Dave Dillon, FSA, MAAA interviews Kelly Backes, FSA, MAAA on her June 2018 Health watch article: Medicare Advantage Star Ratings: Expectations for New Organizations.  The discussion covers the impact of star ratings on Medicare Advantage plan revenue, the current star rating landscape, and star rating considerations and expectations for new organizations.

Direct download: SOA_136_1.mp3
Category:Health -- posted at: 3:26pm CST

For the second year the SOA will be sponsoring the provider risk sharing boot camp. In this podcast, Dave Dillion and Colleen Norris discuss what content will be covered in this two day boot camp, and why this information is so important for health actuaries.

Direct download: SOA_134.mp3
Category:Health -- posted at: 7:42am CST

In this podcast, Dave Dillon interviews Dan Bailey about the SOA Medicare Advantage Pricing boot camp.  They discuss the course and Medicare Advantage pricing.

Direct download: SOA_133.mp3
Category:Health -- posted at: 8:21am CST

Dave Dillon, FSA, MAAA, interviews Greg Sgrosso, FSA, MAAA, about his February 2017 Health Watch article, “Reasons to Reconcile.” Financial reconciliation is critical to a successful Medicare Advantage (MA) bid, and this podcast emphasizes the reasons to reconcile early and often.

Direct download: SOA_101_Dillon_Sgrosso.mp3
Category:Health -- posted at: 10:27am CST

This podcast discusses some promising early results for self funded plans indicating that trusted services, helping people navigate the health care system can help lower health care cost trend.   Hear how having someone you trust guiding you to get the right services in the right setting can be a wonderful approach to eliminating waste in the system.

Direct download: SOA_120_Dillon_Cymerys.mp3
Category:Health -- posted at: 7:34am CST

What do (and should) we know about public health, and why should we care? A brief discussion of the influence of public health on our lives and our work.

Direct download: Dillon_McAleer_SOA_119.mp3
Category:Health -- posted at: 8:32am CST

In the commercial major medical health market, the significant difference between older and younger individuals becomes more important as our population gets older overall and as medical advances allow for longer lives (at a cost).  The Affordable Care Act implemented strict demographic rating restrictions on the individual and small group markets, but recent efforts have sought to relax these requirements.  What should insurers be ready to face in these already-challenging markets?

Direct download: SOA_117_Norris.mp3
Category:Health -- posted at: 8:34am CST

Genomic testing can help inform decision making in treatment pathways for selected disorders. This podcast introduces relevant considerations around the funding of these tests that can support a greater appreciation of the risks and gains to payers for embarking on the personalized medicine journey.

Direct download: SOA_114Serre.mp3
Category:Health -- posted at: 8:11am CST

John Culkin and Joe Slater discuss how changes in the handling of pre-existing conditions and increasing the age rating slopes could lead to remarkedly lower premiums in the Individual ACA market.

Direct download: SOA_113Slater_Culkin.mp3
Category:Health -- posted at: 12:56pm CST

A few months ago President Trump discontinued CSR reimbursements. Join us as we explore what this means for the individual health insurance market and why it may be better to leave them in the past.

Direct download: SOA_105Ratzlaff.mp3
Category:Health -- posted at: 8:41am CST

Find out how actuaries can contribute a unique perspective to driving better collaboration between payers and providers in an integrated delivery system towards a more financially sustainable future for both.

Direct download: SOA_106.mp3
Category:Health -- posted at: 12:05pm CST

Dave Dillon, FSA, MAAA interviews Karena Weikel, ASA, MAAA on her February 2018 Health watch article:  Risk Adjustment:  The Details and Why They Matter.  The discussion covers the CMS-HCC part C risk adjustment model and the intricacies within.  As the health care industry moves towards value-base care, many of the arrangements have some form of a diagnosis-based risk adjustment program.  As actuaries, we understand all the intricacies and complexities built into risk adjustment programs.  We can help educate our providers, demonstrate our knowledge and provide analytic support.

Direct download: 44566978_02-01-2018_08.32.57_Dillon_Weikel.mp3
Category:Health -- posted at: 7:35am CST

Dave Dillon and Trey Swacker discuss the potential impacts health care reform may have on the small employer market.


Self Insurance is, by members, the most important approach to funding employee health benefits in the commercial market, yet comparatively few actuaries specialize in this area. This podcast explains how the SOA Health Section's strategic initiative on self-insurance is working to educate actuaries and others about self-insurance challenges and opportunities.

Direct download: SOA17_33_Health_13_Self-Insurance_Task_Force.mp3
Category:Health -- posted at: 7:46am CST

During this podcast, Dave Dillon interviews Liz Leif about the Next Generation High Risk Pool and its impact on the Individual Market.

Direct download: SOA17_32_Health_12_Next_Generation_High_Risk_Pools.mp3
Category:Health -- posted at: 11:15am CST

Dave Dillon interviews Ken Beckman about his October 2017 Health Watch article, “An Actuarial Model to Improve Health and Reduce Costs.” This model offers financial incentives to health care providers to help patients achieve improved health resulting in reduced overall health care costs. In contrast to the current environment which incentivizes prescribing drugs and medical procedures, this model relies on a prescription of whole food plant-based nutrition which has been shown in the scientific literature to be effective at reversing many common and chronic costly health conditions with no negative side effects.

Direct download: An_Actuarial_Model_to_Improve_Health_and_Reduce_Costs.mp3
Category:Health -- posted at: 10:18am CST

The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 caused sweeping changes in the dental insurance industry, affecting the construct of dental benefits, the pricing of those benefits, and the availability of dental coverage. Now, as changes to the ACA or elimination of some of its provisions could potentially be enacted in the coming months, the dental benefits industry again must determine how to succeed in this evolving environment. In this podcast we explore the impact of the ACA on dental and the potential ramifications of any changes to the dental related components of the law.

Direct download: SOA17_26_Health_08_Health_Reform_Dental_Impact.mp3
Category:Health -- posted at: 7:23am CST

There are roughly 46 million Americans are living with serious illness and functional impairment, and that number will soon swell, given demographic trends.  Palliative care is an added layer of support that relieves the pain, symptoms and stresses of serious illness, appropriate at any age and any stage of illness, ideally concurrent with treatment. Multiple studies demonstrate that the resulting improvements in quality of life translate directly into reductions in avoidable ED and hospital utilization.  SOA sat down with Dr. Diane Meier, founder and director of the Center to Advance Palliative Care (CAPC) to learn more about what palliative care is, who benefits, and what health plans and population health managers can do to improve care for those facing serious illness.

Direct download: SOA17_27_Health_09_Palliative_and_Hospice_Care.mp3
Category:Health -- posted at: 8:29am CST

Learn about the potential impacts of selling health insurance across state lines as it relates to the individual and small group markets.

Direct download: SOA17_24_Health_07_Health_Ins_Across_State_Lines.mp3
Category:Health -- posted at: 10:33am CST

The Medicare Advantage market is currently in the middle of a multi-year transition from the existing Risk Adjustment Processing System (RAPS) to the new Encounter Data System (EDS) for calculating risk scores. CMS has stated that ultimately EDS will be the sole diagnosis data source for Medicare Advantage organizations’ risk scores and revenue. Dave Dillon, FSA, MAAA, interviews Deana Bell, FSA, MAAA, on the topic and they discuss how the transition has shown to have a financial impact on Medicare Advantage revenue and how actuaries are well equipped to help.

Direct download: SOA17_22_Health_06_Medicare_Advantage_Risk_Scores.mp3
Category:Health -- posted at: 2:49pm CST

During this podcast, Dave Dillon interviews Andrew Sykes about his non-traditional path to actuarial work and helping actuaries to develop the skills to influence other people to take specific actions based on their work.

Direct download: SOA17_28_Health_10_Influence_Training_for_Actuaries.mp3
Category:Health -- posted at: 10:45am CST

Bayes’ Theory has been used to find a lost hydrogen bomb, break the German WWII code, identify smoking as a cause of lung cancer and heart disease, establish merit rating in insurance, and enable computers to “learn” and “make decisions.” But each time it was used, the techniques were not published, and the theory was allowed to die.  Actuaries played a prominent role throughout history in originally discovering Bayes’ Theory and resurrecting it to solve practical problems. Roy Goldman brings to life this actuarial history in his Contingencies article “Bayes’ Gift,” based on the book The Theory that would not Die by Sharon Bertsch McGrayne.

Direct download: SOA17_20_Health_05_Roy_Goldman.mp3
Category:Health -- posted at: 10:19am CST

During this podcast, Joe Wurzburger interviews Dave Dillon about the Health Section Council’s initiative concerning healthcare reform. They discuss how the SOA is addressing education and research concerning the important issues in the ever changing health insurance landscape.

Direct download: SOA17_21_Health_Commercial_Healthcare_Whats_Next.mp3
Category:Health -- posted at: 11:26am CST

The field of public health does important work around the world in keeping populations safe and healthy.  This podcast will explain how the SOA Health Section's strategic initiative on public health is working to educate and connect actuaries with the world of public health.

Direct download: SOA17_16_Health_04_Public_Health.mp3
Category:Health -- posted at: 8:10am CST

During this podcast, Dave Dillon interviews Jackie Lee about an article she coauthored on telemedicine. They discuss how the current telemedicine landscape and why actuaries should be paying attention into these types of services as it has potential pricing impacts.  

Direct download: SOA17_13_Health_03_Telemedicine.mp3
Category:Health -- posted at: 8:15am CST

Dave Dillon, FSA, MAAA interviews Randy Herman, FSA, MAAA about the November 2016 Health Watch article  “Review: Do Individuals Make Sensible Health Insurance Decisions? Evidence From a Menu With Dominated Options” that he co-authored. They discuss the sub-optimal health insurance choice decisions made by employees, methods to improve decision quality and how concepts from behavioral finance theory might help explain the results.

Direct download: SOA17_04_Health_01_-_Employee_Choice_Issue.mp3
Category:Health -- posted at: 4:26pm CST

This podcast gives a brief overview of the payment systems being introduced by MACRA as well as the changes to Medicare Supplement.

Direct download: SOA17_05_Health_02_MACRA_Medicare_Supplement.mp3
Category:Health -- posted at: 10:36am CST

Joe Slater FSA, MAAA talks about how under the Affordable Care Act (ACA), all groups with 50 or less employees will eventually be subject to the ACA’s modified community rating rules. While some groups will see lower premiums than they would have without the ACA, others will see significant premium increases. Though self-funding has historically only been a realistic option for groups with at least a few hundred employees, the premium disruption and potential loss of business caused by the ACA has incentivized insurance carriers and third party administrators to develop self-funded product offerings for small groups. These products are commonly referred to as Level Funding products.

Direct download: Health_Podcast_-_Level_Funding_with_Joe_Slater.mp3
Category:Health -- posted at: 5:11pm CST

Dave Petta, FSA, MAAA and Karen Shelton, FSA, MAA discuss their article on Private Exchanges published in the May 2015 issue of HealthWatch  Listen as they describe the tenets of Private Exchanges, how they differ from Public exchanges and their current outlook.

Direct download: Health_Podcast_with_D_Dillon_K_Shelrton_and_D_Petta.mp3
Category:Health -- posted at: 9:43am CST

This podcast features Dave Dillon, FSA, MAAA interviewing Gayle Brekke, FSA, MAAA on the topic of Direct Primary Care, a topic which is also covered in her article in the May issue of Health Watch.  This podcast introduces the direct primary care model, and outlines how it can improve care coordination, ensure that chronic conditions are well-controlled, reduce health care spending and improve the doctor/patient relationship. 

 

Direct download: Health_Section_-_Direct_Primary_Care_with_G_Brekke.mp3
Category:Health -- posted at: 3:29pm CST

This podcast features Dave Dillon, FSA, MAAA interviewing Sabrina Gibson, FSA, MAAA, and Jenny Gerstorff, FSA, MAAA on the topic of Medicaid encounter data, a topic which is also featured as the cover article of the latest edition of In the Public Interest. They discuss how various stakeholders collect, transfer, and use encounter data to understand healthcare benefits provided under managed Medicaid programs throughout the country.

Direct download: Health_Section_-_Medicaid_and_Encounter_Data_w_S_Gibson_and_J_Gerstorff.mp3
Category:Health -- posted at: 10:42am CST

In this podcast, Dave Dillon, FSA, MAAA interviews Kristi Bohn, FSA, MAAA, EA, MSPA on a state regulators insight regarding rate reviews.

Direct download: Health_Section__Rate_Review_with_Kristie_Bohn.mp3
Category:Health -- posted at: 10:40am CST

Dave Dillon, FSA, MAAA interviews Greg Fann, FSA, FCA, MAAA on his May 2016 Health Watch article “Section 1332 Waivers: Coming Soon to a State Near You?”. This discussion covers the process of states applying for waivers of ACA rules, the role of actuaries in the process, current state activities, and the potential market benefits of innovative solutions.

Direct download: Health_Section_-_ACA_Update_with_Greg_Fann1.mp3
Category:Health -- posted at: 9:35am CST

In this podcast, Dave Dillon, FSA, MAAA interviews Juliet Spector, FSA, MAAA on payment reform models.  The discuss key risks, important payment reform team members, and pricing.  Juliet also gives her opinion on whether she thinks payment reform will be successful.

Direct download: Juliet_Podcast.Final.mp3
Category:Health -- posted at: 11:33am CST

Dave Dillon, FSA, MAAA interviews Rex Durington, FSA, MAAA on his December 2015 Health Watch article: Critical Illness Pricing Overview - 2015 Update. The discussion covers the growing popularity of the product and topics from benefit design to product filing.

Direct download: Health_Section__Critical_Illness_Insurance_with_Rex_Durington.mp3
Category:Health -- posted at: 8:37am CST

Dave Dillon, FSA,MAAA interviews Shea Parkes FSA, MAAA about his recent article on predictive modelling with electronic medical record data.  They discuss topics such as the usefulness of electronic medical records in analytics and the visualization tools used to produce the images in the article.


Dave Dillon, FSA,MAAA interviews Brent Plemons, a Health Insurance Specialist in the Rate Review Division of CCIIO, to get an inside look at the role of the Federal Regulator.  They also discuss changes to the filing process and URRT for 2017, as well as common problems seen in the prior year’s rate filings.

Direct download: Health_Section__Rate_Review_with_Brent_Plemons.mp3
Category:Health -- posted at: 7:52am CST

Joe Wurzburger interviews Mark Jamilkowski, Todd Daniels, and Kurt Wrobel about their session from the 2015 SOA Annual Meeting covering ORSA for health plans. The guests reflect back over the primary lessons learned both from their own experiences with ORSA as well as from the Annual Meeting session itself. Listeners will be able to gain insight from three of the industry’s leaders that they can apply to their own ORSA reports going forward.

 

Direct download: SOA_Annual_Meeting_Joe.mp3
Category:Health -- posted at: 1:57pm CST

The affordable care act created a provision for states to offer a Basic Health Plan as an affordable coverage for members with incomes up to 200% of federal poverty level. However, very few states showed interest and only a couple offered the plan. Gain insights into why more states did not implement a basic health plan from an actuary who analyzed the financial impact of implementing this plan in the state of Massachusetts.

ACA@5 An Actuarial Retrospective 

Direct download: ACA_at_5_Karan.mp3
Category:Health -- posted at: 10:37am CST

Rowen Bell provides his insight on the concept and development of the ACA @ 5 An Actuarial Retrospective.  

ACA@5 An Actuarial Retrospective

Direct download: ACA_at_5_Rowen_Bell.mp3
Category:Health -- posted at: 10:34am CST

This podcast focuses on one the most important problems in analytic research - the development of biased analysis by researchers.  In the podcast, Kurt first highlights the problem by describing an internal debate among economists regarding their own biases and how it is connected to their research.  With this debate as background, Kurt then discuss how actuaries can avoid many of the pitfalls encountered by economists in doing their work - particularly when it applies to the most challenging aspects of public policy.  Article from June/July issue of The Actuary.

Direct download: Kurt_Wrobel.mp3
Category:Health -- posted at: 1:31pm CST

Health reform comes with many new rules for actuaries. It also brings actuaries unstructured challenges, such as providing an opinion on whether a particular program saves money. While actuaries have advantages over other professions for such problems, traditional approaches can easily lead the actuary astray. Hear about the right kind of thinking and methods from two non-traditional actuaries at the forefront of actuarial cause and effect analysis. Article from the May issue of Health Watch.

Direct download: Tia_and_Bruce.mp3
Category:Health -- posted at: 1:29pm CST

In this episode Greg Fann interviews Victor Davis and Georgia Attorney General Sam Olens, two panelists at the 2015 SOA Health Meeting, who presented the latest legislative, legal, and market complications related to the Affordable Care Act. They discuss current proposed federal legislation, potential scenarios with either outcome of King v. Burwell, and actuarial challenges projecting risk adjustment settlements.

Direct download: Session_12_Latest_on_the_ACA.mp3
Category:Health -- posted at: 10:24am CST

Rebecca Owen has a conversation with Dave Nieman about the nature of dual eligible members for specific government sponsored programs. 

Direct download: Health_Dave_Nieman.mp3
Category:Health -- posted at: 8:26am CST

Dan Bailey interviews Dave Wells who recently presented at the 2014 SOA Annual Meeting on Professionalism for Health Actuaries in the post ACA era of health reform. For those who could not attend his presentation, this episode will provide you with highlights from Dave’s session

Direct download: Interview_with_Dave_Wells.mp3
Category:Health -- posted at: 9:01am CST

Dan Bailey interviews Gregory Fann who recently presented at the 2014 SOA Annual Meeting on If We Knew Then What We Know Now: ACA Enrollment. For those who could not attend his presentation, this episode will provide you with highlights from Greg’s session.  

Direct download: Health_GregoryFann.mp3
Category:Health -- posted at: 1:54pm CST

Dan Bailey interviews Dave Dillion who recently presented at the 2014 SOA Annual Meeting on ACA Health Rate Review. For those who could not attend his presentation, this episode will provide you with highlights from Dave’s session.  

Direct download: Health_DaveDillion.mp3
Category:Health -- posted at: 10:58am CST

Dan Bailey interviews Jim O’Connor who recently presented at the 2014 SOA Annual Meeting on ACA Implementation and Strategies in 2017 and Beyond. For those who could not attend his presentation, this episode will provide you with highlights from Jim's session.  

Direct download: Health_JimOConnor.mp3
Category:Health -- posted at: 10:55am CST

In part 2 of this podcast, Dr. Mark McClellan continues to share his insights and explain the transformative role of ACOs and how they are helping to re-shape the finance and delivery of health care, not only in the US, but internationally as well.  He addresses the need for different care approaches for different populations, the future of health insurance, and the role health actuaries can play going forward.

Direct download: Mark_McClellan_Podcast2.mp3
Category:Health -- posted at: 1:55pm CST

In part 1 of this 2-part discussion, economist and physician, Dr. Mark McClellan, is interviewed by Daniel Bailey about the changes in the US system for the delivery and finance of health care.  Dr. McClellan is Senior Fellow at Brookings and Director of their Initiative on Innovation and Value in Health Care Reform.  He previously served as Administrator of CMS and Commissioner of the FDA.  In this interview, he focuses on the changes in care delivery and how they affect quality and affordability.  In particular, Dr. McClellan describes the effect of ACOs, their recent results and expected future.  This podcast is a follow-up to Dr. McClellan's keynote address at the SOA Health Meeting in June 2014.

Direct download: Mark_McClellan_Podcast.mp3
Category:Health -- posted at: 1:53pm CST

Dan Bailey interviews Mary Van der Heijde who recently presented at the 2014 SOA Health Meeting on Rate Review 101. For those who could not attend her presentation, this episode will provide you with highlights from Mary’s session. 

Direct download: Health_Section_Rate_Filings_for_the_Affordable_Care_Act.mp3
Category:Health -- posted at: 9:56am CST

Dan Bailey interviews Shari Rodriquez who recently presented at the 2014 SOA Health Meeting on Developing Your Leadership Brand. For those who could not attend her presentation, this episode will provide you with highlights from Shari’s session.  

Direct download: Health_Section_Developing_Your_Leadership_Brand.mp3
Category:Health -- posted at: 8:58am CST

In this episode Syed Mehmud reads the article he wrote for the July 2013 Health Watch, Nontraditional Variables in Healthcare Risk Adjustment. Then, Kristi Bohn holds a roundtable discussion on the topic with Syed and Geoff Hileman. This discussion was recorded at the 2013 SOA Annual Meeting.

Direct download: Health_Podcast__Nontraditional_Variables_in_Health_Care_Risk_Adjustment.mp3
Category:Health -- posted at: 9:19am CST

Listen in as Geoff Hileman reads from What is Available in 2014 for 2015 Individual Health Insurance Rate Filings?, an article from  the October 2013 issue of Health Watch.

 


Listen in as Mischelle Schweickert reads from Using a Global Budget with Risk Sharing to Drive Cost Savings and Improved Quality from the May 2013 issue of Health Watch.


Listen in as Mischelle Schweikert reads from Payment Reform: A Medicaid Overview, an article from the May 2013 issue of Health Watch.

Direct download: Health_Section__Payment_Reform-A_Medicaid_Overview.mp3
Category:Health -- posted at: 3:16pm CST

Direct download: healthcare_complex_models_author_discussion.mp3
Category:Health -- posted at: 2:08pm CST

Direct download: healthcare_reform_2.mp3
Category:Health -- posted at: 9:52am CST

What's going to happen with the exchange in 2014?

  • Introduction to the "metallic" plans.
  • How do actuaries determine Bronze, Silver, Gold, and Platinum?
  • What are outstanding questions related to the plans?
  • What's going to happen with families buying on the exchange?
  • Additional things to know about actuarial value.
  • What will happen with the actuarial calculator over time?
Direct download: healthcare_reform_1.mp3
Category:Health -- posted at: 9:00am CST

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