Description: This article provides an overview of behavioral economic theory as it relates to health and welfare insurance plans and provides summaries of two sample applications of the theories: enrollment in health insurance exchanges created by the Patient Protection and Affordable Care Act, and product design considerations in light of vast health illiteracy.

Description: "Direct medical costs for cancer care topped $209 billion nationally in 2020, accounting for a significant proportion of all health care expenditures in the U.S. Indirect costs are also significant, encompassing loss of productivity, wages, leisure time and decreased quality of life. The way cancer programs deliver and are reimbursed for care is rapidly changing. As the cost of cancer care continues to rise, several new value-based care programs - both public and private - have attempted to curb these rising costs. Learn about the current landscape of VBC oncology programs, several key challenges and opportunities with oncology analytics, as well as anticipated evolution of cancer care in the near future. Topics include: Current VBC oncology landscape, including a more detailed discussion on CMS' latest oncology program, Enhancing Oncology Model (EOM) Discussion on current challenges and opportunities with oncology analytics, including some advanced methodologies that have been developed based on documented clinical pathways to better understand cost drivers Future state of oncology care including emerging pharmaceuticals and novel therapies, personalized care regimens, and other clinical innovations"

Description: The Part D program is funded through a variety of government subsidies and manufacturer discounts. The federal reinsurance, initially designed as protection from catastrophic spending, became a primary source of subsidies for the program. When the Inflation Reduction Act (IRA) is fully implemented in 2025, the funding of Part D will realign to its original intent.

Description: "Examine the impact of traditional deductibles on health care equity and the need for innovative plan designs. You will learn about the limitations of consumer-driven health care costs broadly today, as well as alternative cost-sharing approaches that have been successful in driving consumerism without exposing members to high costs. By attending the session, you will be able to: Have a clearer understanding of the issues surrounding deductibles Be equipped with practical ideas for creating more equitable and effective cost-sharing solutions Assess the feasibility and potential impact of implementing these solutions for your own organization"

Description: In honor of Bob Barker's 100th birthday (December 12, 2023), we will examine the emerging development in the opaque world of health care prices. 'Referenced Based Pricing' has been a cost-cutting strategy applied by some self-insured employers, but administration, employee dissatisfaction with balance billing, and litigation have been barriers to growth. The new transparency data has yielded research indicating that 'cash prices' are lower than commercially negotiated rates in some areas. Dive in with industry experts as they discuss emerging trends of how consumers, employers, and health insurers will pay for health care services.

Description: Many drugs, like the immunologic drugs used to treat inflammatory and oncologic conditions, are FDA-authorized to treat more than one condition. Given different conditions have varying clinical outcomes and costs, it is likely the same drug provides a range of value across multiple conditions. However, such drugs have traditionally had a single list price and corresponding payer net cost. Indication-based pricing and benefit design (IBPBD) is intended to address the variable clinical and economic value for the same drug across multiple treatment indications. As this trend continues to evolve, the determination of drug value by treatment indication will create risks and/or opportunities in pharmacy benefit design, ultimately impacting pharmacy PMPM forecasting and incurred costs. Learn from faculty as they: Provide the business context for IBPBD. Describe varying structural approaches. Discuss the market conditions that can motivate or demotivate payers. Explore operational barriers. Recommend a role for actuaries. To bring the discussion to life, a case study will be reviewed. By attending the session, you will be able to: • Describe the meaning of Indication-Based Drug Pricing and Benefit Design (IDPBD). • Understand the risks and opportunities with IBPBD. • Articulate the advantages and disadvantages of distinguishing the value of a drug by treatment indications.

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: Experience a comprehensive overview of the current purchasing landscape for health care services, with a specific focus on how healthtech start-ups can break into the employer-sponsored health care market. You will learn about the key players in the healthcare industry, as well as challenges that new entrants (+ B2B vendors more generally) face in selling their services to employers and health plans.

Description: The evolving specialty pharmacy environment has created difficulties for actuaries pricing and forecasting pharmacy coverage. Unpredictable specialty pharmacy trends have increased insurers' earnings volatility and affected members' health care affordability. The presenters will highlight the current specialty drug development pipeline and explore specialty pharmacy drug trend management strategies. They will also provide concepts to help manage the coming wave of gene and cell therapies.

Description: This session series is sponsored by Hannover Re Session 1 - COVID-19: Past, Present and Future and Its Impact on Health Products COVID-19 has had an unprecedented impact on the health industry, forcing insurance companies and other risk-sharing entities to re-assess how to write and manage its business going forward. This first of two sessions in the special COVID-19 series will review the impact the pandemic has had on the development, pricing and risk management of health products. The speakers will review COVID-19 mortality and morbidity trends, share possible outlooks for the future of the virus, and analyze how COVID-19 has impacted the pricing strategies and risk management of health business across various markets (e.g., the ACA marketplace, Group Commercial and Medicare). By attending this session, you will be able to explain the latest COVID-19 trends in the US and globally and the resulting impact on mortality and morbidity experience. Attendees will develop a clearer understanding of how the pandemic has impacted the pricing and risk management of health products.