Description: Renal disease is a very heterogenous medical condition whose end state is dialysis, a recurring cost intensive medical condition. Dialysis cost is one of the major medical cost drivers in USA. Insufficient and improper care management in the early stages of CKD (chronic kidney disease) leads to early incidence of end stage renal disease (ESRD) among CKD patients which not only leads to high medical costs, but also reflects poor health quality.

Description: Modern actuarial work, being quite data intensive, provides many opportunities for actuaries to use the statistical skills that are part of their basic training. Furthermore, modern computing allows us to analyze vast quantities of data intensively, and each package will provide statistical 'answers' to any questions the actuary might ask of it.

Description: Hear about some applications using quantile regression-derived individual and group claim distributions and how they may be used in various traditional health care modeling situations. The session will not focus on the technical use of quantile regression to obtain estimates of claim distributions, but more so is intended to focus on the uses of the distributions in actuarial modeling and the additive framework in assessing claims distributions. Presenters will show how actuaries can better assess risks by focusing on the individual- and group-specific claims distributions as opposed to traditional point-estimate-centric models.

Description: Health care has changed rapidly over the past couple of years. The pandemic has shifted consumer behavior in how and where they receive health care as well as consumer attitudes toward health care. Payers continue to design innovative solutions in responses to their patient’s needs and expectations. These changes in consumer behaviors and the responses by payers are expected to impact both health care cost and utilization. Discuss changes in health care that have emerged due to the pandemic and how they are expected to influence actuarial assumptions. Explore epidemiological models commonly used in the industry, the considerations when using these models, as well as the challenges with regards to gathering and interpreting relevant experience data. By attending this session, you will be able to: Identify shifts in consumer behavior that have emerged from the pandemic and describe how payers are responding to new patient expectations. Discuss how these post-pandemic changes by consumers and payers influence medical spending. Determine which actuarial assumptions are impacted and how and if the impact is expected to be temporary or permanent. Discuss considerations taken by actuaries and challenges faced when modelling actuarial assumptions post pandemic.

Description: With the mandated health plan transparency files, health plans and providers are now able to substantially enhance their provider contracting efforts. Although the files are large and cumbersome they are market disruptors and provide new insights for provider contracting efforts. Explore a demonstration on the type of information now available and how it can be used to enhance this from both a health plan and health care provider perspective.

Description: This project was developed by the Predictive Analytics Subgroup of the Society of Actuaries (SOA) Research Institute’s Individual Life Experience Committee (ILEC).

Description: In this session, we will provide examples and highlight real-world analytics that have been done to compare providers of tertiary and quaternary (T/Q) services (i.e., complex and potentially rare conditions). We also will address the need for analytics like this, who the potential audiences are, the data necessary to complete an analysis, and we will walk through actual case studies.

Description: This interactive session will compare industry predictions versus what happened with the unwinding of continuous coverage requirements in Medicaid that were first put in place due to the COVID-19 public health emergency. The audience will be able to participate in a guessing game as the panelists review how enrollment could be stabilizing.

Description: Almost half of recent FDA approvals have been for orphan drugs. This trend is expected to continue in 2023. Orphan drugs are priced more than 30 times higher than non-orphan drugs, therefore their cost burden in aggregate has the potential to overwhelm the budgets of payers, especially that of smaller health plans. Hear how the cost impact analysis for smaller health plans require different considerations than for a larger health plan when modeling the impact of rare diseases.

Description: Unique Data Analysis Techniques to help plans find that 1% edge in opportunity and value. The discussion will vary from a conversation on members who are at high catastrophic risk to provider networks and referral patterns. The goal of the session will be to help show ways plans can create savings through outside-the-box techniques.