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The change in administration along with the shift of power in both houses of Congress creates new opportunities for changes in the healthcare landscape following the 2020 elections in the United States .
Ed Pudlowski moderated the opening session of the Annual Healthcare Meeting sponsored by the Conference of Consulting Actuaries (CCA). Phil Ellis, President of Ellis Health Policy, Inc. and an independent consultant on health policy issues and economic analysis, and Brigen Winters, an ERISA and tax attorney and Partner with the Groom Law Group, joined Ed in offering their perspectives. The panelists discussed the recent legislative and regulatory changes shaping the healthcare environment today as well as the issues and proposed healthcare legislation likely to be front and center in the healthcare debate under a Biden administration.
At the Annual Meeting of the Conference of Consulting Actuaries (CCA) in October, 2020, Ed Pudlowski presented with Greger Vigen (an independent actuary) and Mark Wernicke (VP of Managed Care at ThedaCare) in a session entitled “Value-Based Care Through Physician Groups: An Actuarial Business Perspective.” At the same meeting, Ed spoke with Katherine Hempstead (Senior Policy Advisor with the Robert Wood Johnson Foundation) and Len Herk (Executive Director and Senior Economist with the National Council on Compensation Insurance) in a session entitled “Hospital Consolidation and the Impact on Healthcare Costs” (pictured).
On November 4th, 2020, Ed presented alongside David Tuomala (Optum), Robert Nation (Optum Advisory Services), and Todor Peney (Aon) in a session entitled “COVID-19 and Healthcare” where he addressed best practices in modeling health care claims projections under a pandemic. The session was part of the CCA’s webinar series.
Greger Vigen, Mark Wernicke, and Ed Pudlowski authored a paper entitled "Value-Based Care through Physician Groups: An Actuarial Perspective."
Sustainable Value-Based Care programs, whether through Accountable Care Organizations (ACOs), Medicare Advantage programs, or commercial networks need strong performance from providers, including physician groups. Some groups sustain better performance, defined in terms of higher quality and lower spending for buyers. This paper offers real world insights into the business approaches used by the better performing provider groups, including how physicians organize themselves to meet buyers’ goals.
See "Articles" section below for a full copy of the paper entitled "Value-Based Care through Physician Groups - An Actuarial Perspective."
On, June 4th, Ed spoke on the webinar "Numbers matter – Coronavirus in the UK and US. What we know and what happens next" sponsored by International Longevity Centre UK. (replay available at https://ilcuk.org.uk/webinar-numbers-matter-coronavirus-in-the-uk-and-us/).. Additionally, on May 12, Ed presented with an international panel of experts in the webinar “COVID-19 Pandemic – International Health Care Perspectives, Lessons. What Next?” (replay available at https://www.actuview.com/iaahs-live-session-on-covid-19_299f7d382.html) The webinar was sponsored by the International Actuarial Association as part of their virtual Paris Colloquium 2020.
Ed has also been asked by the Society of Actuaries to participate in a multi-disciplinary working group to offer guidance to insurance regulators and carriers on best practices for modeling the cost effects of COVID-19 on health care insurance rates for 2021.
Purchasers of large group health plans have a myriad of choices when it comes to innovative solutions, or disrupters, designed to improve care and reduce the cost to the participant and the plan. With the expansion of these disrupters and failed promises from some entities, plan purchasers are now demanding a greater level of support for the value propositions, including analyses that are specific to their populations and claim utilization profile.
Ed Pudlowski and Mac McCarthy co-authored a paper published in Benefits Quarterly (produced by the International Society of Certified Employee Benefit Specialists) which addresses best practice approaches to analyze stated value propositions of healthcare disrupters.
See "Articles" section below for a full copy of the paper entitled "Evaluating the Value of Health Plan Disrupters."
Rounding out Ed’s term as President of the Conference of Consulting Actuaries (CCA), he provided the opening address to the largest number of attendees for a CCA Annual Meeting in its history. Ed’s address focused on the accomplishments of the Board of Directors of the CCA over the past year which resulted in an increase in membership to the highest level in the CCA’s nearly 70 years of existence.
Ed also addressed the initiative started earlier in the year to rebrand the CCA to appeal to a new generation of actuaries as well as established actuaries who join the CCA for high-quality continuing education and professional networking opportunities. Ed summarized the CCA's perspective by stating “we empower and propel leaders, providing a meaningful perspective, to advance the practice”.
At the Annual Meeting of the Conference of Consulting Actuaries, Mac McCarthy (pictured above) spoke on best practices for evaluating and selecting innovative healthcare solution providers for health plan sponsors. Mac addressed the need for plan sponsors to identify their cost drivers, develop success metrics, and design the appropriate study methodology to assess the value of an innovative healthcare solution. Mac also discussed how to design the appropriate study methodology for a given solution and the available data.
Ed Pudlowski spoke about the opportunities and risks involved in creating and managing an Association Health Plan, including how best to differentiate an offering through benefit design, pricing, funding, and the use of innovative healthcare solutions. Ed also participated as a panelist addressing professionalism and ethics for healthcare actuaries.
The Conference of Consulting Actuaries held their annual Healthcare Conference at the Marriott Wardman Park Hotel in Washington, DC April 10th and 11th, 2019. Mac McCarthy (pictured above) conducted a session on how healthcare providers can best leverage actuaries. Mac also presented in a session on actuarial professionalism and ethics on healthcare actuaries as expert witnesses.
Ed Pudlowski moderated the key note session on how purchasers can advance value in the marketplace. The key note speaker for the session was Michael Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions. Ed also conducted a session on healthcare actuarial modeling with Gary Miller, Vice President and Senior Actuary with Claros Analytics.
(See "Articles" section below for a copy of the presentation)
Healthcare intervention (or demand management) strategies are widely used in the general service industry to enable effective and efficient use of capacity and improve quality of care. Demand management programs are often key success factors for employers in their ability to manage health care cost and annual increases that continue to exceed general inflation rates.
Mac's and Ed's discussion explored how these programs have been used to control costs, discussed how “success” is defined, and how it may be measured to demonstrate value.
We can help plan sponsors and intervention program providers determine the effectiveness of these programs and validate the value these programs offer.
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