Description: Can Direct-to-Provider Contracting Achieve Value-Based Care for Employer-Sponsored Plans? Direct-to-provider contracting is a strategy in which a self-insured entity negotiates a contract directly with a provider of healthcare services rather than through a third-party administrator (TPA), often with the goal of driving value-based care. This article discusses the considerations for employers and providers with direct-to-provider contracting.

Description: Align carrier, agent, and consumer definition(s) of DTC to establish a collective understanding for the affected parties. Understand why a direct-to-consumer approach may be important for carriers’ and distributors’ growth and development goals, tactics and strategies. Use the agreed-upon baseline and understanding of DTC’s importance to establish and agree upon reasonable expectations for its role in marketing, distribution, and product development and performance. Position carriers and distributors together to align sales, marketing and performance expectations and incentives for all parties to increase the possibility of outperforming in (and outside of) the DTC space; design sales, marketing and distribution systems and approaches to meet consumers where they are at; and expand current sales and cultivate new markets to remain relevant and magnify profiles in an ever-changing industry.

Description: Article on the history of the Long Term Care Discussion Group, a Washington DC-based venue for discussing long-term care and related issues for over 20 years.

Description: Discussion of the ways carriers can deliver a direct to consumer offering in a way that benefits, rather than alienates, the advisor channel.

Description: Blockchain technology has the potential to significantly improve the quality of life and overall health of the members of a health system, while also adding to administrative efficiencies. For the first time, we will have access to members’ entire diagnoses and prescription history, consumer behavioral attributes, and other socio-economic determinants which that are valuable inputs to designing appropriate benefits and proper care management plans. Through the blockchain, we will be able to access data not just of the existing members of the health system but also of potential enrollees and new entrants. The data can be accessed by querying the blockchain through a permissioned granted by the member. This information can be very useful in performing feasibility studies for evaluating entry into newer markets and/or newer products, developing customized care plans, and designing efficient value-based contracts. By executing smart contracts on the blockchain, we will be able to achieve administrative efficiencies like never before. The applications of blockchain technology are numerous and ground-breaking. Organizations that do not pay heed to the benefits that blockchain can bring may find themselves left behind as the rest of the industry marches forward in its quest for efficiency and member satisfaction.

Description: Read the November 26 2019 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: The collective investment in transforming the life insurance proposition exceeds anything seen in the last thirty years — a working lifetime. As one would expect, reinsurers are playing a major role. The past five years have seen global reinsurers raise the bar on client experience to new levels, while also investing, expanding and re-organizing to support the transformation of the primary insurance industry, and in so doing also their own.

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.

Description: MACRA not only impact providers, it will impact the entire healthcare market. MACRA published studies and commentary to date have primarily focused on providers, with the majority of the information addressing the impacts to clinicians. However, our investigation indicates MACRA has far reaching impacts to payers as well as providers. MACRA is impacting each geographic market and line of business in a unique way, and health payers will have multiple strategic decisions to consider given the changing market dynamics.

Description: Bringing managed care concepts into LTC claims management could benefit insurers, policyholders, and providers. This article outlines the case for doing so, and articulates the benefits to each stakeholder in the LTC claims process.