Description: The June 2021 Supreme Court ruling in California vs. Texas has significant ramifications on Affordable Care Act markets. This session will provide the actuarial community an overview of the ruling, the likely impact on health insurance markets, and potential legislation to address the ruling details.

Description: "Are you a health actuary affected by recent developments in business practices and accounting standards that have created situations in which you may be involved in estimating balances under accounting rules that differ from those typically used by insurers? In this session you will learn about situations where non-insurance accounting regimes may intersect actuarial practice, with an intended focus on two particular topics. One topic is general accepted accounting principles (GAAP) for insurance brokers under ASC 606 (Revenue Recognition) for commissions on Medicare Advantage and Medicare Supplement contracts, where the broker may get to recognize the expected value of all future commissions on a contract as revenue when the contract is placed. The other topic is GAAP under ASC 460 (Guarantees) in situations where a non-provider entity is bearing risk related to health care services, which can occur under the CMS Direct Contracting/ACO REACH model or under private sector care coordination contracts."

Description: Predicting mortality (or longevity) and measuring the associated risk are the keys to the success of insurance business. Underwriting has been used for years for this purpose and approved effective. Currently, underwriting has been focusing on human physical conditions such as BMI, blood sample, medical history, and others, as well as severe mental diseases; occasionally, there are mental health assessments such as mental illness or cognitive testing that have been used in underwriting Life or Long-Term Care (LTC) business.

Description: Presenters at session 99 OF of the Maui II Spring Meeting discuss current issues involved in providing stop-loss coverage for provider-sponsored organization PSOs, managed care health plans, and self-funded groups. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: The Health Care Cost Institute (HCCI) recently released their annual health care cost and utilization report on February 13, 2020. This report illustrates employer group commercial health care costs and trends from 2014 – 2018.

Description: The presenters will discuss recent regulatory changes that allow some long-term care benefits to be included in Medicare Advantage plans. Hear an overview of what has become available in the market and what might happen in the near future.

Description: One of the Health Section's key focuses in 2019 is Initiative 18/11. Last year the SOA joined forces with the Kaiser Family Foundation (KFF) and the Healthcare Financial Management Association (HFMA) to answer the nagging question: “What can we do about the cost of healthcare?” A steering group has been formed to lead a research project as to what managed care companies can do to reduce costs without sacrificing quality. The project [called Managed Care 3.0 in the 18/11 paper] will examine historical models that have worked as well as investigate the impact that new technologies and care models may have on cost and quality, with the goal of better understanding the current environment and identify­ing potential risks and opportunities.

Description: State Medicaid agencies have been implementing value-based payment (VBP) models for the last decade and are increasingly exploring advanced population-based payment (PBP) models that increase flexibility, predictability, and accountability for participating provider organizations. PBP models show promise in advancing Medicaid priorities, but are still in the early stages of development, and model design and implementation challenges remain. This article from the Center for Health Care Strategies explores the fundamentals of VBP and how PBP - a particular type of payment model - can help Medicaid agencies achieve goals related to care transformation and quality improvement, revenue stability, and controlling cost of care.

Description: Essay where payers desiring to optimize health gains per dollar spent should avoid “across the board” cost sharing, and instead implement a “value based” design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.

Description: Two years ago, before COVID-19 changed everything about how we provide and receive health care, telehealth was largely provided by third-party vendors to treat a narrow range of acute one-and-done conditions. The value proposition was simple: a fast and easy member experience would drive satisfaction and engagement; high member satisfaction and engagement would drive health plan savings and member retention. Clearly, from the perspective of utilization, telehealth—as a viable alternative to in-person care during a pandemic—worked. And with COVID-19’s nudge—or was that a push?—toward cultural acceptance, the health care system is in a better position to capitalize on telehealth’s original promise of expanded access, lower cost and better outcomes than it was two years ago. But in the wake of the pandemic, it is just as clear to us that if telehealth is to live up to its full potential, some changes are needed. The rest of this article presents five ideas for improving the delivery of telehealth going forward.