Description: A divisive confrontation over health care pricing is almost inevitable over the next few years. What will ultimately happen is a political decision, not an actuarial one—but it will have major consequences for the trend in health care costs and the divergence between public and private insurance premiums.

Description: Health care cost trends are a key ingredient that health care actuaries use in their practice. In collaboration with the Health Care Cost Institute (HCCI), the Society of Actuaries has put together a data extract for practicing health actuaries to be able to better understand historical trends and cost disruptors.

Description: This session discussion is about under 25 life group medical reform, model bills, state variations, congressional proposal, community rate implications, effect of RBRVS on provider fees and plan cost. From Record of Society of Actuaries Vol. 17, No. 4A.

Description: Come explore an in-depth overview of telehealth to set context and navigate the continuing expansion of telehealth and its integration into the healthcare delivery system. You will examine the forces that shape telehealth offerings and expect a view of the possible futures of this evolving modality.

Description: In this report, we explore the impact of clustering using the Medical Expenditure Panel Study (MEPS) data for children (aged 5 to 17) to build a bridge between oral health and overall health using dental and medical expenditures. We include social determinants of health as cluster input variables using the Partitioning around Medoids (PAM) method to identify children and their families who could potentially benefit from population health management related to oral health.

Description: In this report, we explore the impact of clustering using the Medical Expenditure Panel Study (MEPS) data for children (aged 5 to 17) to build a bridge between oral health and overall health using dental and medical expenditures. We include social determinants of health as cluster input variables using the Partitioning around Medoids (PAM) method to identify children and their families who could potentially benefit from population health management related to oral health.

Description: This presentation is a panel discussion from the 1991 Meeting of the Society of Actuaries, held June 3-5 in Colorado Springs. The panelists discuss the potential impacts of recent and prospective legislation on flexible benefit programs, pricing and underwriting considerations in a flexible benefit environment, managed care and flexible benefits, and meeting the challenges that confront employers with flexible benefit programs. Discussion from participants is included. From the Record of Society of Actuaries, Volume 17, No. 3A.

Description: While states face a wide variety of circumstances and have implemented diverse approaches to the MOE phase-out, we revisit the conversation to discuss emerging experience across stakeholders as we examine the operationalization of the PHE unwinding as it relates to this major disruptor in the distribution of the healthcare enrollment.

Description: "Spread pricing is a pricing methodology where pharmacy benefit managers (PBMs) bill a payer one price but reimburses the dispensing pharmacy a lower price for the same prescription drug. PBMs have historically relied on spread pricing as a revenue source. However, a growing number of states are introducing and passing legislation prohibiting spread pricing for Medicaid and commercial clients. In addition, new entrants to the PBM and mail-order pharmacy space are disrupting the market by offering services that promote increased transparency and member satisfaction. Expect updates on recent legislative trends and market disruptions targeted towards increasing PBM drug pricing transparency. By attending this session, you will have a better understanding of how changing legislation and market disruptions may impact current pricing methodologies."

Description: "Hear an overview of recent results and potential scenarios that may impact the future of the ACA market. Review recent reported industry level profitability before transitioning to a discussion of how current market dynamics may influence the future profitability of this segment. Results from microsimulation economic models will be presented to help illuminate market shifts. Issues that will be explored include how ICRA availability might influence individual decision making, as well as how a move to level funding is impacting the small group market. By attending this session, you will: Understand the recent average and variation of industry performance in the ACA market segment. Describe current policy and market forces that are expected to impact this segment. Explain the range of market scenarios that may result due to these forces."