Description: The “Getzen Model” is a set of linked formulas to facilitate projections of average medical care cost increases over the long run.

Description: A divisive confrontation over health care pricing is almost inevitable over the next few years. What will ultimately happen is a political decision, not an actuarial one—but it will have major consequences for the trend in health care costs and the divergence between public and private insurance premiums.

Description: The impact of Medicare on retiree medical. Issue No. 44.

Description: The aftershocks of the COVID pandemic will pass --- eventually. Government subsidies and spending soared in 2020 to meet the challenges of the pandemic. Health expenditures leapt from 17.6% of GDP to 19.7%, and then dropped to 18.8% in 2021, and will fall again to 18.2% (projected) in 2022, but are expected to return to the long-run trend by 2024 and gradually rise thereafter. However, during the next few years most attention will be paid to dealing with complex aftershocks from the flood of Covid funding in 2020 and 2021, a surge of inflation in 2022, and a looming recession in 2023.

Description: COVID has washed over healthcare like a tsunami—things have been tossed in all directions. According to Medicare actuaries, trends have been turned upside down in 2021, but will reverse back in 2023 as medical costs rebound. It is more prudent to base projections on long run trends for a period after the storm, extrapolating from 2026 forward, leaving the intervening turbulence (years 2022 -2025) mostly unspecified.

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.

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: A Request for Proposals (RFP) for research studies on the impact of climate change and catastrophes on the U.S. health infrastructure. It outlines the background, objectives, submission requirements, and selection process for potential researchers.

Description: Chronic Kidney Disease (CKD) affects many lives and has a large impact on health systems around the world. To better understand and predict costs for insurance plan members with CKD in the United States, we built a new model of their individual costs. Our model is the first to explicitly model both the CKD stage transition process and the distribution of costs given those stages.

Description: Employers, health plans, stop-loss insurers and reinsurers are all affected by the high cost of treating cancer. In recent years, cutting-edge pharmaceuticals, bone marrow transplants and CAR-T cell therapies have driven very high cost trends for cancer, with more emerging therapies on the horizon. In this session, we will review these new treatments, showcase models that aid in understanding the range of likely financial effects of the current, expanded, and likely-to-be approved indications for cell therapies that will treat certain patients affected by lymphoma, leukemia, and multiple myeloma. This session will explain important considerations for modeling Medicare, Medicaid versus commercial populations, key risk concerns caused by the size of enrollee pools, and important differences between the various therapies that affect modeling. We will also discuss averted cost, health outcomes, pricing levels, and risks caused by provider billing practices.