Description: Panelists at this session of the SOA 1997 Palm Desert Spring Meeting provide an overview of the business of medicine from both a hospital and a physician viewpoint. Topics include defining the mission, uncompesated care, impact of Medicare/Medicaid, expenses, scheduling and relationships with managed care organizations.

Description: Discover the key components of value-based care (VBC) contracts and their impact on provider credibility. Learn about benchmarks, measurement period results, and the unique challenges providers face in managing insurance risk. Gain insights into reducing costs and aligning financial incentives in the US healthcare market.

Description: Every patient leaving the hospital has personal life-context circumstances that impact their chances of successful recovery and complications can be costly. Complex care management impacts over 50 percent of health care spend, with the admitted commercial population driving 37 percent of spend or $177M per 100,000 lives and the Medicare population driving 53 percent of spend or $600 million per 100,000 lives. The stakes are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context. Discharged patients therefore remain underengaged and undercompliant, leading to costly complications. Innovative technology can help enable and integrate systems and existing infrastructure to leverage evidence-based contextualized care that will enhance care management, improve efficiency, and drive a better experience and outcomes for patients. This technology helps codifies life context, dynamically stratifying and engaging members digitally and telephonically helping virtual care teams to be more effective and efficient. In a recent randomized clinical trial, this technology and approach has shown a 50 percent reduction in the total cost of care, cutting the average and total cost of readmission, increasing virtual care team impact and member engagement and trust.

Description: Millions of aging Americans are challenged to prepare for uncertain health and financial setbacks in addition to cognitive impairment that impacts one-third of adults over age 85. Advanced planning can reduce the negative impact of impairment on personal finances, including financial exploitation, scams and fraud, and care and spending decisions that are not aligned with retirement goals. To address these issues, the SOA’s Aging and Retirement Strategic Research Program co-sponsored work on the Thinking Ahead Roadmap which was created by a team from the University of Minnesota and Stanford Center on Longevity. In this webinar, members of the research team will preview the Thinking Ahead Roadmap and the steps that people can take to help ensure their financial wishes are honored as they age. The presenters will discuss: 1. Advice on choosing the right financial advocate 2. Organizing financial information to pave the way for a smooth transition 3. Starting open and honest conversations about future money management 4. The importance of a financial power of attorney and how to obtain one 5. Shifting money management responsibilities when the time is right

Description: This session 94PD of the Maui II Spring Meeting the panel examines the advantages and disadvantages of collaboration between clinician and actuary. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: This panel will present the perspectives of state government, federal government, and health maintenance organizations HMOs with respect to Medicaid risk contracting. From the Record of the Society of Actuaries, Vol. 21, No. 4b.

Description: This article discusses the expansion of benefits supporting long-term care services in Medicare Advantage plans

Description: Update on Health Section research projects and topics, including health care reform, complexity science, and strategic planning.

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

Description: Medicare and Medicaid finance more than half of American health care. Medicare and Medicaid are at the forefront of nearly every major change in U.S. health care payments, from DRGs in the 1980s to today’s value-based care. Listen to a conversation with Bruce Pyenson, FSA, MAAA, who recently completed six years as a Medicare Payment Advisory Commission (MedPAC) commissioner and Stacey Lampkin, FSA, MAAA, who recently completed six years as a Medicaid and CHIP Payment and Access Commission (MACPAC) commissioner. Hear about programs’ current challenges, what changes the ex-Commissioners anticipate over the next few years, and how these changes might impact Medicare and Medicaid managed care plans, and spillover into employer-sponsored and individual commercial insurance. By attending this session, you will be able to appreciate the role of Medicare and Medicaid as health care payment change agents and foresee future health care payment changes.