Description: CLASS Act and ACA

Description: This session discussion is about a review of experience under PPOs, measuring the success of PPOs, PPOs affect on employer health care expenditures, employee utilization of PPOs, the future of PPOs. From Record of the Society of Actuaries Vol. 11, No. 4A.

Description: As actuaries in health care, we spend most of our time focused on reviewing claims, enrollment and clinical data. That information is captured while patients are in health care facilities. Yet most people spend only a small fraction of their time in these facilities. This article explores what types of data are available to actuaries the provide a more holistic view of the member so that a members physical and emotional needs, the social determinants of health can be taken into consideration along with their clinical needs. Two uses cases are presented so actuaries can see how these types of analyses can be leveraged to improve clinical, operational, and financial performance of risk bearing health entities. Understanding the customer (member) not just the patient enables actuaries to provide new insights and values to our stakeholders across a wide range of business and risk applications.

Description: The article documents the efficacy of infra-low frequency neurofeedback regarding how it improves patient no show rates, decreases mental health symptoms by 40% or more, and self-harm and suicidal ideations.

Description: On Dec. 29, 1973 President Nixon signed into law the Health Maintenance Organization Act of 1973, which authorizes $375 million to be used by the DHEW to stimulate the establishment and development of HMO's over the next five years. This article describes the status of the regulations and the development of additional HMO's.

Description: A discussion of the future of the Brazilian Health Market with a focus on the legislation which passed in June 1998 to regulate the private health insurance industry

Description: Provides a summary of recent proposed regulations for the health insurer fee, section 9010 of the Affordable Care Act (ACA).

Description: This essay highlights a view that many have for meeting these goals is one of a two-tiered system. The first tier in this system is a universal one controlled by the federal government, while the second tier is a private sector supplementing the first tier. The remainder of this paper will examine this two-tiered system and how various stakeholders in today’s system will be affected.

Description: This article explores the changing risk profile between the transitional Affordable Care Act (ACA) period (2014-2016) and under the final ACA period (beyond 2017) for the individual market. Actuaries are in a unique position to help facilitate the change from the current ACA period to the final period when health plans will have to take on substantially more risk.

Description: Medicaid and the ACA