Description: At the beginning of 1999, a new model regulation is expected to be approved by the National Association of Insurance Commissioners and will regulate risk-based capital for managed care organizations. Panelists describe the regulation and offer insights into the why, wherefore, and whereto. They consider the potential impact of the new regulation on the current life insurance company risk-based capital regulation that governs traditional health carriers.

Description: In this session 114 PD of the New York Annual Meeting the panel provides an overview of prevalent risk adjustment methods and focuses on a new method being developed with the help of a grant from the National Institute of Standards and Technology. From the Record of the Society of Actuaries, Vol. 24, No. 3.

Description: ACA risk adjustment has now been in play for years. The original intent of risk adjustment was to help stabilize the market through measuring risk levels of each issuer. However, the risk adjustment program may have introduced additional uncertainty due to annual market shifts and model changes, making risk adjustment estimation is a difficult task. This article analyzes the results over time, including impacts from market changes and model changes.

Description: Discuss the dramatically changing provider landscape, as well as the innovative solutions being leveraged by providers to address the intriguing opportunities and complex challenges. Among the questions to be answered are the following: How can providers capitalize on employers’ desire to contract directly with local providers? What's the path for providers to develop employer stop-loss (ESL) capabilities to maximize network value/impact? Can providers create a risk portfolio including ESL for local employers, their own employee plan, and other delegated risk arrangements such as Medicare Advantage? How can captive insurers support a provider's risk strategy?

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: This session series is sponsored by Hannover Re Session 1 - COVID-19: Past, Present and Future and Its Impact on Health Products COVID-19 has had an unprecedented impact on the health industry, forcing insurance companies and other risk-sharing entities to re-assess how to write and manage its business going forward. This first of two sessions in the special COVID-19 series will review the impact the pandemic has had on the development, pricing and risk management of health products. The speakers will review COVID-19 mortality and morbidity trends, share possible outlooks for the future of the virus, and analyze how COVID-19 has impacted the pricing strategies and risk management of health business across various markets (e.g., the ACA marketplace, Group Commercial and Medicare). By attending this session, you will be able to explain the latest COVID-19 trends in the US and globally and the resulting impact on mortality and morbidity experience. Attendees will develop a clearer understanding of how the pandemic has impacted the pricing and risk management of health products.

Description: Analysis of diagnosis and pharmacy-based methods of health risk assessment. Issue No. 44.

Description: Society of Actuaries Research Brief Impact of COVID-19, April 16, 2020

Description: Fifty-three percent of Americans responding to a survey conducted by the Society of Actuaries (SOA) Research Institute reported that extreme weather events – including hurricanes, tornadoes, heatwaves, wildfires and flooding – have adversely affected their health.

Description: Social Determinants of Health (SDOH) include the social and physical conditions in which people are born, live and work on a daily basis. This project advances a growing body of literature to inform the ongoing optimization of population health and payment models.