Description: After the bid process, desk review, rebate reallocation, an “enjoyable” audit, and open enrollment; the Medicare plan year starts. Throughout the year, organizations find it pertinent to get an accurate picture of their Part D liability as reinsurance, LICS (Low Income Cost-Sharing) subsidy, and risk corridors are accrued. Attendees will learn about the basics of Part D accruals, how future accrual amounts are estimated based on patterns in the data, and how bid assumptions versus actual results impact plan sponsor profitability. We will also discuss financial statement treatment of these items. Real-life examples from bids to outcomes will be provided to enhance the discussion. Ultimately, attendees will come away with a deeper understanding how their bid assumptions play out, and how they can use Part D accruals to plan for future bid development.

Description: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: Presentation on estimating rates of early-onset Alzheimer's Disease. This document contains incident rates, critical illnese insurance information, adverse selection, and more.

Description: The always popular Medicaid Hot Topics session is back with discussions from an expert panel on the most riveting Medicaid topics of the year. These could include the following: • Medicaid Fiscal Accountability Proposed Regulations• Tennessee's Block Grant Proposal• ACA court battles: What are the potential impacts on Medicaid? • Pass-through payments are converting to directed payments: What is changing?• And more current topics of interest to Medicaid actuariesMedicaid is dynamic and it is difficult to stay current on all of the changes. This session provides insightful discussion into the major changes that impact actuaries and their companies or state clients.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: The presenters will provide updates on research being conducted under SOA sponsorship. This includes projects on the topics of Direct Primary Care and Patient Centered Medical Homes.

Description: The presenters will provide insights into fraud and abuse risk in the health insurance industry, including an examination of traditional and predictive modeling techniques for both prevention and detection. Emphasis will be placed on current and emerging risks. Canadian examples and perspectives will be offered, but the applications for attendees to use in practice are non-nation specific.

Description: While intended to assist health plan actuaries responsible for stress testing and ORSA filings, this session will also be informative for actuaries interested in communicating the impact of potential catastrophic events for health plans to their management and board. It will begin with a discussion of event thresholds for stress tests and their impact on capital and financial statements. Presenters will take a detailed look at several catastrophic event case studies (historical and hypothetical) in the following areas: healthcare specific (e.g. pandemic, specialty Rx), financial institution/credit market, operational/business, strategic and multi-event scenarios.</

Description: Intended for actuaries interested in understanding more about the Medical Loss Ratio and the impact Quality Improving Activities (QIA) and fraud reduction expenses have on the rebate calculation. This session will focus on what expenses qualifies as QIA, examples of programs from major carriers, current regulations and the differences between commercial, and Medicare, and Medicaid requirements.

Description: Dental care is an important component of everyone's health, and senior citizens are no exception. With no public dental coverage under traditional Medicare, seniors must seek other ways to obtain dental insurance, pay for services out of pocket, or go without care. In this session we will review the importance of oral care to overall health, the current state of public and private dental insurance for seniors, and innovative ways to reach this population. Medicare, Medicare Advantage, Medicaid, and other types of dental coverage will be discussed by three actuaries with different areas of expertise in the senior dental market.