Description: Discover a comparison of U.S. and international mandated leave programs which mandate employers to provide a minimum level of benefits to employees for qualifying leaves of absence, such as parental leave or medical leave.

Description: Similar to how states had made adjustments to their capitation rates to reflect acuity adjustments caused by the onset of the pandemic, states will need to modify the rates to reflect the unwinding since utilization patterns and average acuity per enrolled member will change. When the continuous coverage requirements set forth by the COVID-19 Public Health Emergency (PHE) ended, Medicaid-managed care programs across the country adopted various approaches to phasing out maintenance of effort (MOE) as a result of changes to the PHE-era continuous eligibility requirements. Phasing out the MOE requirement will ultimately result in members who no longer meet eligibility requirements losing their Medicaid coverage. Further, states are facing a wide variety of circumstances and are implementing diverse approaches to the MOE phase-out. This topic will be of significant interest to all actuaries and stakeholders of the capitation rate development process for Medicaid-managed care programs. Join us as we discuss the operationalization of the PHE unwind while referencing the SOA's research project which models the effects of the unwinding on Medicaid eligibility and population costs. You will learn about the various approaches that different states have adopted to manage the unwinding process, which will be instrumental for accurately pricing managed care rates.

Description: This session will explore the financial health of rural hospitals, especially as it relates to the impact of payer cost containment strategies and government policies. Since 2005, more than 100 rural hospitals have closed and 600 more are at risk.

Description: This topic will explore current and upcoming changes to the risk adjustment models and strategies for payers and risk bearing providers to reduce/avoid headwinds and potentially come out on top in the years ahead. We will discuss the timeline, nature and motivation for changes as well as the anticipated associated impacts.

Description: On July 1, 2023, CMS began their latest Medicare Oncology program, Enhancing Oncology Model (EOM) which was the successor to the previous Oncology Care Model (OCM). Despite a high level of interest during the application period, this model has been met with limited participation, with only 44 participants at the start of the program.

Description: Medicare and Medicaid finance more than half of American health care. Medicare and Medicaid are at the forefront of nearly every major change in U.S. health care payments, from DRGs in the 1980s to today’s value-based care. Listen to a conversation with Bruce Pyenson, FSA, MAAA, who recently completed six years as a Medicare Payment Advisory Commission (MedPAC) commissioner and Stacey Lampkin, FSA, MAAA, who recently completed six years as a Medicaid and CHIP Payment and Access Commission (MACPAC) commissioner. Hear about programs’ current challenges, what changes the ex-Commissioners anticipate over the next few years, and how these changes might impact Medicare and Medicaid managed care plans, and spillover into employer-sponsored and individual commercial insurance. By attending this session, you will be able to appreciate the role of Medicare and Medicaid as health care payment change agents and foresee future health care payment changes.

Description: The cost of prescription drugs is top of mind for consumers, payers, and policymakers. While there have been many efforts to reduce pharmacy costs over the years, the problem remains. This begs the question “Where do we go from here?”. While each of the many policy proposals currently on the table help some people some of the time, none seem to address the root causes of rising prescription drug benefit costs.

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: While we are eight miles from Capitol Hill and a week away from the 2024 presidential election, actuaries and health policy experts will discuss the campaign platforms of the major parties and presidential candidates and the potential health policy implications in the next four years. Focus will be on the changing dynamics within ACA marketplaces with the knowledge benefit of both major party candidates having presidential administrative experience in the ACA environment. Session attendees will be well-equipped to discuss the post-ACA health policy implementation of Presidents Biden and Trump, recent policy proposals from both sides of the political aisle, and potential legislative/regulatory changes on the horizon.

Description: The U.S. health care system continues to have its problems. It costs too much and even with public policy developments we are not meeting the desired objectives. What's next? What else can we do? Discuss some of the emerging ideas that are being pursued and the likelihood of their success at solving our collective problem.