Description: Actuaries historically modeled new launches in pharmaceuticals by anticipating the expected change to the market basket. This became more complicated with the recent launches of gene and cell therapies as they address rare diseases. Rare conditions have low total member volume to study and some do not currently have a diagnosis code to identify them within claims data. Addressing this modeling challenge has been growing more important in the recent years with the number of therapies launching. What has the health care industry, and more specifically health care, done to enhance modeling and how should this be altered for the future? Additionally, historic modeling has sometimes incorporated a level of direct medical treatment cost offsets where studies have shown lower treatment costs are achievable. Can gene and cell financial modeling include cost offsets as well? And if so, what are suggested precautions or limitations to this effort?

Description: Cover a variety of topics centered around the unsupervised learning technique called 'clustering'. The presenters will take you through a wide array of topics that range from 'What is Clustering?' to 'How can I use this technique to solve problems I didn't even know existed?' In the health care industry, everyone is looking for an edge in reducing total spend-cluster analysis finds the unambiguous in an ambiguous framework of results.

Description: You will be reminded how to spot and avoid statistical biases and fallacies that are common to health care actuarial data and problems. We plan to explain various statistical biases and fallacies and for each show one or two examples of how they might pop up in healthcare data and what strategies can be used to avoid/account for them. Likely topics include simpson's paradox, regression to the mean, base rate fallacy, sampling bias, survivor bias, Berkson's fallacy, and others.

Description: The presenters give a history lesson on the origin of CMS Medicare star ratings, including why this demonstration was originally created and how the program has worked over the years. The discussion will cover both the evolution of the underlying measures and the financial impact to Medicare Advantage stakeholders. By attending the session, you will have a stronger understanding of how member experience and outcome-based measures can be factored into the funding within a health care system to better align incentives among various stakeholders.

Description: CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.

Description: How do we take a Minimum Viable Products (MVP) approach to launch new insurance products? Join this moderated discussion and focus on three key development aspects: Distribution, Systems, and the design and pricing of the Insurance product itself. Come discuss reasons to choose an MVP approach and how it solves many of the product launch challenges.

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: This three-part series provides an overview of the rapidly evolving and dynamic gene and cellular therapy landscape, from the clinical, historical, and risk transfer perspectives. It covers the actuarial considerations in pricing cell and gene insurance and reinsurance, the value assessment of the therapies, manufacturer pricing, and reinsurance cost.

Description: The Inflation Reduction Act represents the most significant changes to the Part D program since its inception 20 years ago. The implications will not only alter the benefits offered by Medicare Advantage (MAPD) and Prescription Drug Plans (PDP) but will alter the Part D cash flows and the seasonality of such amounts for interim reporting periods. In this session, we will provide a brief overview of the IRA changes and dive into how the changes could impact the 2008 Medicare Part D Accounting Practice Note.

Description: This session will focus on long term disability insurance reserving practices. It will address current practices in calculating claim reserves and may include topics such as the following: Relevant Actuarial Guidelines, Studies used to evaluate claim termination experience and reserve margins, Estimation of future offsets, Mortality improvement