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.

For health actuaries, 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 changes the way actuaries evaluate provider networks, assess plan competitiveness, and support pricing strategies. Presenters discuss practical ways actuaries can incorporate MRF data into their work—highlighting use cases in benchmarking and analysis across employers and providers. The speakers 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.

Our speakers cover recent legislative and regulatory changes affecting the US healthcare system from the perspective of employers, insurers and individuals. Topics include the recent Budget Reconciliation law (the OBBBA) and CMS actions flowing out of the 2022 Inflation Reduction Act. Speakers address how these changes affect employers sponsoring group healthcare plans for their active and retiree populations, including a perspective on the unique needs of public sector employers. Topics include the pending impact of the OBBBA on the ACA individual marketplace and how evolving CMS rules will affect Part D and Medicare Advantage plans (both group and individual). At the close, panelists provide their thoughts on how the Individual Coverage Health Reimbursement Arrangement, or ICHRA, option can open new doors for employers to consider a DB-to-DC shift for their active employee healthcare benefits.

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 observed that actuaries who leverage AI will replace those actuaries who do not use AI. As our profession undergoes its most fundamental shift in tools since the move from paper to spreadsheets, this session will highlight practical applications of AI in actuarial work. Learn how your peers are applying AI to improve efficiency and accuracy, uncover deeper insights into key business drivers, and explore predictive applications that can enhance decision-making and forecasting in actuarial practice.

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.

In this session, we’ll go through what pension actuaries should be thinking about when performing OPEB valuations. We’ll start with some basics on setting the short-term assumptions, including calculating the implicit subsidy and accounting for Rx rebates and EGWPs. Then we’ll go through trend considerations, including for Medicare Advantage plans with low or even zero premiums as well as the Inflation Reduction Act. Lastly, we’ll go through what considerations need to be made for newer cash-based plan designs such as retiree reimbursement accounts (HRAs).

In a city built on bold moves and big bets, this session dives into the high-stakes world of digital health and point solutions. Are these innovations truly reshaping health outcomes and cutting costs - or are they smoke and mirrors? Join industry consultants as they reveal insider methods for evaluating these evolving solutions, and a panel of vendors ready to lay their cards on the table with real-world results, ROI, and impact stories. Whether you're risk-averse or ready to go all in, this session will help you bet smart on the future of healthcare innovation.

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.

Various analyses continue to show that there is unnecessary overutilization, upcoding, and waste in the US healthcare system. While some unnecessary spend is related to the fragmented nature of our existing system, others can come from provider profit targets or downright fraud. Join us to better understand how various healthcare entities are targeting, tracking, and mitigating unnecessary spend through payment integrity programs to ensure accurate payments to providers and manage overall financial risk for health plans, employer groups and government programs.

More and more of a healthcare actuary’s work is centered on predicting financial, clinical, and business outcomes—projections that carry meaningful implications for patients, providers, and shareholders alike. With the growing reliance on predictive modeling and AI, these tools are drawing heightened scrutiny, leading many organizations to establish AI committees and governance frameworks. This session explores not only the types of modeling actuaries are using today, but also the risks, professionalism considerations, and governance structures needed to ensure responsible application. Attendees gain insight into where predictive modeling can drive value, while also learning practical approaches for balancing innovation with accountability, transparency, and sound professional judgment.

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.