Description: While there are many approaches currently being taken to transform health care, to be successful, we know that leading and planning for quality improvement is a science. Data is the common denominator as healthcare organizations establish best-practices, and ultimately overcome unintended variation through strong analytic systems. Health care leaders require specialized data analysis education and training to hone their skills in understanding and managing clinical variation. The problem with unexplained variation in healthcare is that it negatively impacts clinical outcomes, increases the cost of care, and diminishes value for patients. In this session, Dr. Ted James (BIDMC and Harvard Medical School Faculty) will explain how actuaries can offer practical solutions that provide insights into variations in clinical practice that cannot be explained by differences in medical conditions or patient preferences.

Description: In this article, we describe new approaches to long-term care financing that rely on home equity release and we address several of the challenges mentioned above. While these approaches stand to help expand the potential for long-term care financing to middle-class Americans, even these approaches don’t address a large swath of the U.S. with less privilege, who have little or no home equity. We will discuss the product design, marketing, pricing and risk management of these new approaches and potential behavioral factors that should be considered. The article builds on a growing body of academic research to which the authors have actively contributed. We want to share the key insights of this international work in market research, economics, and actuarial studies to stimulate more research in this area.

Description: Most industry professionals acknowledge that funding retirement needs will almost always require disciplined savings over a period of decades. Today, we are less than 30 years from the second half of the 21st Century. However, a majority of the Millennial and Gen Z generations are either not eligible for or are not using today's tax-preferred options for funding retiree medical and Long Term Care (LTC).

Description: Blockchain technology has the potential to significantly improve the quality of life and overall health of the members of a health system, while also adding to administrative efficiencies. For the first time, we will have access to members’ entire diagnoses and prescription history, consumer behavioral attributes, and other socio-economic determinants which that are valuable inputs to designing appropriate benefits and proper care management plans. Through the blockchain, we will be able to access data not just of the existing members of the health system but also of potential enrollees and new entrants. The data can be accessed by querying the blockchain through a permissioned granted by the member. This information can be very useful in performing feasibility studies for evaluating entry into newer markets and/or newer products, developing customized care plans, and designing efficient value-based contracts. By executing smart contracts on the blockchain, we will be able to achieve administrative efficiencies like never before. The applications of blockchain technology are numerous and ground-breaking. Organizations that do not pay heed to the benefits that blockchain can bring may find themselves left behind as the rest of the industry marches forward in its quest for efficiency and member satisfaction.

Description: In the current value-based care marketplace, there are various reimbursement models that tie payments for care delivery to the quality of the care provided. The purpose is clear – change reimbursement to focus on value by rewarding better outcomes and lower spending. However, implementation it is complex, and many challenges emerge during this transition for both providers and payers.Providers often lack sophisticated actuarial capabilities or clear understanding of the connection between finance and clinical operations. For these reasons, they enter risk arrangements without knowing how to strategically manage and mitigate risks and fully transfer the reimbursement changes into clinical decisions. For payers, a truly viable value-based payment model that rewards the most valuable providers needs a multidisciplinary approach and a solid financial model. Such a model also requires transparency and a clear transitional road map for providers to encourage participation and collaboration. In this session, we will discuss lessons learned through case studies of working with both providers and payers on value-based care issues. We will illustrate the current state of the complex financial structures by presenting examples of value-based financial models, feasibility analyses, and strategies to design a payment model beneficial to both providers and payers. We will also explore the clinical collaboration necessary to make it all work, as well as present some best practice strategies to facilitate strong payer-provider collaboration.

Description: Will the Medicare Modernization Act Jump Start Growth in Employer-Sponsored Long- Term Care Insurance? by Allen J. Schmitz, FSA and Scott A. Weltz, FSA from Long-Term Care Newsletter, April 2004, Issue No. 11.

Description: The implementation of the IFRS 17 insurance accounting standard has brought significant changes to the financial reporting landscape of insurance companies. With new disclosure requirements and altered profit analysis, understanding and interpreting future profitability have become a topic of concern for the industry. While stability remains a key objective for insurance companies, the earning patterns might become more volatile especially when the contractual service margin (CSM) is exhausted, and a loss component (LC) needs to be established. Reinsurance, a common risk mitigation tool, can play a pivotal role in managing earnings volatility and minimizing losses for onerous measurement units. In this article, we propose a new key performance indicator (KPI) called “loss recoverability” to assess the performance of reinsurance treaties in achieving these objectives. We explain how this KPI can be utilized in multiple scenarios to evaluate the effectiveness of reinsurance strategies and pursue stability in earning patterns.

Description: This article was written to increase the knowledge and insights of both the direct writer and reinsurer in optimizing the reinsurance negotiation process. It should help the reinsurer offer a more competitive quote and hence win a share in a reinsurance pool while simultaneously helping the direct writer obtain lower reinsurance costs helping their product pricing and bottom line.

Description: This article was written to increase the knowledge and insights of both the direct writer and reinsurer in optimizing the reinsurance negotiation process. It should help the reinsurer offer a more competitive quote and hence win a share in a reinsurance pool while simultaneously helping the direct writer obtain lower reinsurance costs helping their product pricing and bottom line.

Description: This article is a summary of the SOA Research Institute report published in April 2023 on Megatrends Impacting the Future of Retirement Plans.