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: Actuaries have the business acumen, problem-solving capabilities, and technical skills to develop innovative and data-driven solutions in the social insurance space. It is time we expand our scope and embrace an increased role in making a positive impact within the health care ecosystem. The primary focus of this paper is on social insurance programs dedicated to the most vulnerable population: low-income families accessing care through Medicaid. While there are numerous challenges that require other subject matter experts to take the lead, this article highlights topics where actuaries can be key players in developing and implementing tangible solutions to improve the care for the most vulnerable. Issues and solutions in this paper focus on the following three areas: 1. Access to appropriate care, 2. continuity of care, and 3. social determinants of health.

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: Feature article discussing the impact of health care reform on the direct insurance market and the reinsurance market.

Description: Review of non public options to finance care including personal savings, revers mortgages, family care and private insurance.

Description: Risk Adjustment continues to be a hot topic in Health Insurance since its emergence. This mechanism came into being as a means of reducing the risk of selection, particularly in marketplaces where underwriting is not allowed, and rating factors are significantly restricted. Risk adjustment serves to adjust premiums to reflect the risk of individual members or overall members as a whole within a particular cohort of a health plan. Risk adjustment is not perfect, as it does not perfectly predict future costs or perfectly adjust for the differences in expected costs. Different marketplaces have different challenges with risk adjustment.

Description: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.

Description: What can the United States learn from other countries' health care systems? How are other countries more efficient? We selected five countries that have been among those debated as having some of the most efficient health care systems to explore what the United States can learn from these examples.

Description: Family caregivers are a critical link in providing long-term services and supports (LTSS), but they have significant unmet needs. To better support family caregivers, Congress authorized the Recognize, Assist, Include, Support, & Engage (RAISE) Family Caregivers Act in 2018 and created the RAISE Family Caregiving Advisory Council. The Council identified recommendations to serve as the backbone of a national strategy to improve the physical, emotional and financial well-being of family caregivers. A new report, "Asking Directions: Mapping a Course to Support Family Caregivers," identifies specific actions across a variety of players for meeting the Council’s recommendations. It summarizes insights from a year’s worth of strategy sessions and interviews with representatives of over 100 organizations. The report brings together thoughts on best practices and the most critical action steps from national and state organizations, county health providers, the direct care workforce, large and small employers, aging and disability organizations, faith-based groups, respite care providers and more. This article summarizes the research methods and key findings of the report and the work conducted by the Leading Age LTSS Center @UMass Boston and Community Catalyst’s Center for Consumer Engagement in Health Innovation.

Description: The Society of Actuaries (“SOA”) Research Institute is the research arm of the SOA, providing objective, data-driven research that brings together tried and true practices and future-focused approaches to address societal challenges and business needs. The Institute provides trusted knowledge, extensive experience and new technologies to help effectively identify, predict and manage risks.