Description: In July of 2024, CMS will start operations on its new GUIDE model, designed to support people living with dementia and their unpaid caregivers. GUIDE is a TIN-centered model, offering a standardized approach to care with the goal of allowing people with dementia to remain in their homes for longer and improving their quality of life.

Description: The Social Security Disability Insurance (SSDI) program is a major source of income protection for disabled Americans. Private disability plans, especially group long-term disability plans, typically offset for SSDI benefits, so the programs are closely related.

Description: In this Society of Actuaries (SOA) Research Institute report, authored by consultants from Milliman, Inc. (Milliman) we aim to study the effects of hurricanes on human health: whether there is a relationship between hurricanes and the observed prevalence of healthcare utilization or certain health conditions among the affected population, whether this relationship can be observed through a healthcare utilization dataset, and whether there is an interaction between this observation and metrics of socioeconomic vulnerability.

Description: En el seminario hablaremos sobre los nuevos flujos de tarificación, y nos enfocaremos en la inclusión del análisis geográfico en el proceso de modelado para optimizar la extracción del riesgo en modelos de Machine Learning.

Description: Medicare Advantage Organizations (MAOs) have made dramatic changes to the benefits and plan premiums they've offered members over the past years. Hear about information on the changes to benefits and plan premiums offered over the past few years. Find out where these strategic items are currently (for CY2024 bid year) and get ideas on what might come in the next few years. Presenters will discuss recent proposals and rules from CMS that will impact the current and future landscape. They will also compare these items in relation to the fee-for-service (FFS) Medicare market. This session will help you gain a deeper knowledge of the Medicare Advantage, Prescription Drug Plan, and Medicare FFS landscape and walk away with some strategic thoughts on potential paths MAOs may take from here.

Description: Discuss the dramatically changing provider landscape, as well as the innovative solutions being leveraged by providers to address the intriguing opportunities and complex challenges. Among the questions to be answered are the following: How can providers capitalize on employers’ desire to contract directly with local providers? What's the path for providers to develop employer stop-loss (ESL) capabilities to maximize network value/impact? Can providers create a risk portfolio including ESL for local employers, their own employee plan, and other delegated risk arrangements such as Medicare Advantage? How can captive insurers support a provider's risk strategy?

Description: Hear a summary of the discussion from the Health Section's Pharmacy Partnership Forum in March 2023 entitled 'Reimagining Pharmacy Financing' where a multi-disciplinary group of clinicians, health economists, academics, and actuaries met and discussed the following questions: How do we define the value of prescription drugs? How do we measure the value of prescription drugs? How do we scalably and meaningfully apply the answers?

Description: High performance providers and in turn networks are often a prerequisite for a highly competitive product. If performance is lacking, the ability to offer a competitive product on the street can be significantly hampered. Learn from a case study how an actuary might measure performance and compare and/or rank network providers on multiple concrete factors. Discussed comparators will include efficiency, care management effectiveness, market attractiveness (enrollment changes), inclusion in other health plan networks, etc. By attending this session, you will be able to use principles discussed in this session to more effectively evaluate provider networks for their employer.

Description: The document is a research call for proposals seeking researchers to produce a report on the uses of synthetic medical claims data for actuaries. It outlines the background, purpose, research objectives, proposal requirements, selection process, and conditions for submission.

Description: WeChat is gradually becoming the main force of insurance online marketing for insurance products in China.