Speakers at this session present a refresher on ASOP 6 and discuss what is new in the revised version including the public plans/pooling issue. Definitely of interest to anyone practicing in the retiree medical arena.

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The “official” cost projections for any legislation comes from the Congressional Budget Office (CBO), but the Medicare’s Office of the Actuary (OAct) also develops cost estimates for many health-related proposals, especially those that affect the Medicare and Medicaid programs. This session is an interview format and audience participation is encouraged. Panelists include former chief actuaries of the Medicare program who were involved in many discussions in the past on reforms of the Medicare program as well as national health care.

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What’s going with healthcare costs? Panelists share insights into cost trends, including recent research into emerging healthcare cost trends for commercial populations, and expectations and trend drivers for premiums in the ACA exchanges.

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The presenters outline the impact the Affordable Care Act (ACA) is having on pharmaceutical manufacturers and presents emerging strategies for risk/gain-share contracting to align incentives with pharmaceutical manufacturers around positive outcomes when traditional rebate negotiations reach an impasse.

Panelists demonstrate how the shifting demographics caused by the ACA can affect pharmaceutical manufacturer sales volumes and margin mix. They also explore how episode groupers and risk adjustment techniques can be employed to bridge the gap between the traditional disciplines of health economic outcomes research (pharmaceutical manufacturers) and actuarial science (payers) in the creation of risk/gain-share agreements.

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Representatives of the provider community and those actuaries who consult with them outline the challenges each segment faces in this changing environment:

• Clinical education dynamics of actuarial models of target risk cohorts;
• Identification of efficient and effective health care services so that the right care is provided at the right time in the right setting by the right provider (best practices);
• Understanding of the frequency, intensity and type of services necessary for efficient and effective health care, in the context of covered populations;
• Management of patient expectations versus best practices;
• Correlation of expected care to be provided against expected reimbursement; and
• Quantification of financial aspects in moving providers from fee for service to acceptance of risk.

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Until now, the biggest issue in the financing of healthcare has been payment reform and risk analysis connected to location specific provider cost and quality.

However Medicaid expansion is a vast shift in health actuarial challenges by expanding local variations of risk financing to diverse populations which vary locally within cities counties and states. A prime example are shifts of some Medicaid risk cohorts to public exchanges. Other examples are decisions by employers to stop sponsoring plans and moving individuals to public exchanges or onto expanded Medicaid coverage.

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Does size matter? If you are referring to Mandates, Penalties, Tax Credits, Metal Levels, Marketplaces, Minimum Essential Coverage, the answer is "yes."

Learn which portions of the Affordable Care Act (ACA) impact which size employers and how employers of different sizes are reacting to these regulations in terms of how, why, where, when, and if they purchase healthcare coverage.

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The High Cost Plan Excise tax (i.e., “Cadillac Plan” tax) is three years away but employers are beginning to focus on its potential effects on plan costs. A recent survey suggests that 40% of employers will be impacted in the first year the tax is slated to be in effect. However, at this time actuaries, attorneys, insurers, and plan sponsors have no regulatory guidance to use to completely understand how the tax is to be implemented. The presenters focus on specific issues employers need to consider such as:

• How will plan experience be used to develop the costs to compare against the limits?
• How might this differ from the current COBRA rate development process?
• How might the 2018 limits be impacted by the experience of the Federal Health Employee Benefits Plan?
• How will the age and gender adjustment be applied to the limits for individual plans?
• How do the limits apply to active and retiree plans?
• What adjustments are available for high-risk professions?

All of these issues and more are to be discussed by an expected expert panel consisting of an actuary, a benefits attorney, and a representative of the Internal Revenue Service.

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The presenters focus on the practical aspects of the URRT and Actuarial Memorandum, and how they fit into the rate filing and review process for 2016 filings. Invited speakers include a representative of CCIIO for the Federal perspective, a state regulator who reviews rate filings, and a consultant or health plan representative that submits rate filings. The speakers provide their perspectives on the challenges they see with the process and tools, and what common issues or errors they see in reviewing or submitting rate filings.

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Recent decades have seen substantial changes in the role of health actuaries, both in terms of necessary skills and breadth of influence wielded. ERISA and the emergence of self-insurance, the managed care revolution and retraction, post-retirement medical, consumer driven healthcare, and Medicare reform are a few of the forces that have provided challenges and opportunities for health actuaries. The Affordable Care Act may be the biggest game-changer of all. The risks faced by insurance companies, employers and providers (not to mention politicians) are all in flux and increasingly they look to actuaries to help them navigate turbulent waters. To quote Ian Duncan, “the health actuary of the future at a minimum will need to be part clinician, part behavioral psychologist, part health economist, and part epidemiologist.” Join us for a panel discussion of the challenges that health actuaries are facing, how those on the leading edge are dealing with them, and what you should be doing now to prepare for this exciting new era.

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