April 2017

E&R Sponsored Sessions at the June Health Meeting

By Ian Duncan and Chuck Fuhrer

There are a lot of sessions at the health meeting covering the Affordable Care Act and its putative replacements. Whether we know what these look like by June or not, the E&R Section will sponsor a session moderated by Ian Duncan looking at two alternative structures. One of these is the free market, something that hasn’t existed in U.S. health care—possibly forever, but certainly not since the early 20th century. One of the things that differentiates health care from other markets (aside from the high degree of regulation) is the innovation that has been evident in so many other industries. If we think back several generations, many of the services we experienced were very manual. The 20th century saw significant shifts in automation (think the personal computer and Windows) and self-service (supermarkets; ATMs). These developments resulted in increased efficiency, higher quality and lower prices for many goods and services. Compare this with the health care sector, which is still organized pretty much as it was in Victorian times by Florence Nightingale, just with better technology and drugs. What differentiates innovative sectors from health care is the degree of consumer-based competition that exists in other industries. This session will explore the implications for health care, and how it may be possible to introduce more market-based competition. Kicking off the discussion with a re-cap of the Affordable Care Act and its problems is Greg Fann from Axene Health Partners. Greg has written extensively on the ACA in the Health Section newsletter, Health Watch. Speaking for the free market will be Prof. Ted Frech, a health economist from University of California Santa Barbara. Ted has written extensively on health insurance markets.

The other side of the coin, advocated by many (those that “felt the Bern” in the last election campaign, for example) is a single-payer model. We welcome Dr. Ed Weisbart, MD, CPE, FAAFP, a family physician from St. Louis Missouri. Dr. Weisbart is the chair of the Missouri chapter of Physicians for a National Health Program, and a former chief medical officer of Express Scripts. We can promise the audience a lively discussion.   

The E&R Section will also sponsor a session entitled “Next Generation Risk Adjustment.” The session will discuss the issues associated with traditional risk adjustment and how these are being handled in the next generation models. The session will discuss the credibility and variance associated with risk adjusted claims, some of the biases introduced by traditional models and how they can be fixed, as well as how these models can be customized for non-traditional uses, such as in provider reimbursement arrangements. The speakers for this session will be Chuck Fuhrer on variance in risk adjusted estimates and how the variance can be reduced, Ian Duncan on biases in traditional risk adjusters and how these biases can be reduced, and Jason Siegal on how risk adjustment models can be customized for use in provider reimbursement.

Both sessions promise to be lively and we welcome attendance and participation from those with something to say on the topic!

Ian Duncan, FSA, FCA, FCIA, FIA, MAAA, is adj. associate professor at University of California – Santa Barbara. He can be reached at duncan@pstat.ucsb.edu.  

Chuck Fuhrer, FSA, FCA, MAAA, is a consulting actuary at Segal Consulting. He can be reached at cfuhrer@segalco.com.