Edition

Primer on Long-Term Care Wellness Programs

Background and Purpose

Long-term care insurance is intended to financially support consumers in the event of physical or cognitive health conditions that significantly impair their daily life. These conditions are primarily chronic and expected to last for a substantial period of time. Such conditions can result in a spectrum of needs ranging from support that can be provided in the home to those that require full-time residence in a nursing care facility or assisted living facility.

Given the nature of these conditions, there has been growing use of long-term care wellness programs for managing in force long-term care insurance business and as a feature in new long-term care insurance products. Similar to the goals of health wellness programs used for major medical insurance, there are a variety of ways that these programs set out to promote better health and provide appropriate health improvement interventions.

As these programs continue to evolve and become increasingly pursued by insurers, it is clear there is a need for long-term care actuaries to become better grounded in various aspects of them. With that in mind, the Society of Actuaries’ Long Term Care Insurance and Health Sections have partnered to produce a primer on these programs to provide a useful resource for their members. One of the primary motivations for this partnership is to apply knowledge and experience with health wellness programs to further inform the primer and provide additional context and information.

Research Objective

The Society of Actuaries Long Term Care Insurance and Health Sections are seeking researchers to author a primer on long-term care insurance wellness programs. The underlying motivation for this effort is to educate actuaries on these programs and provide a useful resource for understanding their benefits, structure and limitations. The following are examples of areas that may be addressed in the primer. Note that the list is not meant to be exhaustive but merely provides examples of proposed topics that may be researched. Respondents are not required to address all of these and may be selective in the areas they cover.

Primer topics may include:

  1. Definitions of long-term care wellness programs components with descriptions of how they fit into the overall program design and their relative importance.
  2. Considerations for the design of programs including prevalence of certain features, recent innovations and process.
  3. Description of the benefits of long-term care wellness programs and aspects that have consistently worked well. These would include benefits related to physical, mental, emotional and frailty improvements, as well as enhancing overall well-being.
  4. Considerations in understanding the key program risks and how they can be managed.
  5. Development and tracking of measures to give insight into outcomes along with potential methodologies that may be used.
  6. Case Studies (on an anonymous basis). These may be at different points in a long-term care claim submission (pre, during, post claim).
  7. Lessons learned from health care wellness programs that may be applied to long term care programs.
  8. Projection of costs and how they may be impacted by factors such as specific contractual arrangements
  9. Best practices for creating frameworks for modeling and evaluating the efficiency of the programs.
  10. Future trends and emerging innovations such as the use of technology
  11. Challenges and barriers to program adoption such as funding and resource limitations.
  12. Recognition that the horizon and scope of LTC wellness programs is very long and wide. Insureds typically purchase coverage long before they become claimants, and wellness needs may change significantly over the years.
  13. List of suggested additional resources for further reading.

Proposal Requirements

To facilitate the evaluation of proposals, the following information should be submitted:

  1. Resumes of the researcher(s), including any graduate student(s) expected to participate, indicating how their background, education and experience bear on their qualifications to undertake the research. If more than one researcher is involved, a single individual should be designated as the lead researcher and primary contact. The person submitting the proposal must be authorized to speak on behalf of all the researchers as well as for the firm or institution on whose behalf the proposal is submitted.

  2. An outline of the approach to be used (e.g., literature search, model, etc.), emphasizing issues that require special consideration. Details should be given regarding the techniques to be used, collateral material to be consulted, and possible limitations of the analysis.

  3. A description of the expected deliverables and any supporting data, tools or other resources.

  4. Cost estimates for the research, including computer time, salaries, report preparation, material costs, etc. Such estimates can be in the form of hourly rates, but in such cases, time estimates should also be included. Any guarantees as to total cost should be given and will be considered in the evaluation of the proposal. While cost will be a factor in the evaluation of the proposal, it will not necessarily be the decisive factor.

    Please note that as a policy, the SOA Research Institute generally does not provide funding to cover academic institution overhead expenses.

    As a guide for developing the project budget, please review the Historical Project Cost Guide (see Appendix)

  5. A schedule for completion of the research, identifying key dates or time frames for research completion and report submissions. The sponsors are interested in completing this project in a timely manner. Suggestions in the proposal for ensuring timely delivery, such as fee adjustments, are encouraged.

  6. Other related factors that give evidence of a proposer's capabilities to perform in a superior fashion should be detailed.

Selection Process

The sponsors will appoint a Project Oversight Group (POG) to oversee the project. The sponsors are responsible for recommending the proposal to be funded. Input from other knowledgeable individuals also may be sought, but the sponsors will make the final recommendation, subject to Society of Actuaries Research Institute (SOA) leadership approval. An SOA staff research actuary will provide staff actuarial support.

Questions

Any questions regarding this RFP should be directed to Research-AR@soa.org.

Notification of Intent to submit Proposal

If you intend to submit a proposal, please email written notification by December 1 to Research-AR@soa.org.

Submission of Proposal

Please email your proposal to Research-AR@soa.org; proposals must be received no later than December 15, 2023.

Conditions

The selection of a proposal is conditioned upon and not considered final until a Letter of Agreement is executed by both the Society of Actuaries Research Institute and the researcher.

The Society of Actuaries Research Institute reserves the right to not award a contract for this research. Reasons for not awarding a contract could include, but are not limited to, a lack of acceptable proposals or a finding that insufficient funds are available. The Society of Actuaries Research Institute also reserves the right to redirect the project as is deemed advisable.

The Society of Actuaries Research Institute plans to hold the copyright to the research and to publish the results with appropriate credit given to the researcher(s).

The Society of Actuaries Research Institute may choose to seek public exposure or media attention for the research. By submitting a proposal, you agree to cooperate with the Society of Actuaries in publicizing or promoting the research and responding to media requests.

The Society of Actuaries may also choose to market and promote the research to members, candidates and other interested parties. You agree to perform promotional communication requested by the Society of Actuaries Research Institute, which may include, but is not limited to, leading a webcast on the research, presenting the research at an SOA meeting, and/or writing an article on the research for an SOA newsletter.

Conflict of Interest

You agree to disclose any of your material business, financial and organizational interests and affiliations which are or may be construed to be reasonably related to the interest, activities and programs of the Society of Actuaries Research Institute.

Appendix

The cost ranges below are intended as a guide for budgeting project costs for proposals in response to SOA Research Institute Request for Proposals (RFP). Please note these figures span the 33rd to 66th percentiles for all projects as well as projects that involve a specific approach (lit review, survey, etc.). They are based on historical costs over several recent years. Expected costs for some RFPs may fall outside these ranges depending on the nature of the work and resources required for completion.

All Contracted Projects

This category includes all contracted projects that the Institute has undertaken within the last several years.

The 33rd-66th percentile project costs range is $25,000 - $50,000.

Literature Reviews

This category includes projects that involved only a literature review or the cost for the portion of a larger project that included a literature review.

The 33rd-66th percentile project costs range is $15,000 - $20,000.

Surveys

This category includes all projects that had a survey as their primary component. The 33rd-66th percentile project costs range is $28,000 - $55,000.