Annual Meeting Health & Welfare Sessions

The pharmaceutical landscape has been changing rapidly in the last decade. More and more of the spend on pharmaceutical drugs is being shifted to the medical benefit. Oncology, gene therapy, and many of the immunomodulators are now administered in a doctor’s office. New methods of forecasting and benefit management need to be considered when looking to the future. Where will these techniques come from? In this session the presenters discuss the history of pharmacy benefit forecasting and management and the emerging techniques that require a unique combination of methodologies from other actuarial disciplines.

Inefficiencies, high-cost, and gaps in care in the US healthcare system have created opportunities for innovative solutions to offer value to health plans and plan sponsors. This engaging session features leading experts who have spent years developing solutions for health plans as consultants and as strategic leaders within various innovative solution providers. The panel addresses where the biggest opportunities lie to reduce cost and improve care, as well as the various types of programs that have been proven to drive results.

The pandemic and our response to it have sent shockwaves through the country. Economies, systems, governments, employers, and families have all felt the impact. Our health care system was not spared given its critical connection to those entities. The system reacted to massive demand reduction for many services and massive demand increase for others and the impact continues to evolve. Some of the consequences are reflected in claims experience health actuaries study every day. Our panelists offer several illustrations of the pandemic impact on things like total costs and service specific utilization patterns. Additionally, they provide opinions on the persistence of the experience changes the data has revealed.

COVID-19 has shined a bright light on Social Determinants of Health (SDOH), public health and how we are all intertwined. How can we think differently about how we design and support healthcare for all? In this session, speakers discuss how organizations are looking at SDOH and incorporating it into delivering healthcare to their covered populations.

Actuarial exams seem to be continuously changing so what do students learn taking the health track? Speakers give an overview of the health track topics and then discuss what students are learning in universities to supplement the actuarial exams. Gain a better understanding of what your new hire is capable of doing and how basic actuarial education has changed.

Gradient boosting, neural networks, Area Under the Curve and all those technical things will be covered in the session immediately following this one. This session is not going to be technical, but we will predict in advance, based on the panel’s resumes, it will be informative. Actuaries are tackling some very interesting business problems using predictive analytics and presenters will showcase a few use cases. Predictive analytics provides significant improvement in accuracy in many use cases, but there are also risks associated with using advanced analytics that the panel will address. One of the biggest challenges of predictive analytics is it has the reputation of being a “black box” as it lacks the transparency of more traditional actuarial tools. Reputations can be deceiving, and this panel will share some best practices in peer review and tailoring communications to different audiences of stakeholders so that everyone can leverage the value of the “black box.”

Workshop discussion on any retiree medical valuation issue the group wants to talk about, except per capita costs by age. What does that leave? How about initial per capita costs, trend rates given a recovery from the pandemic, mortality and retirement incidence assumptions, and last year of death valuation methods (including what is being done in Medicare projections).

The American Academy of Actuaries released the ASOP 6 Practice Note in March 2021. Have you read through all 44 pages? Have any questions? Several members of the work group have agreed to make a presentation with plenty of time to provide all the answers.

This session is a more technical follow up to session 409 (“Predictive Analytics: Communicating Strategy and Value to Your Stakeholders”) and focuses on the details around how specific predictive analytic solutions can be implemented in practice. Panelists present more in-depth examples demonstrating techniques used to perform the analysis and modeling for applications similar to those described in the preceding session, attendance at which is helpful but not required. This is intended for those who want to learn more about how these solutions can be implemented in practice, what software tools are commonly used, and what types of coding skills may be required. Some coding and related software applications may be discussed. It is expected to be highly technical and focused on the “how to” aspects of implementing these solutions.

COVID-19 has disrupted almost every aspect of our daily lives. Some outcomes of the pandemic are a significant increase in virtual health utilization and an increase in mental health issues. Are virtual doctor visits finally more accepted and here to stay? Will virtual health provide better access to mental health providers? Speakers at this session answer these questions as they discuss virtual health utilization and outcomes generally and more specific to mental health pre-, during and post-pandemic.

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. Speakers address this and other potential legislation that may be in development.

Would you like to glean insights into how “the other side” thinks? Join us to hear how providers, ACOs, employers, and payers are approaching value-based care agreements pre- and post-pandemic. Speakers discuss: • Case studies highlighting real-world value-based care contracting and performance scenarios; • “I’m supposed to measure what??” and “How do I get paid??” aka, immediate practical issues such as historical performance and future baseline measurements that rely upon data periods impacted by the pandemic; • (Re)defining value and performance; and • Is anything actually different? Forward-looking perspectives on robust contracting.

(Polling included) Speakers highlight current topics in Medicare Advantage and Part D using an interactive format with presentations and audience polling. Topics may include Medicare Advantage, Part D, and retiree medical plans.