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: Learn about the health care cost and utilization impacts of provider consolidation and shortages in the U.S. You will get an overview from a recent SOA research paper of the recent trends of, reasons for, and impacts of consolidation and shortages, as well an overview of the involvement of private equity's role in consolidation and shortages.

Description: Address issues in value-based contract accounting from an actuarial perspective. In Medicare and ACA business, what issues does risk adjustment present to value-based contract accounting? In Medicare, what issues do Part D present in value-based contract accounting and what are possible solutions? What are the issues in the use of provider stop loss in value-based contract accounting? Are there issues in the timeliness of claims in value-based contract accounting? Are we giving providers enough information for them to manage their population? How do we deal with deficit accounts? What are the pros and cons of capitation, gainshare, and full risk in value-based accounting?

Description: The health care sector in general, and physicians in particular, are a large and important part of the market for group and individual insurance products. Explore a variety of subjects related to physicians and disability insurance, including experience trends, purchasing trends, external factors affecting physicians, and the impact of the COVID-19 pandemic.

Description: This will be the most fun you'll ever have learning about applying health status based risk adjustment methodologies in the real world! Quantifying relative differences in the use of finite healthcare resources – due to differences in health status – isn't just fun, it's the very heart and soul of ASOP 45! Get ready for a rollercoaster of statistics, probability, and a few puns that might just make you laugh harder than a data outlier!

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.

Description: America’s healthcare results are lackluster and worsening despite enormous effort and investment over many decades. Spending, affordability, health, coverage, access, quality, and healthcare workforce results are suboptimal or poor. Too many are suffering, and the system is financially unsustainable. We need a new approach, a new way of thinking about healthcare financing and delivery.

Description: If you are a pricing actuary, you have probably been there. A new blockbuster drug has been introduced and the manufacturer is claiming that the value of the drug will offset the higher cost of the drug. But how do you know? In this session, presenters will discuss techniques for measuring the impact of a prescription drug on the total cost of care, including the benefits and limitations of each method.

Description: This presentation seeks to educate SOA attendees on how Medicare provides care for HIV-positive members. HIV is a disease that has occupied a prominent place in the public's view since its initial discovery. Initially a terminal condition for the afflicted population, advances in anti-retroviral pharmaceutical therapies transformed HIV into a chronic condition in the 1990s.

Description: Join a dynamic two-part panel, where we'll delve into organizational and personal innovation strategies, tactics, and success stories. Begin by uncovering how venture studios, payor/employer partnerships, and startup business units can propel your company's innovative edge.