline events. After this session, attendees will have a broader understanding of the implications of what is coming next in the pharmacy pipeline and how they can be thinking about it.

Description: Explore the dynamic intersection of health insurance data and diverse industries beyond traditional health insurance providers. This session will delve into how life science companies, pharmaceutical manufacturers, device manufacturers, and others leverage health insurance data to drive innovation and decision-making.

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 attention 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: With a decade of experience, mature Affordable Care Act (ACA) marketplaces continue to undergo significant changes amidst record enrollment levels. State activity has ramped up and similar themes have emerged. For example, an increasing number of states have either established or are considering operating their own exchange.

Description: The Tri-Agency published the final rule on short-term limited duration insurance and fixed indemnity coverage at the beginning of April. We’ll break down the new rule, approaches to complying with the new requirements, and what implications it could have for the supplemental health market moving forward.

Description: This session will focus on the latest regulatory changes impacting commercial dental plans, including recent developments in Minimum Loss Ratio Requirements (MLR) and the potential inclusion of adult dental services as an Essential Health Benefit (EHB).

Description: Primary care is the backbone of health care service delivery and has been shown to contribute to positive health outcomes. Many states are emphasizing the importance of Primary Care by implementing new or expanded value-based purchasing arrangements. This session will explore recent developments in Primary Care payment models in Medicaid, how they align with initiatives from other payers, and how they address health equity.