01 -
Current State of Price Transparency
April 11, 2023 10:00 AM - 11:15 AM
The No Surprises Act, signed at the end of 2020, contains protections that hold consumers harmless from the cost of unanticipated out-of-network medical bills. In July 1, 2022, group health plans and issuers of group or individual health insurance began posting pricing information for covered items and services. This session will provide an update on the current understanding of the data including accuracy, completeness, challenges in access, any known deficiencies.
Session Category: Health & Welfare
Credits: CPD: 1.50
02 -
How to Work in a Provider Shortage Environment / Negotiations with Providers
April 11, 2023 11:45 AM - 1:00 PM
Discussions in the popular press, industry newsletters and peer-reviewed publications about the nature and impact of staffing shortages in the American health care delivery system are constant, consistent and concerning. Shortages appear at all levels of care from persons who clean facilities and care for patients, through nurses who underpin the system to an aging physician workforce. Some areas of specialty such as mental health professionals pose immediate crises, but none of the shortages should be ignored. Shortages in supply force increased costs and can pose threats to patient safety and outcomes. Actuaries may not deal directly with staffing issues, but certainly deal with the results.
This session will highlight areas of the most crucial shortages, look at the impact to a moderately sized, but rural health system and conclude with some thoughts about the impact to health actuaries in their work, from trends to contracting.
Session Category: Health & Welfare
Credits: CPD: 1.50
03 -
Jeopardy , or Not
April 11, 2023 1:30 PM - 2:45 PM
The session will cover several challenging professionalism scenarios using an interactive format with audience polling, and a mix of role-playing and presentation formats. The focus will be on applications of the Code of Professional Conduct along with ASOPs, ABCD and others as applicable.
The scenarios will include background on the issue, potential precepts or other considerations that may apply, audience polling on potential outcomes, and panelist discussion regarding which outcomes may or may not be correct (recognizing that there may not always be a truly correct outcome).
Session Category: Health & Welfare
Credits: CPD: 1.50
04 -
What's All the Buzz about Level-Funded Premium?
April 11, 2023 3:15 PM - 4:30 PM
This will cover the specifics of level-funded premium, how it works, how to communicate the specifics to employers, advantages and disadvantages, appropriate employer sizes, with contrast drawn against contingent premium and its advantages and disadvantages. The program will include discussions of alternative programs in level funding (e.g., pharmacy-only programs) as well as other developments (e.g., regulatory changes, trends in healthcare provider billing) impacting the program. The focus of the presentation will include perspectives from the employer, stop-loss insurer (including reinsurers) and service providers involved in the program (e.g., retail brokers, third party administrators, pharmacy benefit managers, auditors, etc.). This session will include both panel and audience interaction throughout.
Session Category: Health & Welfare
Credits: CPD: 1.50
05 -
Prescription Drug Hot Topics
April 13, 2023 10:00 AM - 11:15 AM
The speakers address current, important questions on the prescription drug and medical pharmacy landscape. Potential topics include trends, specialty drugs, increased use of diabetes drugs for weight loss, biosimilars, rebates, impact of changes due to the Inflation Reduction Act (IRA), implications of the upcoming removal of Average Manufacturer Price (AMP) caps in Medicaid and how that may impact other lines of business, and other topics.
Session Category: Health & Welfare
Credits: CPD: 1.50
06 -
Health Equity and Proactive Strategies
April 13, 2023 11:45 AM - 1:00 PM
Health equity is taking a front row focus in many health arenas. This session will look at some of the efforts being used to ensure health equity. One area of interest to actuaries is value-based insurance (VBID). VBID can be incorporated into exchange plans. These innovations to prevent and treat disease have led to reductions in morbidity and mortality. Learn techniques to improve the quality of care and reduce barriers to high value-care in the form of high cost-sharing.
Session Category: Health & Welfare
Credits: CPD: 1.50
07 -
Fair or Foul? If Only Identifying and Measuring Bias Were That Simple
April 13, 2023 1:30 PM - 2:45 PM
ASOPs provide guidance to actuaries in numerous areas. However, little if any guidance is currently available in regards to fairness/bias of actuaries' models and algorithms. This session attempts to address some of these issues starting with the appropriateness of data to walking through how fairness testing might be applied to an actuarial model.
Session Category: Health & Welfare
Credits: CPD: 1.50
08 -
Measuring the Value of Innovative Healthcare Solutions
April 13, 2023 3:15 PM - 4:30 PM
This session will focus on how innovative healthcare organizations develop their value proposition for their intended buyers. Panelists will share information about their specific solution and the methods used to derive credible savings estimates, ROI, and performance.
Session Category: Health & Welfare
Credits: CPD: 1.50