Description: Managed care networks are important to control rising health care costs . these need to be priced appropriately to produce the right results for all stakeholders . This includes analysis of utilization and costs for both in and out of network claims . A variety of risk and administrative service options exist for entities assuming such risk .

Description: Cell and Gene Therapy (CGT) are life-changing treatments where conditions such as cancer, hemophilia, spinal muscular atrophy and blindness are being cured. These are great for individuals and society, but the treatment costs are expensive which is bad for payers and reinsurers. This article explores ways for health reinsurance actuaries to participate in the space and evaluate the risk associated with these treatments

Description: The US healthcare system is among the world's most advanced, but is the highest-cost by far. At Swiss Re we studied the highest-cost US Medicare beneficiaries during 2016. The Medicare government program primarily covers seniors and individuals with disabilities. Total Medicare spending during 2016 was nearly USD 700,000,000,000. In our study, the 1% of beneficiaries with costs of USD 125,000 or higher generated 15% of total claim costs. Better understanding of these beneficiaries and their treatment could lead to improved quality and efficiency of care. Analysis of their claims can aid projections of the expected level and variance of costs. We calculated claim costs and rates, and identified higher-cost segments (including inpatient claims, individuals with disabilities or end-stage renal disease, Pacific states including California, and men). We look forward to expanding the analysis in future updates.

Description: Meditation on life, choices and events during the COVID-19 pandemic