Description: The objective of this session is to explore the fast-growing segment of healthcare that is provider enablement. Value-based care (VBC) in its original form was an alignment between providers and payers to deliver on the triple aim of cost of care, experience of care, and health of populations (more recently the quintuple aim including health equity and provider experience).

Description: This session will provide an overview of the challenges found in understanding and managing the medical drug benefit based on standard claims data. Participants will learn what makes coding medical drugs challenging and how to navigate some of the pitfalls when conducting analyses on this important segment of utilization and cost trend.

Description: Come learn how Maryland is leading the charge in improving affordability for its individual market enrollees. Learn about the success of the state's 1332 reinsurance program and additional initiatives including further Medicaid expansion, additional state and CSR subsidies, and eligible population expansions.

Description: "This video by Danika Turner is an introduction to Medicare Advantage revenue, specifically focusing on how Part C revenue works for individual Medicare Advantage plans. It explains how health plans participating in the Medicare Advantage program are paid by the Centers for Medicare and Medicaid Services (CMS), including the impact of Star ratings, risk adjustment, and county-level CMS benchmark rates on revenue. The session aims to simplify the main variables of the revenue calculation and uses conceptual examples for individual MA plans, excluding certain populations like Employer Group Waiver Plans and members with End-Stage Renal Disease or in hospice. The video also covers the basics of Medicare-covered services, mandatory and optional supplemental benefits, and the calculation steps for determining CMS Part C revenue per member per month.

Description: Get highlights from recently published and upcoming research from the SOA Research Institute, including work on specialty pharmacy and 'Valuing the Impact of Technology in Health Care'. Presenters will focus on the financial impacts of these issues as well as trends and other actuarial considerations.

Description: This session will explore the financial health of rural hospitals, especially as it relates to the impact of payer cost containment strategies and government policies. Since 2005, more than 100 rural hospitals have closed and 600 more are at risk.

Description: How do social determinants of health (SDOH) affect health outcomes in the United States, how might SDOH factors be incorporated into financing and risk adjustment of Medicaid, and what implications might this have for market participants?

Description: Valuation at the heart of health insurance

Description: Over the last 10 years, Artificial Intelligence (AI) healthcare foundation models have made tremendous strides when it comes to delivering highly accurate predictive results when compared to traditional models. This is especially true for models developed and trained on the ‘language’ of healthcare. When trained on healthcare data sequences (claims, EHR, CPT, ICD, pharmacy, lab, etc.), these models deliver far more accurate results as to WHAT beneficiary-level health events will occur and even WHEN they will occur.

Description: Hear highlights from recently published and upcoming SOA Research, including work on specialty pharmacy and long-term impacts of COVID-19. You will get an overview focused on the financial impacts of these issues as well as trends and other actuarial considerations.