Description: Discussion of how to mature value-based contracts between health insurers and provider organizations to improve population health and financial sustainability. Centers around contract parameter consistency, revenue predictability and risk assessment. Intended audience are health plan and ACO actuaries and leaders. Authors are writing from the provider perspective in value-based contracts.

Description: Health Section News, August 2005, Issue 50 which discusses the effective management of prescription drug utilization and coverage that continue to represent one of the biggest challenges facing insurers, managed care organizations, employers and consumers alike.

Description: This article examines the history, theory, and effectiveness of high-deductible health plans and health savings accounts.

Description: Disease Management and the impact of overlap, co-morbidity on determining cost savings and employer buy-in. Issue No. 37.

Description: Recap of the health sessions at the 2014 SOA Annual Meeting.

Description: This article attempts to make a modest contribution to the dialogue on the potential and risks associated with novel treatments such as cell & gene therapies. With a fast-expanding roster of what are believed to be one-time treatments at ever increasing price points aimed at curing a wider swatch of the population, they are as much a source of relief for patients stuck in medical limbo, as they are a source of anxiety for payers.

Description: Social determinants of health (SDoH) have been a topic of growing interest in recent years, yet consensus about what the phrase represents and how health-related social needs should be studied or addressed by employers, health plans, providers and other stakeholders in the business of health care have been lacking. For many, low-income populations come to mind when considering the topic, yet SDoH include a wide range of factors beyond income. Many types of data are available, yet each presents distinct challenges and opportunities for analysis. In this article, we describe some of the underlying context for considering SDoH, as well as some of the potential data sources to consult and challenges to grapple with on this important topic.

Description: On July 19, 2021, the Health Section and the Reinsurance Section of the Society of Actuaries (SOA) cohosted a webinar titled “Modeling the Financial Effects of Emerging Cancer Treatments,” which provided an overview of rapidly evolving cancer therapies, including cell therapies (CAR Ts), gene therapies and specialty drugs.

Description: This article discusses the court cases dealing with the severability of the individual mandate from the Affordable Care Act. Severability is related to essentiality, and actuarial input was relied upon to determine essentiality. The article concludes with lessons that actuaries should learn from the legal proceedings.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.