Description: The Health Section Council Chairperson looks back at a historic year for the health care industry, and what it means for health actuaries.

Description: Update on Health Section research projects and topics, including health care reform, complexity science, and strategic planning.

Description: Read the December 2019 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Support systems and new solutions to enable caregivers to deliver better care and reduce personal stress.

Description: Long-term care policy buyouts have been discussed within the industry lately as an additional policyholder option alongside a premium rate increase. This article discusses potential advantages and disadvantages of long-term care policy buyouts from the perspective of insurance carriers, regulators, and policyholders. It also explores certain key actuarial considerations relating to long-term care policy buyouts including potential approaches to valuing a buyout, adverse selection, and reinsurance.

Description: Shared savings deals are all the rage these days. Significant numbers of payers and provider groups in many markets around the U.S. want to engage in shared savings contracts covering commercial, Medicare and Medicaid patients. The fundamental question underlying a value-based contract is, for whom is the value accruing? Ostensibly, value is accruing to the sponsor—whether employer or public payer—but should be accruing to the provider as well. Often design flaws in value-based arrangements and contracts and/or the inability to execute in a value-based paradigm diminish the savings that could have accrued, create inequities in value or drive unintended consequences. This presentation will provide attendees with insights into how to design a workable value-based payment initiative, how to educate both payer and provider participants, and how to oversee the initiative’s operations. Specific topics will include: • Attribution logic: prospective, retrospective and the details in between • Risk adjustment: why one model doesn’t fit all arrangements, and even if it does, how do you implement? • Data and reporting: matching business needs to the payer’s willingness to be transparent and provider capabilities • Quality improvement as a component of payment: actionable and tied to the attributed population or just “out there?”

Description: More and more providers are desiring risk-based contracts instead of traditional FFS-based contracts. This session is intended to outline some of the actuarial best practices in risk-based contracting related to the many flavors of the CMS ACO programs, as well as Commercial risk-based contracts.

Description: What is the difference between a Single-Payer and Universal Health Care System, and how could the U.S. implement a system that would reduce the growth of medical costs while increasing quality.

Description: Creating the complete view and management of the complex interactions between care providers, medicines and behavior.

Description: Coverage of Medicaid home and community-based services under the 1915(i) state plan option: Attractive features and important considerations