What Are We Trying to Prevent Anyways? Considerations When Re-thinking the Preventive Services Definition

The introduction of the Patient Protection and Affordable Care Act (ACA) brought about many legislative changes intended to improve the health of people in all healthcare markets (ACA, Medicare, Medicaid, Employer) in the United States. One such changes was the introduction of mandatory zero cost coverage for services determined to be "preventive"based on clinical criteria. In this session, we explore the evolution and scope expansion of the preventive category and other considerations, including historical utilization and cost of existing preventive services, before contemplating possible future changes to the ACA preventive list. This session is targeted towards actuaries working for health plans or state or federal regulatory agencies interested in learning about how the ACA preventive list could be modified to improve the long-term health of populations.

David Dillon, FSA,MAAA (Moderator)

Sr. VP & Principal, Lewis & Ellis

Dave joined Lewis & Ellis in 1999 specializing in health insurance and healthcare analysis. Dave currently focuses on product development, financial solvency and healthcare reform issues. Since the passage of the ACA, Dave has assisted 15 states with health care reform issues. He currently serves 10 states as their rate reviewer. Dave is very involved in the affairs of his profession and the health insurance industry through his volunteer efforts. Dave currently serves on the SOA's Board of Directors. From 2017 to 2019, Dave led the SOA's strategic initiative Commercial Healthcare: What's Next?. In 2017, Dave was a recipient of the Society of Actuaries' Outstanding Volunteer Award. Dave is also the co-Chair and Host for the SOA's Health Section Podcast series.

Michelle Beth Klein FSA,MAAA

Michelle is an actuary with the Chicago-Milwaukee office of Milliman.  Michelle has over seven years of actuarial experience in various areas of healthcare. Her primary areas of expertise are Medicare Advantage and commercial markets. Other clients have included provider owned health plans, Consumer Operated and Oriented Plans (CO-OPs), Medicaid plans, employer groups, and provider groups. She has assisted clients in various markets with pricing and filing plans, developing financial forecasts, and setting reserves. She also has experience in multiple markets assisting with competitive analyses and risk adjustment modeling.

Barbara Rena Collier FSA,MAAA

Barbara Collier is a ConsultingActuary with Milliman’s Chicago-Milwaukee Health Practice.  She joined thefirm in January 2008.  Barbara’s area of expertise is healthcare programs,including the development and maintenance of the CORAL benefit relativitycomparison model, Medicaid managed care, ACA legislative impact projections,ACA filings for the Individual and Small Group markets, Medicare Advantage,Medicare Part D, and international healthcare projection modeling.

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Webcast Session
09/08/2020 at 11:00 AM (EDT)  |  Recorded On: 09/08/2020
09/08/2020 at 11:00 AM (EDT)  |  Recorded On: 09/08/2020
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