Description: The Society of Actuaries SoA developed this research project to repeat and expand upon its “Group Medical Insurance Large Claims Database Collection and Analysis” study, which was published as a monograph in August of 1997. The general purpose of these studies is to discover and analyze factors affecting claim incidence rates and the distribution of claim sizes. This is the report for the database. Please see the SOA website experience studies for Group Health for the databases themselves.

Description: The Individual Disability Experience Committee (IDEC) of the SOA has gathered industry data covering 2006-2015. This sessions will highlights their findings on the recent industry experience compared to the 2013 Individual Disability Income Valuation Table (2013 IDIVT), including the impact of the recession on incidence and terminations. The audience will gain an understanding of how the recent industry experience compares to the most recent valuation table. The session will cover claim incidence and claim termination Actual to Expected (A/E) using 2013 IDIVT as the expected basis. The adequacy of the modifiers will also be also be discussed.

Description: Data requirements for the Society of Actuaries cancer experience study, for those submitting exposure and claim information.

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are high, but existing care management solutions are mostly clinical and navigation call centers provide fragmented and outdated patient management systems, and do not address individual life-context.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: Anti-obesity medications have been met with reluctance from payers and employee benefits consultants who often lack analogs or empirical data to estimate the cost impact of new therapies coverage. Health plans considering coverage of anti-obesity medications will need to assess and manage the potential costs of covering these new therapies in context of their overall obesity management strategy, including coverage of nutrition counseling, weight management, and bariatric surgery.

Description: This session will bring together public health care leaders in COVID-10 vaccine delivery from both the U.S. and the UK to discuss and compare operational implications of the COVID-19 vaccine rollout in their countries, and how those programs ultimately affected hospitalization utilization and mortality rates for members of their communities.

Description: CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.

Description: 2021 ImpACT Conference - Session 5C: Transforming Health Insurance Through Consumer-Centric Products 10.26.21 Recording

Description: Through the sponsorship of the Robert Wood Johnson Foundation, The Society of Actuaries partnered with Wakely to use their health care data to study the effects of COVID-19 on overall health care claims for individuals with a COVID-19 diagnosis. The conclusion of the study is that individuals with COVID-19 claims had significant increases in health care costs leading up to their months of diagnosis, as well as in the months following their diagnosis. These effects were more pronounced for individuals who were hospitalized due to COVID-19 as well as for individuals with prior co-morbidities. Finally, the overall health care costs of these members plateaued at significantly higher levels than their pre-COVID baselines. In fact, all the main membership cohorts experienced claim levels that were at least 20% higher than their pre-COVID starting points.

Description: Get highlights from recently published and upcoming research from the SOA Research Institute, including work on specialty pharmacy and the long-term impacts of COVID-19. Presenters will focus on the financial impacts of these issues as well as trends and other actuarial considerations.