Annual Meeting Health & Welfare Sessions

Health care trends are hovering around double digits with various reasons including the effect of provider contract negotiations, latent pandemic-related health issues, and the appeal of weight loss drugs. Panelists provide information from large-scale data analyses to offer attendees valuable insights for immediate application, preventing the need to gamble on you next health care claim projections.

The traditional reliance on network discount metrics is being challenged by a new wave of cost transparency regulations and machine-readable files (MRFs). Speakers explore how the public release of negotiated rate data is changing the way actuaries evaluate provider networks, assess plan competitiveness, and support pricing strategies. Presenters also discuss practical ways actuaries can incorporate MRF data into their work—highlighting use cases in benchmarking, provider contracting analysis, and strategic forecasting. We’ll also address the limitations and complexities of this emerging data source, and how actuaries can balance transparency-driven insights with actuarial rigor. Designed for health actuaries working in pricing, network analytics, or provider strategy, this session offers actionable perspectives on navigating a rapidly evolving reimbursement landscape.

This session will dive into the most recent updates and key shifts in US healthcare policy, laws, and regulations. We will explore the implications for providers, insurers, consumers, and employers. Topics will include changes in healthcare coverage and compliance requirements, the ongoing evolution of the ACA, as well as emerging trends in telehealth, data privacy, and insurance reform. Attendees will gain a clear understanding of how these changes impact the healthcare system, and actionable insights for staying ahead in an increasingly complex environment.

Employer groups are looking for programs and a delivery model that addresses various conditions including cancer and diabetes. Since chronic conditions make up 85% of overall healthcare costs, employer groups want to ensure that programs result in savings and improved population health. Determining Return on Investment on Case Management and Disease Management programs are top of mind. You will find out more in this session.

As healthcare costs continue to rise and the landscape evolves, employer provided health insurance is at a crossroads. This session will explore the future of employer sponsored insurance, focusing on everyday trends, continued challenges and innovative solutions. We will examine how employers are adapting to changing regulations, advancements in technology and expectations of a multi-generational workforce. Key topics will include enhancements to the current group health model, and the accelerated adoption of individual coverage health reimbursement agreements.

Speakers highlight current topics in Medicare Advantage, Part D, and changes to the programs due to the Inflation Reduction Act. Topics will include Medicare Advantage, Part D, employer sponsored Medicare plans and OPEB valuation issues.

Many actuarial organizations have noted those actuaries that use AI will replace those actuaries who do not use AI. As our profession makes its most fundamental shift in tools since moving from paper to spreadsheets learn how your peers are using AI to improve the efficiency and accuracy of their work, as well as being able to provide deeper insights into the drivers into what is happening.

The session will explore key updates and trends in Medicare and Pre-65 retiree health plans. Consulting actuaries will learn cost containment strategies and the evolving Medicare Advantage market. Topics will also include prescription drug pricing and the financial sustainability of retiree health plans. Attendees will gain practical insights and best practices for actuarial analysis and plan design, helping them navigate the complexities of retiree health benefits and optimize their approach for both Medicare and Pre-65 populations.

Unique point solutions and digital health innovations continue to evolve. Do they have a positive impact on health outcomes or reducing costs? Join us to hear from a variety of speakers, discussing results and cost impact/ROI. Methods to come up with value techniques.

Rising healthcare costs, emerging technologies, specialized Rx, gene therapies, and inflation are driving increasing spend and volatility healthcare. As a response, employers are seeking ways to better manage risk through stoploss and captives. This session will provide foundational concepts for those new to the topic. We will explore the current landscape, key challenges and outline future trends that actuaries should consider when evaluating risk management strategies for self-insured medical plans.

Do you want to gamble with ethics? Ethics is not a game of chance. Make the right call. In this session, our speakers have developed scenarios sometimes based on real-life situations where professionalism and ethics have come into play. Decision making can be challenging and debatable, but absolutely critical for consultants when considering these scenarios. There is interactive polling so get ready to state your opinion.

The CCA Healthcare Community meets to discuss current issues, outlooks, and news. Neither CCA nor community membership is required to attend.

Healthcare providers refer to hospital systems and provider medical groups that perform illegal actions such as upcoding and unnecessary overutilization to increase financial gains. We will discuss how this is being tracked and mitigated.

More and more of a healthcare actuaries work is focused on predicting a wide range of financial, clinical, and business outcomes. These predictions can have significant impact to all stakeholders in the healthcare industry from patients and providers to shareholders. As a result, the use of these tools are attracting additional scrutiny with many employers and payers setting up AI Committees. This session focuses on what types of modeling actuaries are doing today and potential frameworks to responsibly use predictive modeling and AI to solve problems.

The pharmaceutical industry continues to be the fastest evolving area of healthcare. Actuaries need to stay ahead of the curve as they advise clients on the payor, provider, and employer space. This session will dive into the latest trends and developments in the pharmaceutical industry including GLP-1, biosimilars, and gene and cell therapy.

As the healthcare landscape continues to evolve, Medicaid remains a critical component of the US healthcare system, providing essential coverage to millions of Americans. This session will delve into the future of Medicaid, focusing on recent and upcoming legislative impacts, and what stakeholders can expect moving forward.