ERM Under the ACA

Session Description:

The session will cover the impact of the SCOTUS decision regarding premium subsidies, demographics of those enrolling on the exchange and evolving regulatory environment. The session will also cover morbidity of those enrolling in the exchange, unintended consequences of risk adjustment and unknowns for financial reporting.

Speaker(s):

Janice Knight is Chief Actuary and divisional senior vice president Health Care Service Corporation’s (HCSC). The nation’s fourth largest health insurance company, HCSC operates the Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, which together have more than 14 million members. In her role, Janice oversees health insurance pricing and underwriting for all of HCSC’s small, large and major national groups as well as for all Medicare, Medicaid and individual policyholders. In addition, she has played a crucial role in HCSC’s efforts to understand and implement provisions of the federal Affordable Care Act. Prior to joining HCSC in 1995, Janice worked for a major commercial health carrier. A highly recognized leader in her field, Janice has presented at several industry events, ranging from BlueCross BlueShield Association conferences to Healthcare Businesswomen’s Association meetings on topics ranging from actuarial issues to negotiating health reform. Janice is a Member of the American Academy of Actuaries and a Fellow of the Society of Actuaries. Janice received her Bachelor of Science degree in Mathematics from Michigan Technological University in Houghton, MI. She attained her Fellowship in the Society of Actuaries in 1991.

Jason Siegel performs pricing, valuation, and compliance activities for a number of individual and small group health plans. He has developed expertise in many areas of the Affordable Care Act (ACA) affecting commercial carriers, in particular the “3Rs.” He has led the development of firm-wide models to develop rates under the ACA, and to estimate accruals for new items that carriers will need to account for. Examples of Jason’s ACA expertise include:

• Developing applications for four of the first eight Consumer Operated and Oriented Plans(CO-OPs) that received federal loans
• Guiding strategic decisions related to leveraging the 3Rs, including the use of benefit plan and formulary design
• Assisting several commercial health plans with their post-ACA pricing and population modeling
• Helping plans to implement best practices around diagnosis coding and risk score optimization