Description: Can Direct-to-Provider Contracting Achieve Value-Based Care for Employer-Sponsored Plans? Direct-to-provider contracting is a strategy in which a self-insured entity negotiates a contract directly with a provider of healthcare services rather than through a third-party administrator (TPA), often with the goal of driving value-based care. This article discusses the considerations for employers and providers with direct-to-provider contracting.

Description: Read the November 26 2019 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Bringing managed care concepts into LTC claims management could benefit insurers, policyholders, and providers. This article outlines the case for doing so, and articulates the benefits to each stakeholder in the LTC claims process.

Description: This article provides an overview of behavioral economic theory as it relates to health and welfare insurance plans and provides summaries of two sample applications of the theories: enrollment in health insurance exchanges created by the Patient Protection and Affordable Care Act, and product design considerations in light of vast health illiteracy.

Description: The days of reinsurance treaties bound by a handshake are long gone. Treaties have evolved into complex legal documents. The session will use a recently released study on recapture provisions as a starting point and will expand the discussion to other key treaty provisions. The focus will be on understanding the intentions, concerns and relative positions of both the direct company and the reinsurer so that a mutually beneficial compromise can be explored.

Description: This article discusses that several ERM characteristics mitigate the effects of bad corporate culture, including: • The whole firm is considered the system in view holistic characteristic. • Peers are empowered to lead in positive ways intensive management characteristic. • Risk taking should be separated from risk management objective assessment characteristic. • Risk management is a key corporate value, second only to profit maximization postmodern characteristic.

Description: This article gives a formula for reversing failure into success

Description: This session is about managed-care provider networks: organizing networks, information needs, monitoring utilization and risk/reward methodologies. From Record of Society of Actuaries Vol. 19, No. 1A.

Description: What risks should ERM actuaries be working on?