Description: ACA risk adjustment is intended to "bridge the gap" between allowed rates and actuarial rates. If risk adjustment methodology is not bridging that gap & becomes an additional input to pricing formulae, it is not serving its intended purpose.

Description: On September 14, 2022, The Wall Street Journal hosted its ‘Future of Health’ event, which was a virtual event featuring three sessions on some emerging cutting-edge topics that could impact the future healthcare environment as well as health care actuaries. This report summarizes the event.

Description: The direct and indirect effects of the pandemic have impacted many actuaries’ work since the spring of 2020. This article addresses three considerations actuaries should account for when using risk evaluation models which are focused on projecting remote, highly unlikely losses: model effectiveness, asset risk, and insurance (mortality and mortality) risk.

Description: The health insurance industry has historically used several factors to develop premium rates. Many of these, e.g. gender rating, have been largely eliminated from health insurance rating practices by regulations as the Patient Protection and Affordable Care Act (ACA) because they were determined as inequitable. However, several other factors still remain as differentiators in premium rates charged to individuals and groups. In conjunction with the SOA, researchers studied whether there could be ‘ghost’ rating factors, like race, ethnicity, or socioeconomic status, that are inherently included in some of these remaining allowable factors. Review results and opportunities for future research. By attending this session, you will be challenged to think about traditional rating factors in a different way. Rather than focusing on whether certain factors are sound based on the underlying claims cost, this session will focus on whether or not these factors are impacting certain socioeconomic or racial/ethnic groups disparately.

Description: As results emerged showing the influence of COVID-19 on recent mortality, the Society of Actuaries Research Institute’s Mortality and Longevity Strategic Research Program Steering Committee (MLPSC) began to ponder what it means for the future. Was the coronavirus pandemic just a temporary shock to U.S. mortality with mortality quickly returning to prepandemic levels upon its conclusion or a lingering factor in future U.S. mortality from the potential occurrence of new coronavirus variants, post-COVID-19 conditions (“long COVID”), deferral of needed health care treatment, a fatigued health care system and other elements? Only time will provide the answers to these questions.

Description: Hot topics for Medicare, including enrollment trends, enticing benefits, risk score projections, market strategy trends, formulary considerations, STAR rating changes, and COVID implications including vaccine/testing requirements Proposed/enacted changes to Part D from the Build Back Better (BBB) Act-CMS’s commitment to advancing equity in health and health care for all individuals Discussion of removing barriers to equal opportunity, health disparities, and closing health equity gaps, including collecting more and improved data on beneficiaries’ race, ethnicity and social determinants of health By attending this session, you will be further prepared for current and future changes in the Medicare Advantage program. Gather additional insight into future trends in policy changes and cost spending and to be more equipped to adapt to changes in the marketplace.

Description: Milliman surveyed carriers about their recent LTC rate increase experiences. A total of 20 companies participated in the survey, representing 65 percent of LTC premium in the United States. This article highlights some of the findings from this survey, along with additional considerations when pursuing LTC rate increases.

Description: This book explores diplomatic strategy in an historical context. Many of the lessons in the book are useful to business decision-makers.