Description: Virtual - Session 5B: ACA Risk Adjustment Reboot - Fresh Insights From the 2024 Report and State-Specific Dynamics

Description: This report explores AI bias in insurance and health data, highlighting the ethical role of actuaries and offering cross-disciplinary guidance for fairer decision-making systems.

Description: In this session, participate in a mock negotiation of a typical value based contract taking on the role of either provider or payer and solving for the various negotiation challenges, objections, risk mitigations, data requirements, etc. from either party. Attendees will learn best practices and ideal tools and workflows to engage in when supporting VBC negotiations and gain insights into the typical challenges to equitable and agreeable terms.

Description: In this session, we will address the current landscape of the standalone Medicare Part D market and the challenges to its sustainability. Specifically, we will discuss some headwinds for plan sponsors due to the Inflation Reduction Act and future considerations for prescription drug plan (PDP) benefit design and pricing.

Description: This is Part 2 of 2 on changes affecting Medigap insurers. It focuses on marketing and regulatory differences between Medigap and Medicare Advantage that affect the competitiveness of Medigap plans.

Description: The document provides information on the ACA@15 research project, focusing on the extent that the Affordable Care Act legislation was able to meet its stated goals of reducing the uninsured rate, increasing coverage options, and providing affordable health insurance. It includes research findings, objectives, and key takeaways.

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: 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: Delve into the factors contributing to the rapid growth of high-cost medical treatments and how payers can manage the financial exposure that comes with them. Learn about the current and near-future state of million-dollar medical costs, as well as the trends shaping the industry. By attending the session, you will have a better understanding of the underlying drivers of high-cost treatments and will be equipped with practical strategies for mitigating their financial impact, including risk management techniques, cost containment measures, and new payment models. Additionally, you will be able to identify key considerations for implementing these strategies in their own organizations.

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