Description: This article is focused on sustainability concerns in the ACA individual markets and what we can learn from core actuarial principles as discussed in ASOPs.

Description: Results of an SOA survey regarding the expectation for 2015 accruals for 3Rs and cost sharing reduction payments

Description: This article discusses the challenges and unknowns relating to the regulatory inclusion of pediatric dental benefits within the essential benefits list of the Affordable Care Act (ACA).

Description: Discussion about career events for an actuary working on health care reform

Description: This article provides an overview of the key provisions and impacts of the Affordable Care Act's Cadillac Plan Excise Tax.

Description: Update on the Long Term Care Section activities, including new council members, research, and educating policymakers, the public, and other industry associations on developments in health care regulation.

Description: This presents the results of a May 2010 survey by the Society of Actuaries SOA asking members of the SOA Health Section for their opinions on ways to bend the cost curve in light of the Patient Protection and Affordable Care Act ACA, the new health reform law passed in March 2010.

Description: This session explores the far-reaching changes to how clinical data will be sourced, processed and consumed in many payer use cases including risk adjustment, quality measurement, care management, claims adjudication, prior authorizations, and other payer functions. Robust, interoperable data exchange is a prerequisite for value-based care. Clinical data will be increasingly accessible to augment administrative (claims) data via standardized Fast Health Interoperability Resources (FHIR, pronounced 'fire'), at a fraction of the cost of a accessing a traditional medical record and in real-time. On May 1, 2020, HHS issued a final rule implementing interoperability and the patient access provisions of the 21st Century Cures Act of 2016, although enforcement has been delayed into 2021 because of the COVID-19 pandemic. The new regulations promote, “HHS’s vision and strategy for achieving a health information ecosystem within which all individuals, their personal representatives, their health care providers, and their payers are able to send, receive, find, and use electronic health information in a manner that is appropriate, secure, timely, and reliable to support the health and wellness of individuals through informed, shared decision-making, as well as to support consumer choice of payers and providers.”Once enforcement begins, CMS and the Office of the National Coordinator for Health Information Technology (ONC), have the authority to mandate adoption of interoperability requirements, and also penalize payers and providers for non-compliance or the delay and withholding of data.This ‘digital transformation’ of the clinical data ecosystem has far-reaching implications for enabling technologies including Natural Language Processing (NLP) and entire segments of services and vendors. It will eliminate many departmental barriers, duplication and error sources for health plans and impact every department and the underlying economics of delivering and managing care.

Description: Why is it that two competent actuaries making reasonable assumptions can arrive at very different conclusions when evaluating the impact of proposed health care reforms? Are the answers really as different as they appear to be on the surface? This presentation from Session 137IF of the SOA 1996 Orlando Annual Meeting outlines and highlights some of the key actuarial issues that arise in the course of these analyses. From the Record of the Society of Actuaries, Vol. 22, No. 3.

Description: Panelists discuss issues arising from the Health Insurance Portability and Accountability Act of 1996. From the Record of the Society of Actuaries, Vol. 24, No. 1.