Description: Pharmacy prices are top of mind for many consumers, policymakers, and payers. While there have been many efforts to reduce pharmacy costs over the years, many believe these efforts only helped us cope with the symptoms of the problem without providing a comprehensive cure for the underlying causes of this problem. The Society of Actuaries Health Section sponsored this Pharmacy Partnership Forum to gather multi-disciplinary experts in the pharmacy ecosystem. This report shares the insights and learnings that emerged from this group of health economics outcomes researchers, clinical pharmacists, medical doctors, health actuaries, benefits consultants and brokers, and their collective thoughts on advancing this exploration for society’s benefit.

Description: Delve into the factors contributing to the rapid growth of high-cost medical treatments and how payers can manage the financial exposure that comes with them. Learn about the current and near-future state of million-dollar medical costs, as well as the trends shaping the industry. By attending the session, you will have a better understanding of the underlying drivers of high-cost treatments and will be equipped with practical strategies for mitigating their financial impact, including risk management techniques, cost containment measures, and new payment models. Additionally, you will be able to identify key considerations for implementing these strategies in their own organizations.

Description: Actuaries team up with Payers and Providers, to share insight into their data-driven approaches for improving health plans' CMS Medicare Star Ratings, which leverage experiential analytics to create solutions. 'Experience' is the king-it is broader umbrella, which includes and addresses engagement, cultural competency, equity, cost, and lastly, 'quality'. By attending this session, you will be better equipped to turn real-life data into actionable business solutions-essentially, data science in action. Further, you will better appreciate the importance of stars and risk adjustment in the Medicare Advantage space, along with the consequences of coming up short.

Description: The Inflation Reduction Act represents the largest change to the Medicare Part D program since its inception in 2006. With a complete redesign of the Part D program coming in 2025 (the next bid cycle), there are health plan, operational and analytical challenges that lie ahead. In this session, you will: Hear highlights on some of the key changes occurring in 2025 Learn about key considerations for health plans and other stakeholders in the Medicare and commercial markets Discover potential winning strategies and potential analyses that could inform those strategies

Description: State Medicaid programs have broad flexibility to establish their own payment methodologies and rates for hospital services. Many states direct additional funding to populations, services, and hospitals where Medicaid comprises a disproportionate share of total business, or where there are other access concerns (e.g. rural providers). Actuaries can play a key role in determining where those additional funds would have the most benefit.

Description: Gain a clearer understanding as a provider and a payer discuss the insights gained from being involved in value-based care. Learn about the payer's perspectives on how to develop a value-based contract, the negotiation process and the support they provide the provider. Discover the provider's perspectives on how value-based contracts have impacted them, the analytics they are developing and the collaboration with the payer.

Description: Connect with the health actuarial community -- explore innovative solutions, advance your career, and participate in engaging, interactive events. Join the industry’s leading actuaries, analysts and professionals to network and discuss the impacts of the latest marketplace factors and trends.

Description: Connect with the health actuarial community -- explore innovative solutions, advance your career, and participate in engaging, interactive events. Join the industry’s leading actuaries, analysts and professionals to network and discuss the impacts of the latest marketplace factors and trends.

Description: Learn how medical coding, claims, data-sourcing and more are relevant to actuarial work in the health care field when you sign up for this SOA e-course.

Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.