Description: Changes introduced by various Medicare Alternative Payment Models and the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated an existing market trend of shifting some of what has traditionally been considered “insurance risk” to providers. The Provider Risk Sharing Boot Camp will give attendees deeper insights into methods, current thinking, and alternative solutions that actuaries can use to help providers understand and manage the financial and actuarial risks that they are taking, many for the first time.

Description: Essay stating accessibility, affordability and efficiency are the key to success in the future of healthcare.

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: This article examines the history, theory, and effectiveness of high-deductible health plans and health savings accounts.

Description: Read the March 2017 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section activities.

Description: Essay where payers desiring to optimize health gains per dollar spent should avoid “across the board” cost sharing, and instead implement a “value based” design that removes barriers/provides incentives to encourage desired behaviors for patients and providers.

Description: May 2013 issue of the Health Watch newsletter

Description: This article begins with a comparison of the commercial risk adjuster to the exisiting Medicare model, and goes on to discuss why the existing strategies employed by health plans will not work in a risk adjusted environment. The article elaborates on the importance of diagnosis coding, controlling member mix, and care management in order to mitigate risks and gain from newly created opportunities.

Description: Presenter examines federal and state efforts at parity in the area of mental health insurance. From the Record of the Society of Actuaries, Vol. 24, No. 2.

Description: Essential Health Benefits and Actuarial Value