Description: Explore the value and cost of prescription drugs, how they should be defined and measured and the effects various stakeholders in the pharmacy ecosystem can have on these factors in the latest webcast. You'll investigate the impact of coverage, formulary and rebate negotiations and related benefit design. Find out how actuaries can answer questions related to the prescription drug industry, in addition to improving the access, quality and affordability of prescription drugs in the United States. Join us for this webcast and come learn about value-based contract design, negotiations, implementation and administration for prescription drugs.

Description: As the medicine practice continues to evolve, join us for this webcast to receive up-to-date information about the incorporation of scientific advancements and emerging evidence into the field. The creation of innovative treatments and the focus on improving patient outcome can cause information and price shocks, which will be one of the covered topics. Expect to utilize this webcast as an introduction to precision medicine, which is a genetics-based approach to healthcare. Speakers will share their experiences in demonstrating cost-effectiveness and promoting reimbursement with this new approach.

Description: Dealing with more known unknowns? More scary knowns? Or unknown unknowns? What is the next unthinkable? What future events should actuaries actively be modelling and keep us up at night? The Catastrophe & Climate Strategic Research Program of the Society of Actuaries Research Institute (SOA) put forth a call for essays exploring these risks. The Program Steering Committee selected these essays submitted by Sam Gutterman and Max Rudolph to publish, and are awarding them each a prize of $500. The Catastrophe & Climate Strategic Research Program Steering Committee congratulates the authors and is happy to publish the winning essays on the SOA website.

Description: Healthcare risk adjustment methodologies have become increasingly complex, largely due to the belief that complexity enhances accuracy. However, a disconnect exists between how healthcare risk is assessed and how payments are adjusted. This article explores the stark difference between measuring the accuracy of a risk assessment model at a member level, and that of a risk adjustment mechanism at the health plan level. I show that a highly simplified approach that does not use diagnosis codes can have similar accuracy on risk adjusted payments to models that do. These findings suggest that accuracy is not a barrier to developing simpler risk adjustment methodologies, which can improve payment accuracy and reduce the financial incentive for coding diagnoses.

Description: Measuring the interplay between climate risk and morbidity and mortality is complex and often requires a multidisciplined team approach to meeting objectives. In this session, presenters discuss their journey and the twists and turns encountered in examining the link between wildfires, air quality, pollution, and morbidity and mortality implications. In addition to sharing their insights about the process, presenters will provide results from their, such as: - Mortality and morbidity risk trends influenced by climate change, wildfires, and air quality issues - Regional, risk class, socioeconomic, and temporal variations in these trends - Projections based on the observed trends and their implications for the future - The impacts on specific causes of morbidity and mortality, such as respiratory disease, cancer, and cardiovascular disease By attending this session, you will gain a better understanding of the following: - Implications of the study for life and health insurers - Key risk factors for individuals affected by air quality issues, the drivers for morbidity and mortality impact, and differences between the general and insured population - Process, data, models, and considerations needed for examining the mortality and morbidity consequences of climate risks like wildfires

Description: A priori, one would expect In Home Assessments (IHA) and Telehealth (TH) Encounters to identify some conditions that lead to actions that keep a member or two out of the Emergency Room. Similarly, one would expect Care Management and Disease Management engagement to ultimately influence some improvement in documentation that leads to more accurate Risk Adjustment. The business cases for these activities are often siloed to only the primary activity. The relationship between risk adjustment and care management is often more recognized as competing interests - one generally relying on utilization and the other trying to reduce it. Business cases can change dramatically when profiling has a more complete picture. This session will explore some techniques and share some observations - positive and negative - of the interactions between CoC and Risk Adjustment.

Description: Critical illness insurance is a popular supplemental health insurance product in the U.S. market. This article discusses how carriers have recently sought to add value by expanded the benefits offered in their critical illness products. Specifically, the article discusses the consumer need and development considerations of adding benefits for autism Spectrum Disorder, Mental health disorders, Specified Disease Coverage, and enhance Cancer Coverage to a critical illness contract.

Description: Keynote Speaker: J.D. Kleinke, Author and Medical Economist J.D. Kleinke has been instrumental in the creation of four health care information organizations; has served on the Boards of several health care companies; and spent many years advising both sides of the political aisle on non-partisan, practical approaches to health policy and legislation.