Description: Risk adjustment is used to adjust the revenue stream to health insurers that sell ACA eligible plans and Medicare Advantage plans. This article compares and contrasts these risk adjustment programs.

Description: Article reviews the data a year into the unwinding of continuous coverage provisions in Medicaid, the impact on enrollment counts, how capitation rates have been adjusted, and compares those results to what has been modeled with the SOA Mediciad Unwinding model.

Description: On March 6, 2023, The Wall Street Journal hosted its Health Forum, a hybrid all-day event. The virtual meeting featured 11 different events. This white paper focuses on those events. The sessions were informative and fast-paced, with each one providing a quick hit of relevant and cutting-edge information around health care.

Description: This paper highlights the menace of overweight and obesity which are on the rise. Health care systems and insurance industries are directly affected. Liability claims are on waiting. The food related damage claims are costly. Insurers are therefore driven to find a solution: classify overweight and obesity as a group, adjust their premium to reflect the cost, and justify the classification and the adjustments.

Description: Employer and payers need to actively seek change in the system of mental health care deliveryoperational, clinical, and financial change. From Financing Chronic Care Monograph, M-HB05-1.

Description: This report is a brief summary of a symposium held in Sweden in March 1972, initiated and sponsored by the Swedish insurance companies which discusses the side effects of the development of modern chemical industry and the exposure of living organisms to a variety of chemicals in the environment. The danger of the long term effects on health are addressed.

Description: The presenters will explore the roles of mental health and social determinants of health in the management of a population's total health. We will explore how emerging sources of data and information have led to a renewed focus on managing mental health conditions and social determinants of health. Speakers will address current health care programs that utilize this data and information to manage the total care for populations using predictive models to improve the deployment of resources and initiatives to improve the cost of care and health of populations. The presenters will also look at how providers of care are approaching mental health co-morbidities to manage physical health and social determinants of health in the management of patients.

Description: Summary of research from the Initiative 18/11 - Pharmacy team about the drug development process for traditional pharmaceuticals: Who does the research and discovery? What does the research and discovery process entail? How are targets identified and validated for research and discovery? What are clinical trials and how are they conducted? How is the drug development process regulated? How is the drug development process funded?

Description: Vast sums of private equity are flowing into start-ups intent on lowering healthcare trend. This presents a huge challenge for insurance company actuaries to stay current on such start-ups and the innovations they're advancing. Further, it can be overwhelming to evaluate the many vendors eager to sell their services to the company. This session will provide an overview of the start-up and private equity process, review some of the emerging innovators, and discuss approaches to evaluate their Return on Investment (ROI) as efficiently as possible.

Description: This 1981 session dealt with Risk Classification for Individual Health Insurance. Topics included current legislative/regulatory trends and their impact on pricing and plan design, high risk-sharing pools, and deomographic considerations. From Record of Society of Actuaries 1981 Vol. 7, No. 2.