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: 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: 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: 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: 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.

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: Session 3A: State-Specific Enrollment Modeling - Understanding Disenrollment Trends and Population Dynamics

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. However, in this particular field, it is often worth taking a step back, and ensuring that we recall and consider the warnings that come with each of the statistical procedures we might attempt to use. This will allow us to ensure that we guard ourselves against drawing inappropriate conclusions, which could come back to haunt us later.At the conclusion of the session, attendees will be able to avoid drawing inappropriate statistical conclusions, while doing their work. They will leave informed about the types of pitfalls that exist, and where those might come into play in actuarial work.