Description: The purpose of this document is to inform the user of the 2021 Health Care Cost Model about the sources of data, other reports, and assumptions which were used to populate this report and drive some of the key considerations.

Description: Direct Primary Care (DPC) is a newer model of primary care delivery in which patients or employers pay for care directly on a membership basis; insurance and other third-party payment is not used. Early studies show significantly improved patient health outcomes and lower expenditures for DPC patients compared with similar patients receiving traditionally delivered primary care. Additional research is needed to better understand physician perspectives about the model and the role of patient selection in early results.In this session we discuss research projects that may shed light on the DPC model and on whether early results indicate more about the model or about the patients who use it.We discuss an SoA research project that interviews DPC physicians to better understand their views about the model and its early results. We also discuss a paper that analyzes characteristics of patients who receive primary care from a DPC physician and compares them to characteristics of patients who receive primary care in more traditional ways. This cross-sectional study surveys all adult patients of a convenience sample of several DPC practices. Variables include demographics, socio-economic status (SES), type of additional coverage (if any), whether DPC fees are paid by an employer, and self-reported health status. The Medical Expenditure Panel Survey is the main source of comparison data. For a given cohort of demographics and additional coverage, we determine whether DPC patients have similar health status, demographics and SES as non-DPC patients. This study will provide insight into the degree of selection into DPC by observable patient characteristics.

Description: Panelist discuss issues relating to new medical technologies and how these are going to affect the practice of medicine, the delivery of care, the costs of care, the insuring of care, claims handling, utilization, and cost management. From the Record of the Society of Actuaries, Vol. 25, No. 2.

Description: This article aims to measure the accuracy of official projections.

Description: The momentum in value-based care has produced an opportunity for actuaries to become pioneers in health care

Description: An essay suggesting one solution in theory would be to create a system similar to Medicare Advantage for the entire American population.

Description: First dollar carriers, stop loss carriers, and reinsurers play a different role in reimbursing healthcare claims. This article explores the reinsurer's role in reimbursing COVID-19 related claims.

Description: This session features a moderated discussion between medical professionals who are experts in long-term care. The presenters are outside the LTC insurance industry altogether, which will ensure that attendees receive a truly external perspective.

Description: This session will discuss the continuing evolution of the managed health care process. Topics include precertification, utilization review, retrospective review, case management, appropriateness review, benchmarking, recredentialing, provider contracting, and integrated medical systems. From Record of Society of Actuaries Vol. 20, No. 3A.

Description: The article described recent major advances in measurement of health programs and providers in the public and private sector.